As the pandemic raged from the winter wave through spring, Postmortem lit up with disheartening regularity. I opened it in dread as it revealed which of my patients had perished that week.
The first wave of Covid-19 last spring had been blurry. Although some of my own patients have contracted the disease, the massive waves of patients passing through our medical system and national news carried a patina of anonymity. The death and suffering were palpable, but they also seemed strangely left behind; almost everything that allowed human connection had been razed to the ground.
The surge that started at the end of 2020 and spread into spring was completely different. This wave of Covid has been extremely personal for me, as the dramatic increase in Covid in the community meant that every day more and more of my own patients were falling ill. With each new diagnosis, my patient and I would embark on a journey – often trying – through the disease. We knew perfectly well how the Covid-19 results were a dice game, as the Postmortem dossier regularly reminded me.
When a new message arrived at Postmortem, I tried to clear my desk and my mind before making that heavy phone call to the family. We talked about their loved one, shared our memories and our grief. For many of my patients, our relationship went back 10 years, sometimes 20 years. We were connected for a significant part of our lives, often through difficult health setbacks and extremely vulnerable times. Saying goodbye to them through conversations with their spouses, children and parents was heartbreaking. Much like Zoom’s funeral, which, in bitter irony, the pandemic made it easier to attend.
There is also the uncomfortable bureaucratic part of dying. For my patients who died outside of our hospital system, I should “notify” our electronic medical record of this turn of events. I would first write a note in the table detailing the circumstances of death, awkwardly titled “Expiration Note.” This is the language of medicine.
Then I should take care of the “Patient Status” field. When our electronic health record debuted two years ago, I remember how strange this field was, as everyone’s status was listed as “alive”. (“Well, what other would they be? I remember thinking about every patient who walked into my office. “They are here, no? But the pandemic has pushed back its target.
With a single melancholy click, I would change the status from “Alive” to “Deceased”. And it was this mundane act that always made us cry. The ridiculous equivalence of a stupid computer click with the loss of a human life has kind of dissolved the last of my nerve.
” Are you sure? The system would scold me, knowing that changing that particular status is different from changing a patient’s marital status, or even their Covid-19 status. I know why the system includes this second step warning, but it still felt like salt on the wound.
And of course, the minute I had duly certified my patient’s deceased status, the Postmortem record would instantly light up. Yet another alert to be aware of. Another dose of salt. “How many… times,” I shouted into the computer, “do you have to remind me that my patient has passed away?”
The cruelty of Covid’s destruction hit the hardest when it crept in out of the blue, when I called a patient for a scheduled televised appointment to learn from the family that they were in intensive care in a other hospital, or that he had just died of Covid. pneumonia. I would be ready to discuss high blood pressure and cholesterol levels and suddenly we would be engulfed in existential terror and gross grief.
When the Covid-19 vaccinations were opened to the general public, I emailed all of my patients, explaining how to get an appointment. “Thank you very much for this information,” was one of the first responses. “But unfortunately our father died of Covid two weeks ago. “
The last time I was faced with this blunt death and devastation was during my residency, when HIV struck patients with a savagery from which I will never fully recover. But the patients usually did not live long enough for us to develop prolonged relationships. Maybe that’s why I’ve spent the past 25 years as a primary care physician, nurturing long-term bonds over years of seemingly mundane blood pressure checks, drug refills, vaccinations, management of diabetes and countless episodes of tendonitis and lumbago.Now that Covid-19 has looted my patients, it seems tirelessly personal to me. I know them intimately and there is no easy way around the grief. And it’s not just Covid-19. In the tenuous intervals between waves, all other illnesses rebounded – breast cancer, pancreatic cancer, lymphoma, stroke, kidney failure – the inevitable result of fractured medical care during lockdowns. I have delivered more painful diagnoses in the past eight months than at any comparable time in my career.
I am multiplying this by all the primary care physicians, nurse practitioners, and clinics in the United States and around the world, and the extent of the bereavement is staggering. Healthcare professionals have been through so much in the past year, both physically and psychologically. The personal losses of so many known and, yes, loved patients add yet another layer of anguish.
A few years ago, I was standing in a hospital hallway with a distraught intern. We had just walked out of a patient’s room after a heart-wrenching conversation about moving from curative to palliative care. It was an emotional cataclysm for the patient, who had not fully grasped the extent of his illness until then. The intern, whose eyes had shot into the room, was now crying uncontrollably. She was only weeks away from her medical career and was the first patient with whom she would be intimately confronted with death.
“How am I going to do this for the rest of my life?” she sobbed.
This is indeed the question physicians, nurses and other healthcare workers ask themselves, especially if they have chosen specialties that foster long-term relationships.
I guess there’s some kind of relief in the ability to grieve. It lets you know that you are still alive and feeling what, after a year of Covid assault, is no small feat. I tried to assure my intern at the time – and myself now – that we should be thankful that we can grieve in these really sad situations. “Think of it like an EKG from our inner compass,” I told him. “It’s when it flatlines that we have to worry.”
Yet the intensely personal nature of the second wave has worn off. I have said goodbye to far too many of my patients. The optimism of vaccination makes us all want to celebrate the descent of the pandemic, but the stubborn trail of mourning remains.
Meanwhile, Covid-19 gave me bitter appreciation for my modest exam room. As cramped and claustrophobic as it is, at least I can cry there in relative calm. Without the bulk of a mask.
Danielle Ofri is a Primary Care Physician at Bellevue Hospital, Clinical Professor of Medicine at New York University School of Medicine, and Editor-in-Chief of the Bellevue literary review. His latest book is ” When we hurt: a doctor faces a medical error»(Beacon Press, avril 2020).