Episode 3: By My Side
SYNOPSIS
One of the hardest things about being healthcare workers going through this pandemic is that we've both experienced and borne witness to moments that nobody should have to go through alone. Who do we need by our side when everything falls apart? And what do we do when they can’t be there?
In this episode: a pediatrician recovers from a grueling surgery without family support due to strict COVID-era visitation rules; a psychiatric intern remembers the death of her physician mother as she cares for COVID patients; and an ER doctor is faced with the impossible task of intubating his colleague and dear friend.
LISTEN
Contributors
This episode features the voices of David Zodda, MD; and other healthcare workers who wish to remain anonymous.
CREDITS
Host: Emily Silverman, MD
Podcast Producer: Adelaide Papazoglou
Associate Producers: Isabel Ostrer, Molly Rose-Williams
“This Little Light of Mine” performed by Bridget Wild, MD, and her son, Theodore Kornfeld
Improvisations on guitar performed by Alexander Papazoglou and David Uppal
“Pandemic Theme” composed by Yosef Munro
Series illustrations by Nazila Jamalifard
Audio Engineer: Jon Oliver
Production Assistants: Hannah Yemane, Ricky Paez, Siyou Song
Support for The Nocturnists comes from the California Medical Association, the Patrick J. McGovern Foundation, the California Health Care Foundation, and people like you who have contributed through our website and Patreon page.
TRANSCRIPT
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The Nocturnists: Stories from a Pandemic: Part II
Episode 3: "By My Side"
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You're listening to The Nocturnists: Stories from a Pandemic. I'm Emily Silverman. One of the hardest things about being a healthcare worker during a pandemic is that we've all experienced and borne witness to moments that nobody should have to go through alone. In this episode, we hear three very different stories about the importance of having your people by your side. We'll hear from Sarah, a pediatrician who recovers from a tough surgery without family support due to strict COVID era visitation rules. Allison, a psychiatry resident whose grief about her mother's passing two years prior found echoes in the patients she cared for as a COVID intern in New York last spring. And David, an ER doctor who found himself in the impossible situation of having to intubate his own colleague. This episode is called "By My Side".
Sarah
The pandemic has been just kind of enmeshed with my cancer journey. Those two things will forever be the same story, I think. You know, it's, I think a lot about this as I'm sitting at home, post-op, healing and, and bored that it's been both a blessing and a curse that there's been a pandemic during my cancer treatment. Because while I've been physically completely torn apart and put back together, I haven't had to be out in public for anyone to see it.
In December of 2019, my mom was actually diagnosed with breast cancer. We have a pretty strong family history. I was overdue for my mammogram that I'm supposed to get every year. And so when she had gotten her diagnosis, I called and scheduled my mammogram. It was about two weeks after my mom got her diagnosis that I had my biopsy and got a diagnosis as well. That was a complete shock. I, I was in a really busy, booming practice. It had been a rough year, and we were all already pretty burned out. Anyone who's been in practice for a long time knows you have waves of good and bad and, and then I got my cancer diagnosis. When I started to learn what my treatment was going to be and how involved it was going to be, how much time I was going to have to be out of work it was really telling and a little bit sad that one of the things that I have to admit I thought was, "Oh my gosh, well at least I'll get a break."
Right around the time of the third round of chemotherapy, we started to realize that Coronavirus was coming.
News Reporter
"Now to growing concerns about the deadly Coronavirus officially hitting the US. Here's what we know: a Washington state resident fell ill after returning from Wuhan China where the outbreak began. Officials now say more..."
Sarah
What chemotherapy does to a woman's brain, the kind of immersion back into work that you used to be really fast and good at. And then suddenly you have to slow way down and ask for a lot of help. The first day back, I had a little bit of hair. Essentially what looked like a buzz cut. That loss of hair - it's so visible, and you can't hide it and you have to end up talking to people about it. We kind of all agreed that to ease me back in I would start with just rounding in the newborn nursery. You know, in the old days, rounding on a newborn would have taken me 5 or 10 minutes. A few clicks, look through the vitals, and then the longest part of it is talking to the family and checking in and making sure they're doing okay.
