730 days

I found a twist tie in my desk drawer the other day and I didn't know if I should laugh or cry.  Why, you ask, would a twist tie trigger this reaction?  Allow me to provide some context.  In the beginning of the pandemic our screening process for entering work was to get a temperature check and receive our color-coded twist tie for the day to proudly display on our badge, showing we were safe and screened for COVID-19 with the best technology known at the time.  Every day was a new twist tie, and hence we collected dozens (maybe hundreds) before technology evolved and vaccines ensured a new level of safety.  The twist tie was symbolic on so many levels.  It gave us permission to enter the sacred territory of front-line healthcare when many friends were working remotely from home.  It was an emblem representing the family we belonged to for that moment in time when taking care of people with COVID was everything.  It was frivolous (and ridiculous, now that I think about it), but it was a sense of unity we shared with everyone else who braved the front lines in the early pandemic days.  We had a shared process of entering the door through a common door, going through the screening steps, and securing the twist tie to our badge while we mentally and emotionally prepared ourselves for whatever another day of the pandemic would present to us.

Those were the days when vaccines didn't exist, N95s were scarce (as were ventilators), and we quarantined our mail and library books.  We didn't let our kids touch playground equipment without gloves, we saran wrapped our COVID patients to transport them to a test, we didn't wear jewelry or bring pens into the COVID unit for fear of virus transmission on surfaces, and our high-tech method for keeping healthcare workers safe was a color-coded twist tie.  We just didn't know a lot about SARS-CoV-2 yet (and we still have a lot to learn), and every day was really scary.  Thinking back on it, the beginning of the pandemic seems so very long ago, and at the same time it feels like yesterday.  How far we have come in two years, and yet how far we still have to go.  We're not worried about getting COVID from a pen anymore (or an earring for that matter).  We touch a lot of surfaces without gloves or sanitizer.  We have plenty of N95s and KN95s to go around.  And yet we also know that we can still get COVID after getting vaccinated (although we know it's less severe and that we're less likely to spread it to our vaccinated families), and we haven't yet found the perfect, foolproof set of rules to ensure that everyone in our group is negative.

We all have stories of where we were when our community went into lockdown.  I was at book club at a bar on the night of March 12th as the news streamed in that a lockdown would start the next day, that schools would close, and that a national emergency would be declared.  It was the last time I would see a group of friends in person or go into a bar without a mask for a very long time, although of course I didn't know that at the time.  I went on my normal Friday shopping trip to Target the next morning and I didn't understand why some of the shelves were already bare.  I was still on maternity leave with my 8-week old when I made the decision to homeschool my preschooler for the next four weeks, which we thought would be enough time for this thing (whatever it was) to be over.  

Here we are, 730 days later, and our world will never be the same.  We're fearful and mistrusting of other people.  We're psychologically damaged from not being able to connect in meaningful ways or to choose our balance of social time and solitary time.  There are some things I swear I will never do again, now that we know what we know.  The thought of blowing out birthday candles on a cake that other people are going to eat, sharing a drink with someone, or eating from a buffet, are all really disgusting to me now.  I also can't imagine kissing someone else's kid on the cheek, dancing in a crowded room where bodies are touching, or boarding a plane without a mask on, things that at one point were perfectly normal activities.  Do you ever realize that it's hard to make eye contact with someone if you're wearing a mask and they're not?  Kind of like they're buck naked in the locker room and you want to be friendly but still look away?  What a weird phenomenon.  And who knew two years ago that "omicron" and "sourdough starter" and "pick out a mask to wear to school" would be a normal part of our daily vocabulary.

My kids are growing up in a world where they can't fully see someone's facial expression, where birthday parties are on zoom, and where visiting grandparents is a rarity.  I worry about the long-term effects, but I'm also thankful that they've had the opportunity to stay in school/daycare full-time since April of 2020, and I strongly believe they haven't "missed out" on anything, but they've learned new things and they will be a generation that is shaped by this pandemic.  

