I Cannot Let It Go

It is snowing in spring in southern Ohio, and outside your room we hear people discussing the unusual weather. Inside the room we know why it’s snowing. The snow is for you. Your favorite movie star is an ice princess and we listen on loop to a song about a snowman as you breathe slow and heavy with your eyes closed. Your family surrounds you. We know that by the time the snow stops falling, you will be gone, another victim of the COVID-19 pandemic who was never infected by the virus.

When our communities were thrust into a global pandemic, responsible citizens did what was asked of them, isolating and separating to prevent transmission of COVID-19. Children who were seen and loved by extended families and communities were suddenly shuttered behind closed doors. Stress was placed on caregivers at levels they were not prepared for and for which our society failed to provide support. Our community prioritized individualism and economics over the safety of our children and their families. We left and continue to leave children and families home and isolated for adults who would not mask or vaccinate. Another pandemic arose—one of mental health crises and inflicted trauma, filling our pediatric intensive care units and our hearts with sorrow.

Back in your room, my watch vibrates. I glance at it quickly and see my nanny has sent a picture. It is my son; he has built a snowman and is so proud that he asked her to send me a picture. He is outside in the snow, playing and laughing, standing next to a lopsided snowman with a carrot nose and a winter hat. Suddenly I cannot breathe. The room feels too small and too heavy. I look down at you; you are the same size and the same age as my son but you are here dying in a hospital bed, not outside building a snowman. The pictures shared by your family of you smiling and laughing immediately come to mind. I know you would have loved playing outside today. The tears behind my eyes cascade forward and I take a few deep breaths. Your nurse reaches over and squeezes my hand. I exhale, collect myself, and refocus on you.

This has happened to me before, the breath stolen from my body by grief. You could be one of mine. The teenager wearing my son’s favorite soccer team jersey with a new cancer diagnosis who asks me how I know so much about Premier League soccer. The unconscious child in the trauma bay wearing the same Teenage Mutant Ninja Turtle pajamas I had dressed my kindergartner in before leaving for a night shift. The infant with newly diagnosed pulmonary hypertension who was born the same day as the infant waiting for me at home after my first day back from maternity leave. These experiences stay with me when I return home to watch soccer, play super heroes, or read bedtime stories. I carry them with me.

As a mother and critical care physician, the dichotomy between my world of five healthy sons and my care of critically ill children is often stark yet it helps me be effective in both worlds. The healthy and active children I leave each day are a direct contrast to the children I care for in the ICU. My experiences and insights as a mother shape me as a physician just as my experiences as a physician shape me as a mother, wife, daughter, sister, friend, and scientist. I try to keep these two worlds separate and focus on being present in each setting, but on many days, they are intertwined. Today is one of those days.

Too soon, your room has been cleaned and a new patient arrives to take over your space. The only physical reminder of you in the intensive care unit is a sympathy card for your family left in the break room for staff to sign. Yet, the memory of you and your death is so strong. I cannot let it go. It follows me everywhere. At home, at work, asleep, awake, because this one was our collective fault. It was not a medical mistake. The care our team provided makes me glow with pride. We followed every evidence-based recommendation to give you the best possible chance. Your temperature, your blood pressure…all controlled with precision. But it did not matter—the initial injury was too grave to save you.

We as a society failed you. Our job was to help you grow and thrive but you were allowed neither. Your family fought for you. They loved you. They worried about you. But the support they needed never materialized and now you are gone forever. Another invisible victim of the pandemic who never contracted COVID-19. I will carry you with me always. You could have been mine. I cannot let it go.