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The Least Competitive Person in the Room

There is nothing in the world quite like dirt therapy, I thought as I knelt, shifting every few minutes to ease the sting of grit on my knees. The drought-dry dirt lacks the soft landing of planting season, or even harvest. Shallow roots come up easily; even the tough knobby joints of the wild violets give up their stronghold, and dandelions dangle their long tubers from my grip. Still, it only take a couple breaths until my exhale is a contented sigh. Even when it’s 82 degrees at 7 am, I find refuge in the garden.

Ella wandered around the yard, sticking her nose in every nook and cranny she hadn’t seen in a while. When it’s just the two of us, I can let her wander in the quiet dawn, though it takes some coaxing to get her out of the house without it now. As I pull the invited plants from the garden, I watch her explore the spaces she cannot usually reach: the far corners of the yard where the mismatched fencing meets, the rotting wooden posts behind the tiger lilies, the dried stalks at a permanent-until-pulled lean. I worry a moment she’ll get her head stuck where the two fence slats are missing, but like her human sister, she figures it out without my assistance. 

This was reentry week. I have been out of work since the beginning of June, as I played gracious hostess to a lovely intestinal parasite that moved in and wreaked havoc on my body. I was supposed to go back to work on Monday, only somewhat eased in by a 4 day workweek. I felt ready as I could be; the only part I was dreading was opening my email. The rest, I felt normally nervous about. Figuring on that anxiety to only grow exponentially until Monday morning, I tucked these quiet moments in envelopes in my mind, labeled by light and scent, to pull out when I needed. 

About an hour later, not liking the cough Lucy had woken up with, I wrapped her in a thin blanket to  keep her some semblance of still and stuck a Q-tip up her nose. Covid positive. Well, shit.

On the first day Lucy was pretty much fine. She was vaccinated, and acting pretty normally; there was no need for immediate concern. At first I was, selfishly, more upset about the timing. My friends had been planning on coming in for months; I was all set to head up to Vermont, a place I will always consider home, and take the next step in my dream. I had a writers conference to attend, and an appointment to pitch to an agent who might be interested in my book. I was feeling ready to go back to work, hopeful, armed with my updated notebook and shiny new mindset.  But I shrugged, said c’est la fucking vie, and prepared to hunker down in quarantine with the kiddo. 

Within a day, my symptoms were starting. The sore throat came first, sharp and uncomfortable; less than twelve hours later, on my way to get tested myself, I felt my bones catch fire and my whole body begin to weep. I almost turned around to go home and curl into a ball. By day three, I had the cough and logged less than 600 steps. We were a sorry pair, for sure; we spent the weekdays in our pajamas til nine, the TV on almost constantly, and doing our best imitations of potatoes. I kept up on Lucy’s over-the-counter medication regimen better than mine, and she repaid me by spending the majority of the hottest days sprawled in my lap. The threatening storms had Ella practically attached to me as well, none of which helped the fever that pushed against the Tylenol. Lucy still seemed mostly herself, just subdued. She continued her moratorium on taking naps at home, even as I struggled to simultaneously rest and stay awake with her. 

My anxious and fevered brain began to ramp up when my eyes closed. I remembered being in the PICU last year, with RSV and pneumonia, looking at the uneven tiling in the bathroom by the locked doors. I remembered the 24 days she spent in the NICU before she could come home, this tiny human that didn’t even break 5 lbs until three days before she left. I remembered getting the steroid doses into my body with minutes to spare, to help fortify her underdeveloped lungs were born via emergent C-section at exactly 34 weeks. 

I dreamed of Oscar, gone before he could take an earthside breath. I wept for Hawthorne, who had lived their last months in fear of this new respiratory virus they were convinced would be their death. 

That’s when the guilt hit, taking full advantage of my weakened defenses. 

I hadn’t protected Lucy. I hadn’t stopped her from getting Covid. I had let this plague get to my preemie daughter – because no matter how old she gets, I’ll never fully get past those first 24 days.

But, I reminded myself, had protected her. She was vaccinated, as soon as she was eligible. I took her to one of the first available clinics for her age group, and she’d had the second dose not quite two weeks before. I had done everything I could, for the 870 days since the pandemic was announced as a public health emergency. She is one of the youngest kids I know of to be vaccinated. I don’t need the headlines to tell me that the uptake by toddler parents is frighteningly low; I can see it by our clinics. 

We are coming out of it now, definitely on the upswing. I’m still exhausted, but other than that one day, we’ve gotten outside to at least get some fresh air, and usually a walk around the block. The sunshine, as well as the rain that finally broke the heat, felt so good. I am so glad and grateful that we were vaccinated. I’m completely certain that without it, we both would have been much sicker. Even as it was, it’s nothing I’d want anyone else to get, so we stayed away from people all week, and practiced wearing a mask, too.

I go back to work next week, providing my testing is clear. I’m a tad anxious, which feels about right. I don’t want to think of this as the summer of sickness. I want to think of this as the summer I learned, the hard way maybe, that I need to take better care of myself (and sooner); I’ve got someone watching every move I make. And I’m done feeling guilty; I can acknowledge that I did, and be proud of reminding myself that I have no reason to. And if Hawthorne were to somehow take it up with me from beyond the grave, I’d bank on their competitive streak, and point out that in the grand scheme of the three of us, I went the longest without getting it – that is to say, (morbidly, I know), I win. 

