The Names of the Dead
There they were, listed neatly on the whiteboard in the conference room where all the deaths of the preceding month are discussed and their charts closed. I serve as the medical director at Dialysis Clinic Inc. Philadelphia and my outpatient dialysis unit lost 20 patients to COVID-related complications during the months of March and April. The census fell from 162 to 140. One patient got a transplant, another moved, but all the rest were COVID-related deaths.
I am used to death in dialysis patients --but not this way nor this number. Death is usually expected, after a long struggle with debilitating illness. There are rituals. The dialysis social worker calls the family, a condolence card signed by the staff is sent and if the family requests it, we post the details of the memorials on the bulletin board in the waiting room. Sometimes the family will come in and pay one last visit to the unit. There are tears and hugs.
But how do we mourn now? The unit is closed to visitors. Lingering in the waiting room is not encouraged. There is now only COVID positive, COVID negative, and 'Persons Under Investigation'. There is no place to post details of memorials, if there are memorials at all. And there are so many dead.
Maybe we can hold a group memorial when this is all over.
In many ways a dialysis unit is a family. We see patients three times a week, colleagues every day. Our family watched as the pandemic started as news on a TV screen in the staff break room. We watched the virus march its way here; China, Italy, Washington state, New York, New Jersey, Montgomery County and right into our unit on Henry Avenue in North Philadelphia.
First there was denial. It’s only in Asia. It’s only in Italy. It is only people who travel. “Hey Doc, we don’t have money to go on airplanes or cruises. We’re safe.”
But now everyone knows they are not. There is fear.
Staffer: “I don’t want to be exposed. I don’t want to bring it home to my family. I don’t want to die.”
Patient: “Hey Doc, what if there is no one to do our dialysis? Are they going to let us die?”
There is courage, staff volunteer to care for COVID positive patients. We secure protective gear. We increase cleaning. We corner the hand sanitizer and mask market. We screen patients for symptoms or exposures and cohort them accordingly. We screen the staff as well.
But patients start to fall sick: the eighty-year-old great grandfather, the woman waiting for a transplant who remembered everyone’s birthday, the man who would stops me to tell a bad joke. These and more, gone.
But some patients have recovered and are back. We have swabs! We have personal protective gear! We are sending our N95 masks for disinfection! We have lent Temple Hospital equipment! We have protocols and procedures! All the staff are back and there are no new cases! There is a “Heroes Work Here” banner tacked on the wall in front of the unit!
Yes, we need to have a memorial and a giant staff party when this over. But right now, we are waiting for the second wave of infections. And I am tired. I mourn for the old routines of work. I miss sitting in the waiting room and chatting with the patients waiting for their rides. I miss the gossip of the break room. I go to bed early only to wake up at 3 AM and obsessively read about the virus. I have given up hoping for a quick and happy ending. I remember the dead and think about the heartbreak of their families.
One early June morning, I walk into the unit with a nurse who returned to work after her recovery from COVID. Her eyes are smiling over her mask. “It’s a beautiful morning and I’m so grateful to have made it to the other side,” she says. But, I have not made that journey yet and I am not so certain of the outcome. I believe this is a common if unvoiced sentiment. Yet, the staff come to the dialysis unit, put on their courage, don their masks, shields and gowns, wash their hands and go to work. The patients wear masks, wash their hands and socially distance. Many have taken to waiting outside for their rides. Some even wipe down their chairs with 1% bleach a second time before they sit in them.
Back in March, a dialysis technician asked me. “You were there then, Doc. What was it like when AIDS started?”
I tried to explain. Well, we were afraid but we did the best we could. We did not leave patients to die. Some of us got infected. But we learned. We developed tools to make it manageable. We did not destroy it completely but now it no longer destroys us.
And we will ultimately prevail here, too.