I remember that I logged in to the computer, and I looked at the weight and looked at the weight and oh my gosh, I couldn't do the math. And I had to get my phone out. And I just had this panic. I just had this panic like, you know, I'd been at home I was doing fine. I could do the dishes and drive the kids and do a basic grocery list. Suddenly I couldn't, I couldn't do it. I called my oncologist. And I was like, "I can't I, I was not mentally prepared for it to be like this." The initial advice that I got was just get a lot of rest and do crossword puzzles. My mom and I still laugh to this day, if anyone ever buys me a crossword puzzle or hands one to me, I mean, we want to have a bonfire. A crossword puzzle is not gonna get to that level of thinking that you don't have after chemotherapy has wiped out your ovaries and your estrogen and your brain function. That was a day I'm not sure I'll ever forget.
When I had my surgery in January, it was a 10 hour surgery. They weren't allowing any visitors. Gabe was allowed to come up and see me after I got up to my room for about an hour. And then he wasn't allowed to come back into the hospital until I went home three days later. And, I mean, I loved surgery as a medical student, but to be on the other side of the table and, and to wake up and see that your body's been, you know, just completely rearranged. When I woke up, my left hand was numb, my first three fingers were just completely numb. And it freaked me out. I just remember being disoriented. And why is my hand numb? I had an IV on each arm, and completely irrationally, I was like, "Get it out of my arm, my left arm is numb," like I was so upset. And Gabe was there, and it was dark. And then I got a fever. Then he had to leave.
I was pretty delirious that first night when I was trying to be you know, of course, 'cause we're doctors and we all think that if other people need three or four days in the hospital, we need two, right. I didn't want to take too much pain medicine and so I just hurt, I hurt everywhere. In the middle of the night, I just could not get comfortable in bed. And so I'd wiggled myself over and up and I got myself into the recliner next to the bed. And I'm looking at my body, which is just, I mean, it's just a patchwork of incisions you know, hip to hip and all over and I'm having all this like, you know, morphine-induced, exhaustion-induced self doubt and overwhelm. I mean, what I really needed was Gabe, who had been on this whole journey of a year with me to be like, "Look, it's okay." I needed him to physically be there. But he couldn't be. So I cried for a while and then fell asleep after another dose of morphine. And that was a really, really hard night.
I haven't seen my mom in person, but a handful of times. I hugged her before my first surgery. And I hugged her after my last Herceptin infusion in December. She just got her first COVID shot actually today, makes me tear up to think about it. And I just can't wait to sit in a room with her. Because my, my dream is simple right now. It's that we can go back to having our family just think about the next trip or you know, travel, soccer, hotel rooms, and oh my gosh, gathering with teammates and friends and families again. That's my dream right now.
(Guitar Music)
Allison
I've been spending a lot of time thinking over the past 24 hours about those last moments with my mom and um. So she, she died January 16, 2018. Right, so before all of this COVID stuff. Hers was the first respiratory death I had ever seen closely. The image that sticks out to me most is, is her fingertips. I was so intimately familiar with my mother's hands, the hands that raised me and bathed me and were a part of my life since before I was in this world. And it, it's such a jarring experience to see hands you know so well look dead while, while a person is still alive.
I kind of thought it would be probably the only respiratory death I would have to see for some time. I certainly, you know, there's no way any of us could have anticipated how many respiratory deaths and how many similar blue fingertips and agaped jaws and discolored skin, I would, I would see.
Losing my mom was like one of the hardest things I've lived through. It's one of the hardest things I continue to live through. But I was with her. You know, I was with her and I was able to hold her blue hand in my pink hand. And particularly when I was in New York, and my whole patient panel was all COVID patients and we at that time, you know, no one really knew what we were doing. We were all just kind of watching people on oxygen, seeing, you know, day seven to day ten are they gonna plummet or are they not? And so often, you know, all I could do was hold people's hands. But how different it was to be holding these blue fingertips that reminded me of my mother's.
I was searching my email inbox from for emails she sent me. I always use the same search words, which are "love" and "proud." Like I just love reading emails where she talks about love and where she talks about how proud she is of me. But I had exhausted all of those emails. And I was just reading through the mundane emails where, you know, she was asking me if I wanted to go out and have dinner or if I could possibly fly home from college for a weekend and just all these times that I had said no, you know, for stupid reasons. Like I had a sorority initiation event or some dumb bullshit, right? And I just got into such a shame hole about it of like, all these times I said no to my mom. And I just, I wanted so badly to just be able to say yes to her one more time.
And then the night, the night she died, I had this dream. In the dream, I was with her. She was sick in the dream. And she was having trouble breathing. And I could tell that like she was cyanotic. And her lips were blue and, and she was struggling. And for whatever reason, I had brought her to my friend's house and my friend was having some sort of party and they were all of my home friends and their parents there and, and she was sick. And we were sitting there at this party. And I said, "No, this is just ridiculous, Mom, like, let's go." And in this dream, we just sat there on some couch with her head in my lap. And I remember trying to prescribe her opiates and she was like, "Allison, you don't need to prescribe those for me, I have them in my purse." And just her letting me take care of her and choose her.