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It’s the Ghost of Love That’s Made You Such a Mess

We talk so cavalierly about love and death. Flip on the country station for a while and listen; for that matter, the pop station, or anywhere you’ll hear (usually) a man professing how he cannot or will not or does not want to live without the love of this woman (again, usually). There is no pause in the lyrics, nothing to actually address the mortality, and I fully understand that it is a turn of phrase. To profess that you would rather die than live without, that you don’t want to even breathe without, is to walk with a privilege forgotten by those who have lived with loss. To announce that there is no way, even in the romanticism of song lyrics, that life could possibly continue after the death of your beloved, is blind arrogance. 

When we married, Hawthorne carefully curated the list of approved songs to make sure there was no mention of death in the lyrics. We didn’t mention it in our vows; the closest we came was using an instrumental of “The Luckiest,” which has a verse about an old couple who passes away within days of each other. Even then, we both were too well acquainted with death; had felt that cold hand rest on ours as we tried to pump life back into a still heart, had lost enough of our own to not be intimately aware of our own mortality. We refused to invite death to our wedding. 

And yet, it found us in our marriage, time and time again. I think I’ve thought about the movies of the Final Destination series more in the past year than I have ever before. Logically, I know that death touches everyone; and in pandemic times, even more so. I get that. It doesn’t mean I’m OK with it, or that I can easily accept it, or that it changes the individual losses experienced by each person. 

I’ve been talking a lot about the difference between seeing patients and population health at work recently. I am privileged enough to work with a group of great providers and staff who care about their patients. In my position, however, it’s integral that I see both the forest and the trees. It’s harder for the folks who see patients to do that; they sit for a few minutes to an hour with individual people, learning about them and what they are feeling and experiencing. I’m grateful that I know what that is like from my paramedic days, that I have that background to draw from. 

But I am also trusted to remember the fact that we are serving both individuals, and a population. From that 30,000 foot view, it is not the individual that we are caring for: it’s the subset of people who have breast tissue and need mammograms, it’s those who have high blood pressure and diabetes, it’s kiddos under the age of two who need their vaccines. In that thinking, the individual is not the concern, it’s the group. I realize that sounds callous, but both views are absolutely necessary. 

The fact that I have lost so many in my time and in my family means nothing in the grand scheme of life and death in this world. How many people, lives, relatives, humans died in the past week due to disasters or the pandemic? Over 600,000 have died directly from Covid-19 or its immediate complications, to say nothing of those who have perished due to more ancillary complications: not being able to get a hospital bed for another condition, not having access to the social services that helped keep them alive. It is a heavy thing to know the weight of the forest as you watch individual trees be felled.

I am still standing. 

That’s not a brag, or even a point of pride here. It’s just fact. I have lost, our families have lost; we are all tired of watching Death come for our own. 

There are moments where I have absolutely wanted to give up and lay down, let my body be consumed by earth or fire or water, and join my son and my beloved in the stars. I have no shame in admitting that. 

And so the songs go:

I don’t want to live without you, I don’t want to even breathe.” 

How do I breathe without you, if you ever go.” 

I could never live without your love.” 

And here I am. Living, breathing, carrying on.

Grief has torn me to pieces so small that it’s a wonder there’s enough left to be stitched back together, and makes it hard to find the needle and thread. But I’m holding on, if (at times) for no other reason than my body isn’t done with me yet.

We talk about this love, this undying emotion that is so strong it would kill us to lose our partner. We hear the songs and stories about elderly folks who pass on within days or hours of each other. We read and watch The Notebook. We talk about dying in the same moment, so we are never without. 

It doesn’t usually work like that. 

In the movie Midsommer, (possible spoiler alert, but it came out in 2019, so catch up), the couple whose “time has come” is preparing to jump to their deaths. One has accepted this, the prescribed end of his life. His wife has not. She weeps and wails, not ready, even though her love is laying below, bloody and bludgeoned and gone. I can’t tell you if she is “assisted” over the edge, because I closed my eyes. I couldn’t watch. 

“How do I live without you?” It’s hard as shit. But you do. 

“I don’t want to even breathe.” Too bad. Your body just keeps breathing, your heart keeps beating. It requires far more action to stop those things than you have the energy for. Even if you just sit there, wishing to go gently into that good night, the time passes. People urge you to eat, drink, live, and at some point it becomes easier to give in to that than fight it. Grief demands the path of least resistance. You take the road that requires the least amount of energy and effort, because you have neither to give – but you are still on that road. 

I have lost, immeasurably. And while it’s hard, I still want to live. I want to continue. Some days more than others, some hours are spent just letting the time pass and my body breathe for me; but I want to live, even without Hawthorne, without Oscar. I know that I have their love, I just don’t have them with me here. 

Sometimes when these songs come on the radio, I get angry. There’s no choice, I scream out the open window on the highway. That’s not how it works. Sometimes I cry, tears slowly rolling out of my eyes. Sometimes I just shake my head at the audacity of the songwriters to think that life stops because the body that held your love died. 

Life doesn’t stop. Time doesn’t stop. 

