A Doctor’s Dark Year

Brittany Bankhead-Kendall arrived in Boston in July of 2019. Tall and trim, with straight, blond hair, bright-blue eyes, and an easy smile, she has a sunny disposition and the hint of a Texas drawl. She had just finished a general-surgery residency in Texas, and, at Massachusetts General Hospital, she would complete her training as a trauma and critical-care surgeon. As summer eased into fall, she struggled to acclimate to the weather. At the hospital, she operated on patients who’d suffered serious injuries—people hurt in car accidents or house fires, or by gunshots. Patients would arrive with fractured skulls and ruptured spleens, collapsed lungs and bleeding bowels. Bankhead-Kendall got good with gore.

In March, 2020, as the coronavirus descended on Boston, she learned that her role would evolve. She would be stationed in the I.C.U., where the sickest COVID-19 patients would be treated, and start working primarily as a physician, not a surgeon. Bankhead-Kendall read with care the flurry of hospital-wide e-mails detailing new procedures and protocols: where patients would be isolated, how P.P.E. would be rationed, when additional staff would be called in. Keeping track of new information felt like a full-time job. Still, at first, the surge didn’t materialize. “There was just this impending sense of doom,” she told me recently, over Zoom. “Then, all of a sudden, it was at our doorstep.”

The first COVID-19 patient she cared for was a woman in her mid-thirties. (Some details have been changed to protect patient privacy.) The woman was admitted to a step-down unit—the rung between an I.C.U. and a general-medicine floor—and, though previously healthy, she now needed concentrated oxygen delivered through a nasal tube to insure safe levels in her blood. Bankhead-Kendall’s shifts began in the evenings. When she arrived, she’d stop by the patient’s room. She’d watch her breathing through a window, record her vital signs, review her blood tests, and consider whether and when she should intubate her. For a few days, the woman was the only COVID-19 patient in the hospital.

Then things accelerated. One patient became three, three became ten, ten became thirty—an overwhelming deluge of COVID-19 patients. Her nightly rounds transformed into an escalating struggle. “We just tried to stay afloat,” Bankhead-Kendall said. “It was pure survival mode.” She was tapped to join the hospital’s “airway team”—a group who rushed to intubate patients when their breathing collapsed. The airway team received emergency pages and overhead alerts; when the alerts came, with alarming frequency, Bankhead-Kendall sprinted with a neon backpack full of supplies to the patient’s room, where doctors, nurses, and respiratory therapists had converged. A swift, coördinated ritual commenced. The patient could be unconscious or heaving and coughing, spraying virus everywhere. A mask connected to an oxygen bag would be placed over his nose and mouth. Someone would lower the head of the bed, another would guide a catheter into a vein (or, if that failed, drill it into a bone), and a third would administer sedative medications. Yet another doctor—sometimes Bankhead-Kendall—would peer down the patient’s throat, spy the vocal cords, and insert a plastic tube, while others monitored, prepared to perform C.P.R.

Bankhead-Kendall had never experienced anything like this. The number of patients needing intubation kept rising; often, she was startled by the speed with which their breathing declined. Debates erupted over whether the team should start intubating patients sooner, to prevent the chaos of doing it in a rush later, or continue waiting, to give patients a chance to recover without ventilators. These questions were further complicated by a constant fear of infection. Doctors were still learning about how they might keep themselves safe; intubation was already seen as among the riskiest of medical procedures. Bankhead-Kendall, who has asthma and regularly uses an inhaler, felt especially vulnerable. “Whenever I got coughed on, it felt like a death sentence,” she said. “Every day I thought, This could be the end.” She rewrote her will and told her parents where to find her passwords and what to do if she ended up on a ventilator. She taped important documents to the inside of her apartment’s front door—if she died, and someone had to enter her home, she didn’t want them to risk getting infected.

When I started speaking with Bankhead-Kendall this spring, a year had elapsed since the start of the pandemic. She had begun to emerge, shaken, from the most physically and emotionally taxing experience of her life. As a physician myself, who had also treated large numbers of COVID-19 patients at a big-city hospital, I was trying to understand what the pandemic’s stresses had done to health-care workers and their families. Clinicians have suffered extraordinary levels of mental distress during the pandemic; many have reported anxiety, depression, suicidal thoughts, and symptoms of post-traumatic stress disorder. According to some estimates, more than three thousand health-care workers have died after being infected by the virus. Today, thanks to vaccines, the medical crisis of the pandemic is starting to wane. And yet its mental-health consequences will linger, for patients and doctors. For Bankhead-Kendall, as for many other clinicians, this has been a long year of fear, despair, isolation, and tenuous resilience.

In Boston, last year, February turned to March, and the winter deepened. Days of viral surge became weeks. Bankhead-Kendall started to feel the weight of the never-ending intubations. She was often charged with calling families to discuss the procedure, and she found that people viewed it with horror. “Being part of the intubation team meant being a person that patients and families saw as a ticket to death,” she told me. “I went into medicine to help people—now I was someone they feared.” Despite her exhaustion, she started to have trouble sleeping. When she did fall asleep, she was jolted awake by nightmares. She saw huge masses of sick people, coughing, bleeding, gasping for air. She watched as they approached the hospital and burst through the doors of the emergency department, crying for help. She saw herself standing alone—stunned, angry, confused—choosing who would live and who would die.

Bankhead-Kendall was born and raised in West Texas. The eldest of three daughters, she was determined and ambitious. Her father was a petroleum engineer and her mother a teacher, but she knew from an early age that she would be a doctor. One day, in middle school, she rushed home beaming, carrying a small object wrapped in Kleenex; inside was a sheep’s eye. She told her mother, “I was the only one in class who cut it out without tearing anything.” When she was in the seventh grade, her family relocated to Argentina; within weeks, she decided to run for class president. “I said, ‘Brittany, no one knows you here! Are you sure?’ ” her mother, Athena Bankhead, told me recently. “She didn’t win, but after her speech everyone knew who she was. She was never afraid to put herself out there.”

The family soon moved back to Texas. Bankhead-Kendall attended college at Texas A. & M., where, during her senior year, she met her future husband, Brian Kendall, in a medical-communications class. After graduation, she moved to Miami to start a master’s program in biomedical sciences; Brian entered the Peace Corps and worked in Albania as a health-education volunteer, then joined Brittany in Miami. They became active in a local church and, to make ends meet, picked up shifts at a nearby golf course (he worked as a bag boy, she drove a beverage cart); they used their tip money to buy health insurance. In 2008, they married. They applied to medical school together, while on their honeymoon, in Bali. They had a son, Knox, while in medical school, and a daughter, Tinsley, six years later, during their residencies.

In 2019, the family moved into a two-bedroom apartment in Cambridge, Massachusetts, near the Longfellow Bridge, just across the Charles River from Boston. Brittany started her fellowship in surgical critical care, and Brian worked as an E.R. physician at two community hospitals north of the city. In March, as coronavirus cases surged across the Northeast, they began spending nearly all their time at their hospitals. Brittany was working a string of fourteen-hour overnight shifts when Boston’s schools closed. Between shifts, unable to sleep, she lay in bed reading the Internet: one browser tab contained lesson plans for her son, another emerging evidence on how to treat COVID-19. She began to have a terrible feeling that, during the pandemic, it would be impossible for her to be a good parent and a good doctor simultaneously.

Source: https://www.newyorker.com/science/medical-dispatch/a-doctors-dark-year?utm_source=pocket-newtab-intl-en

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