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Wednesday May 13, 2020

When My City Cheers, It Lifts Up the Front Lines

Back in March, I saw viral videos from Italy,(www.reuters.com) Spain(www.theguardian.com) -- even Atlanta(www.policemag.com) -- where evening clapping for health care workers was already a routine thing. In New York City, we were still waiting for the worst of COVID-19 to hit. The tension was thick in the air, the fear palpable. Waiting for the storm to hit was almost (almost!) worse than the storm itself.

[two women on balcony wearing face masks and applauding health care workers]

In our practice, we started to see an overflow of patients with respiratory symptoms in early March, as we tried to educate our patients and keep them home. While our in-person volume dropped quickly, the work of reaching out to patients doubled. On a daily basis, I called all my scheduled patients for the next day, asking them to stay home and checking to see if I could do anything for them, often completing a full 15-minute informal visit over the phone.

I stopped hanging out with friends. I started carrying hand sanitizer in my pocket, and I used napkins to open the door to my apartment building out of fear of getting other residents sick. I tried to spread the word via social media about how this virus was going to stretch the health care system to its limit, but I wasn't seeing any behavior change among friends, neighbors, patients or even some co-workers. Those who were trying to be thoughtful in preventing spread of the virus were torn between maintaining normalcy and succumbing to outright panic.

As someone who fervently followed the disturbing reports from physicians in Italy,(www.weforum.org) the weekend before St. Patrick's Day was nothing short of traumatic for me.(www.nytimes.com) There were thousands of people all over the city partying, seemingly climbing on top of each other at bars and in parks. Out of anxiety, I kept forgetting to eat (friends had to remind me), and the visuals of packed ICUs and deaths of colleagues and patients crammed my nightmares.

The stay-at-home order finally took effect on March 22.(www.governor.ny.gov) New York didn't start clapping until March 27.(www.timeout.com)

During the five long, slow-moving days leading up to that, it still felt like my community didn't understand the gravity of what COVID-19 could do to a city where people live in such close physical proximity. I thought I was alone, that no one else heard the ambulance sirens blaring every 10 minutes,(www.cbsnews.com) that no one else cringed when people walked too close together, that no one else cared.

It might sound dramatic now, but at the time (and for many weeks after), I took everything personally. I felt singularly responsible for my patients. If I couldn't work in an ICU, I damn well could make sure people didn't go to the emergency room unnecessarily. I responded to patient portal messages at odd hours of the night. I randomly called patients who were high risk because I was nervous they might already be sick and hospitalized. My first patient died of COVID-19. I also had my first follow-up visit with a patient who was discharged from the hospital after recovering from COVID-19.

The stories of grief and loss from other patients started pouring in -- this person's auntie, that person's father and now brother, another's husband, another's pastor. Emotionally I was spent. I couldn't talk about "quarantine boredom,"(i-d.vice.com) I couldn't share memes(www.al.com) or binge Netflix(www.nytimes.com) because they felt like trivial pastimes that required a level of concentration I did not have. I had to consciously save up empathy for close friends who lost their jobs,(www.nytimes.com) and I didn't feel comfortable asking for support for fear of traumatizing someone else with the stories I carried.

I actually stopped feeling anything on March 27. After a long telemedicine day, sitting hunched in front of my laptop for hours talking to patient after patient, I reflected on how I finally felt nothing, which was far easier to manage than the overwhelming emotions I experienced just a few days before.(hbr.org)

Then, at 7 p.m., the clapping started. It was a dreary and cold evening. There were only a handful of people outside their homes clapping and hollering on my street, but it was enough to open the gates for my blocked emotions. It was confirmation that there were others out there who understood how scary this was, how scared I was. I no longer had to carry the burden of educating and holding space for others' feelings while caring for my patients. I could outsource some of those things to nonmedical people who got it. I wept, relieved.

My turbulent emotions have stabilized during the past few weeks, and the clapping now feels like an uplifting, communal, primitive act that brings New York City together every night. My street, in particular, has elevated it.

Not only do we clap and bang pots and pans, but kids (and adults) come out with trumpets, tambourines, harmonicas and drums, all cacophonic and beautiful. It is a hodgepodge of musicality, not only thanking our health care, front-line and essential workers, but also reverting back to a basic, ancient human desire to make enough noise to drive the coronavirus away.

The clapping is not a perfect thing. As the stay-at-home order comes to an end in NYC, I wonder how many of those clapping might disregard the need for social distancing at beaches and parks if it's nice outside.(www.cnn.com) I wonder how many who clap will take action when the opportunity arises to improve on the inequities(www.thelancet.com) and health care gaps(www.vox.com) now illuminated with floodlights due to COVID-19.

For now, I've come to terms with what it means to participate in this communal ritual. (I clap too, for my colleagues working in hospitals and nursing homes, as well as those working in places like grocery stores, post offices, etc.) As someone who holds space for the grief, anxiety and physical health of patients and their family members on a daily basis, I've also come to terms with what it means to accept and allow myself to receive the gratitude and positive energy. I've recognized that we're all trying to give and do what we can, so I'll take any token of kindness, especially one as powerful as the sound of my city cheering(www.nytimes.com) in its attempt to process our collective experience during this bizarre time.

Lalita Abhyankar, M.D., M.H.S., is a family physician practicing in New York City. You can follow her on Twitter @L_Abhyankar.(twitter.com)

Read other posts by this blogger.

Posted at 12:15PM May 13, 2020 by Lalita Abhyankar, MD, MHS

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