I’ve been sleeping with my husband again, but last night I sneezed twice, and he shouted “Not good! Not good!” and rolled away. I left to sleep in the basement.

I’ve gotten used to sleeping in the basement. I did it for weeks during peak COVID in the Spring of 2020 when my husband was afraid to breathe my breath during sleep, when sleeping apart was a survival strategy. Sleeping in the basement has its advantages. It’s quiet and cool underground. The children don’t wander down in the middle of the night. Sometimes I hear animal noises in the walls or behind the toilet (mouse, cricket, moth). The basement cricket’s soothing plaints reminds me of dreams I had in childhood in which I dug for thick worms with my little brothers in the soil next to the plum tree, teased fish with hooks at the lake. In the dream, children—a blonde, a brunette, an older boy with hair in his eyes—watched me and my little brothers from the green-ringed shallows. I know now that each of those children in my dream was me. Each child held out pink fingers, pointed. Look at the worm, fish, lake. The dark, twisted plum tree hung heavy with fruit, chirping insects, chirping frogs. You’re free in your sleep, says the dream. Like the dead, you are released from life. Sleep here, now. Sleep underground. Sleep like the dead.

You should keep a journal, said my husband. A dream journal, a COVID journal. That’s a form of writing, yes? Write down what happens to you.

Three of my colleagues have died. Two were nurses, and one was a very good friend of mine, Dr. Lorna Breen. I dream about Lorna sometimes. It is a recurring dream, best accessed by sleeping in the basement, alone. In my dream, Lorna sits in an overlarge armchair and reads a child a story. Her light brown hair hangs down just below her chin. She is calm as she turns the pages of a picture book, pointing to interesting illustrations. The child is too large to be sitting on Lorna’s lap. The child squirms. I cannot tell if the creature is a boy or a girl, but I know that the child is me. Child-me’s face contorts as if crying, angry, or afraid. In the dream, child-me struggles to breathe, pushes their way out of Lorna’s lap, runs into the shadows. When I wake, I hear the cricket again.

I have great capacity for fear.

Before peak COVID in New York City, I endeavored to prepare. I’d procured my own N95 mask and goggles, and sewed myself a silk head scarf which resembled a hijab—this to prevent bringing droplets of virus home in my hair. I would go to work having eaten a full breakfast, with no intention of taking my mask off for nutrition of any kind. Sometimes I would make an exception and remove my mask in the open air of the ambulance bay, just long enough to eat a granola bar.

The case mix was bad, and then it got worse. On a Sunday morning in early April, I arrived at work to find more than seventy patients in the ED at our community hospital—a full order of magnitude more crowded than one might find on a usual Sunday morning. My colleague from the overnight shift stared into space as we discussed each patient. He was sweating and his mask left a mark on his face. I duly took my notes as we circulated among the stretchers.

“I’m sorry,” said my colleague. “I did the best I could.”

I was one of two doctors coming on shift, but there were only three nurses, because so many were out sick with COVID. Three nurses to do everything: give medications, chart, receive new patients. That’s more than 23 patients per nurse, conditions of war or mass casualty. The nurses moved around the ED. They rolled weakly from one patient to the next. They had orders, but no reserve. What were they supposed to do?

“I’m sorry,” said the overnight attending again, handing over care. “They just kept coming in.” Oxygen hissed from the wall. Monitors chirped irregularly.

“You did the best you could,” I said, smiling. Or at least that’s what I hope I said. Perhaps I said something curt, worried. Perhaps I cursed, used the Lord’s name in vain. Perhaps my face betrayed impending tears. I certainly wanted to cry. I was afraid.

Fear, that most misunderstood of emotions, is so often miscast as ignorance of love. Poor Fear. I imagine Knowledge with all of her dear emotions gathered around her feet. Love is the most beautiful of her children. Love leans into her lap, and Knowledge pets her head. Joy and Peace lounge gracefully beside her. Shame hides in the corner, and Hatred has stormed out to look for trouble in the neighborhood. But Fear sits six feet away, watching his mother tell her children about how the world works. Fear pays attention. Fear absorbs information, matches it with patterns. Fear has a keen sensitivity to disharmony. When notes jar and patterns clash, Fear’s eyes widen. Fear asks: is it trying to kill me? What if it tries to kill me?  

In my hands I held a list of names, ages, diagnoses.

Person of color, bilateral pulmonary infiltrates, hypoxic, suspect COVID.

Intubated, suspect COVID.

Watch out, this one’s a likely intubation, COVID confirmed.

This one’s going to die soon, DNR.

That one’s going to die today, not DNR. Don’t touch him if you can help it. Don’t expose yourself unnecessarily.

