My Black Scrubs

Another late night, another return from work, another exhausted walk naked from garage to shower.

9 months later and this pandemic isn’t close to being over; long enough for a baby to be born but not for a demon to be destroyed.

9 months of solitude and sorrow, spliced with joy and family.

9 months of being forced into a real, tight, exclusionary nuclear family.

9 months of being hugged and touched only by the three I love most, but distanced from the others I love equally strongly.

When will this end?

1:17 AM

The emerg locker room, in my dirty scrubs

“Can I touch you?” she asked, as we faced each other.

Would it really have been right of me to say no?

Standing there I felt naked, feeling my bare arms exposed to the room, anticipating the touch and dreading it at once, wishing for the protection of the yellow gown worn in the examination room.

We were standing in a room full of recliners stuffed with patients, by the nursing desk. Unclothed in my armour, wearing but my short sleeved scrubs, mask and safety glasses, feeling vulnerable – and in my discomfort I felt sharply her raw need.

I did not refuse.

She placed her hand on my arm like a feather, a slight grip, enough for her to feel my humanity. Alone, solitary, her husband recently deceased and her children living out of town, this elderly lady needed what only human touch could provide.

The tears in her eyes like glass, the hand on my arm like a weight underwater, I let her stay there for a moment. Frozen, warm, I waited until she released. We parted, to meet again later.

Can I touch you?

Can you touch me?

These gestures, so simple before, so rare and even frightening now. We are living in a time of complex emotion, in a time of physical division, when what we all really need and crave is unity. Touch. Each other.

She touched my arm, and I was touched. And reminded, of the little moments that I can give my patients, that have nothing yet everything to do with being a healer.

Letter to my children

I’m sorry you missed the first day of grade 5 today, my girl, and I’m devastated that you will miss your first day of kindergarten tomorrow, my big boy. This isn’t how life was supposed to go. You weren’t supposed to experience hardship in childhood. You were meant to have a peaceful and stress-less development. I was supposed to be able to protect you, as your mother, from sadness and distress.

But I can’t.

I can, however, protect you from sickness. I can keep you safe from disease. Your dad and I have chosen to keep you home with us to shelter you from this sweeping pandemic that has rushed like a wrecking ball into our world. We will help you learn at a distance from your peers, but connected by the same screens we often hate. We will sit with you, encourage you, emotionally support you. I vow to do this, to the best of my ability as a mother and a person.

When this is all over you will still have missed this special transition to new grades, new phases of life. You will be behind socially. You will have to work even harder than normal to integrate into a group. You will feel left out. You will cry. I know this. But I also know that you are both sweet, smart, friendly and are learning resilience. You are fighters, survivors, like I am. You will break through the barriers that covid has erected, and you will become the people you were always going to be.

Let’s enter this journey together, my loves, and we will come out the other end stronger as a family and as people.

Love

Mommy

Life has changed.  Will it go back to normal? Hard to say.  If, when, where, how?

Motherhood has changed.  Become better, in some ways.  Become harder, in others.  Keeping my children safe means something much different today than it did a year ago.  I keep them closer, rules are stricter, the leash is tighter.  And not by choice.  I would love to give them the freedom they need and deserve; to let them run gleefully in the park with friends, hold hands with others, climb playground structures and hang from monkey bars without worrying about who touched the surface just prior.  I wish I didn’t have to keep calling “keep your distance”, as they bike on our street with the neighborhood kids.  I wish I didn’t have to worry about the babysitter exposing the kids to a possibly fatal illness just by virtue of her having a new boyfriend.

However, I am thankful for the extra time with my children.  Spending days with them, talking, hugging, playing, swimming in the lake, discovering new experiences together, it’s a blessing.  Even the thought of homeschooling them come fall is exciting to me – and to my daughter.  We talk about the curriculum and how we will learn cooking, gardening, how to fix things, nature, and so much more.  What we can teach our kids at home far exceeds what a rigid school curriculum can encompass; we can focus on what is important while still making sure they get their core subjects.

But.

