Stories from a Pandemic: 8. Insomnia
Synopsis
The mass media portrays healthcare workers as “heroes,” or soldiers fighting a battle. For some people this language may ring true, but for others, it feels wrong.
This week you’ll hear voices from California, New York, New Jersey, Maryland, and Pennsylvania. They include a geriatrician, ER nurse, hospitalist and historian of medicine, two emergency medicine physicians, and two medical students.
*This episode includes themes of mental health crises and suicidal actions. Listener discretion is advised.
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CREDITS
Hosted by Emily Silverman
Produced by Emily Silverman and Adelaide Papazoglou
Medical Student Producing by Vishal Khetpal and Raphaela Posner
Audio Engineering by Jon Oliver
Original Music by Yosef Munro
Illustrations by Lindsay Mound
The Nocturnists is made possible by the California Medical Association, the Gordon and Betty Moore Foundation, and people like you who have donated through our website and Patreon page
TRANSCRIPT
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The Nocturnists: Stories from the World of Medicine
Part 1 Episode 8: "Insomnia"
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
A quick warning: this episode of The Nocturnists includes themes of mental health crises and suicidal actions. Listener discretion is advised.
Over the past few weeks, there have been so many news articles about health care workers as heroes or soldiers fighting the battle of coronavirus. For some people, this language may ring true.
But for others, the metaphor feels wrong. One of the questions I've been grappling with a lot this week is who gets to tell this story and how? Can there be something more than the slogan: “Heroes work here?” Can we tell our stories while preserving the complexity of our inner lives? Our doubts, fears, anger, resentment, our vices, our insecurities?
Can we be...not heroes? Can we be anti-heroes even? You're listening to The Nocturnists: Stories from a Pandemic. I'm Emily Silverman, and this episode is called “Insomnia.”
Kim, ER Doctor, New Jersey
Hey, it's Kim, ER doctor in New Jersey. I haven't sent anything for a while, um, I started to feel like this isn't really my story to tell anymore.
Now, the surge is ending here where we are, and I think the last time I sent one of these was before the shift where I had to withdraw care from a patient while talking only to the family over WhatsApp.
And somewhere around there, I just decided this isn't something I know how to talk about in any way that doesn't seem like I am making it about me and my experience. And it really, really isn't, because after that, I went home and saw my family.
We got a dog. We have a new pandemic dog. And things for me personally have really not been that different. I always felt distressed and dismayed about the things my patients had to face that I haven't had to face. And this pandemic has been no different.
Now we're starting to have a little bit of our regular business again, and the weather has warmed up, which means that traumas are starting to come back in, and the people who are using drugs and alcohol to escape their difficult lives are coming back in. And I–it's not that different, except that now I wear a mask.
Lakshmi Krishnan, Hospitalist and Literary/Cultural Historian
My name is Lakshmi Krishnan and I'm a hospitalist and a literary and cultural historian.
I haven't shaken hands with a patient in two months. I just finished a day off of clinical service and for the first time in two months, felt this irresistible urge to touch a patient. What happened was that I had been consulted to do a perioperative evaluation, but also she had multiple, multiple medical issues going on. And I walked in, and she was just weeping. She's about 80-years-old, and she had come in with symptoms of cord compression, but she had had those symptoms for three weeks.
And so, you know, by the time she came in, she had no lower extremity motor function, no bowel or bladder control. And the orthopedic surgeons weren't planning to do anything unless she absolutely needed cord stabilization.
They had just told her, it turned out, that she would likely not regain any function at all.
And when I walked in and she was sobbing, I was there with my face shield and my mask and, you know, all my PPE, I overcame all of these months of COVID-programming and just felt like, you know, this–this woman needed a human being to touch her, more than she needed a doctor at that moment.
So I was thinking about this as I was also thinking about history and how we are all making meaning together. We're making history together, but we're also historians of this moment together, all of us who are living through this.
Keith Wailoo, historian of medicine, said, “History, in a way, allows us to orient ourselves to where we are in the plot–which chapter, which line–and this helps us orient ourselves in a way, if only to acknowledge our uncertainty, which in some regards brings a certain comfort.”
I think of how physicians and our patients–we're all in community together as historians of this moment. I mean, as physicians, we are writing micro histories all the time–the very act of getting a story from a patient or interviewing a patient is called a history and physical–so thinking about that, and how we can make meaning together amidst this, amidst this crisis, and how we're all historians of this and narrators of this moment.
