In a New York State of Mind

An ER doctor’s meditation on loss in the time of Covid

I spent the day before my birthday this year in a long ER shift. By the time I saw my last patient, checked out a few responsibilities to the oncoming ER doc, and wrote my last note, I had been in the hospital for almost 15 hours. I removed my PPE, showered in the physician call room, and walked to my car in the dark.

Driving out of the crowded parking lot, I turned on the car radio and then turned it off. After the chaos of the ER, music was too noisy. And with reports of rising Covid case counts and hospitals running out of beds, the news was simply a replay of the scene I had just left-interrupted with updates about the US election. I needed some quiet to clear my head.

My drive home takes me through a high mountain canyon, with peaks that top 10,000 feet. Pale grey light silhouetted the mountains and faint stars illuminated the night sky. I followed the road to the summit and then down into the valley on the other side.

As the dark landscape rolled by, I tumbled into a melancholy reverie of everything that happened in the last year. The pandemic and school closures, the unending press of Covid patients in the ER and single-parenting at home, all formed a macabre highlight reel of the last year that played over and over again in my head. I had lived in New York City as a younger woman and spent my last birthday there. Looking back on the year, I was stunned at the naivety of my one-year younger self, wandering around the city, incapable of imagining what the coming twelve months would bring.

And perhaps because I was tired and hungry and needed an antidote to everything I had just left in the Emergency Room, I soon gave myself over to those New York City memories. Part of me drove home but another part relived autumn in a place and time far away. Mountains became skyscrapers and stars turned into blinking lights in tall buildings. Then New York City set up shop in my mind and stayed for a couple of days.

I was only 21 years old when I moved to New York. I had a bachelors degree from a western college and a piece of paper that said I had been accepted to the graduate program in English at New York University. I knew nothing of pandemics or big cities and had never imagined that I would one day become an ER doctor. I was simply taking my chance to see the world.

Within days of matriculating at NYU, I found a place to live and just was as lonely and culture-shocked as you would expect a girl raised in western, wide-open spaces to be. The long, canyon-like grid of buildings made it hard to orient myself. I missed the mountains and wished I could get up high enough to see the horizon.

But over time, I learned to love New York in the same way I had learned to love the west-by treating it like a landscape to be discovered. I rode my bike up and down the length of Broadway, learned to use prominent buildings as landmarks, and discovered which parks had the most comfortable benches or mix of sunny and shady spots to sit.

I ended up living and working in and around the city for the next eleven years. I earned a PhD in English and thought I would have a life as a college professor. But the city had something else in store: during my final year in Manhattan, I was running in Washington Square Park when a stranger collapsed in front of me and I gave him CPR. It was an event that saved his life and changed mine. By the time a favorite professor hooded me in my PhD commencement ceremony at Carnegie Hall, I had decided to go to medical school.

I left the city soon thereafter, moving back “out west,” applying to medical school, and becoming an ER doctor. But New York remained a spiritual touchstone. I found myself returning every few years to remember what it had given me and to mark what had happened since. On the birthday trip I made in the fall of 2019, I walked to all my favorite Greenwich Village haunts, jockeyed shoulder-to-shoulder with other New Yorkers in crowded delis, and shared benches with strangers in parks full of fading autumn light.

Photos from the trip capture that beautiful, late fall light-along with a kind of freedom from worry I did not know yet to cherish. Sitting on the High Line, I sent the pictures to a friend who is a landscape architect. “Austere western landscapes and frenetic urban cities both allow anonymity and the ability to lose oneself in their immensity-even if they are familiar and well-loved places,” he texted back. Yes, I thought to all of that: yes. And I promised to bring myself and my children back in the spring.

Then the pandemic happened. During the week we would have traveled to Manhattan, New York City hospitals filled up with sick people and my kids and I followed instructions to stay at home in our state far away. The hospitals I work for began preparing in earnest for our own wave of patients and my ER colleagues and I scrambled to learn everything we could from the physicians we knew practicing in New York.

And although I was not still living there, the trauma inflicted on New York City by the coronavirus felt like a personal wound. I recognized street corners and buildings from images on TV and could identify which hospitals reporters were broadcasting from by their vestibules. And it was during one of my own ER shifts-in a small, rural hospital-that a friend from NYU texted to tell me that a beloved professor, Gordon Pradl, and his wife, MaryAnn, had both died from Covid.

Along with ER doctors in other parts of the country, I spent the rest of the spring and summer learning about Covid in bits and pieces-encountering in six weeks or six months what our colleagues in New York faced in the first few days. And despite a wish that our rural surroundings would protect us from what New York suffered, I watched and waited, tracking case counts across the country, and wondering when my two worlds would collide.

