Jefferson Hospital caregivers have been writing about the pandemic. Here are their top 3 essays

Jefferson University Hospital has been publishing a literary magazine, Evanescent, since 2019. The publication aims to help staff from around the hospital share their experiences working in health care. But in the spring of 2020, the project suddenly took on a new seriousness. Hospital staff were preparing to work through a pandemic of historic proportions, and the editors of Evanescent realized how important it would be to document it.

They put out an open call for submissions, asking everyone from housekeeping staff and security guards to nurses and doctors to contribute. Initially, the essays were collected on a website, Jefferson COVID Stories. Later, Evanescent published selected submissions in two print editions — including the three essays below, the winners of Jefferson’s inaugural Drs. Theresa and Charles Yeo Writing Prize.

“The hope of the prize and the larger mission of [the literary magazine] is to demystify writing — to use it as a tool to share humanity and the community we’ve created at Jefferson, especially during this pandemic and the isolation that comes with it,” said Danielle Snyderman, an associate professor and geriatrician in the Department of Family and Community Medicine and one of the magazine’s editors. “Through this writing endeavor, people can be seen through the written word, and their stories.”

-Aubrey Whelan, Inquirer Staff

I was looking intently at a sandwich tray when I broke down in tears. The platter was centered on a timeworn table with a faded-pink laminate top, within a windowless locker room repurposed as a provider breakroom. The tray had arrived earlier that day, much to the delight of the ICU staff. I, in contrast, had spent much of the day trying to avoid it. My aversion to this tray was not because of anything I had against Primo Hoagies, but because it had been sent in by Bill’s family.

I had spoken on the phone with Bill’s wife and son every afternoon since he had entered the Methodist ICU in respiratory distress the week prior, each call meeting their sense of optimism that he might wean off of the ventilator with discouraging news and regrettably reminding them of the COVID-19 visitor restrictions that prevented them from coming in to see him. Staring at the sandwiches, all neatly arranged in tiers of concentric circles, I envisioned Bill’s family; his wife, his siblings, his children, and his grandchildren — sitting around the living room together and sharing hopeful words through their masks. I imagined their mental picture of him: weathering the storm by himself but surrounded by attentive doctors and nurses. Though they knew he was unconscious, I wondered if they could still feel him reaching out for them.

The sandwich tray was their refusal to be denied entrance into the ICU. It was both an expression of gratitude for his team and an assertion of love to revitalize Bill in his battle. Perhaps it would give him the warmth that was missing in their absence. I started sobbing, suddenly shivering with icy apprehension that I would soon tell them that he suffered a massive stroke overnight and would have no chance at recovery. I felt the sound of his son’s voice quivering over the phone burrow deep inside of me, nesting in the new space where more somber patient memories would soon dwell.

Intern year crawled along, and I watched more people labor through their last breaths alone. These were sobering moments that I struggled to exhale. I could not wholly express them to my partner, family, or friends, separated 300 miles apart from them. My smile withered without their laughter. My feet numbed to the once soothing feeling of my socks pressing on the creaky wooden floor of my apartment. The jovial relationships I had envisioned sharing with co-residents and hospital staff were replaced with transactional conversations held behind masks, face shields, and phone screens.

Escaping for a few minutes to the top floor of the hospital where I could silo myself inside of a call room was freeing. Alone, I could feel my lungs scrape my chest as they filled with air and hear the hum of the nearby generator whispering to me while I lay face down in the call room bed, embracing a pillow. I was nothing but a keyboard and a mouse. I was just white noise walking through the hallway.

“Let me see you without your mask,” she pleaded.

I lowered my mask.

“Oh! you are going to make such beautiful babies,” she said.

I blushed. Her comment surprised me. It was funny and colorful, gleaming through the silt of a series of identical, dispiriting days. To June, a 67-year-old woman with newly diagnosed pancreatic adenocarcinoma, I was transparent. She knew that I did not understand the complexities of her condition well, and that the vague updates I gave her each day collectively implied her bleak prognosis.