And I was thinking about this because that moment between me and this patient, I record it now, but I certainly wouldn't put it in my history. And her moment–this moment of not being able to see her husband, this moment when she's learned that she'll probably never walk again–that, too, is a morbidity of COVID.
Sarah, New York
This is Sarah in New York. It's May 11th and I've had, I don't know, four or five hours of sleep in the past two days? Not because it's been busy or anything, just really bad insomnia.
I was so exhausted. And at the end of the day, the only thing I wanted besides sleep was a cigarette, which I know is so bad.
I haven't smoked in years since I broke up with an ex who was a smoker. I was just really worn thin today, I guess. I wanted it so bad, and I was this close to buying a cigarette from the bodega across the street on my way out.
But it occurred to me, like, how am I going to smoke this with the mask still on? Because I can't take the mask off on the sidewalk. So that's how COVID-19 saved me.
Anonymous
I got a care package in the mail from the, like, the neighbors of the mom of one of the other residents. She organized this thing where everyone in the neighborhood is paired with a resident and sending care packages, which is so sweet. It's very nice.
But a part of me is like, why? I mean, this past week at least, I've been doing nothing. I've been in my pajamas. I'm living with my parents right now because I was between apartments when this all started. So I don't know. It really–it makes me feel very guilty.
And then yesterday, I heard from a reporter who wanted to interview me about graduating early from medical school. I have no idea where this reporter got my information from. And I don't know. So I–I said that he could interview me. I told him I didn't want to be like a big part of whatever he's working on, but I would be happy to be interviewed as a background, you know, for background information.
I've been not very happy with the way a lot of this has been covered in the news, about health care heroes and about early medical graduates being drafted or like signing up for war–that language makes me very uncomfortable because I don't see myself that way.
And I don't know, I think it's…I guess what I'm trying to say is I–I think that when people talk about me like I'm going to war, that's a–that's an excuse for–it means it's okay if something bad happens to me, if I get sick, and it means we should be prepared for, you know, we've signed up for the risk.
But, you know, I didn't sign up for risk. I signed up with the hope that this school, the hospital would protect me adequately, you know, to the best of their ability. So I guess I just didn't want to attach my name to something like that without knowing how it would be written about. And I think also I don't want to, you know, I feel, like, imposter syndrome. You know, I'm hearing from all these people about how great what I'm doing is, and how proud they are of me. I'm getting check-ins from family and friends all the time. And, you know, I feel like people are looking at me and seeing this hero.
And I feel ashamed. Like if they saw what I'm doing now, would they really–like they would know that I'm not worthy of this. I don't want to put my face on something claiming to be something that I'm not.
Anyway, hopefully I'll be able to fall asleep easily, unlike the past couple of nights. I’ve really just been tossing and turning and staring at the ceiling. It's like that thing when you want to go to sleep so badly, but you can't.
Pediatric ER Doctor, New York, New York
I'm in New York City. I'm a pediatric ER doctor.
Things have really slowed down in New York. ER volumes across the board are down, ER deaths are down. We're still seeing surprises in terms of the pathology and trying to understand COVID patients, which now has sparked some intellectual curiosity.
But the real thing I wanted to talk about, or reflect on a little bit, was that two nights ago we found out one of the adult ER doctors in my department died. She had had COVID five weeks prior, so everyone was very confused.
And then yesterday news came out in The New York Times–it’s how a lot of people found out–that she died by suicide. I didn't know her, really, I'd only interacted with her a couple of times. I feel really terrible for my colleagues who knew her very well. She was very beloved in the department and apparently she was a really good boss to the people who worked with her in that ER.
It's a huge loss for a lot of people. And what I've been thinking about a lot is everyone's mental health. This news just came out of nowhere for a lot of people. Sounds like nobody knew she was struggling as much as she was.
At some point, somebody said something like, even though it's not COVID-related, and someone else said it is COVID-related, it is COVID-related. I worry about more suicides. I worry about, you know, the people that Lorna was responsible for, and the people that were responsible for Lorna, and how they're coping with this.
I can only imagine the sort of despair she must have felt based on what had happened in her ER. She worked in one of the more under-resourced ERs, and at one point, they were just overflowing, unbelievably. You know, I think there's levels to COVID, in terms of how bad this is. I mean, the level of trauma, death, acuity, volume, and just being overwhelmed and that–that COVID experience is really singular for like ER doctors in New York, ICU doctors in New York, and in Italy and China.
