6 days ago on my birthday, I was having dinner with a few friends who simply wanted to catch up before a possible 2nd NYC lockdown; none of them knowing that it was my birthday at the time. I was okay with that; I guess as you get older — especially during a worldwide pandemic — you don’t need to be reminded anymore that everyday should be a celebration of life and we should just be grateful for the company.
That’s when I got the late night dinner-interrupting phone call from the NYC Marathon Medical Director asking I could at the last minute organize a ragtag crack squad of medical volunteers for a never-done-before pandemic-proofed Macy’s Thanksgiving Day (Virtual) Parade by the next day. I said yes without hesitating.
Within hours, the 45 of us — whether from the annual NYC marathon or via a random DM on Instagram — rallied together as strangers and colleagues for a common purpose. As if the universe was dancing to the familiar tune of irony, it felt like the past 5 days have become that delayed birthday celebration I was supposed to have all along.
And with this experience already becoming another memory, I’m grateful for another birthday I’ll never forget, as if I have been celebrating the past 5 days with so many wonderful souls that make this city what it is, who remind me what’s worth living for in a year like 2020. So on a day like Thanksgiving, in a year like no other, all I can say is: Thank you, thank you, thank you. Without you, this could never have been.
New Year’s Eve
To my badass NYE medical team:
It’s become nearly cliché these days to pen one more diatribe against 2020, especially on the Eve of a New Year. But allow me to express bittersweetness when tearing myself over how this will be the only time we’ll ever work something like this again, let alone if these state of affairs weren’t as dreadful the many of us would never have even met in the first place. The sweet is never as sweet without the sour.
I’d still much prefer that we didn’t have to suffer during these uncertain times, whether it’s secondary to a pandemic or toxic individualism. However if we must play the hand we’re dealt, then alas let me at least affirm the profound privilege I’ve derived from this year to have gotten to know and worked with all of you.
Many of us met less than a month ago, whether by referrals or a message on social media. And yet without so much as a first name and first impression, we rallied as strangers at the last minute to become haphazardly assembled ragtag crack squad without any blueprints from years past. We flew by the seat of our pants when somehow asked to be *the* medical screening for both the NYC Thanksgiving Day Parade and the NYE Ball Drop in Times Square while the world watched amidst a worldwide public health crisis. You took on new roles and skills without a moment’s notice. Y’all were flexible, adaptable, and did this all with a smile, whether it was 4:30am in the morning or if the donuts slowed us down. And all this within 4 weeks: We pulled it off, twice.
Therefore, thank you all for being my resolve to stay in this fight, and thank you for helping demonstrate to this damaged world there remains good people out there who are willing to shoulder a horrible year through to the end. Although I again wish that we all could have worked together under better circumstances (annual NYC Marathon anyone?), I nonetheless will be eternally grateful how our trajectories collided. If our last week together is how 2020 wants to bid us farewell with, then I’m already blessed for that much. Better us than never.
Looking forward to better times. Stay in touch. We’ll work together again someday.
- At time of posting in NYC, it was 13 °C -
Humidity: 73% | Wind Speed: 8km/hr | Cloud Cover: clear
“Our battered suitcases were piled on the sidewalk again; we had longer ways to go. But no matter, the road is life.”
After we returned from LA yesterday night at 11pm, we turned in at our lodgings situated immediately next to the Emeryville train station, which provided us a false sense of security in making the 9:10am 3-day long Californian Zephyr train tomorrow morning.
Because right as everyone woke up at 8:30am, Sina and I headed out with our rental car to the local Avis (also located at the train station) thinking we had plenty of time.
8:35am – Then we remembered we had to fill up the gas tank
8:45am – Return the car to a closed office despite it having a posted opening time at 8:00am
8:50am – Try to get the car into the garage, which was locked
8:55am – Sneak in behind another car that did have access to the garage
8:57am – Leave the car behind in that garage hoping for the best (luckily the Avis person would return a minute later with her coffee berating us for coming 5 minutes early…yeah makes no sense)
9:00am – Run to the train station
9:03am – Arrive to meet up with Evie and Mihaela who had brought us coffee, with only 7 minutes to spare before the train would leave us.
Thank goodness the train station is tiny at Emeryville, otherwise we would’ve very likely missed it.
