‘This Is Not the Flu’: What Doctors Say About Their Fight Against Coronavirus

She’s the head of an emergency department at NewYork-Presbyterian, a huge hospital at the center of the coronavirus pandemic. She’s talking to a close colleague and friend who is a veteran emergency room doctor.

Dr. Lorna Breen, head of the emergency department at NewYork-Presbyterian’s Allen campus in Upper Manhattan, killed herself the previous night. It’s a Monday morning in late April. Many department chiefs know it was a suicide, but aren’t permitted to say — the family’s told the hospital it doesn’t want that information released. Both know that their friend Lorna had Covid-19 and recovered about a week ago.

He says this with a slightest uptick of question on the last word. She looks down.

A long pause. She sighs. Then he sighs. And they both begin to cry.

Take a break from this bracing, terrifying, deeply unsettling moment of change and challenge to think like a historian. Which “eyes” from this clearly consequential time will scholars seek; whose perspective — built, as perspectives are, from truths ranging from the widely known and broadly experienced to the personally felt — will be most instructive for history’s record?

A safe bet: doctors and nurses treating Covid-19.

They are, of course, like everyone: wives and husbands, parents and children; many are immigrants. They worry about what’s ahead, and their loved ones, and — with much more intensity than the rest of us — whether they’ll be infected, infect others, or will die.

They also are the first expert eyes to really see this nasty, clever virus up close, and feel its strength in hand-to-hand combat. They fight with it each day in front of frightened patients who are praying for victory and who, if conscious, try to detect how the battle is proceeding through subtle tonalities in what the doctors say, because what they tell a patient is not always all that they know or feel.

That’s what they reveal to the work friend, that trusted soundboard at a shift change, when they exhale and share a moment with the colleague about your condition, your prospects, the situation at hand. That’s also where you’d get a good glimpse of a single life’s fortunes from those who, at this moment, most poignantly experience the interplay between our greatly-altered daily rhythms and a virus that so savagely fells its victims. Someday, a historian will kill for that.

And right now — in a country all but crying out for contextualized truths to help everyone live their lives — hearing those private conversations would come in mighty handy.

But they are devilishly difficult to capture. When people talk to journalists or to someone, like a boss, for whom expression carries consequences — or to virtually anyone on the post-and-present digital landscape — their words take on a performative and transactional quality, where audience matters, as does reaction and effect. It’s not the way we talk to close friends. That’s our real voice, the authentic one, which rests on familiarity and trust.

So I took a digital platform I’d built for autistic people like my son to engage with their friends, a conversation catcher of sorts, to enter that special zone of intimacy — a technology that needs to be operated with particular care as to privacy and disclosure. Then my team and I brought aboard 40 doctors in the thick of the struggle: 20 from NewYork-Presbyterian and 20 from Massachusetts General Hospital in Boston, both of which have been enduring a battle with the disease that other cities are likely to face.

In late March, each doctor found a trusted colleague and paired off for regular encounters on the platform, called BongoMedia, where they sit, usually at home — their faces side-by-side, like on Zoom — for a 10-minute session guided by preloaded questions that pop up on the screen every few minutes: How are You Feeling? What Do You Fear? What Are Your Hopes?

The questions are meant to start conversations, to help the doctors think and feel and explore together, the way friends do. The Bongo pairs get into just about everything — clinical, emotional, experiential, philosophical and powerfully predictive — in videos that are captured, but not released. To preserve privacy for those made public, we anonymized videos by morphing audio and masking faces, wrapping in only the context needed to understand what’s being said. Next stop, the nurses.

What has unfolded in a hundred sessions with doctors thus far — many lasting more than 10 minutes — is the gyrating crisis mapped to the day. As each city hits its peak, as bodies pile up in New York while Boston prepares for bigger blows, doctors are stunned by how quickly, and mysteriously, the virus kills. They are troubled by the way the elderly and poor fill their emergency rooms, guilt-ridden for feeling relief at not being in otherwise high-risk categories and fearful about how the past weeks have shaken them.

