08/10/2020
I see you. We all see you. And we’re here with you.
I just wrapped up 18 days on duty in the Intensive Care Unit. Two hundred and sixteen hours in just under three weeks.
This last stretch was tough and the last five nights were by far the worst. My team lost people. A lot of people. Nurses who spent hour after hour at the bedside lost a patient. Families lost a child. A spouse. A parent.
My job is somewhat unique in my field. I’m a Solo Nocturnist. I trained as a Family Nurse Practitioner but after years of working 24 hours shifts as a Paramedic and nights as an ER Nurse it was clear I wasn’t cut out for working days in an outpatient office. My first job was on a busy Hospital Medicine service working overnights covering the floors and admitting patients from the ER. Now I cover the ICU at night with a Physician available remotely for consultation.
Night shifts demand a lot and they attract certain types of people. I fit most of the stereotypes. Not particularly well socialized. Not particularly fond of oversight. Comfortable with ambiguity.
I’ve always had what could most charitably be described as a rich internal life, which is to say that I’m not particularly fun at (or outside of) parties. I never got the hang of letting people in. Four years of working 2-300 hours a month while the rest of the world sleeps hasn’t done much to change that.
After my first year on the Medicine Service I began to notice I was having a hard time looking at peoples faces when they spoke to me. I spent most of my time alone, isolated in small rooms talking to patients trying to decide how sick they were. It was difficult at times to not only interpret the torrent of information I was responsible for collecting but to also have to connect with all those faces. The fear, anxiety, and frustration was a distraction interfering with my ability to distinguish what was concerning from what was not. Do you need lab work? Medication? A CT? A Surgeon? A code cart?
And then I noticed it wasn’t just at work.
For months now we’ve worn masks. To separate ourselves from our environment. To reduce infection. We’ve been told to create distance. To avoid contact. To avoid touch.
Facial expression is a large part of how we communicate. It holds more truth than the spoken word. Words are great for nuance but a split-second glance will show you what’s in someone’s heart. You don’t have to speak the same language or be literate. You don’t even have to be human. Primates and many other mammals rely on their bodies to speak for them. In my experience the body tells you everything you need to know; it holds the secrets that language will try to hide. This is especially true in the ICU where many of my patients can’t speak.
Upon entering the hospital everyone is given a mask. Visitors masks are thin and fragile. The staff’s masks are much more resilient.
Despite what we are told the eyes are not the window to the soul. 2020 taught me this There is a vast repository of human feeling behind the mask. Microexpressions determine so much of what we find attractive, endearing, funny, objectionable, sympathetic, or heart-rending… but only when you see them. The mask locks those treasures away behind cold and impassive perception.
What you see above the mask can appear disengaged and judgmental. It doesn’t convey the frustration we feel when, after weeks of caring for the same patient, they are slowly fading. The mask prevents us from seeing the fear and powerlessness in the faces of families. Their grief. The pure and unfiltered pain of loss…. and it prevents them from seeing that we feel it too.
In the ICU the patients no longer require a protective mask. Their mask is the flaccid nonexpression induced by sedation and paralytics. My mask is just as inscrutable. Green N95. Clear glasses. Bloodshot eyes.
My night is made up of moments that many people remember for the rest of their lives. An unexpected phone call at 3 am. An update in a hallway under florescent lights. Always these damned florescent lights. He isn’t responding to treatment. Things seem dire. Should we continue? What would they want? Despite our best efforts, we were unable to bring them back. An empathetic however well-rehearsed condolence. There were so many of these conversations this week. I force myself to remain present and engaged. I force myself to remain as vulnerable and available as this distance can allow. I won’t let them become routine.
The inability to console- to connect with someone in pain so that they know they are seen, reflected, validated, is killing us. I wish they knew.
I see you. We all see you. And we’re here with you.
Behind closed doors our masks come off. Truths are spoken. Not in the professional language that we use to diagnose and sterilize tragedy. Not in language we use to separate specialties and professions. We use the language of frustration and disappointment. Of the shame of our own powerlessness. We hear and are heard. We are seen and reflected. When we leave the room the masks go back on and we reengage in the skirmishes and battles that we fight between sunset and sunrise.
As humans we crave connection. A knowing glance, smile, or laugh. An infant wrapping a hand around your pinky. The entwined fingers of new love. A widow holding the hand of their spouse while we stand, clad in plastic. Masked. Distant. Isolated.
The longer we spend behind the mask the harder it becomes to feel. Connection. Empathy. Reflection. I wear the mask. It’s my responsibility.
Fearful, we trade community for safety. Connection for anxiety. Presence for distance. Time spent behind the mask blunts our perception. Signals about our own internal condition go unseen and unreflected. Empathy withers. Objectification seeps in. Isolation becomes normalized.
No matter how long it feels, this night will end. I’ll walk out of the hospital and the mask will come off. The sun will warm my face and the double doors will slide shut behind me, holding back the weight of what happens between sunset and sun rise.
There’s an infant asleep at home right now. In a few hours she’ll be awake and her face will seek out mine. She’ll look up with big brown eyes and a crooked smile that says
I see you. I’m here with you. You’re home.
