Brittany Bankhead-Kendall arrived in Boston in July of 2019. Tall and trim, with straight, blond hair, bright-blue eyes, and a simple smile, she had a sunny disposition and the trace of a Texas drawl. She had simply completed a general-surgery residency in Texas, and, at Massachusetts General Hospital, she would full her coaching as a trauma and critical-care surgeon. As summer time eased into fall, she struggled to acclimate to the climate. At the hospital, she operated on sufferers who’d suffered severe accidents—folks harm in automobile accidents or home fires, or by gunshots. Patients would arrive with fractured skulls and ruptured spleens, collapsed lungs and bleeding bowels. Bankhead-Kendall received good with gore.
In March, 2020, because the coronavirus descended on Boston, she discovered that her function would evolve. She can be stationed within the I.C.U., the place the sickest COVID-19 sufferers can be handled, and begin working primarily as a doctor, not a surgeon. Bankhead-Kendall learn with care the flurry of hospital-wide e-mails detailing new procedures and protocols: the place sufferers can be remoted, how P.P.E. can be rationed, when extra workers can be referred to as in. Keeping monitor of recent info felt like a full-time job. Still, at first, the surge didn’t materialize. “There was just this impending sense of doom,” she informed me lately, over Zoom. “Then, all of a sudden, it was at our doorstep.”
The first COVID-19 affected person she cared for was a girl in her mid-thirties. (Some particulars have been modified to guard affected person privateness.) The lady was admitted to a step-down unit—the rung between an I.C.U. and a general-medicine flooring—and, although beforehand wholesome, she now wanted concentrated oxygen delivered via a nasal tube to insure protected ranges in her blood. Bankhead-Kendall’s shifts started within the evenings. When she arrived, she’d cease by the affected person’s room. She’d watch her respiratory via a window, file her very important indicators, evaluation her blood assessments, and take into account whether or not and when she ought to intubate her. For a couple of days, the girl was the one COVID-19 affected person within the hospital.
Then issues accelerated. One affected person grew to become three, three grew to become ten, ten grew to become thirty—an amazing deluge of COVID-19 sufferers. Her nightly rounds remodeled into an escalating wrestle. “We just tried to stay afloat,” Bankhead-Kendall stated. “It was pure survival mode.” She was tapped to hitch the hospital’s “airway team”—a gaggle who rushed to intubate sufferers when their respiratory collapsed. The airway staff acquired emergency pages and overhead alerts; when the alerts got here, with alarming frequency, Bankhead-Kendall sprinted with a neon backpack stuffed with provides to the affected person’s room, the place docs, nurses, and respiratory therapists had converged. A swift, coördinated ritual commenced. The affected person might be unconscious or heaving and coughing, spraying virus in every single place. A masks linked to an oxygen bag can be positioned over his nostril and mouth. Someone would decrease the pinnacle of the mattress, one other would information a catheter right into a vein (or, if that failed, drill it right into a bone), and a 3rd would administer sedative drugs. Yet one other physician—generally Bankhead-Kendall—would peer down the affected person’s throat, spy the vocal cords, and insert a plastic tube, whereas others monitored, ready to carry out C.P.R.
Bankhead-Kendall had by no means skilled something like this. The variety of sufferers needing intubation stored rising; usually, she was startled by the pace with which their respiratory declined. Debates erupted over whether or not the staff ought to begin intubating sufferers sooner, to stop the chaos of doing it in a rush later, or proceed ready, to offer sufferers an opportunity to get well with out ventilators. These questions had been additional sophisticated by a relentless worry of an infection. Doctors had been nonetheless studying about how they may preserve themselves protected; intubation was already seen as among the many riskiest of medical procedures. Bankhead-Kendall, who has bronchial asthma and frequently makes use of an inhaler, felt particularly weak. “Whenever I got coughed on, it felt like a death sentence,” she stated. “Every day I thought, This could be the end.” She rewrote her will and informed her dad and mom the place to seek out her passwords and what to do if she ended up on a ventilator. She taped essential paperwork to the within of her residence’s entrance door—if she died, and somebody needed to enter her dwelling, she didn’t need them to danger getting contaminated.