As the country reopens for the summer, with cases plateauing in some states, rising precipitously in others, what these doctors are facing, what they’re learning and how they’re reacting are leading indicators of where we’re heading. Hear them talk to close friends, and you get a sound diagnosis of America’s condition, its prospects and risks and underlying strength.

Two New York-Presbyterian doctors, Kelly Griffin and Lindsay Lief, each with over a decade in the free-fire zone of a big city emergency room, talked on a morning in late April about their harrowing nights and days. The two doctors — the only pair to have their identities made public here — traded reports; one, still in her pajamas, of the previous day’s bruising shift; the other, coming off a long night that “was terrible.”

At this moment, health care workers are like an army in conflict, where everyone in uniform is a medic. In cities where Covid-19 has struck hardest, they’re battered, suffering from acute stress, exhaustion, trauma. And they’re buckling, even with the overall patient volume down in some cities, like New York and Boston.

“Hospitals lost so many of their doctors and nurses in Wuhan and Italy — up to 15 or 20 percent from sickness, burnout and PTSD — and we’re not going to let that happen to us; we just can’t,” said Dr. Steve Corwin, the president of NewYork-Presbyterian. “This will be a long struggle for us, and they’re all we have. Their skills and experience, their knowledge of Covid – you can’t just replace it. For the hospital chiefs, the policymakers, the country at large, this is our fight. Figuring out, and fully funding, all the ways we can support the people who are risking their lives each day to save ours. It’s a business issue. It’s a moral issue.”

Like Dr. Corwin, Dr. Peter Slavin, president of Massachusetts General, is struggling with the day-to-day management of a battle where, he says, “we can’t see the frontlines of the struggle, or hear what they’re saying in the bunker.” Dr. Slavin and Dr. Corwin will both get analytics on what’s in the sessions and can see anonymized videos to learn, as Dr. Slavin says, “what they’d never say if they were talking to the boss — that’s what we most need to hear.”

Not only how they’re feeling, and coping, but what they’re seeing with the clearest eyes.

As Massachusetts General scrambled to rearrange itself to focus on Covid, one doctor noticed how all the “normal diseases” were disappearing.

This would be the non-Covid wave of illnesses that hospitals are beginning to see.

Around the same time, a doctor from New York echoed a similar concern, but from a different angle: that of domestic violence rates rising as more people were stuck at home and were unable to seek help.

These concerns — now starting to be part of the wider national conversation — were on our doctors’ minds two months ago.

These are what you notice when treating a huge procession of patients. But here’s the catch: the ones who are the first to spot patterns are also those who are first to experience trauma, from facing endless flows of misery about which they can do little.

“The problem with this disaster is its progressive quality,” said Dr. Lloyd Sederer, who as a senior mental health official for New York City oversaw the FEMA-funded effort to deal with trauma among health care and emergency workers and the wider population after Sept. 11.

“With the coronavirus, there will be no return to normal: The virus will just keep rolling along, striking blows to the population and to the confidence of doctors — a confidence in their ability to help and save,” he said. “That’s the core of their identity, and it’s been shaken. They don’t feel like themselves. There’s no horizon, no clear end to this.”

This puts doctors in an uneasy position. Many can’t sleep, wondering whether they’ve infected loved ones. Or they live away from their families. In the sessions, they curse at Covid-19, calling it a “beast,” living invisibly among us and spreading fast, as they await the first signs of the next surge coming — yes, they’ll see it first — and wonder what they’ll do then.

As one young New York doctor succinctly put it: “I’m just going to get in my car and drive the other direction.”

Though there has been much made of “flattening the curve” since we began collecting the sessions in March, doctors seem no less inundated with patients. In our quantitative analysis we found that one of the most common words used by doctors in both New York and Boston was “still”:

For these doctors, the arrival of critically ill patients seems more like ebbs and flows of a fairly steady tide — some days tolerable, others unbearable.