Here’s the posted timetable on their website, even though the Californian Zephyr is frequently late.
Once we boarded and as the train was about to take off, we were led to our 3 roomettes that were thankfully switched around at the last minute so we could all be together:
And just like the trains Mihaela and I (and 16 others) rode in Egypt only 9 months prior, each roomette fits 2 beds with the top bed being able to flip up to provide more room during the day.
About an hour into the train ride we were asked for our lunch orders and time slots to eat in the dining car (to provide ample physical distancing):
We began our lunch at 11:45am:
Despite what you may have heard and if you manage your expectations well, the food on the train was surprisingly good:
Each meal starts off with a salad:
And some favorites were the red wine braised beef:
Shrimp in Lobster Sauce:
Chicken Marsala:
…and more controversially, the Creole Shrimp & Andouille:
The viewing/observation car, located just past the dining car, is where most of us would spend our time:
If you need more food, snacks, beverages, or liquor, there’s a bar car downstairs below the observation deck where you can pay for items with a credit or debit card.
And once you have your setup ready (whether it’s music, speakers, headphones, a book, a laptop, a phone, snacks, a beverage, or any other combination), kick back and enjoy the views.
The first “sight” would be Donner Lake of the morbid and infamous Donner Party incident.
Nearby is the cute town of Truckee, California:
The sunset over the plans of Nevada:
And by 8:30pm it was completely pitch black. Although the observation car is open all night for socializing, movie watching, or staring off into the abyss, it remained completely empty on our first night.
So make your bed and sleep in — this very well may be the best sleep of our trip!
Day 2:
“My whole wretched life swam before my weary eyes, and I realized no matter what you do it’s bound to be a waste of time in the end so you might as well go mad.”
The next morning I woke up at 6:30am, mountain time:
And in the back of the observation car, I set up my home office for the morning:
Once we arrived at Grand Junction, CO, we assembled a SWAT-style strike team at 11:30am to pick up our pre-ordered food at the adjacent Puffer Belly Restaurant within the 10 minute window we had before the train would leave us.
Mission success!
By 2:30pm we reached the valley past Glenwood Springs, CO. Commonly regarded as the most beautiful parts of the California Zephyr, we instead witnessed the profound devastation of the Grizzly Creek wildfire; a currently active (at the time of posting) wildfire that has now been regarded as the worst in Colorado’s history.
It will take over 200 years before the trees here will grow back.
Then by 2:45pm we had come across a boulder that had fallen onto the tracks, damaging them. Our train thus backed up into Glenwood Springs where we disembarked for a few hours as the maintenance teams arrived to remove the boulder and repair the track.
Not a bad town to get stuck in for a few hours:
It was at this point our train conductor Brad, walked up to me and asked if our group really did bring a guitar (Evie brought her ukelele!). When I answered in the affirmative, Brad became excited about the prospect of an physically distanced jam session outside the station as we waited for the tracks to be repaired.
Within minutes he was on his phone giving his credit card information to buy a $498.99 Ibanez guitar at a local music shop in Glenwood Springs, after which Evie and a new friend we made on the train, Crosby, took an Uber to retrieve it.
When they returned, the next 2 hours was all magic (remember what I wrote about COVID not spreading well outdoors, as well as the fact the all Amtrak staff and our group have all tested negative before going on this trip)
The impromptu concert then continued inside after we were back on our way at 5pm, and it made all the feels as the sun was setting outside:
Day 3:
“I felt like lying down by the side of the trail and remembering it all.”
The next morning we woke up an entire day of this as we traversed across Nebraska and Iowa:
Endless cornfields as we finally took this pause to reflect on an adventure still unfolding.
As the sun began to set on our final night of the trip, we begin to receive and give one another feedback on how to do better on future trips. This is after all, our first monsoon since the pandemic began and there was no way any of us would be able to execute anything perfectly the first time — let alone during a pandemic.
In fact, we’re grateful to know that as things could have been much much worse leading a travel group across the country twice during these uncertain times, we knew we would and could always make the best of it. Although at the time of positing I’m currently unsure how much I can convey without the consent of others onboard the train, let’s just say when the right humans collide in the right way, that is everything.
We then say goodbye to our new friends:
…and rush over with 20 minutes on the clock to catch our 9:30pm Lake Shore 48 train from Chicago to NYC.