Confronting her mortality over the course of her admission was as unpredictable as it was painful for her, an oscillation between emotional extremes, an avalanche to endure without a soul to receive her rescue signal. Her abdomen seared from within. Her red, sunken eyes echoed a depth of suffering beyond what I could conceive. But, through the scrap heap of my annotated handoffs and used gowns, she found something to hold on to, something from which I, too, had become estranged: me.

She actually appreciated my clinical inexperience and my innocence. I did not have much to say as an intern, but I was someone who could listen, a friend unbound by the COVID visitor restrictions. My visits with her gradually became less medical. At times it seemed as if we were just sipping coffee together, taking time to show each other pictures from our lives beyond the four walls of her patient room on 7 West.

With each passing day, I watched a stack of envelopes on June’s bedside table grow. The return labels held the names of her children, grandchildren, friends, and members of her church community. I asked her why she had not yet opened them one morning, to which she calmly replied, “I’m not ready yet.” I was immediately struck by this, for this statement was not a denial of her illness, but rather an acceptance of her mortality. She knew that she would never get to physically see most of her family ever again as a result of the pandemic.

Those letters, thus, contained their presence, and would serve to stand in for the goodbyes that she would never get. They were the light to guide her through her last day of life. The letters were her sandwich tray. June died on the first day after she was discharged to inpatient hospice. I do not know how she spent her last day, but I like to imagine that she opened those letters, and one by one felt the warm touch of all the people whom she loved. I often reflect on that time I spent with her, and I wish that she could read the letter that I would write to her now.

I did not have much to say as an intern, but I was someone who could listen, a friend unbound by the COVID visitor restrictions.

Dear June,

You told me once to not see you as the person who was sick and dying in the hospital. You wanted me to see you the way you lived your days before those final three weeks. You showed me a picture of you with your family, dressed up and standing in a parking lot, with an ear-to-ear smile, your arms around your grandchildren. You showed me a picture of the sun setting from the view of your living room. You showed me a picture of you drinking a ginger ale. Most of this year, I have felt like I’m not supposed to be here in Philadelphia. I have longed for my family, my friends, and my partner every day. I have felt so alone, hidden behind the mask and the face shield that I wear. I have felt overworked but irrelevant, responsible but unfulfilled, and engaged but hollow. The pictures I shared with you of my life in Boston were how I thought I wanted you to see me, but I changed my mind. Please see me as the young doctor who ran out of answers and just sat beside you. Please see me as the friend whose hand held yours when morphine could not alleviate your pain. Please see me as the broken person that was revived when you said, “I love you.” You showed me that there is always light in the darkest of places. You showed me that there is always a path to happiness in the present, even when you run out of tomorrows. I love you, too.

On my first day of third-year clerkships, I spent two hours in an elevator. That elevator in June 2020 in the middle of a global pandemic provided the most profound learning experience of my third year of medical school.

I walked into clinic that morning with my white coat draped over my arm, a symbol of my much-anticipated admittance to the world of hands-on learning. I carried with me, too, the excitement, anxiety, and uncertainty that comes with translating knowledge into practice. I was rotating in a clinic that focused on caring for patients with intellectual and developmental disabilities (IDD).

That morning, I watched with amazement as my attending cared for her patients and their caregivers in a way that so clearly communicated empathy and understanding of their specific challenges. These challenges were exacerbated by the pandemic; routines were disrupted, day centers were closed down, and caregiver exhaustion was at its peak.

Around 1 p.m., my attending and I were called out of a patient room mid-visit with a request for help. We learned that one of the morning patients was refusing to leave the clinic. It caught us by surprise, as this 19-year-old gentleman with autism was remarkably calm, cooperative, and interactive during our visit. Now, in the discharge area, he was hunched over in a chair, hands clenched around a clinic toy, eyes fixed on the floor. It was clear that he had been in this position for nearly an hour.

Finally, after 30 minutes of coaxing and help from various team members, his rigid posture relaxed, his furrowed brow softened, and he hesitantly stood from the chair. As we took careful steps toward the elevator, I saw relief bloom on his mother’s face.