I have likened both Oscar’s and Hawthorne’s deaths and the days that followed to being on a train, speeding through the land. Inside the train car, everything is still; everything is how they left it, nothing is touched. There’s some change from the sway, the outside pressures of acceleration and movement and disturbances, but it’s almost like you remembered it. 

Then you look out the window and see everything rushing by, and you realize, the stillness is false. Time hasn’t stopped out there, all around you. Life continues. And at some point, you have to get back outside the train car. 

It hurts my heart to think about how many people are going through this; hundreds of thousands of people who may not have had to face it right now, were it not for the pandemic. I see the struggles my friends are facing with their family and friends. I am primed for bad news at any moment, guarded constantly. This isn’t living in fear, it’s living with reality. The forest is vast, and each tree cut down is a fresh wound to it, no matter what view you are taking. 

One artist Hawthorne and I never got to see live was Jason Isbell. I’m getting to the point where I can listen to his song “If We Were Vampires,” again, without H, but rarely without crying. And while I’m not ready to see time running out as a gift, I can at least be grateful to a songwriter who understands both the depth of love we had, and the cold, hard truths of mortality. 

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It’s Knowing That This Can’t Go On Forever

One year. 

It’s been one year since the World Health Organization declared the novel coronavirus a worldwide health emergency.

At the time of this post, there have been over 102 million cases, over 2.2 million deaths globally. In the US alone, over 25 million cases, and over 436 thousand deaths.

You hear the numbers. They’ve climbed so high, they cease to make sense. Who can comprehend of hundreds of thousands of deaths? It’s as if Oakland were wiped off the map. All those people, gone.

You can see the effects. You look around; almost everyone knows, or knows someone who knows, someone who has contracted the disease. You see the businesses that have closed, the decrease in traffic, the increase of delivery trucks, and lack of big yellow school busses. I wonder, can you see the ghosts? The nursing home overnight environmental staff whose ’13 Honda doesn’t pass your house when you sit down to dinner. The schoolteacher who no longer needs her parking pass. The taciturn grandfather who used to pick up a 30-rack from the convenience store every few days. 

You taste your food, and you’re grateful in a way you never have been before. You have been home, cooking; all your ingredients are delivered, hand-picked. It’s easy to bitch when there’s been a substitution you weren’t expecting, and there’s no one there to explain or make it right. You make your sourdough, post it on Instagram. The tang of the warm bread, the melting butter seeping into all the nooks and crannies inside, are a comforting reminder that you have followed the rules, that you’ve kept yourself safe. Your hands taste like sanitizer, so you’ve stopped biting your nails while working from home. 

When you do go out, you smell your breath behind your mask, remind yourself to add mouthwash to your Instacart. Maybe it’s time to cut back on the garlic. You cough once, as the dry winter air reaches your lungs. All heads turn. Your eyes both apologize and deny that it’s the ‘rona, it’s allergies. Remember to wash your cloth masks; they’re telling people to double up, as new strains wind through communities, spreading through the mountains and the cities to raise the threat of contagion. 

You touch no one. You pay for your coffee from your phone, you do the still-awkward “I’d shake, but,” smile-and-shrug when you meet someone new. You watch people approach with the warning in your eyes, meeting the same in theirs as they watch you. You rub sanitizer on your hands when given the opportunity; you’ll scrub your hands at home, smooth and soothe the dry skin with a lotion made with oats or aloe. 

Or maybe you don’t. Maybe you go out, like everything is okay. Maybe you do your shopping at a busy supermarket, 2:00 PM on a Saturday, grab a free sample. Maybe you go to church and shake hands with your neighbor. Your kids go to school, you go to karate and yoga and soccer. Maybe you somehow don’t think it’s a big deal, that it’s just politics, the China virus. Maybe you think your faith will save you, or maybe you’re just tired of the restrictions.

I’m tired. I don’t know about you, but my hands hurt from the emptiness. My arms ache to wrap around someone; my cheek yearns to be laid upon another’s. I’ve always been a hugger; physical affection wasn’t just reserved for my beloved, but was always available for anyone who needed or wanted. 

The way I talk has changed over the past year, not just since Hawthorne died. I tell my friends that I love them more often; I tell people I miss them. The words “be safe” leave my lips every day. I make much more of an effort to stay in contact with those distant from me. I RSVP to online events with every intention of logging in, I promise. I have a harder time staying organized, keeping track of the days, remembering things. Relegated to mere mortal status, Hawthorne would say. 

There is no resolution, no lesson in this. Yes, the vaccines are coming, and again I recognize the privilege I carry in having had my first dose already. But the preliminary numbers show that as of December 13thover 16,000 people in the US alone have died over the past year than was expected based on data from the past ten years. That doesn’t include the past 6 weeks which saw nearly 140,000 additional coronavirus-related deaths.

Not everyone has a chance to live through history, and know it as it is happening. As we enter year two of this global pandemic, I again think back to the Ebola epidemic in 2014. I remember how terrifying it was to watch the newscasts and see these tiny numbers in large text in the corner of the screen, vying for attention with the different ALERTs and BREAKING NEWS banners that scrolled by. 11 people had Ebola here in the US. Now the numbers grow so large the news is forced to either abbreviate them or minimize the font size; I’m sure marketing teams decided based on what was thought would retain the most viewers. 