The train is newer than the California Zephyr, and hence the roomettes are a little spruced up:
Unlike the roomettes on the Zephyr, each roomette has its own toilet and sink:
But it didn’t matter as our onboard wagonmaster was able to score us a proper full sized bedroom since nobody else was on our train:
Unlike the roomette with the toilet, the bedroom also has a shower:
Although there’s no observation car with ceiling windows on the Lake Shore, it makes up for it with a larger, swankier lounge car:
But in order to get food during off hours, the snack bar is 5 train cars away:
And despite 3 days of trying, we finally make time for movie night with one of my favorite travel films:
Day 4:
“I realized these were all the snapshots which our children would look at someday with wonder, thinking their parents had lived smooth, well-ordered lives and got up in the morning to walk proudly on the sidewalks of life, never dreaming the raggedy madness and riot of our actual lives, our actual night, the hell of it, the senseless emptiness.”
Our final day on the roads across America. Once we woke up after our late night movie night, this was our office for the rest of our train ride:
And unlike previous trip endings, where there would always be the next “cab” and “flight to catch” that would rush our goodbyes, this first purely overland monsoon on RVs, vans, and trains would now have us instead waiting for our goodbye; the ending came to us.
The slow farewell thus left us a lot of time to reflect on not only the past 3 weeks of traveling together but also the preceding 5-6 months of lockdown that prevented us from even leaving our homes. And from that juxtaposition I can’t describe the feeling any better than Mihaela (who’s been on 10 of these monsoons with me now) when she writes: “This trip doesn’t feel real . . . like it was a long dream.
I felt like we were in an alternate dimension; one where the pandemic is real but also distant — we traveled within the confines of the pandemic yet there were so many moments of what felt like freedom or some type of liberation from the confines of the virus even though the type of travel was because of the virus. I feel like the closest thing I could relate to is it felt like I was in a comic book and we would sometimes break the 4th wall.
And now I’m crying again.” – Mihaela
You’re not alone.
Once we arrived at Penn Station at 6:30pm, we were received by none other than our vlogger Noeleen (from the first part of the trip!) and then our videographer Raubern (also from the first part!) at the very spot where we had our orientation 22 days ago:
August 7, 2020
Oh how time flies:
We stayed out until midnight, just because saying goodbye will always be just too difficult.
Phase 2 of our reopening has begun, and with our infection rates continuing to decline here in NYC, the irony is not lost on me that profound changes happened to us even when we were trapped in stasis.
During the past 3 months since March 20th — the country’s longest — I didn’t lament just the loss of discrete “things” such as work, hangouts or trips, I also mourned the promise of “missed connections,” “lost opportunities,” “the ones that got away,” and “what could have been.” That’s why quarantines, as necessary as they may be to save lives in the interest of public health, is harder than we give ourselves credit for.
I have thus reframed my own lockdown and pandemic experience as not only an odyssey of trauma and uncertainty with no end in sight, but also a pilgrimage I have embarked on with countless others of my generation — a different type of journey where in lieu of visiting other countries, we instead steered inwards and towards a different kind of foreign territory of self-growth. And thus I have been recovering from my grief through reclaiming a personal agency as I have had for any loss: I must come out of this stronger.
Therefore privileged to have been spared from death during this pandemic so far, I have instead uncovered unexpected opportunities to become even more resilient — Can we garner more freedom from fear, no longer postpone life and experiences long overdue, be a little less fragile over a simple piece of facecloth, nurture greater empathy for what others have been enduring, and discover avenues to work together for a better society amidst perennial pandemics of disease, iniquity, and injustice?
If we can reexamine challenges that come with a lockdown instead as part of a meditative transformative experience to become better individuals, then we no longer have to mourn “what could have been” —
We would instead have become “what could have been.”
- At time of posting in NYC, it was 29 °C -
Humidity: 36% | Wind Speed: 19km/hr | Cloud Cover: partly cloudy
“Ships are safe in the harbor, but that’s not what ships are built for.”
After 78 days of a lockdown and 100 days since our first confirmed case of COVID-19, NYC begins Phase 1 of reopening today. What felt like a COVID tornado outside our harbor in April has gone and instead a sun seems to be shining in its place in June. Whatever we’ve been doing is working.