I like to think that, you know, from wherever it is that her soul and energy exists now that like her returning to me in that dream was her way of trying to, you know, soothe my grief and care for me from beyond the grave. And it just felt like such a, like it truly felt like she had like put herself, come back from the dead to like put herself in this position of being in pain just to give me the opportunity to choose her. And I was just overwhelmed with love.
I think there's a lot of tragedies of COVID that are going to extend far beyond the mortality and morbidity that this virus has taken on, on our country and our world. That like the, the lack of touch, and like the lack... it like I, I almost sometimes feel like I'm just kind of floating in this, like my own womb. And yesterday when I saw my stepsister, we hugged. And like, holy cow, like the power of a hug! Again, it sounds so like cliche and lame and like, now I have to associate these hugs with like, the moral hangover that follows, right? Of like, I hope it was okay that I hugged her and that she hugged me but like, like, it's just this is vital, you know, human connection is, is vital and, and touching is vital, and being embodied is vital. And I think, you know, these are the more subtle effects of COVID that are gonna take far longer time for us to you know, figure out what the fallout is, but it's, it's definitely not good.
(Guitar music)
David Zodda
It was my first day as an ER attending at a new job at a new hospital in a new city. I didn't know a single soul. But I heard the best coffee was in the doctor's lounge. I got my paper cup. There was a gentleman in front of me, he had a long white coat, glasses, thick black hair. He's only about five-two, but what he lacked in height, he made up for with a great big grin. He put three sugar packets in his cappuccino and stirred it with a plastic straw. And he turned and he looked at me and he said, "It's cappuccino time."
His name was Dr. Lee. I knew instantly at that moment we were going to become really good friends. Turns out he's an ER doc as well and we'd both trained at trauma centers. Dr. Lee training at a trauma center made him incredibly cool as a cucumber in a bowl of hot sauce I would use to say. You never saw him sweat. It could be a patient in cardiac arrest, crashing right in front of you. And he'd be talking to the nurses calmly, ordering medications calmly, being polite and genuine to his residents and scribes and medical students. Dr. Lee also liked to have a good time. I worked with the residents and one graduation party I'll never forget him walking out in the middle of the dance floor. I believe he was wearing a Members Only jacket, he ripped it off, spun it over his head. Man you've never seen residents and attendings so happy in their whole life.
In March of 2020, when the pandemic hit the United States, it particularly crushed our hospital. We're only about 15 minute drive from downtown Manhattan. And boy, we felt it. I'll never forget that first case, a case with the hazmat symbol on it. Pretty soon 25 of my active 25 patients all had hazmat symbols on them. We didn't know what to do. We didn't know what treatments worked. Testing was so unbelievably difficult. I remember looking at the first chest x-ray of my COVID patient, and I'd never seen anything like it before. Where it should be lung tissue and clear, differentiated, it was completely whited out. The patient was drowning with fluid. I asked Dr. Lee if he's ever seen anything like this. And he said yeah, during the height of the AIDS epidemic he'd seen pictures of this. Looked like PCP pneumonia, he told me.
As the days went by, we lost nurses and physicians to sickness and to quarantine. And there were a lot of shifts that needed to get picked up. But man every time I tried to pick up a shift, Dr. Lee would pick it up just before me. Our emergency department has about 60 rooms. During March of 2020, we had over 200 patients in our emergency department. Patients were doubled up in the rooms, were in the hallway. We completely converted our cafeteria to house COVID patients. Tents were set up outside our hospital. I did everything I could to not get sick. Once things started to really heat up in our emergency department I realized that it was too risky to even go home. So I made the decision to move out. I got a hotel room.
On March 27, 2020, I showed up for my shift -- 7am -- just like I'd been doing for the last eight years. When my phone rang it was a charge nurse. She said that I needed to come back to the emergency department immediately because I had an emergency resuscitation. The patient was critically ill and crashing. I said, "can you tell me a little bit more about the patient?" "It's Dr. Lee." I was confused. I said, "I don't understand. If it's Dr. Lee's resus, why are you calling me?" She said, "No Dr. Zodda, the patient is Dr. Lee."