But what was necessary? How were we supposed to know which dying patient required us to risk our life? What if we got sick? How many patients saved was worth one doctor’s multi-week illness? What about one doctor’s life? What’s the calculus for that?

A group of suits appeared to tour the ED. Dr. Lorna Breen was still the ED director, still alive, but she wasn’t with them. I hadn’t seen Lorna in a number of days, but that was not unusual. It turns out that she was home sick with COVID, but I didn’t know that then. It turns out that she would die by suicide three weeks later, but the only inkling I had of this was my own general sense of fear.

Pay attention!

Pay attention!

Something very bad is happening, and no one is noticing!

The suits walked in a circle around the emergency department, grinning. Am I sure they were grinning? Weren’t their smiles masked? I recall that my heart started to pound. How could they stand there? How come they weren’t screaming into a phone, making things happen? I moved closer to an administrator. 

“Just a normal Sunday morning in the Emergency Department, huh?” he asked. I shook my head slowly.

“All of these people are going to die,” I said. I should have understood his quip as dry humor. I should have understood that he had read the room as well as I, that he had gone down all available avenues. But I didn’t understand. He gave a brief nod, and drifted along with the pack of suits, smiling broadly. Maybe if you smile a whole awful lot, fewer people will die. Maybe if you bare your teeth, the virus will put its head down, slink off into the cool forest, never to be seen again. The leaves will rustle under your feet. A stone cast in a still lake will make a soft plink.

There was one patient left over from the overnight shift who was different. She was thirty-seven years old, asthmatic, skinny, dark-skinned, tattooed. I’ll call her Ana. Dark-lined designs snaked all over Ana’s arms. Some of her tattoos were intricate, others crude. She’d been discovered that very morning to have diabetes, the kind that carries a life-threatening complication: diabetic ketoacidosis. COVID was causing new onset diabetes in previously healthy patients, something we’d not seen in other infections. Ana couldn’t tell me much. The oxygen in her body was insufficient. Her illness had deranged her systems. She rolled her eyes. Sweat dripped off her skin. IV lines slipped out of the plastic adhesive at her elbows. She’d not had labs drawn for seven hours. Insulin and fluids ordered three hours prior had not been administered. Our shell-shocked nurses rolled slowly between patients bound for death at variable speeds. But Ana was mostly alive, young. It was then that I decided: of all the otherwise undifferentiated patients in the ED struggling to breathe, running out of oxygen in the hall, falling down on the vinyl floor in search of a glass of water, I would save Ana.

She’s the one I wanted to save.

I wasn’t sleeping with my husband at the time. Mostly, this was because he was sheltering out of state while I stayed alone to work on the front lines. But even if he’d been home, I would still have been relegated to the basement bedroom, with my yellow patterned bedspread on a queen bed on a dark green carpet. The walls are a light silver-blue. A white mirrored mandala hangs at the head of the bed. A simple pine closet the size and shape of a coffin stands in the corner, sheltering my work clothes. There are books scattered on the floor, novels and short stories and poetry and theory. There’s even a Bible, which I read over and over again, trying to understand fear. What is fear, and how does it relate to knowledge? Was I afraid because of what I knew, or what I didn’t know?  

After work, I would enter the empty house through the garage, and strip in the laundry room, which has a shower and a toilet. I’d spray down my leather clogs, pen, photo ID, and phone case with disinfectant. I’d carefully remove my mask for reuse, throw the headscarf in the washing machine with all of my other clothes. The cricket hiding behind the vacuum cleaner stayed silent in my presence.

The shower in the basement bathroom barely has room for a body, and the showerhead points directly at the door, so the only way to avoid getting water all over the bathroom floor is to turn on the water once you are already in the shower. I did that after every shift, turned on the water while naked in the shower. It was a cold shock to the chest every time, no getting used to it. I always gasped, an involuntary cry. I soaped down with an ayurvedic bar, dried with a new towel, bundled all the fabric into the washing machine, ran the wash. Then I ate leftover lentil soup. This was my routine for 13 weeks. My only companions: my colleagues at work; my writer friends on Zoom; my cricket.

The cricket only spoke to me when the lights were out.

I’m alive! I’m alive! it cried.

Ana struggled to breathe. She lay on a stretcher in a corner of the ED not visible from the nurse’s station. There were two patients per bay, plus more in the halls throughout the ED, and in chairs leading all the way to radiology. It was impossible for me to keep track of Ana unless I was at her bedside, and there were scores of patients who had a claim on my attention, with more coming in. She became increasingly ill, critically ill. She thrashed around, ripped off her oxygen.

“Ana,” I said, replacing the tubing. “Keep your oxygen on. You need it to live.”