I remember healthcare workers scoffing at having to learn and then practice regularly how to don and doff the significant personal protective equipment required to safely care for patients suspected to have Ebola. It won’t get here, they said. And then, they were right. Still, they also believed that Ebola was a real disease, and a threat to anyone close enough to it. Nobody wanted to be the one who died bleeding from their eyes. 

I wonder if that jaded response helped to lead to where we are now; where people don’t trust scientists, where literally an entire disease is thought to be propaganda by some. Where people don’t want to take the precautions necessary. After all, no one is bleeding out in the streets. Not here. Not this time. 

I do have hope that with the old regime gone, we may have greater faith in a leadership who puts their trust in science. Will that change again in 4 years? Maybe. 

Maybe by then, everyone will know how to keep their mask over their fucking nose. 

I love you. 

I miss you. 

Be safe. 

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Don’t Stop Thinking About Tomorrow

It’s the second week of April, and it has snowed nearly every day this week. The heavy, wet flakes cling together in the shadows, blanketing the barely-awake grass in patches so the snow looked crocheted. It will melt as the sun encroaches, seeping into the cold ground. The brook has finally receded back to its springtime levels after rising a few feet during a day of torrential downpour. By the time we walk in it, it will be impossible to tell which storm or melt moved new boulders into our path. 

The air is no clearer, there are no changes in the traffic on our road. Stay-at-home looks almost no different than when the world is bustling and busy. We still hear a plane maybe once a week; logging trucks still thunder by. 

Our governor declared that Vermont has passed the peak of coronavirus infection. Watching the first signs of a plateau in cases, I am almost ready to be maybe cautiously optimistic. To paraphrase the meme I’ve seen regarding the northern New England states, staying six feet apart seems awfully close. Vermonters have been pretty good about staying, in local terms, one cow apart

We have not seen the influx of illness and death that had been projected just 4 weeks ago. Social distancing, “stay home, stay safe” orders, and the Vermont attitudes toward independence and resilience are working to reduce and prevent transmission of Covid-19. 

Working for the hospital as a non-clinical member of the infection prevention team and scrolling through my echo chamber on Facebook have validated this first tingle of hope that we have avoided catastrophe. 

Of course, one only has to blink to see outside that bubble.

I have decided that arguing with men on the internet is a form of self-care I am indulging in during this pandemic. I have not been one to wade in to internet arguments much before; I don’t enjoy feeding trolls. When I did engage, it was not necessarily to argue (ha!) but to correct something blatantly false that wasn’t also a conspiracy theory – I have my limits. But right now, there is a deadly pandemic; a gorgon at the door, its hot breath blowing in from New York and Massachusetts. 

When I worked in EMS, we had to prepare for blizzards and hurricanes, and in 2014, for the possibility of Ebola finding its way to us. My counterparts made the necessary arrangements and backup plans but teased my high level of concern in both situations. I was a newer member of management, relatively young in the field, and one of extremely few women at the table; I was not as jaded when it came to preparing for disasters that never seemed to materialize. I was better at keeping quiet then, too. I did not fool around during PPE training, but I wasn’t as vocal as I am now. 

Seeing the carelessness with which some people are conducting themselves during this pandemic enrages me on every level – personally, professionally, and academically. The misplaced bravado, the utter disdain for guidelines, the willful ignorance of science pumps up my blood pressure. I feel it build like some sort of apocalyptic katamari in my chest, jagged and off-kilter, heating and churning to boiling point when I can’t stop reading for incredulity. I need to release the valve, blow off some of that steam; scalding men on the internet who call me a sheep has been a fun little release (I am specifying men here because when I argue with women, they don’t often respond; and when they do, it lacks the utter condescension and vitriol).

Why is this affecting me so? Why can’t I just scroll past? I don’t like how much time I spend on social media anyway, why can’t I just put my phone down? I have asked myself this several times lately, and the answer comes from my idol, Leslie Knope:

I care too much because I understand the stakes, and I have seen enough suffering.

I have seen the panic in the eyes of the vented patient when the perfectly spaced breaths aren’t enough, when the air sacs in the lungs fail to inflate. I have locked eyes and delivered breaths through long, drawn-out minutes of a power outage, waiting for a generator to click on, and a machine to take over the squeezing of my hands. I have seen the terrified disbelief in the eyes of someone drowning by inches in a dry bed.

I am no stranger to Death. I have seen her come for the unfamiliar and family alike. I have felt the brush of her hair as she has reached past me to spirit away the hand that I hold. I have ignored her gentle admonishment to stop when pushing, pushing, pushing on old and broken ribs. I have seen her leave the memories, a trail of blood-red rose petals to the afterworld; and I have seen her snatch away breath with greedy hands. I have seen her wait patiently for my father, and smooth my mother’s hair away from her soft face. I have seen her cradling my son, tears in her eyes, an unspoken promise to care for him. No, Death and I are not strangers. 

Death has already come for tens of thousands around the world, invited to this grim party by the coronavirus in addition to her normal rounds. Already the numbers have reached those a degree or two away from me. Right now, thankfully, they seem to be plateauing. Our vigilance is working; alternate care sites and negative pressure rooms stand empty, boxes of supplies on the shelf. Staff is still ready, all hands on deck; the hallways echo without visitors. Work pushed aside so quickly in March is starting to pop up on to-do lists for some; furloughs and lay-offs have emptied the common areas. 