When I began talking with Bankhead-Kendall this spring, a 12 months had elapsed because the begin of the pandemic. She had begun to emerge, shaken, from probably the most bodily and emotionally taxing expertise of her life. As a doctor myself, who had additionally handled giant numbers of COVID-19 sufferers at a big-city hospital, I used to be making an attempt to know what the pandemic’s stresses had executed to health-care employees and their households. Clinicians have suffered extraordinary ranges of mental distress through the pandemic; many have reported anxiousness, despair, suicidal ideas, and signs of post-traumatic stress dysfunction. According to some estimates, greater than three thousand health-care employees have died after being contaminated by the virus. Today, due to vaccines, the medical disaster of the pandemic is beginning to wane. And but its mental-health penalties will linger, for sufferers and docs. For Bankhead-Kendall, as for a lot of different clinicians, this has been a protracted 12 months of worry, despair, isolation, and tenuous resilience.
In Boston, final 12 months, February turned to March, and the winter deepened. Days of viral surge grew to become weeks. Bankhead-Kendall began to really feel the burden of the endless intubations. She was usually charged with calling households to debate the process, and she or he discovered that individuals seen it with horror. “Being part of the intubation team meant being a person that patients and families saw as a ticket to death,” she informed me. “I went into medicine to help people—now I was someone they feared.” Despite her exhaustion, she began to have hassle sleeping. When she did go to sleep, she was jolted awake by nightmares. She noticed large lots of sick folks, coughing, bleeding, gasping for air. She watched as they approached the hospital and burst via the doorways of the emergency division, crying for assist. She noticed herself standing alone—surprised, indignant, confused—selecting who would dwell and who would die.
Bankhead-Kendall was born and raised in West Texas. The eldest of three daughters, she was decided and impressive. Her father was a petroleum engineer and her mom a instructor, however she knew from an early age that she can be a physician. One day, in center faculty, she rushed dwelling beaming, carrying a small object wrapped in Kleenex; inside was a sheep’s eye. She informed her mom, “I was the only one in class who cut it out without tearing anything.” When she was within the seventh grade, her household relocated to Argentina; inside weeks, she determined to run for sophistication president. “I said, ‘Brittany, no one knows you here! Are you sure?’ ” her mom, Athena Bankhead, informed me lately. “She didn’t win, but after her speech everyone knew who she was. She was never afraid to put herself out there.”
The household quickly moved again to Texas. Bankhead-Kendall attended school at Texas A. & M., the place, throughout her senior 12 months, she met her future husband, Brian Kendall, in a medical-communications class. After commencement, she moved to Miami to start out a grasp’s program in biomedical sciences; Brian entered the Peace Corps and labored in Albania as a health-education volunteer, then joined Brittany in Miami. They grew to become lively in a neighborhood church and, to make ends meet, picked up shifts at a close-by golf course (he labored as a bag boy, she drove a beverage cart); they used their tip cash to purchase medical health insurance. In 2008, they married. They utilized to medical faculty collectively, whereas on their honeymoon, in Bali. They had a son, Knox, whereas in medical faculty, and a daughter, Tinsley, six years later, throughout their residencies.
In 2019, the household moved right into a two-bedroom residence in Cambridge, Massachusetts, close to the Longfellow Bridge, simply throughout the Charles River from Boston. Brittany began her fellowship in surgical important care, and Brian labored as an E.R. doctor at two neighborhood hospitals north of town. In March, as coronavirus instances surged throughout the Northeast, they started spending practically all their time at their hospitals. Brittany was working a string of fourteen-hour in a single day shifts when Boston’s colleges closed. Between shifts, unable to sleep, she lay in mattress studying the Internet: one browser tab contained lesson plans for her son, one other rising proof on learn how to deal with COVID-19. She started to have a horrible feeling that, through the pandemic, it could be unimaginable for her to be guardian and physician concurrently.
On a frigid Sunday in mid-March, she began a twenty-four-hour shift within the I.C.U. A little after midnight, she intubated a affected person; at round 2 A.M., she was paged to the bedside of a girl who was deathly unwell with the coronavirus. In latest days, Bankhead-Kendall’s worst fears had began materializing. The I.C.U.s had been stuffed with coronavirus sufferers for whom little might be executed; she and others had been consistently racing across the hospital, intubating sufferers whose respiratory had collapsed—and every day extra folks flooded the emergency room, wheezing, heaving, in varied states of consciousness. At the bedside, she felt a sudden, overpowering urge to get her youngsters to security. From a cot within the trainee workroom, she referred to as her dad and mom, Athena and Dale, in Texas.