“Just let me die,” said Ana.

“No. I’m not going to let you die.”

You’re the one. You’re the one I’m going to save today, I didn’t say.

I zombied my way through the shift, crying three times before noon. Walking in circles, walking from bay to bay to see which patient was almost dead. I simply walked in circles, writing down vital signs, putting oxygen back on people who’d knocked it off. I didn’t order complex treatment—no one was available to deliver it—just walked in circles putting oxygen back on bodies that were three-quarters dead. On my continuous rounds, I encountered a 50-year-old woman with a history of liver transplant, and COVID. Her oxygen tubing dangled from the bedrails, not on her face. Her pulse oxygenation was perilously low, yet when I reattached her to oxygen and repositioned her, it came up to normal levels. I wonder now: what if we had one-to-one nursing, would more people have lived? If we’d had another seventy-two nurses, and seventy-two more ICU beds, would that have made a difference? What if we had a magic wand and a time machine?

Many people died that day in the ED. The status board was striped with black.

“Just let me die,” said Ana, sweat pouring off her skin, rolling down her arms and fingers. Her eyes rolled backwards in her skull. Her oxygen level drifted lower.

“I won’t,” I kept saying. “I’m not going to let you die.” 

You’re alive! You’re alive!

My husband and one of my children returned to the house in early May. My husband circled wide, as if I had the plague, which perhaps I did. How many patients saved is worth the multi-week infection or death of the doctor’s spouse? I didn’t have the math for that, so I slept in the basement with my cricket until summer.

Stop trying so hard, I thought. You can’t move the needle on a pandemic, institutional priorities, national politics, capitalism, marital distress, personal safety. At least, not all at once. Why leave yourself open to injury? Just turn yourself off. Make yourself less available rather than more. Make your world smaller, with fewer people and objects to consider. Listen up! You are insignificant! If you want to matter, if you want control, create a fictional universe, I thought. For this is exactly what we all do! We experience the world in our minds, creating an analog from sensory inputs and memories. We all do it! Even institutions, hospitals, governments, social organizations create fictional universes. Hospitals are caring. Americans are brave, and more importantly, free. Committed partners can weather any storm. Smart and dedicated people can do anything if they put their minds to it. You can’t? Pull yourself up by your bootstraps! Pretend, pretend. Keep up appearances, step into a role. Play the part convincingly for colleagues, family members, and whoever pays your salary.

If only I had a verbal code, a thought-key, I thought. Some magic words to utter to the people in the hospital, the media, the government, God.

Evidently, “Everybody is going to die,” didn’t cut it.

Approximately 25% of patients admitted to our community hospital with COVID in April 2020 died that month, a mortality rate that does not take into consideration the people who died after discharge, or those who live with strokes or disability.

But it’s not my fault.

There’s no reason to think that what I do will affect the broad outlines of the pandemic, because reason has nothing to do with it. Reason implies a logical chain of events and a predictable outcome. But reason has failed us. Reason only works when your world is very small, and your map of the world is very accurate. But once your world expands, your map no longer represents the territory.

The sadness and fear of a roomful of seventy isolated dying patients floated around me, infected me. Now, in other places, COVID is peaking again. What will I do if it peaks near me? I don’t want to power down. I don’t want to lose the capacity to feel the feelings of others. The capacity to fear goes hand in hand with the capacity to love, and I don’t want to stop loving people, or imagining their hurt and despair, or carrying their grief. People who have low empathy are said to be “tough.” But in some ways, the ones who cannot love are already dead.

Dr. Lorna Breen, my good friend, survived COVID, but couldn’t withstand her own sadness and desperation. She couldn’t do anything to save patients or protect employees. She became dispirited. The fictions she had relied upon about power, agency, capacity, resources, all failed her. At least, this is how I conceptualize her death.

Ana kept ripping off her oxygen, and I kept replacing it. We made minimal headway with her diabetes, and I begged the ICU attending for a spot for her. There wasn’t one, of course, and I burst into tears, again. I transferred her to the pediatric hospital, even though she was an adult, and hoped for the best.

I don’t know if Ana lived or died, but I need to imagine she lived. I imagine she remained hospitalized for weeks, but recovered. I imagine her walking down to the park by the river and sitting in the grass. I imagine that a child runs to her and crawls onto her lap, that the child points with thick fingers to a butterfly, a wasp, a ladybug. A willow droops over the river, trailing branches in the flow. The pair relaxes, grows drowsy. We are together, they say. We’re okay now, let’s close our eyes. Let’s sleep above ground.

Sleep like the living.

© Barbara Lock
[This piece was selected by Valerie O’Riordan. Read Barbara’s interview]