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On the Front Lines of a Pandemic, ‘I Love You’ Can Mean ‘Goodbye’ On the Front Lines of a Pandemic, ‘I Love You’ Can Mean ‘Goodbye’
(3 days later)
“I love you,” I said to my wife. Then, quietly: “Goodbye.”“I love you,” I said to my wife. Then, quietly: “Goodbye.”
It was 6 a.m. and I was getting up for work. If I had said more, she would have had trouble falling back to sleep. She already had been woken numerous times in the night by our two boys, aged 4 and 13 months. Our loudly breathing 4-year-old was now curled on a pillow beside the bed.It was 6 a.m. and I was getting up for work. If I had said more, she would have had trouble falling back to sleep. She already had been woken numerous times in the night by our two boys, aged 4 and 13 months. Our loudly breathing 4-year-old was now curled on a pillow beside the bed.
“I love you,” she replied, starting to stir.“I love you,” she replied, starting to stir.
I felt an overwhelming desire to approach her, to feel the softness of her hair, the warmth of her touch, a simple kiss. With a hollow feeling, I turned and hurried away, not knowing when I would see her again.I felt an overwhelming desire to approach her, to feel the softness of her hair, the warmth of her touch, a simple kiss. With a hollow feeling, I turned and hurried away, not knowing when I would see her again.
Almost three weeks had passed since the Kirkland, Wash., hospital where I work diagnosed a pair of novel coronavirus cases and saw the earliest Covid-19 patients succumb to the ravages of the disease, becoming the epicenter of the national outbreak. That dark morning was the last time I saw my wife or children in person, as of this writing.Almost three weeks had passed since the Kirkland, Wash., hospital where I work diagnosed a pair of novel coronavirus cases and saw the earliest Covid-19 patients succumb to the ravages of the disease, becoming the epicenter of the national outbreak. That dark morning was the last time I saw my wife or children in person, as of this writing.
My wife and I had guessed — correctly, it turned out — that I had been exposed to patients infected with coronavirus before anybody knew the virus had landed here. While my colleagues and I scrambled to don and doff personal protective equipment that first day back on service, my wife scrambled to collect sippy cups, clothing for the family, activities and a travel crib, distracted by worries about whether I would become ill.My wife and I had guessed — correctly, it turned out — that I had been exposed to patients infected with coronavirus before anybody knew the virus had landed here. While my colleagues and I scrambled to don and doff personal protective equipment that first day back on service, my wife scrambled to collect sippy cups, clothing for the family, activities and a travel crib, distracted by worries about whether I would become ill.
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She and the children would bunk with a sibling’s family while I worked at the hospital and stayed in our house. The cousins could play together and she would have help; it would be safer than close quarters with grandparents.She and the children would bunk with a sibling’s family while I worked at the hospital and stayed in our house. The cousins could play together and she would have help; it would be safer than close quarters with grandparents.
We both knew that I faced greater exposure with each passing day at work. It’s the reality of caring for hospitalized patients infected with a virus that spreads through air and can persist on surfaces for days. Each shift and patient increases the probability that another health care worker will become infected. Even more unnerving is the possibility of the virus hitching a ride home to our loved ones.We both knew that I faced greater exposure with each passing day at work. It’s the reality of caring for hospitalized patients infected with a virus that spreads through air and can persist on surfaces for days. Each shift and patient increases the probability that another health care worker will become infected. Even more unnerving is the possibility of the virus hitching a ride home to our loved ones.
After the initial quarantine period passed and I remained healthy, I pleaded for my wife to come home with the children. By then, I had developed a ritual of changing out of scrubs at work and leaving them there, then removing my street clothes outside my house in the cold air and heading straight into a hot shower. In any other time, this would have seemed unnecessary, overwrought and compulsive. Now it was the norm.After the initial quarantine period passed and I remained healthy, I pleaded for my wife to come home with the children. By then, I had developed a ritual of changing out of scrubs at work and leaving them there, then removing my street clothes outside my house in the cold air and heading straight into a hot shower. In any other time, this would have seemed unnecessary, overwrought and compulsive. Now it was the norm.
To keep everyone safe, I proposed that, upon returning from work, I would avoid the children entirely and isolate myself in a spare room while my wife brought me food.To keep everyone safe, I proposed that, upon returning from work, I would avoid the children entirely and isolate myself in a spare room while my wife brought me food.
“Then I would have three boys to take care of, instead of two,” she said with a laugh. But she had another concern: She’s a dentist and didn’t want to put her patients at risk.“Then I would have three boys to take care of, instead of two,” she said with a laugh. But she had another concern: She’s a dentist and didn’t want to put her patients at risk.