I am trying to be extremely deliberate when I say the measures are working – present tense, a current and ongoing action. It will be a long time until we can say it worked. As the internet says, ending quarantine now because it’s working is like stopping medication because you feel better. We just aren’t there yet. Projections show that the curve has been flattened absolutely, some places much more than others; but we have to keep looking down the line. This virus doesn’t magically disappear when we hit a certain date or temperature or season. There is much more work to do. We are not out of the woods yet. 

I understand the gravity of the economic situation. I know hundreds of thousands of people are scared of what the next days will bring, even if the lockdowns were to end immediately. I can see the havoc wreaked by the virus on sectors other than healthcare. I worry about the success of our small businesses, and the education of our students. I miss concerts and baseball and my family. I see the effect quarantines and lockdowns are having on people, and I sympathize – but without people, there won’t be an economy to fix. If we were to lift all the restrictions, the only things different would be that some places would be ready for a second wave of infections and fatalities, and some would continue to be devastated. 

There is no going back to life as we knew it. That is a switch that cannot be flipped, as most in the US were able to do after the Ebola outbreak in 2014. This time, we are heavily involved, whether people want to admit that or not. Going forward, life will be irreversibly changed. No one will be unscathed. If we continue to handle with caution and test tomorrow’s ground with every step, we can maintain this plateau. If we don’t, if we start going out and gathering together in the streets as we did before, we will rewind this tired clock and have to start again. 

And if you want to fight about it, get ready to step. I can keep up this argument as long as the willfully ignorant can.

Keep staying the fuck home, friends.

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Everybody’s Safe and It Can’t Happen Here

A couple years ago, the internet discovered the Japanese word tsundoku – the universal habit of collecting of so many books that there is little hope of ever reading them all. Like millions of others on Pinterest, I looked at the listing towers tucked around me and thought, same. There are stacks and piles in every room – on shelves, on counters, behind toilets. Our clutter is made up of our bursts of creative energy, pretty rocks, and books. There is one on a shelf upstairs that has been on my mind this week that has just cut to the front of the line – David France’s How to Survive a Plague

As I have been researching past coronavirus pandemics (SARS in 2003 and MERS in 2012), my mind keeps wandering to other infectious disease outbreaks. Zika and Ebola are two of the more recent diseases to leave their mark on humankind – that we like to talk about. The havoc these diseases wreak on the human body is gruesome and for the most part, happens elsewhere. We sit safely in our homes, watching as other parts of the world deal with these emerging pathogens. It was not our mothers and sisters bleeding through old army cots to stain the earth; it was not our babies born with microcephaly. It was not our friends, our favorite waitresses, our pediatricians who were dying from just doing their jobs. It was not our nieces and nephews unable to prevent mosquitos from taking blood and leaving the virus. We watched as black skin bled and brown mothers cried, greedily eating up the images. It was proof that it wasn’t happening to us. They ate weird animals, bush meat, we said, as we sucked the ketchup from our quarter pounders off our fingers. No wonder they have crazy bugs, look at their garbage problems, we said, as we packed 13-gallon trash bags with plastic and wasted food.

And those were the diseases we cared about; the shock value of the footage of these ravaging viruses made us feel like infectious disease is a rarity. We felt safe. Even when Ebola made its way to American shores, we didn’t feel like it would affect us, it wouldn’t reach our families. And for the most part, it didn’t. 

Most infectious disease transmissions never make a blip. There is no BREAKING NEWS ticker for cholera. Tuberculosis doesn’t ping on our radar. Swaths of people have the privilege to ignore the history of medicine, declining to vaccinate children from things like measles, so sure that the risks of adverse effects of the vaccine are so much worse than the disease itself. We blow off the flu vaccine as if 35.5 million people didn’t contract it in the 2018-2019 season, as if 34,200 people didn’t die from it. 

We always think we are safe, that we won’t be touched by death’s ungloved hand. It’s always happening to someone else. 

The AIDS epidemic changed things, for a while. Young men started dying of pneumonia in Los Angeles. The first case report made sure to include in the very first line that all five cases were “active homosexuals.” After publication in June 1981, reports began to come in from major metropolitan areas with similar men dying of the same pneumonia. You can read the very clean Sparknotes version here. The CDC (disclaimer: an organization I would LOVE to work for someday) wants a pat on the back for having guidelines established in 18 months for the “prevention of sexual, drug-related, and occupational transmission based on these early epidemiologic studies and before the cause of the new, unexplained illness was known.” By then, over 1100 people – mostly gay men – had contracted the mysterious illness, and over 500 people – including over 20 children – had died. Before the virus responsible was found and named, the illness became known as “gay cancer.” In the years that followed, nearly 800,000 people have died from AIDS, and more than 1.1 million are living with HIV. These numbers are for the United States alone. Globally, there have been 75 million people infected with HIV and 32 million AIDS-related deaths since the start of the epidemic. 

AIDS hit home. The nightly news squawked about it, helping to spread false information, a trend that continues today. White families that lived in quiet suburban neighborhoods didn’t want to admit it. The government, which now glosses cleanly over its inaction, didn’t want to admit it

Sound familiar?