Furthermore even amidst a lockdown, 6 weeks have passed since I saw hundreds of picnickers casually gathered en masse in all the parks outside without face coverings in multiple neighborhoods, and 2 weeks since our first protest for #BlackLivesMatter (where nearly everyone wore face coverings and stayed mobile). And if we know that 98% of patients develop symptoms within 11 days of exposure (w/ median time of incubation — or time from exposure to symptoms — being 5 days), there still remains no evidence of a 2nd wave. This correlates with the studies from Wuhan that suggest that if we confine COVID only to the outdoors (air flow dispersing viral spread) or homes (nobody new to infect), and deny it opportunities that a lockdown would bar anyway (eg. public indoor spaces with no air flow that COVID would love to spread in), a virus has nowhere else to go. So whether it’s outdoor picnickers or protestors, whatever we’ve been doing is working.
Nevertheless with a Phase I reopening the threat of a COVID tornado may still be around the corner — whether the 2nd wave returns with a pent up demand for indoor public spaces or the notorious annual flu season. But I’ll carry on as I always have been: watch the numbers, work my ERs, take more steps outside that fit within my personal risk tolerance based on those numbers and ER shifts, and be ready to run back towards any tornado when it returns. But evidence is evidence, and right now it’s telling me that actions that would not have been wise amidst tornados in April may now be okay in a sunny day in June (caveat — this is based on NYC data only and may not apply to where you are?).
Either way with our harbors clear, you can feel a little safer choosing your next move: Just know whatever we’ve been doing is working.
- At time of posting in NYC, it was 22 °C -
Humidity: 55% | Wind Speed: 6km/hr | Cloud Cover: clear
About 9 weeks ago I had written how in the middle of the tsunami of the first wave, the safest assumption (with the relative little information we had) at the time was that one should come to the ER only if they had a life and limb threatening emergency and to minimize any unnecessary exposure to, or spread of, COVID-19 for the sake of saving as many lives as possible. The goal was to keep everyone who was otherwise healthy or could improve on their own, out of what was the equivalent of being drowned unnecessarily in flooded buildings filled with sick patients.
Now that the floods have subsided and patient volumes continue to decrease across ERs in NYC (thanks to you and our communities working together!), I have time now to ruminate over what exactly just happened in the past 2 months: the overwhelming number of patients, rampant cross-contamination, fear for personal safety, afflicted friends,hyper-coagulation, cytokine storms,sudden deaths, and burying my grandfather.
They are now giving one of my nightmares a name: Silent Hypoxia. To this day I can still see it all too clearly — Patients that appear well one minute, suddenly collapsing into respiratory failure and cardiac arrest in the next. Simply put: patients who seemed to get better but then died. Patients like my grandfather.
Therefore during our temporary ceasefire we should not only prepare ourselves for a possible next surge, let alone an even more challenging flu season under the shadow of COVID-19, but also switch gears in making sure we don’t present too late to the ER: Instead of acquiescing to a new harbinger of inevitable sudden death, how do we now prevent it?
When circumstances begin to change, so must our dance: Sometimes we need to freestyle, sometimes we need to tango.
If You Are to Ever Contract or Are High Risk for COVID-19:
If you or anyone you know will ever be diagnosed with COVID-19 but still feel well enough to stay home (as to not spread the virus to others), I suggest to become more aggressive with the following:
1) Engage in safe physical activity (such walking around the house, proning yourself on your stomach) to help prevent possible clot formation and help you breathe better.
2) Coordinate closely with a primary care doctor via TeleHealth/Skype/Zoom/FaceTime (messaging another doctor via casual social media like myself DOES NOT COUNT).
3) Monitor symptoms with a verified pulse oximeter (“pulse ox”) device, whether mailed over by an online purchase, the primary doctor, a local healthcare facility, and even some ERs (For the record, smart phone apps are not as good as they measure only one waveform, not multiple, and thus may add another unnecessary risk).
You can then check your oxygen levels by placing the pulse ox preferably on the middle or index finger of your dominant hand. If you have COVID-19 and your fingers do not have any known circulation problems, are not cold, not sporting nail polish, and the device shows a legit SpO2% value less than 88-92% (the exact threshold depends on your history and the doctor you chose to coordinate with) consistently for more than 5 minutes, call your doctor. You may have to go to the ER immediately for supplemental oxygen to prevent silent hypoxia from manifesting.
