When I started keeping a detailed diary in February 2020, I was a pediatric surgery fellow at one of New York City's top hospitals in the home stretch of nearly a decade of medical training. I had just signed the contract for my dream job as a full-fledged pediatric surgeon in Boston, where my husband had already begun his own surgical career and was waiting for me and our two young children to join him. Living as a single mom while completing my fellowship already made it a tough time. It soon became unimaginably harder. What follows is my diary of the next 6 soul-scorching months.
Before pursuing a medical career, I intended to be a journalist, and as the COVID-19 pandemic wrecked my world, I turned to writing as a kind of therapy. I made the time to write at home, usually late at night when I had anxiety-fueled insomnia.
This book details everything I saw and did in those dark and terrifying months inside the walls of a New York City hospital while most of the city was locked down at home. My story is a true-to-life account and a cautionary tale to future generations should they have to face another pandemic. I recognize that many people feel they never want to think or worry about COVID ever again, but this book is about our shared human capacity to survive inconceivable tragedy and trauma. I don't like the saying "What doesn't kill you makes you stronger." I think it all leaves a mark. Yet, I also believe that reflection and recollection can be healing.
There is so much that has already been written about the COVID-19 pandemic, but very few people had the front-row hospital experience that I did. Like so many healthcare workers, I ran to dying patients and performed chest compressions in full personal protective equipment, sweating under the layers of plastic gear while terrified that I might be spraying a deadly virus into my own airway. I operated on the bellies of children whose intestines were mysteriously necrosing and dying from tiny blood clots caused by COVID.
Every doctor, nurse, and healthcare worker has their own story to tell. Like me, most of those frontline medical workers were women. Many of them, also like me, were parents and frantically worried about bringing a deadly virus home after a day of treating infected patients. The collective trauma and moral injury suffered by all healthcare workers from that time is still unfolding.
Many colleagues of mine did much more daily, hands-on COVID care than me. As COVID struck, I continued to perform surgeries that were unrelated to the pandemic. Perhaps having some distance from the hourly traumas in the ED and ICU gave me a clearer view of what I saw around me in real time. The shell shock from spending 24-hour days in the COVID ICU wards meant that many of my closest friends and colleagues, in order to survive, had to freeze out or compartmentalize the experiences of those days and erase the painful details from their minds.
I took a different approach. I recorded everything because I knew that we were living and working through something historic. I would also soon be leaving for another hospital, which meant I had the luxury to speak up about what I was seeing. This included the unconscionable lack of protective gear for health workers. The gowns and gloves I once threw away without a thought disappeared from our shelves like batteries before a hurricane. I wrote op-eds and went on TV to push for more manufacturing and donation of critical gear. For a time, I became one of the media's "COVID doctors."
After years of surgical training, I developed a reflexive ability to turn off my emotions in order to function at my job. Pre-pandemic, this skill allowed me to whisk dying children from the trauma bay to the operating room, to use blades on their bodies with the decisive and commanding nature required of a surgeon. There's no crying in baseball or surgery. But some things still get through: the haunting sounds of wailing mothers, the screams of babies in pain.
In some ways I think my softness and humanity as a young mother is my greatest strength as a pediatric surgeon. When I have a sick patient about the same age as one of my children, I can feel a sudden grip on my throat, a sudden welling up of tears when a child looks up at me with fear as we roll them back to the operating room. It takes a huge effort to disguise my emotions and hold back my impulse to cry. "Don't worry: I promise everything is going to be okay," I say to my patients as I grasp their tiny hands. But I carry it all with me, and once I'm away from the operating room, I have to let it out. Writing helps.
We've all lost something or someone to COVID. Many people have lost parents, grandparents, children, or dear friends. Still more have lost their jobs, their homes, their school years, and the sense of stability that characterized life for many before the pandemic. We lost the easy confidence in our daily routines: home, work, travel, holidays, parties, celebrations. Many of us, myself included, lost our sanity at times. The pandemic has forever planted a nagging uncertainty and danger into the moments of togetherness that bound us in pre-pandemic times. A wet cough is all it takes to put everyone on edge in a crowd.
While I am grateful that I didn't lose a close family member, my house, or my job, like many healthcare workers I lost the illusion that my own life and work were paramount to my employer. In the years since the pandemic started, I have grown more cynical, skeptical, and sometimes despondent about the future of medicine and healthcare, which is increasingly being driven by corporate and financial constraints that make our jobs even more stressful than they need to be. Our nation's hospitals are collapsing from the inside.
The consequences of the COVID pandemic are still unfolding. There's a staffing shortage as hundreds of thousands of healthcare workers -- including some of my closest friends and mentors -- have left the profession they once loved. Nurses are overworked and underpaid, often covering an unsafe number of patients on their shifts. Emergency departments are overflowing with patients lined up in the hallways. Wait times of more than 8 hours have become the new normal. Pediatric wards are shutting down left and right because they don't drive enough revenue to hospitals. And the mental health crisis among our nation's young people has everyone alarmed.
If our society can't make sick children a priority, how are we supposed to support and grow the next generation? Healthcare in the U.S. was broken before COVID, but the pandemic has left even our nation's best hospitals in critical condition.
Despite this bleak outlook on healthcare, the main thing that keeps me coming to the hospital is my belief in the goodness of taking care of sick children. I hope you will see in my stories about my patients that children are both astonishingly fragile and resilient. And if I'm being honest, I am addicted to the dopamine rush of saving young lives. Nothing infuses you with blinding hope quite like bringing a child back from the edge.
I want to believe that our nation's hospitals can be resuscitated too. Look at what we've just survived. Last summer I enrolled in a Master's program in public health. If another pandemic does happen in my lifetime, I want to be prepared to help steer policies to get it right. For my sanity and for my own children's sake, I believe that there is a possibility to rebuild for the better. I hope these pages help you more fully understand the urgency of this task.
is a triple board-certified pediatric surgeon in Boston. She is the author of the new book, The Sky Was Falling, from which this piece was excerpted. While writing her memoir, she was a pediatric surgery fellow in New York.