This relief was short-lived. As the patient crossed the threshold of the elevator, his demeanor shifted. In a moment, he was curled in a ball on the floor of the elevator, head in hands, and unwilling to move. We tried everything: toys, snacks, a call from his father, fewer people, more people, a water bottle, his favorite song. He wouldn’t budge. He was frozen in time, scared, beyond our reach.

An hour later, my patience started wearing thin. The constant, irritating buzz of the elevator, angry that we’d been holding the doors open longer than its programmed time, was a nagging reminder that this moment of crisis defied the limits of any plan, schedule, or timetable. The whispers and glances of curiosity from onlookers frustrated me. The patient’s meltdown was on display while we seemed to be making no progress, adding to my feelings of helplessness. As my mind wandered, I looked to the mother and saw patience, love, and resilience — strength I couldn’t comprehend.

Ninety minutes later and out of options, we decided to physically remove the patient from the elevator. We knew that the use of force would only escalate his fear and resistance, but there was no alternative. It was physically difficult, as he was a well-built, strong 19-year-old, but even more, it was emotionally jarring. As his mother and a security guard carefully carried him over the elevator threshold, his body tensed and his agitation grew. As he lay on the lobby floor, he grabbed his mother’s shirt, all his fear channeled into his desperate grip, pulling her closer in panic.

After nearly two hours of patience with no visible frustration, his mother broke down. Bent over his body, her tears flowed onto the son whom she loved but could not rescue from this moment of fear. My face shield began to fog as my eyes teared. I saw the exhaustion on my attending’s face. One of the medical assistants who had been helping for the last hour began to cry, thinking of her own son with autism. The patient’s father soon arrived, having left work to help physically get his son into the car. We could hear the fits of screaming and agitation even from the second-floor clinic.

I walked into clinic that morning excited to learn, to feel like a doctor, to move toward certainty in diagnosing and treating diseases. In the span of a few hours, I felt further from certainty than ever. I felt like I bore witness to a collision of the pain, uncertainty, and fear of this moment in history with the lives of this patient and his mother.

I walked into clinic that morning excited to learn, to feel like a doctor, to move toward certainty in diagnosing and treating diseases. In the span of a few hours, I felt further from certainty than ever.

The disruption of routines, which everyone felt in the height of COVID-19, is more visceral for those with autism who rely heavily on routines to calm anxiety. COVID-19 has also exacerbated caretaker burnout as day cares, family members, and other sources of support can’t operate in the ways they normally would. Particularly poignant, in light of George Floyd’s death just a few weeks prior, this moment of crisis could have ended tragically for the patient and his mother, who are Black.

George Floyd’s death has brought to front of mind the history of police violence toward Black Americans and the deadly consequences of racist presumptions of danger associated with Black men. It was all too easy to imagine how this patient, agitated and unyielding, could become a victim of police violence. If this same crisis happened in a different location, without the support of the clinic staff and understanding of the context, it could have ended very differently.

In health care, we can’t avoid the messiness of humanity –– family stress, broken systems, physical suffering, collective grief, historically rooted racism, one young man’s meltdown, a mother’s exhaustion. And for all these problems, we don’t have easy answers. The elevator crisis continues to remind me that there are so many problems that a prescription or vaccine can’t fix, no matter how many years of clinical training and experience I complete.

The elevator crisis also reminds me that as a doctor and as a human being, there is more I can offer when answers and solutions run out. When I think back to the elevator crisis, I remember not the absence of certainty, but the presence of my attending’s compassion that extended far beyond the walls of the exam room, the presence of an interdisciplinary team that dropped everything to respond, and the presence of a mother’s resilience and love for her son.

Who knew that, in the year 2020, “I can’t breathe” would change the world forever? At first, it was the cry of the people, mainly African American or Black like me. It was a cry of injustice at the hands of the police but later turned to the cries of the people regardless of race, religion, or sexual orientation. “I can’t breathe” was but an ignored whisper from the lips of George Floyd, but there was no ignoring the screams of “I can’t breathe” that came from the millions of men and women who gasped for air after being infected with COVID-19.