Therefore, in tackling BOTH the challenges in avoiding the virus’ contagiousness and yet also preventing the newly observed phenomenon of silent hypoxia, our tango demands that we neither act too early nor too late.
If You Don’t Have COVID-19: When Can We Go Out/Travel Again?
IF YOU ARE WELL / STILL DO NOT have COVID-19 or symptoms: I suggest that you not worry about silent hypoxia just yet. Instead, it may be more productive to fortify your baseline mental health and take control of your life again.
Watch the numbers in your area when things start opening up — if they stay consistently low after 2-3 weeks (the average incubation time it takes from exposure to symptoms), then that could be your cue to take the next step towards restarting your life depending on your risk tolerance and personal circumstances. And if you do decide to take a step outside, continue to proceed with caution: Maintain elevated hygiene standards (wash your hands with soap & water, cover your mouth, etc.), be aware of touching others, keep clear of crowds, and avoid small tightly packed interiors with minimal air flow. In other words: always look out for the safety of yourself and others.
But if numbers spike up after 2-3 weeks, then you know we’re not yet in the clear, that the virus does not care about the weather, and you had a 2-3 week head start with staying inside and safe from exposure.
If You Never Ever Had Symptoms or COVID-19: The Antibodies Test
If you are NOT a frontline health care worker and NEVER ever had symptoms, risking going outside during a pandemic for an antibodies test to determine if you ever were exposed to the virus may be less useful for you personally than it would be for local public health efforts to track and control the spread of COVID-19 in your area.
I leave such a decision up to you, your ethics, and your risk tolerance.
(To clarify: the PCR nasal swab is for presently active infections only, while the blood draw for antibodies are ideally done 2-3 weeks after a highly suspected or known infection occurs and/or resolves)
Perspectives
This all might seem like a lot of moving parts, but remember (especially with new disease processes) medicine is more of an art than science. Our knowledge of this virus is ever evolving, and everyone’s specific care may differ depending on genetics, access, resources, housing, and risk tolerance. And yet whatever your circumstances are, cherish the autonomy you still have to choose what the best care is for you: The people who survive the apocalypse are not the smartest or the strongest, but the most adaptable. And therefore we must all adapt both individually and collectively to the perennially changing circumstances expected from a worldwide pandemic.
If we do this right we can ensure our ERs still can care for the right patients, encourage people who do need the ER won’t be too scared to come, soften the impact of the next surge, decrease the chances for a next wave, and be better able to handle the next flu season.
Thank you Diana Klatt (of Global Caveat), Dr. Sharon Li, Mel Jeng, and Dr. Linus Sun for feedback, suggestions, and addressing some blind spots to make this PSA possible.
Stepped outside in the middle of my ER shift on Monday, April 13th to take a moment to myself when a passerby with a camera happened to be at the right place at the right time:
I needed to breathe. I needed to know if I was still alive.
A few weeks later and through several degrees of mutual friends, serendipity would have Kareem find me again and send me this photo; a moment which barely encapsulates 8 weeks of COVID-19 related care since my first case in March 8th in Brooklyn.
Since then and within 50 days I’ve worked 35 shifts (all 10-12 hours long) across numerous ERs in mostly The Bronx, Queens, and Brooklyn (and a few in Manhattan), added 3 new ERs to my roster, met so many supporters, while also losing colleagues, friends, and my grandfather to COVID-19.
As patient volumes are now decreasing and I have much fewer shifts needing to be filled, I take pause to reflect on the souls and the innocence we’ve lost. And as bury our dead, tend to the injured, and process all the emotions we had held off during the first surge, we also brace ourselves for the possible next wave.
But alas even if there would be no next wave, life is life, and there always will be “a next wave.” Whether it’s more COVID-19 patients, the patients that waited too long for care, the rising mental health toll, the livelihoods lost, the next pandemic, or the next disaster, those of us remaining will keep holding the line so we can all see to another tomorrow.
Until then, channel gratitude for the precious opportunities you still have and don’t forget to take a moment to yourselves right now. Don’t forget to breathe. Don’t forget to live: All you got is right now. This world doesn’t wait for anyone.
