Howl

      Gallows humor and a healthy level of dissociation when necessary have carried me far in my career. During my nights in the ICU a decade ago I learned these as helpful tools of the trade. Death was all around us and we did our best to strip it off with our scrubs after a long night’s work in hopes of a deep and dreamless sleep. Sometimes I would work 16 hours with the same patient who kept dying over and over again, only to be jerked back to life by us; delaying the inevitable peace of a final death.  

      I don’t work in the ICU anymore. Now I am a nurse practitioner working in outpatient sexual and reproductive health care. When the pandemic started, I was working in this capacity as the supervising clinician for my small clinic, parenting a 4-year-old girl, trying to hold my strained marriage together, and writing a dissertation. Although I wasn’t diagnosed until age 30, I have had OCD as long as I can remember; I just didn’t know what to call it. For someone like me, the combination of a wealth of healthcare knowledge and worst-case scenario obsessions led to one of my longest-standing nightmares coming to life: the global pandemic. 

      I’ve been waiting for a global pandemic ever since I watched a documentary on the Ebola virus in 8th grade that my parents had to sign a permission slip for me to view. Although Ebola was not an issue then, when the first cases started popping up in the US after the outbreak in West Africa in 2014, I thought that would be it. It wasn’t, to my great relief. We know how Ebola works, which doesn’t stop the spread-but it is a powerful weapon. There’s some saying about the enemy you know vs the enemy you don’t know. I can’t remember what it is. Coronavirus, COVID-19, Sars-CoV2; we didn’t know that enemy. 

      My daughter was sent home from preschool, never to return. My husband was sent to work from home. And I kept going to work to see my patients. When everyone went to buy out all the toilet paper in the store, I bought fever reducer, cough suppressant, an oxygen saturation monitor, electrolytes, shelf stable food, and water. My husband and daughter were not to leave the house. We switched work schedules so that one of us was always off with my daughter while the other was working-we no longer saw much of each other. I did all the errands to keep my family safe from the enemy that I did not know. I got tested routinely to make sure I wasn’t bringing a dangerous virus home, I was afraid to hug and kiss my family, my husband, my daughter.  I didn’t hug and kiss my parents for nearly a year. 

      I held monthly, and then weekly, and then daily staff meetings at work. I solemnly gave the number of new cases, any new updates, what we knew, and what we didn’t know. Unlicensed staff would come to me with questions about how to help their family members who were sick, what to do. I bought everybody lunch one day, determined to keep morale up. I was so proud of everyone. Our tiny clinic, we kept going, we kept caring for patients, no matter what. Our building is small-we could no longer eat together. Eating in our cars, or by ourselves in an exam room, isolated. Lonely. Scared. 

      My patients were sick. They couldn’t get routine appointments (all primary care providers stopped routine or non-urgent appointments to prioritize sick patients). They didn’t have insurance. They couldn’t afford to get sick. They got laid off. They got COVID and couldn’t go to work. My patients were not getting routine care and came to me in bad shape. We managed what we could, to try to keep the ER from getting inundated with patients. Even when I had to send someone, I warned them that there may not be room, the ERs were all full. The hospitals were full, the staff were getting sick. My friends were getting sick. People started dying. I watched my colleagues fight for PPE. I watched my friends who still worked in the hospitals struggling for sanity, making jokes, doing their best. The N95 mask I wore to work bruised my face and hurt the area where my nose had been fractured years before. My goggles fogged up so much I couldn’t see through my microscope lenses. My dad was exposed. I was exposed. 

      I spent 3 days isolated in my bedroom away from my husband and daughter, terrified that I had infected them. Terrified they would be lying in the ICU while nurses did their best to separate work from their own lives, from their own fears. I tested negative. My daughter started school. She went to school remotely on an iPad from our dining room. I smiled and clapped along with songs and helped her with ABCs while I took consult calls from work. I worked on my dissertation when my daughter went to bed, or when my husband could watch her when he wasn’t working. All I wanted was to keep them safe. 

      Every night at 8pm I would open the sliding glass door to my backyard, step out, and listen to the whole town howling. The 8pm howl, I called it. My daughter in bed, my husband at work, the howling of so many strangers. I would joke about it with my health care friends, joke about the applause and howling for health care workers (how when people saw me in scrubs after work, they either gave me a wide berth-undoubtedly terrified they would catch COVID from me, or they thanked me for my service) and how we had always done the same job. How funny it was that we were celebrated now when we, nurses, had always been exposed to viruses and illnesses when caring for patients, when we had always forfeited bathroom and lunch breaks, when we had always done this, now it was a big deal. Now they can howl about it.  Now that everyone knew. 

      Every night the howling brought tears to my eyes. It was stupid and corny. And I loved it. I missed my parents and my friends. I missed my husband. I was completely alone. Alone smiling at my daughter trying to think up a new fun activity for distance-learning, imagining her intubated in an ICU bed. Imagining the death of my parents, my husband, my friends. Imaging my own death, being taken away from my daughter. Talking to her with a smile on my face about being careful because there are “new germs” and how the scientists are working so hard to get a shot ready to protect us from the germs. Excitedly talking about all the things we could do when “the germs are gone”; when we would get our “germ shots”. Making things special, hoping I was doing a good job, praying she couldn’t see through my confident and upbeat front. 

      The howling became fainter. Soon, there were just a few howls every night. And then none. I got my germ shot. Later, my husband got his. My patients are still sick, but not as bad. I don’t wear the n95 anymore, I wear double surgical masks and goggles. I finished my dissertation. I see my husband again. I am worried about the delta variant, and future mutations. I am worried it’s not over. I am infuriated and broken hearted over the people who refuse a vaccine, and even a mask. The people who put my unvaccinated daughter at risk. The senseless deaths. 

      I miss the howling, like we were somehow in it together. The stupid howling that I never felt confident enough to join. I can’t take my daughter to the movies, or to a restaurant. I’m too scared. I see her in the ICU bed. The scientists are working hard, they are working so hard. Soon, she will get her germ shot too. I told her that we can have an ice cream party and watch movies in our pajamas the day she gets her shot. I will cry silently in the bathroom and quietly howl with every other mother who has had a young child growing up in the middle of a global pandemic. And then I will walk back out in my pajamas to join the ice cream party.