In the midst of it all stood me, the black nurse in a predominantly white profession who had to help the sick both physically and mentally while being heartbroken at the loss of another Black man at the hands of the police.

I listened to colleagues say, “Don’t treat him like a martyr.” Yet, he was not a martyr by choice but a man murdered by chance. His death started a movement that started a rage, that began to burn so hot and so bright that the pandemic of racism that has plagued this country for centuries no longer would be ignored. At the same time, the arrogance of man proved itself again too much and the universe answered in kind. It felt almost biblical. When Mr. Floyd cried out for his mother, every mother cried to the heavens on behalf of their sons. It was like God answered by taking the breaths of so many.

I noticed the louder hateful voices rang promoting hate, the louder the cries of “I can’t breathe” rose until you could not decipher whether it was a chant for anti-racism or fear from those afraid to die.

In the midst of it, all was me, a little black nurse who works in a predominantly white profession, put in a position to educate the oppressors on why their actions are oppressive — while also taking control of the fear to treat the sick that surrounded everyone. How I did both and kept my sanity still amazes me to this day. Being a nurse during parallel pandemics did not afford me the time to be afraid, but I was. It didn’t allow me to second-guess myself, but I did. I was not allowed to show weakness, yet I felt broken every day. It was to the point that I, too, could not breathe.

What choice did I have? None –– I am a black woman with a son, I am a black nurse in a white world. More important, I could change the world if given a chance. So, since no one gave me one, I took one.

Being a nurse during parallel pandemics did not afford me the time to be afraid, but I was.

When I had to be a nurse, I gave 100%. I treated my patients with respect and dignity. It did not matter whether they tested positive or negative, they were afraid and my job was to be there for them. I listened to the fear, educated the ignorant, mourned those that could no longer fight, and cheered those that survived. All the while, I was afraid to catch the virus because I am immunocompromised. I was afraid to take it home to my family. Above all, I was afraid of dying and my family having to say goodbye over a tablet. But, in the words of Maya Angelou, “Still I rise.” So, each morning, I got up, took a deep breath and breathed.

More than a year has gone by and I have learned true resilience through faith. I have always been spiritual even when I was not religious, but 2020 taught me grace, renewed hope, humility, and recharged my humanity. The most important lesson I learned is knowing one’s value. Not all value is monetary, but rather what you bring to an organization, community, or group.

During this year, I have joined Jefferson Community and Family Medicine’s Social Justice committee; the value that I bring to this group is being unapologetically me. I will not allow the past culture to ignore its cultural bias or microaggressive behaviors any longer. I am not afraid to be shunned or ostracized because I have right and wrong on my side. If we have seen nothing else during these pandemics, we see the cries of the righteous will no longer be silent.

Taking off the mask of oppressive behavior does not mean belittling or attacking a person’s character; it means putting the spotlight on the behavior and charging those that claim to want change to address it. Removing the mask and seeing people for who they are, opens a conversation, hopefully –– a truthful conversation about behavior they may not even know they are demonstrating.

I have learned not everyone that acts in a racist manner is racist, just ignorant. It is left up to people like me to educate and inform so that they can chose whether to continue the offensive behavior. It also allows me to make informed decisions if this is someone I want to know. After all, tolerance and acceptance go both ways.

Also, through faith, I have started to heal. The very idea that none of us would come out of these pandemics without some form of PTSD is laughable. But accepting our biases and fears is a start. I know that we live in a world that judges based on the color of one’s skin. My future in health care may very well be limited because of someone’s belief that I am less than my white peer or afraid that I may outshine them. I have to teach my children how to interact with the police just to get home safely. I have to pray daily thanking God that my family is whole, but this is all OK.

I have survived a pandemic that stole the breaths of millions. I have survived a pandemic of hate that stole the breaths of black men and women throughout the country. For so many who have been silenced, I have gained a voice so strong and so clear on behalf of my patients and my race that my mere whisper will shake foundations.