When I go to work, and watch the emergency department gradually fill again to bursting, I remember the danger lurking in the corners of our existence.  The serpent’s venom waits behind every contact; stealthy, it bides it’s time, ready to pounce if the slightest error is made.  While things look better here in Quebec, I see our board turning brown again with rule out covid cases.  I see our resuscitation room full of brown squares representing patients with respiratory illness going to ICU, who may or may not have the infection.  I observe many more cases of young people presenting through our hot zone garage, having symptoms quite likely to be covid.  This thing, it’s not leaving.  It’s here, it’s waiting to flow over again in a second wave of illness.  And scary to us as physicians, this tsunami may arrive in concert with the torrent of influenza and other respiratory disease, come fall.  Then what will we do?  Our department is overflowing now with regular patients, non covid, non flu – what happens in September, when kids go back to school, people go back to work, and the double edged sword of respiratory disease strikes?

My heart is full of love for my beautiful children, and full of dread for the future.  The calm surrounding me when I see so many people going about their daily lives, gives hope but at the same time fear.  I am writing this sitting outside a Starbucks, in a parking lot, at a table that I wiped down with an antiviral wipe.  I haven’t done this since February, and the only reason I allowed myself to do it now is because I’m the only one here.  I won’t step foot inside, however, but I see dozens of people doing so.  In they go, wearing masks, a new reality.  How safe is it?  I don’t know.  Nobody does.

So, we will wait, and hope, and survive.  There will be so many stories for our grandkids one day.  How their parents and grandparents and great grandparents lived through a pandemic, made the most of what we were given, and moved forward with more love than we had before, and more gratitude for eachother.

Dear neighbours, community members, friends, family:

Covid has not gone away.

I just drove home from my shift as an emergency physician at my site which is a Covid center, to my home here in Montreal (which happens to be the Covid epicenter in Canada).

I was saddened and frightened to see many of you out, gathering in groups without masks or social distance between you. In fact, who I really saw were your children, teenagers, in throngs on the sidewalk. On Saturday on my way home I saw groups of sometimes 20, 30 people, men women and children, all close together without masks. Yesterday driving home I saw people in restaurants picking up take out, no distancing, no masks.

My husband and children went to throw a frisbee in an open field, and had to navigate on their bikes by an outdoor bouncy castle party on the street with a dozen small children playing, and in the park another group of ten women sitting side by side on a picnic table without masks.

Perhaps all of you believe that because the premier of Quebec said parks, pools, stores, daycares can open, that this means that there is no risk.

I PROMISE YOU THE RISK IS REAL.

You or your friends, or your children, will catch this virus. You may not get very sick, you may remain asymptomatic. But you will breathe on, talk to and spread droplets, hug or otherwise interact with someone who will end up in the ICU or even dead. That person could be your husband, your mother, your diabetic best friend, your neighbour with metastatic cancer.

That person could be your child.

Or that person could be you.

When that person comes to my hospital, we will care for them. The hardworking mothers, fathers, brothers, sisters, children, grandparents who are nurses, orderlies, paramedics, housekeepers, respiratory therapists, security guards, doctors and clerks, will then be exposed and the cycle will continue. We go to work every day and risk our lives and the health of our family members, in order to make sure you and your loved ones are cared for when you fall ill. But don’t be fooled – we aren’t seeing less cases right now. We are seeing many. And we are at risk every single day.

When you choose to go out and interact with others without a mask or social distancing, you are not only affecting your own health. You are throwing yourself like a stone in a lake, with ripples that spread outwards in ever expanding circles. Your actions affect others, and can in fact affect the whole world.

Please, I implore you: stay safe. Keep yourself, your families and therefore me and my family, safe.

The fight is not over and the road will be long. Patience.

#stayhomestaysafe

#wearmaskssavelives

#socialdistance

You run to me, arms outstretched, as I drag my weary limbs to the garage door.  You have been anticipating my arrival, and burst through the backyard gate upon hearing my car door close.  Sunkissed and joyful, the two of you delicious little people want nothing more than to be scooped up in mommy’s arms and snuggled.  “Stop!” I call, “Stay back, wait till I have my shower!”; alarm rings in my voice as you hang precipitously before me, a few feet from possible contamination.  Your faces fall when you realize that, yet again, mommy can’t hug you right when you need it most.

