Last days of the Before Time

We are all different people and the world a different place than a year ago.

I saw the pandemic coming from a long way off. As an ER doctor and single mother, threads of the developing story that one part of my brain missed, another part noticed, and soon, almost in spite of myself, I was tracking case counts on cruise ships and in other countries — growing more and more certain every day that it was not a question of if, but when, the pandemic would come to my door.

But the thing that really kicked me into high gear was an afternoon in February 2020 when I heard Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, tell a reporter that she had sat her children down and explained that their lives would change. That simple statement from another physician-mother — overheard on television while I was folding laundry or making dinner — was all I needed to hear to begin prepping in earnest.

By ‪8:15‬ the next morning, I had dropped the kids off at school and was on my way to the nearest Costco. Winding my way up and down the aisles of the store, checking items off a list and piling them into a towering cart, I was not sure if I was shopping for the apocalypse, a long stay at home, or a time when I would be trapped in the hospital and could not care for my children. But the ER doctor and mother in me were united around a single purpose: no matter what was coming my direction, I needed to prepare.

Back at home, it took me a couple days to unload the car and organize the pantry. A good friend came over in the middle of all of it all. Standing in the garage, surveying the results of the grocery run and talking about the possibility of the pandemic, she turned to me with a quizzical look on her face and asked, “Really?”

“Yes,” I said. “Really.”

A couple days after the Costco trip, I called Dr. Michael Wadman, chairman of the department of Emergency Medicine at the University of Nebraska Medical Center (UNMC) and director of the National Quarantine Unit. He had also been my Emergency Medicine residency director when I was in training to become an ER doc.

I was glad he took my call. He’d been busy. Throughout the middle of February, he and his staff had cared for people infected with Covid-19 from the Diamond Princess cruise ship. At the time of our phone call, he was one of only a few people in the United States who had hands-on experience with these patients.

I was at work in the Emergency Room during the call and stepped outside to get better cell phone reception. While I paced back and forth in the ambulance bay, he gave me a five minute primer on all things Covid: best practices for intubation, how to triage and simultaneously run a clean and dirty ER, and the idea that patients with a lot of comorbidities — like diabetes and COPD — seemed to fare the worst. “But kids seem to mostly be spared,” he offered, almost as an aside, toward the end of our talk.

“Really?” I responded.

“Yes,” he said, “or to have very mild disease.” I felt my shoulders lower and heard myself let out a long exhale.

“This disease is going to be with us for a while,” he then predicted. “It’s dangerous — but probably more disruptive than deadly.”

Staring out at the hospital parking lot on that cold February morning, I had no idea how prescient — in many ways — his comments would prove to be.

A few days later, I started talking to my children about the possibility of a pandemic — not in a big, earnest way, but small, off-hand things at dinner or when we were in the car. Did they know what a virus was and had they ever heard the word “quarantine”? We talked about cruise ships and looked at the world map. I told them schools might close. I tried to approach the topic in a matter-of-fact way. I did not want to overwhelm or scare them.

I may have overshot the mark. A few days after one of these talks, my daughter came home telling me she had gotten into trouble in science class when she spoke up in a lesson on handwashing to say that schools might close. In a grade school schism that hinted at more contention to come, the teacher scolded her in front of the class. “You’re overreacting,”he said. “Epidemics happen in other parts of the world,” he explained, “not where we live.”

Looking at her over dinner, as she ate her spaghetti and told this story, I felt immensely proud of her for the way she had spoken up. I also wished that what her teacher said could be true.

At some point in this same sequence of weeks, I also saw the first patient I was concerned may have Covid. He was a man about my age with cold and flu symptoms who had a family member who recently returned from a business trip to China. I had not worn a PAPR since biohazard terrorist training several years before, but put one on to see this patient. After I examined him, I called the health department for my state to ask about tests for Covid, which were still in short supply.

“I have just evaluated a patient I am concerned may have the novel coronavirus,” I explained to the woman who was answering the phone after-hours for my health district. Although she was eventually able to connect me to the epidemiologist who answered my questions, there was an initial moment of confusion.

“What?” she asked, after I explained the purpose of my call. “I don’t know what you mean.”

“You know, the new coronavirus that causes Covid-19?” I repeated.

“No, I don’t,” she continued. “Can you spell it?”

“Sure,” I said. “C-o-r-o-n-a-v-i-r-u-s,” I spelled out, one letter at at time.

“Oh,” she responded and then I could hear a sense of recognition on the other end of the phone. “Like the beer.”

“Yes,” I chuckled and said back. “Like the beer.”

A couple weeks later, schools shut down and the pandemic was upon us. In the twelve months that followed, my children and I ate our way through all the groceries and learned to Zoom. My hair turned grey. I saw more Covid patients and wore a PAPR more times than I can count. I spent a year trying to save lives in the ER while politicians denied the severity of the pandemic — a reality not even a year’s supply of groceries could have prepared me for.

My children and I have not yet lost a family member to Covid — and I still have a good, if also stressful, job. But we are different people and the world is a different place than it was a year ago. It is hard to remember a time when we did not wear masks in public, when wearing masks in public was not divisive, or when the first thing that came to mind when someone heard the word “corona” was the name of a favorite beer.

The other day in the car, my son asked when Covid would be over. Before I could even answer, my daughter said, “Covid will never be over, will it Mom?” and then continued, “The pandemic will eventually end but Covid the sickness will never go away, right?”

“Yes,” I said slowly, stunned by my 12-year-old’s grasp of science and the world she was rapidly coming of age in. “It will probably always be with us in some way or another,” I continued, and then went on to give some kind of explanation from medicine and biology about how once everyone on the planet had either had the disease or was vaccinated, Covid would probably become a seasonal illness like RSV or the flu.

But even as I answered, I knew we were talking about more than just the disease — that the personal and political sequelae of Covid would always be with us in ways we were just beginning to understand.

One of my fondest memories from the last days of the Before Time was attending a performance where my daughter’s youth orchestra played with members of a symphony in a neighboring city. It was a great event at a storied venue, where professional musicians sat side-by-side with grade school students and sight-read music the kids had spent months preparing. Delighted to see his sister on the stage, my five-year-old son stood up on his seat and waved every chance she looked our direction.

The music was powerful and the concert hall filled up with emotion and the sense of community that children and beautiful melodies can create. Parents took photos of their kids and then turned to each other and smiled. Some of us had tears in our eyes.

And throughout the performance, I could not help but wonder if this would be the last time my kids and I would be able to gather in a group this size. Then I tried to imagine everything that would have to transpire before we could meet in a venue like this again. I looked around the room and wondered if other parents were worrying about the same thing.

Driving home that night in the dark, my kids and I talked about the performance and a trip they hoped to make for Spring break, imagining a fanciful vacation that far outstripped anything that was logistically possible or our family budget could afford. Then we drove through McDonald’s for dinner.

And for the rest of the way home, I kept holding back the urge to turn the conversation into another the-pandemic-is-on-it’s-way teaching moment. Especially because it was only days from being taken away — and because the coming year has proven to be so hard — I am grateful now that I let my kids hang onto that pre-Covid springtime dream for as long as they possibly could.

Marion Bishop is an emergency medicine physician who works in northern Utah. Her views are her own. You can find more of her writing and learn about her ER experience during the pandemic at marioncbishop.com.