That worry became moot when her clinic canceled all appointments and remained open only for emergencies. Also, the virus was determined to be endemic, meaning there already had been community spread for weeks, so my family getting exposure from me seemed less of an issue. We made plans for them to return home, but then my 4-year-old developed a fever, cough and fatigue. Our normally energetic toddler spent two days in bed with shaking chills.That worry became moot when her clinic canceled all appointments and remained open only for emergencies. Also, the virus was determined to be endemic, meaning there already had been community spread for weeks, so my family getting exposure from me seemed less of an issue. We made plans for them to return home, but then my 4-year-old developed a fever, cough and fatigue. Our normally energetic toddler spent two days in bed with shaking chills.
There still wasn’t adequate testing available to confirm whether it was the new coronavirus; it was safest to assume it was. Now the greater fear was me catching the virus from my family and having to miss two weeks of work when I was needed — a fear that was validated when I was called in to take over for a potentially sick colleague, causing me to work 10 out of 11 days.There still wasn’t adequate testing available to confirm whether it was the new coronavirus; it was safest to assume it was. Now the greater fear was me catching the virus from my family and having to miss two weeks of work when I was needed — a fear that was validated when I was called in to take over for a potentially sick colleague, causing me to work 10 out of 11 days.
For now, after each shift of 12 hours or longer, I have to be content with talking to my wife and children through a screen. I end each day waving at the laptop and saying, “I love you,” bidding another good night. The image quality is so good — their sweet faces so crisp and full of life — that it’s almost as though they are right here with me.For now, after each shift of 12 hours or longer, I have to be content with talking to my wife and children through a screen. I end each day waving at the laptop and saying, “I love you,” bidding another good night. The image quality is so good — their sweet faces so crisp and full of life — that it’s almost as though they are right here with me.
This real-time technology is at times a taunt of sorts, an agonizing reminder that our real-time technology wasn’t good enough to recognize a virus spreading unnoticed through so many communities. A taunt that despite our technological prowess, our testing capabilities are still woefully inadequate. Because we don’t have the technology, capacity or resources to test and to know, friends and families must stay apart.This real-time technology is at times a taunt of sorts, an agonizing reminder that our real-time technology wasn’t good enough to recognize a virus spreading unnoticed through so many communities. A taunt that despite our technological prowess, our testing capabilities are still woefully inadequate. Because we don’t have the technology, capacity or resources to test and to know, friends and families must stay apart.
In the time of the coronavirus, “I love you” is what we say before loneliness or loss, not before a hug or kiss.In the time of the coronavirus, “I love you” is what we say before loneliness or loss, not before a hug or kiss.
“I love you,” says a female colleague of mine to her newborn baby after she tests positive for Covid-19 and has to self-isolate at home.“I love you,” says a female colleague of mine to her newborn baby after she tests positive for Covid-19 and has to self-isolate at home.
“I love you,” says an emergency room physician I know to his family before a breathing tube is inserted into his airway and his co-workers descend upon his body, working to save his life — the emotional struggle shattering the aura of invincibility we often feel as health care providers.“I love you,” says an emergency room physician I know to his family before a breathing tube is inserted into his airway and his co-workers descend upon his body, working to save his life — the emotional struggle shattering the aura of invincibility we often feel as health care providers.
“I love you,” says husband to wife, both of them ill from coronavirus, hospitalized in adjacent rooms. Their eyes meet as he is rolled away to the intensive care unit for mechanical ventilation as his condition rapidly worsens. It is possibly the last time they will see each other alive. Their exchange of “I love you” may be the last words they ever say to one another.“I love you,” says husband to wife, both of them ill from coronavirus, hospitalized in adjacent rooms. Their eyes meet as he is rolled away to the intensive care unit for mechanical ventilation as his condition rapidly worsens. It is possibly the last time they will see each other alive. Their exchange of “I love you” may be the last words they ever say to one another.
Behind the gowns, masks and goggles, there are no dry eyes among the nurses, respiratory therapists and doctors who have fought so hard to support him as they watch him get wheeled down the hall and out of sight.Behind the gowns, masks and goggles, there are no dry eyes among the nurses, respiratory therapists and doctors who have fought so hard to support him as they watch him get wheeled down the hall and out of sight.