This is the toll that the pandemic is taking on my family, and on so many families like mine.

Today, I am in mourning.  I grieve the loss of our daycare; ten years of joy, friendship, warmth and love stolen away in a flash by sickness.  Covid destroys so much more than we know – besides killing hundreds of thousands, besides overwhelming health care systems and hospitals worldwide, besides tanking economies globally – the worst part for me is the effect it is having on our children’s wellbeing.

On June 1, the government of Quebec is forcing daycares to reopen to the general public, after two months of being a safe refuge for children of essential workers like me.  Though they are putting in place safeguards like small class sizes, masks and visors for teachers, and increased sanitizing, as a health care professional I know that none of this is enough.  The likelihood of one of the children or parents transmitting Covid to the group is not negligible.

So today was my son’s last day at the daycare that raised my two children, nurtured them, loved them.  These were his final moments in his, and our, second home.  It was going to happen anyway at the end of August, but with a graduation ceremony and joy instead of sorrow and pain.  Luckily, being so young he will be very unlikely affected by the arrows that pierce my heart at this separation, and I know we will ensure he has a wonderful summer at home with us.  But the end of this phase of life, daycare, in this way, hurts.

My daughter, ten years old and blossoming, is suffering.  She, like all kids right now, misses her friends with an intensity of emotion that only the young can feel.  The hardest thing I’ve had to do so far during this crisis, is the one I did a few weeks ago when I had to collect her belongings from school.  On March 13 we had come to school only to be told the doors were shut, and home we went with the most important of her schoolbooks.  Two months of online learning later, and the decision was made that schools would not reopen until September.  I pulled up in front of her school, which had been my high school, and felt ill as I donned my mask and headed in the doors.  One parent at a time was allowed in, and I spent twenty minutes wandering the hallways of her innocence, opening her locker, touching her big girl belongings and stowing them carefully in a bag.  Going through her desk and her classroom to collect the rest, my heart felt ripped up as I, for her, said goodbye to grade 4.

Who would have thought, at this time last year, that our world would be so changed?  That coming home from work would be an ordeal of decontamination, that I wouldn’t be able to hug my children at a moment’s notice, that I would fear for my own and their safety every time I entered my Emergency Department?  How could we have known that grandparents would be isolated, families unable to touch eachother or have Sabbath dinners for fear of exposing each other to a fatal disease?  Thankfully my parents taught me very early in life to love and love hard, like tomorrow would never come.  I am so glad that we had dinners with my parents and my sister every week, for years, before covid.  We are blessed to have had so much time to be happy, to be together, so that we could save up those memories and get ourselves through these hard times.

For now, we will continue to be strong for our children, to love them, and have them love us, as fiercely as possible, as if the world is ending.  Because it is not, and one day we will remember how much we loved and how much we pushed so that we would stay safe, and keep eachother safe, so the world will go on.

So for now, run to me, my children, but stop a few feet away.   In half an hour when all the fomites have rinsed off my body and many tears have spilled in the shower, we will snuggle and reassure each other that we are still here, we are still alive.  One day this will all just be a time we lived through; we will tell your children about how “once upon a time, when your parents were just little kids like you, the world changed – and changed back.”.

I am a front line health care worker.

I am an Emergency Physician.

I am also a mother to two glorious, growing, miraculous children and wife to a handsome triathlete stay at home dad.  Additionally, I am one of three daughters to a pair of still practicing exceptional pediatricians in their late 70’s, and sister to two strong, beautiful women.  I am also a severe asthmatic well controlled only by being on puffers and a medication called a biologic, which can compromise my immune system.

And now, I am one of the hundreds of thousands of physicians trying to stand between a monster of a virus, and the citizens of the worlds’ countries who are vulnerable to it’s fangs.

The people I work with are heroes; doctors, residents, nurses, orderlies, xray technicians, unit agents, registration clerks, security guards, respiratory therapists and so many more.  They come to work each and every day with fear in their hearts but passion in their souls, and devote themselves to caring for patients.  In the background the defenses are being laid by remarkable people who have been working day and night preparing protocols, simulations and contingency plans for us all to fall back on when the enemy breaches the gates.

And that enemy is coming for us quickly.