A generation of young men were lost. Thousands of people who society didn’t care about – sex workers, people using IV drugs, and poor people – died. Others with no “moral failing” died as well; those who had received blood transfusions that carried the virus, or babies born to mothers who were unaware of their status. And beloved icons like Freddie Mercury died. Most died alone, and afraid. 

And still it was not the government who stepped up. It was not treated as the public health crisis it was. 

If you are still reading this, I implore you to go and read Vito Russo’s speech from 1988. He said it best:

“living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you’ve lost more of your friends, but nobody else notices. It isn’t happening to them. They’re walking the streets as though we weren’t living through some sort of nightmare. And only you can hear the screams of the people who are dying and their cries for help. No one else seems to be noticing.”

The situation today feels somwhat similar. Different, of course; only certain religious figures (including an advisor to the president) are blaming the gays this time, and it’s not just the unworthy who are dying. The coronavirus is reaching into homes across the world and leaving few families untouched in places like Italy and Spain. Only now, only the past ten days or so, has the majority of our country seemed to pick up on the fact that this is happening. All the talk about “flattening the curve” has given way to the grim realization that it will never be flat enough for our hospitals to not become overwhelmed and for our lives to go on as normal. There is no normal anymore; we will never return there. 

People in hospitals are dying alone, afraid. Extreme measures must be taken to keep others from the same fate, but at heartbreaking cost. Families are separated; I’m hearing of paramedics sleeping in their cars, I’m seeing my coworkers send their family members away while they work in Covid units. Field hospitals are going up across the country, and across our county. The deaths of doctors, nurses, and case managers only a few hundred miles away are shake the voices of their steady-handed counterparts. Watching in horror at the events unfolding in New York City, we begin to gird ourselves for battlefield triage and for the trickle of patients to become a deluge. We cannot stop it. 

The AIDS crisis took years to be taken seriously. The communities affected can never be made whole. For queer folk, healthcare has always been political. We need to remember our history and keep fighting to ensure something like that never happens again. When the surge fades, we need to keep acting, keep caring. There will be more waves; we need to make sure that no one gets left behind.

The coronavirus response has been delayed from the beginning, and we are still going to see unprecedented morbidity and mortality. But if there is any hope to be had, it is that we have learned from the AIDS epidemic that we are not safe from infectious diseases. They happen, not just elsewhere, but right here at home. If we don’t believe we are safe, maybe, just maybe, people will be willing to listen, and policies and behavior will change. How many HIV infections have been prevented since the advent of needle exchanges, condom use and availability, and PrEP? How many deaths prevented since blood has been screened for disease before transfusions (don’t get me started on the FDA restrictions right now)? 

How many infections and deaths can be prevented if we keep washing our hands and keeping our distance? 

We are not as safe as we want to think we are. This is happening here, to us, to everyone. We are not so special that we won’t be affected. 

Stay the fuck home, friends. 

Posted in Uncategorized

How Am I Going To Be An Optimist About This

In the middle of a massive forest, surrounding by rolling mountains, sat a village. It wasn’t perfect, but it was picturesque; a white steeple rose from the middle of the valley, and the whole scene became vividly painted in autumn. It had your general assortment of people; some folks weren’t as nice or law-abiding as they could be, some went out of their way to be contrary. Mostly, people there kept to themselves, living and letting live. In times of crisis or need, however, so many of them were ready to help in a moment’s notice. 

Like most places that sound idyllic when encapsulated by an outsider, the village had its share of problems and concerns. Most folks went about their day-to-day lives with an ease of accessing all they wanted, often unaware of their own privilege. Others struggled to get where they needed to be, or find ways to meet their essential needs. For long stretches of time, everyone forgot that they lived on the slopes of a volcano. 

There had been occasional talk in the lofty treetops of being ready when the volcano awoke. Such plans were often brought up when money needed to be spent or leaders wanted to be elected, only to be waved off like smoke once the price was paid or the election over. Everyone murmured agreement with the vague statements of preparation and planning, but there was always something else to pay attention to. Anyway, they said, the volcano had lay dormant for a hundred years. There were a few rumbles, now and again, sure; but nothing that hadn’t been weathered with some extra grit and good old Yankee know-how.

The volcanologists who happened to live in the village even forgot about the sleeping giant for periods of time. 

But lately, when snow still blanketed the forest floor and the tops of the pines brushed against the winter blue sky, the birds had been twittering. The woodland creatures scampered with a more frantic step; in the way of things, they were tuned into something much bigger than the villagers, mere mortals, could feel. The wind blew with the barest whisper of what was to come; no one noticed.

The rumbles started from far away, far enough that the village had an almost imperceptible shimmer. The scientists and scholars  glanced at each other, unsure of how to acknowledge the tiny trembles, not wanting to believe what they could mean. Messages came from far-off places; earthquakes, eruptions. Those who worked the land began to take heed, and helped the scientists amplify their voices. As the ground started to shake closer and closer to home, the village began to prepare. 

Businesses were shuttered, schools were closed. Windows were boarded with plywood, and people lay in odd supplies. Bottles of water and rolls of toilet paper were hoarded; antiseptic cream and clean bandages were stockpiled. Surely, these would be what they needed to survive the coming torrents.  Some went through the motions, not believing it would be as bad as others said. They called it an overreaction, even as they added cans of food to their shopping carts. 