And I cannot fathom really at the peak what they were experiencing. But obviously it was bad. It was really, really bad. And I think there will be a lot of trauma.
Nobody signed up for this. We didn't sign up to go to war. All these metaphors of war and heroes and fighting the good fight, just–that is not what medicine is. No one should be fighting this fight that was totally preventable, and certainly no one should be dying from it. Not the patients. Not the doctors from COVID. And not doctors by suicide.
I'm just thinking about how hard it must be for a lot of doctors right now. I just hope that people will get the help they need. And it's really sad to know that people feel a glimmer of hope now. A lot of people feel like we've, you know, passed the peak, it’s going down. Patients are getting extubated. Every hospital is playing some silly song when patients get discharged.
And Lorna was, you know, stuck on the bad side of this, and didn't get to see this more hopeful part–this part where people can imagine an end.
Anonymous
Today has just been rough, and I don't really know why. I took a shift off last week and got a test because I wasn't feeling well, and it was negative.
Everybody was like, “Oh, that's great news.” I'm like, “Is it really?” I’d kind of rather just not feel very well and have it be positive. Maybe. I don't know.
So I can't even figure out my emotions about something that straightforward. I just feel like I think I have this expectation that all of this time spent in my home and with my family should lead to a sense of organization, some sort of rhythm, some sort of something.
And it's just…not. And I just feel generally frustrated overall. We're hearing horrible conditions through the grapevine. They are putting up with the homeless people in what they're calling “COVID hotels,” and deploying nurses to go monitor the situation.
So all of our poor clinic nurses who would normally have been taking patients in for their regular clinic appointments are now trying to figure out what to do with 75 homeless people in a hotel that are apparently running out of toilet paper and alcohol and want to go outside and smoke.
And this sounds ridiculous and unmanageable, and nobody's exactly sure what to do about it. Nobody is sure who to talk to about it. Nobody's sure who's in charge of it–who's running it. Communication is poor. Directives are limited. It's kind of a mess. It just feels like one more layer of frustration.
We're not going to provide you with a safe working environment. We're not going to provide you with adequate communication about the pandemic. We're not going to tell you if your colleagues are sick or getting sick. We may or may not deploy you to someplace where you've never been before to do a job that you've never done before. And, gee, thanks for your service!
You know, when it puts us in such a crap position, I mean, like…I want to quit my job. Nobody wants to quit their job right now. It's a terrible time to leave your job. They know that.
And, as a nurse, you would never want to do that because you feel like the communities that you serve need you now more than they ever have. So it's an even harder time to feel like the people who are your directors and your administrators and your city leaders who are supposed to be protecting you are just kicking you around, just treating you like a disposable commodity that, you know…it just doesn't matter.
So I'm having a really hard time today, and it's unfortunate because it's an otherwise beautiful day.
And I feel, you know, mixed emotions. I should be grateful, I should be happy that, you know, we are in such a, by comparative terms, such a good position. We aren't, you know–this isn't going to financially ruin us. We haven't lost our jobs yet. We aren't sick. We haven't, you know, lost any family members.
I feel like, if anything, I need to be really relishing this time. And I'm…I'm just struggling, I’m struggling. I think I'm just…I don't know, frustrated with the lack of control, the lack of ability to plan for the future.
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Jenny, Medical Student, Philadelphia, PA
All right, is this thing…? Okay, it's on.
Hi, this is Jenny, a medical student in Philadelphia. I'm currently volunteering in the Transport Department at my hospital.
I'm on the night shift, so it's currently seven o'clock in the morning. Yeah. I just, I am running very low on cleaning wipes, so I started keeping things in my locker because I don't want to bring as many things home, because then that slows things clean, you know, less wipes, etc.
So I’ve started hanging, like, my face shield and my, some of my masks and some of the stuff I use in the hospital in my locker. And I realized that I hadn't seen my locker in like almost two months, which is just so weird, because I used to use it every day–like it has all my books in there. I have a blanket in there holding a coffee. My white coat’s in there. My stethoscope’s in there. Holy cow, I haven't used my stethoscope in like, two months. I'm not going to use my stethoscope for another two months. Man, that's weird.
It's like…it's so weird to see all my old stuff–all my school stuff on the bottom of my locker and now all the new COVID stuff hanging at the top. It's just weird.
There's also a slinky in there, for some reason, you know, which makes it even weirder. But, that's not really important, I guess.