“Everyone is dying,” Brittany stated to her mom. “They’re talking about shutting down the country.” As the solar rose, she drove dwelling to collect her youngsters. “We’re going to see Honey and Bear,” she informed them.
On the aircraft to Dallas, she was among the many few passengers carrying a masks; she disinfected the seats vigorously with wipes, enduring quizzical glances. Travel had already began to sluggish, and the Dallas terminal felt eerily quiet beneath its fluorescent lights. Athena and Dale met Brittany and the youngsters close to baggage declare. The youngsters ran to greet their grandparents. Brittany stood alone on the carousel, the place a suitcase made the rounds. She flinched when her father walked over and tried to hug her.
“Dad, you have to stay away,” she stated.
Dale and Athena took Knox and Tinsley into one of many airport’s household restrooms, eliminated their garments, and scrubbed their our bodies with wipes. They dressed their grandchildren in pajamas and put their journey garments in a separate bag. When their daughter got here into the room, to retrieve one thing from the youngsters’ baggage, she appeared dazed. “She had no emotion,” Athena recalled. “She was so matter-of-fact. I could tell she was compartmentalizing. It was just ‘This is the task at hand. This is what I need to do.’ ”
Out within the terminal, Bankhead-Kendall waved goodbye from a distance and turned to stroll to her gate. She knew that some docs had been killed by the coronavirus; as she boarded the flight again to Boston, she didn’t know whether or not she would see her youngsters once more.
In regular instances, some ten to twenty per cent of sufferers admitted to an I.C.U. go on to die. In the spring of 2020, the COVID-19 mortality price for sufferers requiring I.C.U.-level care approached fifty per cent. For Bankhead-Kendall, the carnage felt suffocating and infinite; it was aggravated by the merciless truth that almost all sufferers died alone. Each day, orderlies introduced metallic gurneys to the I.C.U. to hold the our bodies out. They generally hesitated, double-checking to ensure that they’d come to the proper room—there had been so many deaths that it was exhausting to maintain monitor. Months later, the sight of a gurney would set off paralyzing flashbacks for Bankhead-Kendall. At the time, they primarily made her really feel inept. “Nothing I did ever felt like it was enough,” she stated. “We were supposed to be good at getting people better. Instead, we got good at dealing with dead bodies.”
These emotions of inadequacy had been exacerbated by the uncertainties of treating COVID-19. Often, medical professionals had to attract on hypothesis and anecdotes in making medical choices. “It was, like, ‘We’re going to drop you off in enemy territory, but we don’t actually know how to fight them, so, good luck!’ ” Bankhead-Kendall stated. She joined a WhatsApp group wherein physicians from all over the world—China, Italy, France—shared their medical experiences. She scrolled via more and more ominous messages: F.Y.I., we’re seeing random bowel perforations when persons are actually sick; F.Y.I., we’re seeing deadly arrhythmias after sufferers get higher.
On Easter Sunday, she labored one other in a single day shift. Among her sufferers was a girl in her fifties who was experiencing lots of the most severe COVID-19 problems: blood clots, coronary heart harm, kidney failure. She’d been on a ventilator for weeks, and there was little indication that she would get well; her household had determined that prolonging her life would solely extend her struggling. It fell to Bankhead-Kendall to name the girl’s husband and talk about the method for withdrawing care. The man informed her that he himself had persistent medical issues and couldn’t are available. Bankhead-Kendall promised him that she would keep along with his spouse after the respiratory tube was eliminated.
In the night hours, the girl pale out and in of consciousness, and Bankhead-Kendall held her hand. She spoke aloud the names of her relations, and informed her that they liked her. She took out her telephone, opened the Pandora app, chosen a Frank Sinatra station, and positioned it in a ziplock bag close to her head.
She appeared via the window, into the corridor. Outside the room, nurses held up indicators containing lab outcomes for different critically unwell sufferers and queries about their ventilator settings. Bankhead-Kendall mimed solutions to their queries.