Updated June 5, 2020 Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
An older woman, her lungs filling with pus and inflammation, struggles to say “I love you” to her grandsons via video chat; the virus is too contagious for an in-person goodbye. She’s breathing hard and visibly distressed. Both her daughter, who is a nurse, and I ask her to let us increase the dose of medications that will make her comfortable but sedated. She refuses for now as she wants to have a little more time with her grandsons to ask them about their homework.An older woman, her lungs filling with pus and inflammation, struggles to say “I love you” to her grandsons via video chat; the virus is too contagious for an in-person goodbye. She’s breathing hard and visibly distressed. Both her daughter, who is a nurse, and I ask her to let us increase the dose of medications that will make her comfortable but sedated. She refuses for now as she wants to have a little more time with her grandsons to ask them about their homework.
I hear the patient’s daughter explaining to her boys that grandma is going to heaven and they won’t see her again. I walk closer to give her a hug, as I have done for many other dying patients, but I stop myself. This simple act of empathy as a health care provider, as a human being, carries too much risk of transmission.I hear the patient’s daughter explaining to her boys that grandma is going to heaven and they won’t see her again. I walk closer to give her a hug, as I have done for many other dying patients, but I stop myself. This simple act of empathy as a health care provider, as a human being, carries too much risk of transmission.
As intensive care units here and around the country begin to run out of available beds, equipment and staff, these moments of people saying “I love you” when they mean “goodbye” will only become more commonplace.As intensive care units here and around the country begin to run out of available beds, equipment and staff, these moments of people saying “I love you” when they mean “goodbye” will only become more commonplace.
And I am one of them.And I am one of them.
“I love you,” I say to my own parents after telling them to stay at home as much as possible. I warn them they will not see their grandchildren or me for weeks, possibly months. My mother and father were fortunate to have survived the killing fields of Cambodia and to have emigrated to America. They were lucky to have found work and a home and a life here. But in their old age, with medical problems, I don’t trust their luck in a pandemic.“I love you,” I say to my own parents after telling them to stay at home as much as possible. I warn them they will not see their grandchildren or me for weeks, possibly months. My mother and father were fortunate to have survived the killing fields of Cambodia and to have emigrated to America. They were lucky to have found work and a home and a life here. But in their old age, with medical problems, I don’t trust their luck in a pandemic.
“Be careful,” my mother says. “I’m worried about you. You work too hard.”“Be careful,” my mother says. “I’m worried about you. You work too hard.”
She still remembers me as a frazzled medical student at the end of a 30-hour shift. Back then, she was a janitor at our county hospital, proudly watching her son make use of her sacrifices to work toward his dream of becoming a doctor. Now she is simply a mother worried about her child on the front lines of a war against an invisible enemy.She still remembers me as a frazzled medical student at the end of a 30-hour shift. Back then, she was a janitor at our county hospital, proudly watching her son make use of her sacrifices to work toward his dream of becoming a doctor. Now she is simply a mother worried about her child on the front lines of a war against an invisible enemy.
Saying goodbye as a way of showing love is also how we fight this virus. Right now, social distancing is the only way to protect loved ones who are most vulnerable. Video technology does help to bridge divides, as inadequate as it may feel.Saying goodbye as a way of showing love is also how we fight this virus. Right now, social distancing is the only way to protect loved ones who are most vulnerable. Video technology does help to bridge divides, as inadequate as it may feel.
It was bittersweet to watch my younger son’s first steps recently on an iPad. I was proud of him and glad to be able to witness him achieving this milestone, but I desperately had wanted to be the person he was walking toward.It was bittersweet to watch my younger son’s first steps recently on an iPad. I was proud of him and glad to be able to witness him achieving this milestone, but I desperately had wanted to be the person he was walking toward.
Getting through the outbreak will not be easy and the worst is yet to come. None of us will emerge unscathed. But I believe that saying goodbye for now — and then keeping our distance — is our best hope of surviving and being able to return to a time when I can hold my wife and children close without a sense of fear.Getting through the outbreak will not be easy and the worst is yet to come. None of us will emerge unscathed. But I believe that saying goodbye for now — and then keeping our distance — is our best hope of surviving and being able to return to a time when I can hold my wife and children close without a sense of fear.
When “I love you” means “hello” again.When “I love you” means “hello” again.
James Kuo is a hospitalist physician at EvergreenHealth in Kirkland, Washington. You can follow him on Twitter @jmkuomd.James Kuo is a hospitalist physician at EvergreenHealth in Kirkland, Washington. You can follow him on Twitter @jmkuomd.
Modern Love can be reached at modernlove@nytimes.com.Modern Love can be reached at modernlove@nytimes.com.
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