Others rallied to action, making supplies by hand to handle the fallout. Their movements brought the community together and helped to ease the anxieties of so many. This was how they would save the village. Those who needed the supplies accepted them with gratitude and grace, but with a heavy heart as well. 

The volcanologists worked tirelessly, preparing for a future no one wanted to acknowledge, that everyone wanted to believe could be avoided. They screamed the truth, but no sound came out. 

This is Rutland, Vermont. This is the town I work in, the hospital I have dedicated the past 5 years of my career to, the community I have come to embrace as my own. There is no fault to be had in this village. The leadership has been excellent, from our CEO to our governor. The preparations have been running at full speed. The community has come together, donating time and supplies, helping each other. The streets are nearly empty; most everyone is staying home, staying safe. My drive to work has no traffic now. I pass storefronts with fluorescent paper signs in the window – Closed, Stay Safe. The hospital feels like a ghost town, employees working from home or not working at all. The air is heavy with foreboding, and people are taking the threat of coronavirus seriously. 

I’m screaming, and no sound is coming out. 

This is what I have studied for years. This is what I went to school for, giving up hours upon precious hours with my wife. Hawthorne knows what the back of my head looks like in every mode and mood. They hear my silent cries, and I’m grateful, but it doesn’t stop the screaming.

People cannot fathom what is about to hit. They have weathered storms and natural disasters and fought on; they have taken up the shield before. They think we’re ready; and truly, I think we’re as ready as we can be. But you can’t board up your windows with plywood and expect to make it out when the floor becomes lava. 

We are flattening the curve. The rise of corona cases in Vermont follows the same trajectory as in other places, true to the epidemiologic curve, but at much smaller numbers. As of 8 AM Saturday morning, March 28, 2020, we have less than 200 cases, and ten deaths. That number will rise today, tomorrow, and the days after that. We are practicing social distancing, and bleach is the new ambience. The measures are working. 

I don’t know if it is the human condition or us in particular as Americans that lead us to believe we are special. Ask a group of people if they think they think they would be in the 70% of the population who is going to contract the virus, or the 30% who is not; nearly everyone believes they are in that 30%. We don’t want to think about losing loved ones, about what it actually means to get the virus, and to be in the high risk groups. It’s always somebody else who is going to get it; someone else’s grandmother, someone else’s spouse. 

I am not special. I have more chance of catching this virus than I do of staying clear. I work for a hospital; not in clinical care, not even in the main building, but with people who do. There is an acceptance in our office, a knowledge that sits within each of us that we will most likely be infected. People in healthcare, grocery stores, supply chains, and cleaning professions around the world are familiar. We are not so special that we can avoid the virus. 

Putting aside factors like age and general health, if I have one hundred people in my life, 70 of them will contract the coronavirus. Out of them, 14 people will become life-threateningly ill. 3 of them will die.

The town I live in has 650 people. 455 will get the virus, with 91 needing critical care, and 21 will die.

My hospital has over 1700 employees. We need to expect 1190 to get the virus, with 238 needing critical care, and still, 51 will die.  

Flattening the curve doesn’t necessarily mean less people will need critical care or less people will die. We don’t yet know enough about the virus to know that. What it means is this. 

Hospitals, like ours, will still be overwhelmed. It almost doesn’t matter in some respects if you are short 30 ICU beds or 3000. Those working the front lines are still overrun and still doing their job as best they can for as many people as they can. Flattening the curve means that we are giving our healthcare workers who WILL get sick time to get better, and hopefully return to help. It means that instead of the loss of hundreds of lives within days, when everyone gets sick and all the critical patients arrive at once, we at least have the chance to save more by spreading thin resources out. We don’t want what happened with toilet paper to happen with ventilators. 

I am scared. I know I am likely to get the virus, to pass it on. I am so likely to lose people, and I don’t want to acknowledge that, let alone make my peace with it. I am no politician. I’m not trying to get elected for anything. I’m not a motivational speaker, not a preacher or priest. I cannot offer hope, a silver lining, or promises of bright future if we just fight hard enough. I can’t even fake it.

But along with memes and messages of hope I cannot smile at, there are also those of support, and I’m here for that all day. Knowing the grim statistics will not make me fight less. It just makes me hyper aware of what devastation our village will endure. The world is going to look very different in a couple months. We will be changed; no one will be unaffected. And it will be up to the survivors to make sure those silent screams are captured by the history books.

Stay the fuck home, friends. 

Posted in Uncategorized

Time I Had Some Time Alone

This isn’t the post I have been trying to write. Here there is no research, no fact checking. I realize now why it has been taking me so long to finish that one.

I am anxious as hell.

For those of you who know me well and this is not a revelation, I’ll thank you to keep your “well, duh,” under your breath – behind a mask optional.

I am not anxious about the coronavirus. I earned my master’s in public health just this past year from johns Hopkins Bloomberg School of Public Health, with a certificate in Quality Improvement, Patient Safety, and Outcomes Research. That certificate won out narrowly to one in epidemiology or statistics, two other public health realms near and dear to my heart. I feel I have a pretty solid grasp on the behavior of the virus, the steps to mitigate the spread, and the danger we are in.