Around midnight, the girl’s coronary heart price grew to become erratic and sluggish. Bankhead-Kendall listened as, via the telephone’s audio system, “Over the Rainbow” began to play. The lady’s coronary heart stopped; she took her final breath. Bankhead-Kendall turned to take a look at the clock and pronounce the time of loss of life.
After sending their children to Texas, Brittany and Brian informed their colleagues that they might choose up extra shifts. If they had been going to be aside from their youngsters, they needed to take advantage of it. They’d hoped that the separation would final a couple of weeks, however, because the climate warmed, it grew to become clear {that a} reunion was far off. The surge was unrelenting—hospitals had been so full that sufferers had been generally handled on stretchers in hallways. After a protracted shift on her birthday, in late April, Bankhead-Kendall got here dwelling and propped her telephone up towards a bowl of avocados on the kitchen island; as the youngsters watched over FaceTime, she blew out some candles. As a trainee, Brittany had much less management over her time than Brian did. In the time that she did have off, she had hassle disengaging. Brian seen her temper darken. “She would come home and tell me these horrific stories, day after day,” he recalled. “I’d try to pull her back a bit. I’d say, ‘You have to maintain some sort of boundary. There’s such a thing as being too invested.’ ”
In Texas, on a chalkboard on his grandparents’ fridge, Knox began preserving a tally of the variety of days since he’d seen his dad and mom. On some evenings, he and Brian would play Battleship over FaceTime and chat concerning the day’s actions, which for Knox may need included a hike, a picnic, or a motorcycle journey. Occasionally, Brittany’s sisters would cease by with their children, in order that Knox and Tinsley might play with different youngsters. Knox missed his dad and mom, however largely managed. Tinsley, who was two, had a more durable time. She was confused by the separation. She grew withdrawn and indignant; she began having extra tantrums. When Brittany and Brian learn to her over FaceTime, she would push the telephone away; after they’d hung up, she would ask for them. One day, when Athena was altering Tinsley’s diaper, the lady noticed a photograph of her dad and mom on a close-by wall. “She just started wailing and wailing,” Athena stated. “It was devastating. I thought, No baby should have to be away from her parents like this. It’s not right. But what choice did we have?”
In June, in Boston, the tempo started to sluggish. Infections fell throughout the Northeast, and among the makeshift I.C.U.s at Mass General had been dismantled. But Bankhead-Kendall was nonetheless seeing COVID-19 sufferers, and her nightmares continued. In desires, she sprinted towards their rooms solely to reach too late; she stared at them via home windows as they gasped for air over the sounds of alarms and ventilators. She noticed herself separated from her youngsters without end. One afternoon, after rounds, whereas ending her notes in a workroom, she began to cough—a guttural, productive cough that wouldn’t cease. She gathered her issues, rushed to the worker clinic, and received examined for the coronavirus. The check finally got here again destructive, however she nonetheless needed to self-isolate.
That can be her final shift in Boston: by the point she was out of quarantine, her fellowship—a one-year program, starting and ending in July—was over. The earlier 12 months, she’d accepted a college place at Texas Tech University, in Lubbock; Brian had moved there in May, to start out his personal school job and work as an emergency-room doctor. Now Brittany packed up the final of their issues and adopted. When she landed in Lubbock, Knox raced throughout the terminal and jumped into her arms. Tinsley, nonetheless, held again. “As a mom, it was heartbreaking,” Bankhead-Kendall informed me. “It felt like she’d forgotten who I was.” As they walked via the airport, Tinsley began speaking. “I realized how much she’d changed,” Bankhead-Kendall stated. “I realized how much I’d missed.”
In Lubbock, the coronavirus case price was decrease, and the hospital ran kind of usually. Bankhead-Kendall returned to the working room. The work was intense: throughout a typical shift, she may see thirty new sufferers and function on 5 or ten. Most of her sufferers had suffered severe bodily trauma—a motorbike accident, a gunshot wound; beforehand wholesome, they relied on emergency surgical procedure to outlive. “That’s my jam,” Bankhead-Kendall stated. “I was riding high.” When she had a spare second, she would pop all the way down to see Brian within the emergency division.