This creates an ever-bigger gap between what the doctors see and what’s widely believed, and felt, in public. Whatever’s happening at the White House’s daily briefings, the doctors and nurses get more than they can reasonably handle. A week before Dr. Breen died in late April, the two women with years of experience in the critical care department, Dr. Griffin and Dr. Lief, talked about this discrepancy:

Dr. Lief says people — really smart people — ask her: “It’s like the flu, right?”

“This is not the flu” is a mantra heard throughout the tapes, which rarely get political, but often carry base notes of incredulity and resentment about denial and misinformation coming from many directions — and the well-known failures of America’s government, economy and health care system. All of that is putting this small class of workers, upon whom so many lives depend, under untenable pressure.

Pressure that continues with a steady stream of patients even after the economy-crushing quarantine slowed the virus’s transmission and “flattened the curve” — basically stretching it out, to avoid the hospitals being flooded with patients. It largely worked in Boston, which avoided Italy-like crises, and partly in New York, where doctors in mid-April sessions talked about patients “seven deep in the hallways.” And it’s natural for the public to want to feel hopeful about the value of its costly sacrifice.

But, as Dr. Lief and Dr. Griffin say, the social distancing was largely an instrument of delay, so the growth of the virus would drop to match the hospital’s capacity in handling patients. Unless there’s testing at many times the current rate, along with contact tracing, the “disease itself,” as Dr. Griffin exclaimed, will continue its rampage, largely invisible and untreatable.

And hitting some Americans much harder than others.

Massachusetts General typically has mostly white patients. But during the pandemic the majority of its patients have been minorities, particularly Latinos, most of whom live in Chelsea, a Boston suburb. One younger doctor goes on at length in mid-April in a conversation with a female doctor about his difficulties in working with Spanish-language patients. When he sees scared patients, not only is he unable to give them a comforting touch, he also can’t directly talk to them. Translators help, but it’s not the same.

Dr. Sederer, the psychiatrist, said, “It seems like all the weight of society’s problems are coming down on them. Whatever the causes, these doctors and nurses will be feeling the hard effects, and dealing with them every day in ways that make them feel like something less than they trained to be.”

It’s what those who deal with PTSD in veterans call “moral injury”: when soldiers are involved in something, or just witness something, that violates their moral code, that seems an injustice. It haunts them.

“This is a bad combination of forces,” Dr. Sederer said, “and it’s not a one and done. It’s a persistent state.”

To the platform’s posted question, “What Are Your Hopes,” a doctor from Boston in the first days of April tells a colleague what she hopes to avoid. She says she hopes the experience won’t hinder her as a doctor and that the trauma doesn’t scar her forever.

“I’m afraid for all of our friends in our unit,” she says. “We’re seeing a lot, we’re seeing things that we were never prepared to see, that we never thought we would see, that are completely unfathomable.”

A response to the unfathomable, to that which overwhelms, is to step away, to compartmentalize and establish some distance, in whatever way possible. It’s a survival strategy that informs the sessions between two young NewYork-Presbyterian surgery residents, a woman and a man going through their trial by fire in the middle of April, right before New York’s peak.

There’s something discomfiting about their conversations, with their smooth, affably ironic tint of the late-20s, early-30s demographic. The residents begin their conversation shooting finger-guns at each other.

They veer into a matter-of-fact description of the horrors they’ve faced over the last few weeks. She talks about a man in his late 80s with a litany of preconditions that she encountered along with an I.C.U. fellow a few days before. The man’s condition was critical. There’s not much hope for him.

Even on seemingly easier days, it’s still difficult for hospital workers to care for patients in a way that honors their humanity. Patients are often left at the hospital’s front door and end up in a room alone, without the family members with whom the doctor usually talks to learn about the patient, and unable to talk to loved ones about their medical condition, treatment and choices.

