NEPHROLOGIST/ASSOCIATE PROFESSOR
OF MEDICINE COLUMBIA UNIVERSITY
IRVING MEDICAL CENTER
NEW YORK, NY
This essay is part of our new 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.
Dr. Klemmer’s email finally broke me. His message arrived when I’d already been consulting on kidney failure cases in my hospital’s intensive care units for a week. Each day I’d start four or five more patients with COVID-19 infections on dialysis. Most of these patients followed the same course: admitted to the hospital with fever and mild respiratory distress, acute decompensation a few days into their hospitalization requiring rapid transfer to the ICU for intubation, and then a call to my service 24 hours later because their previously healthy kidneys had just failed. We were running low on dialysis machines and anticipated a shortage that would be just as dire as the shortage of ventilators that dominated the news cycles. None of this broke me, however. I didn’t cry until I opened Dr. Klemmer’s email, addressed to both my wife and me. Xenia and I met during our second month of residency, when Dr. Klemmer was our attending on the inpatient kidney service. He eventually would become my mentor, the reason I chose nephrology as a career.
“Me telling the two of you to ‘stay safe’ is like you telling me I can win the NYC marathon by just moving my legs faster,” his email began, “but I truly wish you to be safe.” I smiled, as much for the assurance that Dr. Klemmer’s sense of humor was intact in a time of crisis as for the simple feeling of knowing he cared about us. Then came the line I could not stop reading over and over, the line that made me burst into tears in front of my laptop and kept me crying later that night in my bathroom. The line that clouded my vision the next morning on the drive into work. The line that still haunts me almost a month later: “You did not sign up for this.”
I’ve thought long and hard about why this sentence shook me so deeply. The answer lies in what “this” means. I assume Dr. Klemmer meant we didn’t sign up for a job that potentially puts our own lives at risk. I understand where that sentiment comes from, particularly in light of all the horror stories of limited personal protective equipment (PPE) circulating on the news and across social media. My Facebook and Twitter feeds are filled with physicians talking about sleeping in different bedrooms from their partners, avoiding cuddles with their children, and adjusting their wills in case they catch COVID-19. Xenia and I are lucky to work at hospitals that have not run out of PPE and have wisely put in practices that protect their healthcare workers from unnecessary COVID-19 exposures. “You did not sign up for this” did not break me because I feared for my own health, because I don’t.
In the COVID-19 climate, “this” could mean a number of things I didn’t sign up for when I started medical school 21 years ago. I never signed up for a job that involved convincing older colleagues not to come into work. I never signed up for a job that diluted the doctor-patient encounter to a video visit or, when the internet didn’t cooperate, a phone call. I never signed up for a job that forced babysitters to say they didn’t feel comfortable coming to my home to watch my three small children. But none of these things I didn’t sign up for are why I cried when I read Dr. Klemmer’s email.
The “this” I didn’t sign up for is losing. I was only a week into treating the surge of COVID-19 patients that was expected to double and then triple over the following two weeks and already seeing the limitations of my profession. The tens of thousands of deaths predicted in the United States due to COVID-19, it turned out, would not be due to healthcare workers, like me, simply not having enough machines, medicines, staffing, space, and time to save patients who, in different circumstances, could probably be saved. My original fear was we’d lose patients because we had to ration care, but I’ve been amazed by how my hospital has been able to administer extraordinary care under the most extreme conditions. The fear that was already disturbing me when I read Dr. Klemmer’s email and plagues me still is that we’re battling a foe stronger than us.
The “this” I didn’t sign up for is watching my chosen profession fail. I cried when I read Dr. Klemmer’s email because I saw it happening already, and it continues to happen despite our best efforts. I’ve seen a recurring meme on Twitter and Facebook of a doctor wearing scrubs and a white coat, but with Superman’s “S” logo bursting out from the doctor’s chest. In truth, doctors like me are not Superman. We are Clark Kent. We are smart and nerdy and kind and hard working. We signed up for 18-hour days in the hospital and weekends where we might only see our children for 10 or 15 minutes. We signed up for exhaustion and frustration, fatigue, and heartbreak. But we also signed up knowing that medicine should prevail in the end. Even if we are Clark Kent and not Superman, our field, like a superhero, should be guaranteed a victory just by the nature of the narrative. The COVID-19 crisis has put that narrative into doubt. That is why Dr. Klemmer’s email broke me.
Andrew Bomback is an associate professor of medicine at Columbia University Irving Medical Center and the author of Doctor (Bloomsbury/Object Lessons).