Going to work in my hospital used to be enormously pleasant.  We worked hard, all of us, because we had the highest volume of patients in the surrounding regions yet our flow was exceptional due to the intense devotion of our group.  The social banter was always there, smiles and jokes happening all around.  We were a family.  We still are.

But coming into work these days is like entering a war zone.  There are barriers that come up randomly and block movement, so that a covid patient can be transferred without risking contaminating others.  There are signs on patient doors that say “STOP” “CODE C”; reminding that the patient within can pass the contagion to anyone that comes in unprotected.  Pandemic carts sit open in each section of our department, with N95 masks, impermeable gowns, long gloves, hair covers, plastic stethoscopes, and the material to urgently resuscitate covid patients.  The mood is different; eery silence permeates the empty hallways and waiting rooms, and the lively conversations of before are muted.

Fear thickens the air, causing me to wade through curtains of anxiety each time I leave my car.  I steel myself for what’s coming by closing the door to my heart as I close the door to my vehicle.  By the time I reach the elevator I am ready to face the shift, though deep inside I am teetering.

When I don my armour and prepare to enter a room, it is a dance such as a surgeon does when she scrubs.  Gown, and tie at neck and waist.  N95 mask, two straps, make sure they don’t cross.  Mold to face, breathe, breathe out and feel for air escaping.  Face shield, then hair cover on top, tuck in the braid or ponytail and ensure no whisps creep out on the sides.  Long gloves, pull up and straighten over the wrists of the gown.  Plastic stethoscope in hand.  Walk to the door, sign the sheet to show you’re entering the room.  Breathe.  Enter.  Breathe.  Speak with patient, examine as best you can.  Time to doff.  Make sure someone watches from outside that you don’t screw it up.  Wash gloves, peel off gloves, wash hands.  Peel off gown and discard.  Wash hands.  Exit room.  Hair cover off, wash hands.  Face shield off while leaning over, wash hands.  Last and most dangerous; the mask.  Lean over, pull bottom strap over head, hold down straight, take other strap off over head.  Pull mask away from face slowly, drop in garbage.  Wash hands.  Wash again.  Breathe. Breathe. Breathe. Walk away.

This dance is repeated many times each day now.

At the beginning, our team ran a simulation one day to see how such a scenario would go.  We learned to don and doff.  We got the hang of it.

Slowly, our board that shows the patients in the rooms began changing colours.  It used to be full of pink, orange and purple squares, signaling new patients or patients leaving, etc.  Suddenly a new colour began to creep in, and has now taken over most of the board.  Poop brown, or puke coloured, fitting, signaling to anyone looking that the patient whom that square represents is being tested for covid.  First there was one square.  A couple of weeks ago.  Then a few more.  A few more.  Suddenly most of the board turned shit coloured and it’s stayed that way.

We are also working in our ambulance garage, triaging rule out covid patients.

We are running simulations on how to intubate a covid patient while wearing our personal protective equipment, and how (if) to do CPR on these patients.  We are learning to stop CPR.  We are learning to change how we approach each case.

And here we are; officially in it.

The pandemic has made it’s way to us, and within a week or two we will be overrun.

The enemy will breach the gates, of that I am certain.
It remains to be seen how our secondary defenses will hold; how our shields will protect us individually, how many of us will fall.

We know this is a war we may not entirely win.  We will take heavy losses.  But we are fighting it every day.  We are fighting not only for survival of individual patients, but survival of our way of life.  Our world has changed drastically in a matter of days to weeks, and may change much more in the near future.  It is up to us to make sure that the world we knew is there waiting for us on the other side.

So the Emergency Physician superhero goes to work, but the Mother superhero comes back at the end of each shift.  Mommy and Daddy don capes and fly to rescue our children from despair.  We take them outside and bike, scooter, play frisbee.  We do arts and crafts. We play board games.  We home school them.  Most of all we shower them with love and make sure they know that this world is going to be there when all is said and done.  School will resume, one day.  Friends will still be there, and can be chatted with over facetime or zoom until they can once again play side by side.  Pools will one day re-open, tennis lessons will resume, piano will be played, horses will be ridden. Grandparents will be hugged, and kissed, and loved.