Man, I hadn't thought about the fact that, like, I won't, like…I'm supposed to be using my stethoscope every day now, I should be in clinical rotations, and I'm just…it’s just going to sit there in my locker collecting more dust for another two months. And then I'm going to have to roll out onto the clinic floors and pretend I can hear things through it.
It's terrifying. A lot of times patients will ask me things, as if I'm their doctor. And tonight, my first run, I took a patient from the emergency department up to our COVID CT scanner and then to the floor. And as we left the CT scanner, he asked me, “What are the tests show, Doc?” And um, I mean, I told him that I wasn't a doctor, and I didn't know.
But even before, you know the…the CT part happened, like, the X-ray picture comes up, and it was just a lot cloudier than it should be. And I heard the–the techs say, like, “Oh, that doesn't look good.” We did the scan, and it was just all throughout his lungs. I actually thought as I was watching it, it almost kind of looked, the thinner–the thinner lines looked like shooting stars almost? Going across the sky. And the thicker ones looked like a paintbrush–kind of like a stroke of paint. I don't know, part of me feels like maybe that's a bad thought to, like, see something beautiful in this man's lungs that are just full of this virus, and I'm not sure if I should have, like, told him what I think I saw? Or if to say nothing was the right thing? I'm sure his real doctor will tell him later.
But it was just hard to–to say, I don't know, I guess, when that wasn't fully true. But I guess maybe it would be worse to try to stumble through an explanation and say something wrong, I guess?
I don't know. There's a lot that I don't know. And I just realized that more and more, when patients ask me questions, and I don't know when I realize just how little I know, and I feel like I'm never going to know enough.
It's not really like COVID -elated, but just in general, sometimes I just feel like I don't have what it takes to like actually treat patients one day? Like I have somehow made it to this point by tricking everyone, and I'm somehow going to graduate, and then I'm going to roll up on patient floors and have no idea what I'm doing, at all. And I'm never going to know what I'm doing. Which is scary. I don't know if that's just, like, a me-feeling, or something that everyone feels. Should I drop out of medicine or not?
I don't know. It's like too early in the morning for this…and I need to go to bed and I'm too much in debt to drop out of medicine anyway, so…Oh, this is like eight minutes long. I'm sorry. Okay, bye.
Anonymous
I just stopped going for a run because I’m really out of shape. I haven't gone for a run by choice in many years. Um, and I don't know, I just had to get out of the house today.
I keep thinking about this idea of “First, do no harm,” and how s***ty a job we're doing of it.
I feel like in the time of this pandemic, we should just revise it to “First, do less harm. Do as little harm as possible,” because to “do no harm” involves a high degree of certainty about what you're doing. And we don't have that right now.
I think a lot of us just don't know what's the right thing anymore…about doctoring. If we're doing enough of it through video, if we can make enough of a difference that way, if we won't miss something–I know I missed something, something big with a patient, but I just found out this week.
I met my patient for the first time over video, and I missed something that she and her daughter had pointed out because there were four thousand things that they pointed out that day, all of which needed attention. At least that's what it felt like.
I think I'm not doing as good a job as I would like to be doing over video. I'm not feeling–not feeling good about that one. Her daughter asked me when we were on the phone the other day if we missed something. She was asking it for herself, more than for me. Um, she wanted to know if she could have done anything different. And I told her, why bother to think about that?
In a way, I was trying to relieve her because she just had so much on her plate. But I was also just as much trying to relieve myself. And it's just–it's not feeling good. Not feeling good. I felt up until this point, like, pretty confident about my skills as a doctor and I'm–I'm not sure that I'm adapting as well as I could be.
I think a lot of us are feeling this way. Um, there was already kind of like a mental health, depression, burnout, s***ty working conditions thing going on in health care for a while before this.
Um. Lost a lot of good people. I lost one of my students. And I heard about the–the doctor who committed suicide, and it's scary to think about, like, are we going to lose more of our own, and who? Who am I not checking in on enough to make sure that they're okay? Am I taking care enough of myself? Like… this is so hard, like I… sometimes I want someone to take care of me!
Um… Phew, okay.
Okay.
I'm almost home now, and I feel good.
Emily Silverman
This has been The Nocturnists.
If you or one of your loved ones are experiencing thoughts of suicide, please reach out to the National Suicide Prevention Hotline at 1-800-273-TALK.
I'm Emily Silverman. Until next time, remember: we’re in this together, you are not alone, and we are listening.