The first year of Selina Mahmood's neurology residency at Henry Ford Health System was scary, historic and unusually instructive.
Daily experiences were so vivid as Covid escalated rapidly that the physician-in-training kept a journal and turned it into a book, "A Pandemic in Residence: Essays from a Detroit Hospital."
It’s part-diary of an eventful March through December last year, and part-essays with philosophic reflections and literary references. Quotes and namechecks include Yeats, Joan Didion, Noam Chomsky and Vladimir Nabokov.
Dr. Mahmood recalls the chilling reality of a turning point last spring:
It’s the evening of March 24 and my neurology co-interns and I got notified that we’re being "redeployed," that is, pulled from our current rotations to make a new Covid floor. Not gonna lie, I was scared. Not gonna lie, I wavered. … Damn, it really feels like we’re going to war. ...
The hospital has basically become a Covid center. There’s worry that Detroit and Chicago are the next New York, which has gotten the worst of it in the U.S.
The neurologist (brain and spinal cord specialist) was born in Detroit, raised in Bloomfield Hills and graduated from the University of Michigan in 2012 with a history degree, which she recalls as "a previous life." Her 2016 medical degree is from a college in Lahore, Pakistan.
The 176-page paperback, being released May 18 by Belt Publishing of Cleveland, is promoted as "her personal and meticulous document of an unprecedented year in medicine." The publisher adds:
In the tradition of writers like Oliver Sacks and Paul Kalanithi, Dr. Mahmood takes the science of neurology and spins it into poetry, exploring theories of the mind, Pakistani-American identity, immigration, family, the history of medicine, and, of course, the challenges of becoming a physician in the midst of a global health crisis.
The young doctor recalls how “the bars are emptying as we try to make sense of it all” in mid-March 2020. She describes a sudden blizzard of new hospital routines and learning that "it's cumbersome maneuvering in protective gear."
Our administration is preparing for the worst and creating more ICUs. Entire floors are becoming dedicated to Covid patients. … Overnight there were approximately ten [emergency] codes spread across the various Covid floors. … The hospital’s first Covid-19 death has occurred. ...
Every time I start feeling like I'm being overly dramatic, something happens to trigger a reality check. Physicians and health workers have been talking to their partners about code statuses—meaning, whether they would want to have CPR and intubation.
In an exclusive excerpt below from her final chapter, Dr. Mahmood describes how wearing "protective eye goggles [makes me] perpetually feel like Amelia Earhart" and a post-vaccination sense that “the end isn't the end.”
'Covid cases are starting to surge again'
It's finally warm outside. We made it through our intern year—the interns who lived through the pandemic, which I'm sure will make for a good story towards the ends of our lives when we're wrinkly and hooked up to dialysis machines, with baseball caps alluding to the earlier part of this century. A new intern … will be surprised to find a human who’s lived through something only read about, like the way we look at the rare human who made it through the Spanish flu.
July marks my transition into my second year of training. The [pandemic] epicenter has moved from the Midwest and Northeast to Florida, Arizona, and California. …
The two mRNA vaccine contenders are Moderna/NIH and Pfizer/BioNTech. The viral vector vaccines are Johnson & Johnson and the University of Oxford/AstraZeneca.
On July 14, Reuters reports the first-phase trial for Moderna, the first to enter large-scale human trials, as being both safe and effective. … The U.S. signs a contract with Pfizer for vaccine delivery by January. …
Things in the hospital have normalized except for all the masks and virtual [instruction]. While life for health workers has retained some level of normalcy, the majority of humanity’s existence has been upended—my family and friends have had to work and study from home for months by this point.
Why does this feel so abnormal and what was normal to begin with? It’s strange that being able to walk out of the house means so much. But then again, all paths lead to movement. …
'Warped sense of time and existence'
It’s August and I have my first two weeks of night float, when we work through night shifts from 7 p.m. to 7 a.m. … The exhaustion starts kicking in by the third night, the lack of natural light contributing to a warped sense of time and existence. …
Pfizer expands the number of people participating in the phase three trials of their vaccine. According to The New York Times (Sept. 28), the number of worldwide coronavirus deaths crosses the one million mark.
I’m on night float again for the first presidential debate on Sept. 29. My senior [physician] and I laugh through what has to be one of the most ridiculous American presidential debates in history. One of the patients on the floor is admitted for a transient ischemic attack (colloquially known as a minor stroke) after his stress levels shot through the roof during the debate. …
‘I feel like Amelia Earhart’
AstraZeneca and Johnson & Johnson restart their halted vaccine clinical trials [in October]. Thirty-four editors from The New England Journal of Medicine publish an Oct. 8 editorial, “Dying in a Leadership Vacuum,” that starts trending within hours. It criticizes the Trump administration for having "taken a crisis and turned it into a tragedy." …
The covid cases are starting to surge again. A new emergency order is put in place restricting social gatherings.
ICUs are preparing again, with the plastic partitions going back up. Steroids work well before patients are vented, but once patients are vented we have limited treatment options that actually work. In addition to masks, we have to wear protective eye goggles and I perpetually feel like Amelia Earhart.
I cancel my plan to attend my best friend's wedding, something I never would have imagined.
It's November and we've had our first snow. I run into the new interns, faces I've never seen behind surgical masks, who still unadulteratedly empathize with their patients. As a second year, I'm jaded and perfunctory.
A new intern sits at her patient's bedside, the patient’s hand in hers, as she tries to calm him down from an obvious panic attack. … I am surprised to remember that that was me only a year ago, when I'd followed a patient's re-admission to the hospice floor and placed my hand over his death-waxing heart.
'The absurdity of reality'
Dig in the heels, clap back. I have to purposefully slow myself down instead of rushing from one consult to the next. Time can come and go, moments stay though.
It’s mid-December and the vaccine has been approved and shipped and our hospital has started vaccinations. …
Events and months and now years are rolling out like coins. … The years in my life have started adding up as a damning tally and I feel caught between the absurdity of reality and wanting to feel protected, closer.
Some days I'm everlasting enough to make it all last. Most days I'm not enough to make it through that last blast, but most days most don’t believe in life or death or death or life. They just make it through to the end completely endless—that’s my only goal really: to be endless to the end.
Most days we fight against what we know as death with numbers and words. It’ll take a minute to figure out what it all does, all that talk of no will no free no something; until then we’ll just have to make space between words and thought, wedged open with a nudged gentleness moving through the night, trying to fill in the space ever after.
It's Dec. 22 and my dad and I got inoculated with the first dose of the Pfizer vaccine. It's December and the UK has a new strain of covid. If it feels like the end it isn't the end.
© 2021 by Selina Mahmood
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