Life will continue.

Yet when I close my eyes at night the darkness grabs me by the throat.  When I drive home from work the empty streets yank sorrow from my soul and it’s all I can do to see through walls of tears.  Remembering childhood innocence and wishing my kids could play at the park feels like a punch in the gut.

And I am left reeling, shaking, gasping for air in a world that wants to steal my breath.

So I go to work, each day, both at home and in the Emergency Department.  I risk my life.  I work for you, for our future, for the future of our children, and the future of our world.

#stayhome.

You are new.

I dress

Slowly

Under watchful eyes

I don my armour.

Walking in,

We meet.

Your presence crawls

I feel it

My patient is sick.

You are an enemy.

A new one

A snake coiled

I keep you at bay

Knowing your danger.

I sense it

The spectre

Lost, in the wrong host

Searching

Taking life

I challenge you, breathless.

Darkness

Illness

Novelty

Pandemic

My patient’s eyes

Search me.

“Will I survive”

They say.

I don’t know.

Slowly, carefully,

I wash my gloves

Strip off the protection

Gloves

Wash

Gown

Wash

Hat

Face shield

Wash

Leave the room

Antechamber

Wash

Remove one band of the mask

Pull down

Remove the other

Hold straight

Don’t shake

Drop into trash

Wash

Wash

Wash

Exit

Wash again

Breathe

Move on.

It’s my birthday today.  I am 41.  How did that happen?  In the mirror I can see silver in my hair.  It shines like the gold my hair used to resemble, when I was seven and the world was a magical, beautiful place.  Now the sparkle in my tangles reflects the life I have led until now, the highs and the lows, the love and the pain.  It becomes steel that guards me until the workday ends, and I come home to my safety.

When I get home from a long shift these days my head aches with the stories of others.  It used to be that my heart was shielded by a wall that I erected, when I worked as an ambulance medic through times of terrorism and fear in Israel.  I built that barricade when I realized how soft and sweet I was, how young and innocent, trusting and naïve.  I kept it up so that no one could interpret my emotion as weakness; I girded myself against judgement.  That fence around my heart became a dense thicket that kept the reality of medicine at bay; it forced the daggers of others’ suffering to turn away from injuring my soul.

When I became a mother, my carefully constructed mechanisms for shelter crumbled.  Exposed, I could no longer hide behind my shields.  I had to become open, available, unguarded.  My children needed access to all of me, so the armour fell away with a shiver.

Now, I am defenceless.  I am vulnerable.  My patients’ pain finds its’ way into me, and though I may not show it nor feel it during the moments I care for them, their journeys weave silver tendrils into the twists of my ponytail.

So, here I am at 41, and the weight of my life’s choices sit heavy on my heart.  I know I do what I do because I am good at it, and it makes a difference in peoples’ lives.  I save lives.  But I also change lives.  I am the face they see when a diagnosis is given.  It’s my voice that echoes in their nightmares.  It’s my hand that sits hot on their shoulder as I give a life sentence.  They meet me once, and I destroy their souls.  I know, it’s not me, I don’t cause the illness.  But I introduce them to their destiny.  In so doing, I chip away bit by bit at the parts of me that still believe in a higher power.  Every time I see a young person, an innocent, struck down with the lightning of fatal illness, I question.  When I read a radiology report of a new ovarian cancer in a thirty year old mother of three, I feel sick; when I used to raise my eyes to a heaven and ask why, I now look inside and wonder who I was asking to begin with.

41.  At the cusp of losing my faith, at the cusp of gaining my faith. It seems that life is not what I thought when I was seven.  It’s not simple.  And sometimes I wonder what it is at all?  Does what we do each day matter?  When I ask myself those things I feel a real fear, that all that I believed and all that mattered to me meant nothing.

Then, I look at my children.  My incredible, spectacular, interesting, innocent kids.  And I remember – they came from somewhere.  Somehow.  They make 41 the best age of my life.

When I was a medical student, I spent two months of my clerkship at a psychiatric hospital that sits atop a small mountain, rising up from the rocks, a place that to this day sends shivers down my spine.  It may not sound like a place one would enjoy, but the time I spent there was in fact both interesting and alluring.  Encountering patients in the midst of their struggles with mental illness opened my eyes to another existence; one that I did not recognize from having lived it, but that I understood somehow deep within my soul.