All that many Covid patients see of the doctor or nurse, often standing outside the doorway, is their eyes above the mask, maybe the last eyes they’ll meet before the end. If everyone strives for a “good death” — in a caring place, with the finest doctors and family at their bedside — this would define the opposite.

The young male resident returns from his shift a week later, when things seem to be looking up — he says that this was the first week where hospitalizations were down. Meanwhile, his Bongo partner has been working triage for the past couple of days, a shift that, though done from home on a laptop, involves making real-life decisions about where patients go.

And therein lies the struggle – for doctors and nurses to find their humanity, and a measure of hope, in a pandemic that conspires against both. In the moments they can, it feels like a return home.

“I hope that we can come out of this saying that we did right by our patients and right by each other, you know, with whatever cards we’re dealt,” says a young doctor at Massachusetts General on April 3, watching New York’s body count rise and looking with dread at what may be in store for Boston. “It’s an odd mixture of feeling at the same time in the media, and in the story that I tell myself in my head, that we are heroes here and I’m charging into battle. And at the same time, kind of like, like soldiers who charge into battle, you’re also very small.”

“The things that will matter,” the doctor continues, “are not, you know, the big decisions, as much as the small ones. If we’re able to take a moment to be there for colleagues that are struggling; when we’re not able to offer some intensive care or ventilator, that we take a moment to feel that pain with people. People who we’re caring for. Those small acts of humanity, I hope we can hold on to them.”

A month later, in early May, two doctors in New York — both women in their mid-30s, good friends who more often than not bring a glass of wine to their sessions — talked about the well-worn difficulties of each day, then about music.

A little over a week later, one of them says:

This is the world they live in now — overwhelmed, but not unmanageably so. The future remains perilously uncertain. But they’re learning, day by day, to cope.

As our Bongo sessions stretched into June, the Massachusetts General doctors who’d previously talked about class and racial divides brought up the “rivers of humans" protesting police violence each night. They’re worried about the Covid cases that are still spiking in parts of the country.

“I’m seeing all these rallies in the streets,” the doctor tells his colleague. “And I'm like, 'This is literally the opposite of what we have been telling everybody to do for the last three months: Stay home, stay far apart.’ I hope these people are not sick, and I hope the ones who are sick are sitting at home, rallying from their computers."

They both agree, as he says, that the demonstrations are “super-important and unprecedented.” And yet, “the coronavirus is hitting the people who are in the least-privileged areas of the country,” the colleague says. “And now it's not really getting much attention. Again, there's this weird class divide in the way things are sort of treated.”

They both pause, put their heads in their hands, and say the same thing. “I don’t know. I don’t know.”

Doctors, professionally focused on the well-being of patients — and generally wearing what Dr. Corwin of NewYork-Presbyterian calls the “I’m fine, no problems here” mask — are now reckoning with their indisputable status as an at-risk population.

In one session, a doctor flips the mask metaphor to the airlines, as in, “Put on your own mask before you help the person next to you.” More and more, they’re dealing with issues of self-care. Many are meditating — a practice both hospitals are pushing hard — and seeking ways, often quite creatively, to keep whole by turning that healing gaze on themselves.

One of the New York doctors, who deftly weaves lines of Shakespeare into his sessions, spoke of finding an old fir tree on his daily walks, “hugging it, and looking up and sort of drawing this strength from this tree that’s probably 125 years old, that’s seen lots of storms, and saying, ‘You know what? I’m going to absorb that into my chest.’ It sounds hokey, but whatever floats your boat.”

That’s his response to the challenge of dealing each morning with profoundly disruptive change, of finding some footing and stepping into a world that mocks our most natural desires for stability and certainty, and of preserving that which we’ve come to know and love.

Hours after he received news of Dr. Breen’s death, another doctor, one of her colleagues, has a conversation with a friend.

You can hear him willing himself to feel what he’s describing. He’s planning to see the hospital chaplain in the I.C.U.

Two minutes later, he logs off from the session. His friend sends him an air-kiss. He waves back. The screen freezes for a split-second. Then, both of them are gone.