Resident Physician in Internal Medicine and Pediatrics
David Geffen School of Medicine at University of California, Los Angeles
Los Angeles, CA

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This is part of our series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.

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Lying in my call room at a hospital in Los Angeles, I imagined a deoxygenated red blood cell traveling through the circulatory system. After traversing the vena cava, the cell would be deposited into the right atrium, where it would make its way through the tricuspid valve, the right ventricle, the pulmonary valve, and finally the pulmonary artery: that glorious gateway into the lungs, where it would encounter an oasis, a relief, a breath. It was a journey that I had pondered before under different circumstances — for example, when studying for a physiology exam during medical school or when caring for my pediatric patients with congenital heart disease during residency. It was not a journey that I had used to facilitate relaxation, calm my nerves, and ease my way into sleep. And yet, here I was thinking about the mechanics of circulation and respiration in order to facilitate the very act of deep breathing. Pulmonary vein, left atrium, mitral valve, left ventricle, aortic valve, aorta. Deep breath.

In between my silent recitation of these anatomical structures, which had now become an incantation, I reminded myself of how lucky I was to be able to breathe. I do not often find gratitude in breathing, and I am rarely attuned to my own respiratory patterns. However, over the past few weeks and months, breathing no longer seemed to be a simple physiologic function: that thankless business of the brainstem. Breathing had become a source of hope, a sign of life, a luxury.

Breathing has been the very bodily function at stake during the COVID-19 pandemic, and for many communities of color, for much longer. A viral illness transmitted through the air we breathe, SARS-CoV-2 causes respiratory failure in nearly all who succumb to its unforgiving wrath. Thus, we wear masks to filter the air inspired by those closest to us. We stand six feet apart, hoping that the particles they expel will not enter our lungs. We stay away from certain crowded or enclosed settings, knowing that the air we inhale is the same air exhaled by others. We depend upon each other to ensure its preservation and, in turn, our own health. And if a global pandemic does not remind us of this truth, then the myriad recent examples of racially-charged police brutality must. The death of George Floyd by asphyxiation at the hands of a white police officer — the violence that forced him to utter those chilling words I can’t breathe — must remind us that we are all responsible for one another’s ability to breathe freely. For the use of our own voices, our own breath, to not only advocate for the dismantling of structural racism but also to create the structures that will protect the most marginalized among us, is a matter of life and death. Given that racial and ethnic minority groups are more likely to have underlying health conditions and reduced access to healthcare, to work in service industries without adequate protections, to live in densely-populated areas and in multi-generational households, and to be overrepresented in prisons and detention centers, it is no wonder that these groups have suffered a disproportionate burden of illness and death from COVID-19. Those realities merely skim the surface of the deep-seated intersections between systemic racism and health disparities in the United States. The recent anti-racist protests and the current global pandemic thus must be uttered in the same breath.

Lying in my call room, I pictured my own red blood cells coursing through my veins. I pictured them traveling steadily toward my lungs: that haven they were seeking, that potential peril they unknowingly approached. I had just found out that I was exposed to COVID-19 from an unsuspected source, an otherwise healthy child with uncomplicated appendicitis whom I had just examined in the emergency department, and I had not been wearing the proper personal protective equipment. While my exposure was not as high-risk as it might have been under other circumstances — circumstances that friends and colleagues across the country were facing day in and day out — it was still an exposure. My breath quickened and then deepened as I practiced various maneuvers, performing a makeshift pulmonary function test of sorts to convince myself that, yes, I was still breathing. That I could still breathe. As a white, immunocompetent medical resident in a city that until now had been relatively spared compared to others around the world, there were many reasons beyond my right ventricle and pulmonary artery that I could still breathe, many layers of privilege feeding and scaffolding my own breathing apparatus. My breath slowed as a faint yellow glow emerged behind the mountains outside my window. The new day would usher in tens of thousands of fresh inhalations and exhalations, and they would be louder and stronger than ever before.