But it was not until autumn that the big wave of Covid found its way to the grand, wind-swept spaces of the Intermountain West. The indiscriminate virus infected first one person, and then another, until it filled up so many Emergency Rooms and hospitals that our governor declared a state of emergency, and hospital systems considered overflow protocols and rationing ICU care. The virus that started in one place I love had come to the other that I now call home.

So this year, instead of being in New York, I spent the day before my birthday working in the ER. It was not all-Covid, all the time, but part of what is difficult to understand unless you work in an ER is that other emergencies do not stop. The usual hectic cohort of heart attacks, gastrointestinal bleeds, and motor vehicle accidents keep right on coming. The average daily census for the ER balloons and bed space shrinks not because every patient has Covid, but because in addition to your usual job, Covid brings a whole other group of people into the ER who except for the pandemic would never have a reason to be there.

So on that day, in and around suturing lacerations, caring for people with chest pain and the victim of a drug overdose, I had also seen Covid patients. I intubated one within minutes of arrival. Another was a kind man in his early seventies who thanked me multiple times for our care. After stabilizing them, I had to transfer both patients to another hospital because the facility where I work does not have an ICU. We were lucky they still had room. “He just looks fragile,” I told the accepting doctor on the other side of the phone about my elderly male patient. “He won’t make it at home.”

“I know,” he said. “The hospital is full of [patients like him],” he continued, turning the man’s first and last name into a plural noun that substituted for all the people in his care.

The image of this man’s face struggling for air, the sensation of another man’s chest moving against my hands as I gave him CPR on a cold New York City morning-and so many other memories-are what came to me on that macabre movie reel as I drove home that night in the dark. I am used to thinking of my life in separate, discrete chunks, lived in different cities, that have little to do with each other. That night, they all felt the same.

Maybe I am just getting older, I thought to myself as I finished the drive and pulled into the garage. Then I changed out of my hospital scrubs, snuck in the back door, showered again, and let the babysitter go home.

The next morning, there were gentle tufts of snow on the ground. My kids and I ate cupcakes my daughter had baked for breakfast, packed a lunch, and then headed out on a hike. I wanted to spend my birthday somewhere beautiful and safe-and to be with people I loved.

I know the mountains and canyons near my home as well as I know New York City. I picked a tough hike, not because it was hard, but because of where it would take us-a high mountain ridge with long views in nearly every direction. After the last night’s ER shift, I needed perspective. I wanted to see.

The first mile of the trail is a series of steep switchbacks. It was a cold day. My thighs ached. The kids complained. And as we made our way up the mountain, the previous night’s reverie returned. I tasted sweat on my lips and then the sparkling water I drank with dinner last fall at the Union Square Cafe. I saw soft wrinkles on my elderly Covid patient’s face, smelled fall mountain leaves, then heard them skip across city streets. And another patient smiled at me from across a congested New York City subway platform before closing her lips around an endotracheal tube as I intubated her.

Of course you feel this way, I reasoned, and then shook my head just a little, trying to bring myself back to present day. You miss New York. But just as soon as those words came to mind, I realized that what I was feeling was even more: you miss the world as it was last fall, the thought continued. And then I allowed the sadness and weight of the past year to settle in.

Finishing the switchbacks and cresting the top of the hill, I also wondered if the meditative, scene-shifting space I had been in since the night before was not just a way of processing my own grief, but also a way of understanding what had happened to our world. With the advent of Covid, New York and my mountain home had come to seem a lot more the alike-and not just in hospitals. With climbing daily death counts and the stress of a contentious election, the entire country had suffered an enormous blow.

And just as I had once come of age in an unfamiliar city, I wondered if Covid had taken us all to a new place-and also taken away some of our innocence. I mourned the loss of a thousand, everyday, pre-Covid pleasures I had taken for granted, and was ashamed of every time I had mistaken good luck for invincibility.

When we finally got there, my children and I stayed at the top of the mountain for a long time. We ate lunch, leaned into the wind, and played with the dog. I thought about sharing with them everything I was thinking about New York and the pandemic but held it close, instead.

I had left my glasses at home that morning because the backs of my ears were raw and hurt from wearing PPE. Looking down the canyon, across a valley, and towards another mountain range beyond, we pointed out landmarks and I strained to see the horizon. It was not always clear. But feeling small with my children in such an immense and beautiful place was its own form of comfort.

The afternoon grew longer and colder. The sun moved overhead and then hung lower in the western sky. It was time to leave. New York City memories and Covid worries returned. And as we made our way back down the trail, I understood that my children and I had spent an afternoon measuring ourselves-and the last year-against an enormous landscape, using the scale and scope of it to understand where we had come from-and to imagine where the world might take us next.

Originally published at https://www.marioncbishop.com on November 20, 2020.