I am not anxious about getting the virus. I am a relatively healthy 33 year old; I have high blood pressure, but it’s well controlled on medication. I was recently pregnant and my daughter is exclusively on breastmilk, but there is no indication that this puts either me or my daughter at risk. I have a decent immune system, honed by nearly ten years in emergency medical services, dealing with some level of exposure to whatever is going around. I am vaccinated accordingly, I receive the annual flu shot, and I wash my damn hands.

While I am increasingly worried about Hawthorne contracting the virus, that is not the source of my current gripping anxiety. Hawthorne has poorly controlled asthma, and has for years. Their immune system takes a beating, often. Whenever we are sick together, their symptoms at least twice as long as I do, and the asthma exacerbations continue into weeks. We have sort of made our peace with the fact that Hawthorne will likely come down with it, and we have made preparations for how to handle things if and when they become significantly ill. They have been tested for the coronavirus and are currently quarantined in our home; we have divvied up the silverware and towels, we are following the guidelines as close as we can while not leaving me with all of the parenting, cleaning, chores, and my own work. 

I’ve been up since 4:30 on a day where I do not have to go to the office. Lucy was up every hour last night; it’s strange to think that something that I’m eating is disagreeing with her tiny tummy so much. I couldn’t sleep any longer, couldn’t try. My mind has been racing, my eye twitching. Lucy learned to screech this weekend, and practices every chance she gets, testing it out with every mood. It’s adorable to see her smile, all gums and joy, and then jarring to hear her hellshriek with the same smile. I’m not anxious about the impending couple weeks at home with her on my knee, coffee at my elbow, and data on my screens. 

I am anxious because right now, with seemingly inevitable quarantine (which I agree with!), I am about to lose the hard-won routine and structure I have developed since returning to work after maternity leave. Self-isolating or quarantining leaves a lot of wide open days; Lucy is too young to have lesson plans, and I’ve never worked from home for multiple days in a row. I feel like I have just completed my reentry into work life, crash landing and stumbling out, dazed by the sudden atmospheric shift. I have made it over the first hurdles of balancing work and life with a new baby at home, the first days of not knowing quickly how to proceed when I don’t have childcare, the first extended hours of feeling like a vital and visceral part of me is missing. 

Years ago, Hawthorne helped me realize that one of my coping mechanisms for stress and lack of structure coalesces into overworking myself. Maybe I start spending long hours at work, or banging away at work projects off the clock. Often it means I start looking around the house and the world and everything in between, making lists upon color-coded lists of projects to do. What is coming to surface right now is the drive to help. I feel useless, helpless, here at home when I know how hard my colleagues are working. It doesn’t seem to matter, internally, that I will be back at the office soon and able to jump back in the trenches with them and support. I understand how hard it is to believe that the best thing that I and millions of others can do is simply #staythefuckhome. I’m fighting the urge now to not be involved in every community initiative, moderate every Googledoc, deliver every meal, and write to every isolated senior. 

Part of the reason I never questioned becoming a doctor when I was growing up was I felt that doctors were, above and beyond, helpers. They were able to take care of people, to fix things, to make things better. Watching some of the doctors my father interacted with when diagnosed with ALS scuffed my rose-colored glasses, so long trained on the medical field. I remember my anger at his first neurologist, a jaded man with wire-rimmed glasses on a straight nose and zero compassion. Even at 15, I felt nostalgic for a time I had never known, when doctors visited the homes of their patients and occasionally accepted bread and unlabeled jams as payment. I had watched Patch Adams too many times, I guess. If I was going to be a doctor, I was going to be a doctor who cared.

Jumping headfirst into emergency services felt natural; there, I was helping people, I could see that every day. I did fall into the EMS culture (another story, another day), but mostly, I was able to remember what I walked away with from my original EMT class. When people called 911, they were doing so for a reason. They needed help. People have been taught for decades now that when there is an emergency, you dial 911. No one has done a good job at defining what an emergency is on a wide scale, so the term has become completely subjective to folks outside of the healthcare fields. I don’t get to define what someone else’s emergency is. Maybe it’s loneliness. Maybe it is running out of a medication and not knowing what to do, or maybe it’s a dead cat; whatever it was, there was a reason.

There were, undoubtedly, many more frustrating calls than there were true medical emergencies. It wasn’t prestigious; benefits were practically nonexistent, and the pay was terrible. Then the Fight for 15 began, it became a contentious point in EMS: most people entering the field wouldn’t see a payrate like that for years, even though they are literally the first line of response in life-threatening situations. We weren’t in it for the money; some may have been for the glory, I suppose. It took a lot of work sometimes to remind myself that, as EMS professionals, were being given an honor by the public we served; there were times it took substantial effort to remember that we were being not only called, but invited in to people’s emergencies, their worst moments. We were the ones who showed up in the times when people were most vulnerable. We were the helpers.

I let my card lapse with absolutely no regrets. Since then I have happily remained in a non-clinical role. The decisions I have are not life and death; if I make a mistake, it needs to be fixed, but no soul hangs in the balance. This experience, sitting home while the virus creeps over the land, has made me realize I don’t know how to not be a helper. I know there are thousands upon thousands out there like me, feeling stymied, even as we are doing the best possible thing – staying home. Somehow I will have to find more of an actionable way to help; I just don’t know what yet.