Not only are children forever changed, but the industry of healthcare will never be the same.  The level of trauma that everyone has witnessed on an everyday basis without the opportunity to debrief, without support to bear some of the burden, without the reassurance of knowing that there may be an end somewhere on the horizon, is too much for any human to bear for one week, let alone 104 weeks.  Death from COVID takes many forms, but I think everyone on the front lines would agree that it's like nothing we ever witnessed before.  The multiorgan failure and severe systemic inflammatory response, the rapid deterioration from slightly hypoxic one day to dead the next day, the strokes and heart attacks in young people, the profound muscle wasting from critical illness myopathy and prolonged bedrest, the copious amounts of blood when patients are proned,  the agonizing and traumatizing air hunger that patients experience for days before they succumb, and the isolation and loneliness of people dying alone while their family members are spread out at other hospitals across the state, all of these things are cumulative and weigh heavily on the caregivers.  

Some healthcare workers are coping better than others, but I think it's fair to say that no one is really okay.  It's hard to relate to people or have a normal conversation that doesn't involve vaccine status, body bags, or who saw the lowest oxygen saturation of the day.  It's hard to trust anybody because we constantly wonder who's vaccinated and who's not.  I think we reached a point in the middle of the Delta surge when we had to hold back some of the compassion we give day after day because we knew there wasn't enough to go around and that this work wasn't sustainable.  Somewhere around that time there was also a shift from sadness and caring to anger and resentment, when vaccines became accessible to everyone and yet many refused to get it, and it was tempting to place blame and point fingers because the deaths we were witnessing were completely preventable and in vain.  We were singing a very different tune in fall of 2021 compared to winter of 2020.  Our patients no longer seemed like innocent victims if they had the opportunity to get a vaccine a chose not to.  We put up barriers to avoid getting too attached and to protect ourselves from getting burned out.  It's hard to keep going day after day when there is no end in sight.  Our patients are really sick.  All of them have lost somebody.  All of them are dealing with mental illness in some capacity.  The work is really hard.  

Despite all of this, and although we have been fooled by our naive hope many times in the past two years, I believe right now that the worst is behind us and that whatever happens this year will not be as bad as the last two years.  I believe that COVID is going to be part of our vernacular and our day to day  consciousness for a very long time, but I also believe that there will be parts of every day that we forget about it and that we can experience joy over new experiences again.  I remember the first concert I went to -- Brandi Carlile at Red Rocks -- after over a year of only virtual events, and it felt like a big step in the direction of normalcy.  I used my passport twice in recent months, and went out to eat indoors for the first time in ages.  Our library just re-opened for in-person services and we attended a group storytime in the children's room.  These things were scary and unsettling, but also important steps toward a meaningful life once again.  We are going to have many "firsts" this year as we emerge into the world and test the waters.  

Our state's mask mandate ended in February, and the public schools will make masks optional after spring break next week.  This was way too soon for many of us and seemed entirely politically-driven and not evidence-based, especially when it's still too cold for kids to eat outside at school and vaccines are not yet available for the little ones.  Just three months ago we were replacing our cotton masks with double masks or KN95s, and now we're letting go of masks completely, and I wasn't even close to ready for this.  But at the same time I knew that this had to happen sometime and that we couldn't continue with masks, distancing, and virtual gatherings forever.  I knew that eventually we would have to come out of our pandemic cocoons and hope for the best.  We're afraid of being vulnerable, but maybe that's what it will take to feel human again.

After two years of N95s, vaccines, and very limited in-person contact, I tested positive last week.  I knew it was inevitable, working in a high risk area and raising young kiddos in full-time school, and I'm just thankful I was able to avoid it as long as I did.  Of course I'm fearful of the long-term effects that we still have yet to discover, but that's just something I'm going to have to live with now and I have accepted that I can't change that.  I'm also forever grateful that I'm fully vaccinated, that I don't have a family member who is immunocompromised, and that I know I will still have my job when my quarantine is over.  And now that I have recovered, it feels like a weight lifted to not have to live in fear of getting COVID (at least for the next few months, or until the next variant emerges).  I'm already daydreaming about all the things I could do with my newfound boosted immunity.  I could sit at a bar.  I could go to a movie.  I could even get a haircut, if I'm really feeling adventurous.

There's still going to be a lot of death and a lot of sadness at work and home, because healthcare is forever changed and we will all lose someone close to us to COVID.  But there's also a lot to look forward to as we navigate this new normal.  I wonder where the next 730 days will take us.

most importantly love

like it's the only thing you know how

at the end of the day all this

means nothing

this page

where you're sitting

your degree

your job

the money

nothing even matters

except love and human connection

who you loved

and how deeply you loved them

how you touched the people around you

and how much you gave them

-Rupi Kaur