I walked into the department and there behind the glass doors was my friend sitting there on the stretcher. I put on my PPE, my gown, my gloves, my face shield. I don't remember what we said initially, but I do remember kind of going through the motions just he and I, as I helped him onto a monitor and put on his blood pressure cuff. I put on his pulse ox, put on his cardiac strips. And as his pulse ox came over the monitor, we watched closely, I noticed that he was kind of leaning forward and he was a little sweaty, he was breathing a little quickly. But his pulse ox came up with a perfect waveform, 95%. And then just a second later 85, 75, 65, 55% and a perfect waveform. And it just stayed there. And we both just looked at that number.
After a second or two, I grabbed the non-rebreather face mask and hooked it up to oxygen, turned it all the way up, put it on his face. I asked him to flip over and to get in the prone position to help oxygenate the back of his lungs. His oxygen level went up to about 75%. It was then I knew things were really serious, as did he. He asked me to call this wife and give her an update. The chest x-ray came back and it looked just like that chest x-ray that I'd shown him a couple weeks prior. During this part of the pandemic there was a real push to intubate patients early. Once you get put on a ventilator and went to the ICU, your chances of walking out of the hospital after surviving COVID were incredibly low. The second ABG came back worse than the first and I knew what I had to do.
We got everything set up in the room. It was just myself and a nurse and a ventilator. Got my meds ready. Pushed the sedative, pushed the paralytic. And in a moment he was out. And as I stood over him at the head of the bed and I positioned him for intubation, I looked at his eyes in disbelief that we'd gotten to this moment. Once he was on the ventilator, his oxygenation went up to 100% and I breathed a sigh of relief.
I walked out of the room shaking. Everyone's eyes on me. I'm not sure how I made it through the rest of the shift. But somehow I did. Dr. Lee was whisked off to the ICU. I drove to the place where I was staying and showered quickly and decided to go for a run. I wanted my lungs to burn like his did. I wanted to feel air hunger, like his did. And at the end of my run, I lost it. That's when it dawned on me that I had intubated a dear friend and that I was very close to losing him.
The first week in the ICU for Dr. Lee, it was very difficult to sedate him. It was very difficult to continue to oxygenate him. But by the second week, he was doing much better. And by the third, I walked up to visit him and there he was. He wasn't intubated anymore. He was on a non-rebreather, looking at me through the glass. A little dazed. I gowned up, walked in the room, sat next to him. I said I'd get him a cappuccino.
Bridget Wild
I'm Bridget.
Theodore Kornfeld
I'm Teddy. Teddy Kornfeld, I mean.
Bridget Wild
That's right. And we're gonna sing "This Little Light of Mine."
Theodore Kornfeld
I picked it!
Bridget Wild
Alright.
Theodore Kornfeld
Enjoy the show!
Bridget Wild and Theodore Kornfeld
(Singing) This little light of mine, I'm gonna let it shine. This little light of mine, I'm gonna let it shine. This little light of mine, I'm gonna let it shine. Let it shine, let it shine, let it shine. Everywhere I go, I'm gonna let it shine...
Emily Silverman
That's our show. The Nocturnists is produced by Director of Story Development Adelaide Papazoglou, Associate Producers Molly Rose-Williams and Isabel Ostrer, and me. Our student Production Assistants are Hannah Yemane, Ricky Paez and Siyou Song. Our original theme was composed by Yosef Munro. Our audio engineer is Jon Oliver and our illustrations are by Nazila Jamalifard. Thank you to pediatric hospitalist, Bridget Wilde and her son, Theodore Kornfeld, for their performance of "This Little Light of Mine." Thanks also to Alexander Papazoglou and David Uppal for their original music heard in this episode. Our Executive Producer is Ali Block, our Chief Operating Officer is Rebecca Groves, our Admin Assistant is Suparna Jasuja and our Social Media Intern is Yuki Schwab. The Nocturnists is made possible by the California Medical Association, a physician-led organization that works tirelessly to make sure that the doctor patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org. Support for The Nocturnists also comes from the Patrick J. McGovern Foundation, the California Health Care Foundation and people like you, who have contributed through our website and Patreon page. Thank you for supporting our work in storytelling. Join us next week as we take a deep dive into health care workers' pandemic dreams and nightmares. I'm your host, Emily Silverman. See you then.
Bridget Wild and Theodore Kornfeld
(Singing)...Everywhere I go, I'm gonna let it shine. Everywhere I go, I'm gonna let it shine. Everywhere I go, I'm gonna let it shine. Let it shine, let it shine, let it shine.