The Hospital is a behemoth, a nightmare come to life, the monster under the bed.  Within its’ walls stories are told verbally, emotionally and physically.  I remember sitting in group sessions with senior psychiatrists and a room full of patients in the throes of psychosis, depression, mania, all interacting or withdrawing at their own level of comfort or ability.  We would listen attentively to complex, colourful and vibrant delusions; these tales woven by the psyche of a patient were tangible to them and as a clinician it was often hard to tell reality from confabulation.  Some believed the radio or television spoke to them directly; others believed magically that the world turned just for them or that a higher power spoke through them.  Others were dark, and told frightening accounts of what they had perceived had happened to them that night or early morning when supposedly alone in their beds.

I was assigned patients throughout the two months, and during my time on the inpatient unit I remember very specifically one young woman whose illness terrified me.  Interviews with patients were done privately, either in clinical, white walled spaces, or in a patient’s own room.  I entered her room; she was eighteen, tall, thin and devastatingly beautiful.

But her eyes were wild, if you looked carefully.

At first, she sat, calmly, on her bed.  She spoke with me, like any young woman would with a person of around the same age.  Not much older than her, I related to her situation. Here she was, in a stark cage meant to keep her safe, to help her heal; trapped in her own mind she had multiple locks to shatter before she could fly out.  Suddenly in the midst of normalcy she threw her head back and shrieked at the ceiling; she hurled her lean body down on the bed and suddenly I was in The Exorcist.  Speaking in tongues she had become a demon; no longer but yet still the girl who had sat softly on clean sheets.  Arching her back, fighting with someone inside her mind she sent ice through my veins as she tried to pull me into her encounter; as I struggled to guide her back to me she yanked my mind just as thoroughly towards a place I did not want to go.  We separated as I backed quietly out of her space and fled slowly down the hallway to find my attending staff.

First episode psychosis, was the official term for this presentation.  She had never had any psychiatric issues before, and over the last few months had been withdrawing from her family.  She had isolated herself in her room at home, refusing to go to school, talking to herself, at times frightening her family in the same way she scared me.  Prognosis?  Unclear.  I left her to her possession and spent the years since meeting her still unsettled.

Another sparkling memory that pokes it’s sharp teeth to the forefront of recollection is perhaps the most physically disturbing of all.  On call in a psychiatric institution at night is not a place one particularly relishes being.  At least not I.  In the basement of the Haunted House we had a call room, with lockers, a land line phone that sometimes worked, a couch, a washroom.  It was locked with a key.  Down those stairs my heart fell like stone, eyes always searching, feet quiet, in the cavern of that deep dark space.

Reaching the door and closing it quickly behind was always a relief.

One night, the hairs on my neck tingled and suddenly I saw a man looming out of the darkness.  Not far from the call room door I froze, unsure, whether to run for it and lock myself in or turn back and try to make it to the stairs.  This man was not a physician, not an orderly, not a nurse; he was not even a harmless patient who had gotten lost.  This was a 6”4 criminally insane, violent, rapist.  He was supposed to be in the locked inpatient unit upstairs, and in and out of an institution where criminals with mental health issues are sent.  Instead, here he was, and I can still see the shadows on his face as he perceived my fear.  Lunging for the room I flung myself inside after fiddling with the key, slammed the door, and called upstairs to notify security that there was a very dangerous patient lurking in the basement.  His quiet, calm, fearsome demeanour still haunts my nightmares to this day, as I feel him stalking the dusky corners of my thoughts.

And yet, this Hospital taught me so much about medicine, my patients, and the mind.  It was a fertile ground for growing the crops of my learning.  When I work, I carry the nuggets of insanity in the back pocket of my scrubs and draw on all that those patients taught me by allowing me into their intellects.  Sure, cavorting in the unstable psyche of the human brain is a startling experience; but it expands one’s own understanding of the way we all think.  Comprehending abnormal allows me to better recognize normal, and to better identify with my patients who are caught in a world we cannot see.