“Temporary Housing for Employees at High Risk of COVID-19” is the title of an email in my inbox. Sweat runs down behind my eye shield, but I remind myself not to rub my eyes. I click on the email. “We have worked with Temple University to make temporary housing available to staff at Temple University Hospital who work on units such as yours where patient-care duties convey a high risk of COVID-19 exposure.”
I’m a pulmonary and critical care medicine attending physician and assistant professor at Temple. Lately I’ve been serving as one of eight attending pulmonary and critical care physicians caring for COVID-19 patients within our institution. We are wearing masks and shields, gowns and gloves.
Despite the equipment, I can feel the heat of my patients’ fevers. Through the mask, I can sense the air moving as they breathe. No mask is perfect. I am at a high risk of COVID-19 exposure, as the email says. I read on.
“Availability is initially limited to staff who have an especially frail family member at home whose condition may put them at great risk if they contracted the virus.” That’s me, too.
My husband, Chris, is a software developer, thank goodness. I couldn’t imagine having a spouse in health care, especially not as we face down a historic pandemic. Normally, I like to joke that I’m a racing car, and Chris is my pit crew. I pull in, brakes smoking, and with practiced efficiency he swaps my tires and tops up my gas tank, just in time for me to pull out onto the track again.
I’ve always felt some guilt regarding his role. Medicine is a 24-hour business, and it doesn’t stop for holidays. I get home from work late, a lot. I work weekends. I come home sweaty and exhausted. I come home emotionally devastated. If we have plans to attend an evening concert or a social event, I usually get a text message from him sometime in the afternoon: “You know, it’s OK if you don’t have the energy to go.” He worries that he stresses me further, beyond the stress of my work, by wanting to go out for dinner with friends. I worry that he worries about that.
When I met Chris, I immediately noticed signs that a physician would notice as more than personal quirks. The first time he drove my car, he cranked up the driver’s seat back to a 90-degree angle, bolt upright. “That’s just how I’m comfortable,” he said. As I laid my hand on his elbow, he winced. “Tennis elbow.”
After testing, Chris was diagnosed with Crohn’s disease. His immune system was attacking his colon, small bowel, and tendons. The seat back was bolt upright because the disease had also inflamed the joints between his tailbone and pelvis. His colon was so inflamed that bacteria within it had escaped into the surrounding tissues, causing what doctors call a fistula.
Over the last few years, he has improved with medications. He now takes three of them, all strong drugs that suppress his immune system. Every Saturday, after I make coffee, I give him an injection. He takes a handful of pills every day: his medicines, and many vitamins his body can’t absorb properly.
Despite this, he still has regular fevers and disease flares. On a good day, he can be described as fragile. We miss many of those evening concerts and social events, the very same he’s worried I won’t have the energy to attend. We still haven’t seen a favorite band, despite having purchased front-row tickets, twice.
I read the sentence again. “Availability is initially limited to staff who have an especially frail family member...”
Frail. I feel the texture of that word. Is frail the next step after fragile? For a moment, I try to reassure myself that he’s not frail. I send a text message to him. “How are you feeling?” “OK,” he replies. The exchange doesn’t make me feel better.
After evening rounds, I sanitize my ID badge. I sanitize my office key, my glasses frame. My stethoscope, twice. I wash my hands. Again. Again. I bring a sanitizing wipe up to my office, I sanitize my door handles, my keyboard, my cell phones, my purse strap, and the pull tab on my winter coat. When I get home, I launder my clothes immediately. I shower, and I scrub my skin; like Lady Macbeth I rend out Duncan’s blood. The water is so hot.
Afterward I dress, and find Chris in the kitchen, working on dinner. I take his hands in mine. “I think I might need to go live on campus.” Chris looks up. “What? For how long?” I look down. “I don’t know.”
There are so many changes to our lives in this pandemic, so many decisions yet to be made, some easy, some hard. How do we make this one? How much happiness and comfort do we give up to keep Chris safe, and for how long? Am I doing enough for him now? How could it be possible to do enough? We resolve to talk about it together tomorrow; there are too many emotions, too much we have to feel out.
Overnight we both wake with fevers, looking at each other in the dark. “How do you feel?” I ask him. “Cold, and then hot,” he groans. I roll over and look at the ceiling in the blackness, my mind swimming. I can feel the seconds ticking. I feel the air movement as Chris breathes beside me. I feel the heat of his fever.
In the morning, I report my symptoms, am sent for testing, and return home, feeling guilty. I haven’t seen any patients, but I still shower and launder the clothing that went with me to the hospital. Chris and I joke together, paradoxically a bit more at ease, as we portion out acetaminophen in addition to his usual medication. I look at the pile beside his morning coffee. It looks reassuring, and ominous. “Maybe we’re off the hook for this hard decision,” I think. “Maybe we don’t need to decide after all.” I feel guilty for this thought.
After receiving word that the test is negative, I return to work.
Another cycle on the way home: sterilize, drive, wash, scrub. Chris, feeling better, is making dinner. I think about taking his hands in mine again tonight. Looking into his eyes and saying goodbye. Goodbye, with no end date. I think about my grandparents, who were separated for all the years of World War II, and admonish myself for being so soft. I adjust my posture. I take deep breaths. “We can do this,” I say. I try to imagine the on-campus housing. I wonder if it faces our home. I imagine myself there, looking out the window over the darkened city, trying to see our house.
“I can’t do it,” he says, as soon as I turn the corner into the kitchen. This time, he looks down, and I look up at him. “I can’t be home without you. I can’t even sleep if you’re not here. I’ll spend every minute worrying about you.” I take his hands in mine. He’s trembling. “You’ll be careful,” he says. “We’ll get through it together.”
I know that there are no guarantees, and that there is no such thing as careful enough. But Chris has decided for us, and in his eyes I can see resolve. “In sickness, and in health,” he says, and wraps me in a hug.
Erin Narewski is an assistant professor of pulmonary and critical care medicine at the Lewis Katz School of Medicine at Temple University. In 2019, her essay “Room 201” won first prize in a university health-writing competition.