Have you ever done something so many times, you sort of forget why you started doing it in the first place?

Perhaps there was a time it brought you joy, but now it’s just a routine. Muscle memory.

My mind is far away as I walk the path to the hospital entrance. 1/
The experience of each COVID surge in a city hospital in South Texas has been the same, and yet distinctly different.

The first surge felt disorienting, frightening.

The second surge felt the same, and also tragically unnecessary.

This third surge… 2/
I round in one of several COVID ICU units.

These units were hastily created in the very beginning of the pandemic, then shut down as cases waned, then reopened again.

It’s soothingly quiet. Hisses of pressurized air, distant beeps.

Patients tethered to life support. 3/
Time passes differently in a COVID unit.

Maybe it’s because of how sick the patients are. Maybe it’s because of how tenuous every moment can be, and also how strangely static.

Minutes feel like hours.

I get to leave, but the nurses and patients are here, every moment. 4/
This place used to strike fear into the heart of me. Fear and sorrow, and pity, and longing to help.

A nurse sits outside one of the rooms, looking down at the tattoo on the inside of her forearm.

I know what she is holding on to.

We all hold on to something.

Or drown. 5/
The ICU no longer inspires fear. It no longer makes me feel sorry, or pity, or longing.

I feel… anger. Numbness laced with raging fury.

I hate this place. I hate the tragedy of it. I hate the needless loss.

The elevator ride here is a descent into hell, every time. 6/
I used to wish I could show this place to skeptics, to bring home the reality of this virus, the dangers of this pandemic.

Now I know that even as they’re being intubated, people choose their own realities.

Before COVID ever got here, we were infected with something else. 7/
The mood, the atmosphere, in the hospital has distinctly shifted.

There is an undercurrent of simmering anger, occasionally bubbling over.

“You think I want to be here? Taking care of so many people dying. You think if there was a goddamn cure out there I wouldn’t use it?” 8/
The intensivist is a kind and caring human being.

Watching the pandemic take its toll on her has been very difficult.

She is my friend.

“I’m just so tired of people attacking me while I’m putting everything I have in me to help their loved ones.”

I listen to her speak. 9/
“I’m a scientist. I can’t help it. I practice medicine based on the science, as I was trained to. People ask me what I believe in, I believe in science damn it.”

Her voice cracks for a moment, and her eyes redden.

She takes a deep breath and her shoulders sag, defeated. 10/
I listen to her, and I understand.

She isn’t alone in feeling this way.

A deep and widespread cynicism is rippling through even the most idealistic among us.

Many are leaving.

A skilled hospitalist I know is moving to an outpatient only practice.

“Enough, man, enough.” 11/
He’s a brilliant clinician and has taken care of many complex patients with me over the years.

To lose his skills in the hospital is a real loss.

I sit with him in the lounge. He takes a long drink from his water bottle, then exhales deeply.

“I’m done.”

He’s only 41. 12/
Later in the day, I run into one of the chaplains.

He is a kind man.

We don’t share the same beliefs, but we believe in the same things.

I ask him how he’s doing. He says the days are long and difficult. More difficult than he’s ever seen them.

His gaze is distant. 13/
“You know Dr. T, let me tell you a story... A Buddhist monk was once asked why he meditated for so long every day. His answer was: so he could see the tiny flowers that grew alongside the road to the temple.”

I smile, “So you’re telling me to notice the flowers?” 14/
He smiles in return, “No. I’m just saying make some space in your heart to notice them, if you wanted to.”

I nod, mulling over his words.

Make space in my heart.

I thought my heart was empty. What’s my heart already filled with?

I thank him for the talk.

“Anytime.” 15/
I’m back in the ICU talking to a family member on the phone.

“Why can’t you just give more plasma? I heard the … the plasma cures it.”

I give my standard responses, my mind and my heart on autopilot.

They have one more question for me.

“Tell me doc, are you a believer?” 16/
Am I a believer?

I think they mean religion. Or perhaps they mean belief in some treatment or the other.

What do I believe in?

I thought I believed in people, in humanity, in each other. In kindness. In science.

I am silent. 17/
Have you ever done something so many times, you sort of forget why you started doing it in the first place?

Perhaps there was a time it brought you joy…

As I walk up the path to the hospital entrance, I notice a small cluster of wildflowers growing through cracks in the road.

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2 Sep
The longer I practice medicine, the more I feel that time is circular as well as linear.

We see orbits within orbits, everywhere we look.

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The past is never far. 1/
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I have a free weekend.

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Open road, past small Texas Hill Country towns. 1/
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They’ve been married for forty-five years, and reached the point in their relationship where most of the communication happens wordlessly.

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Carl and Annie have lived in the same house, in the same small town, their whole lives.

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I visualize it.

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“Sometimes I wish I wouldn’t cry.”

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I say nothing, and she continues.

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I remember it was a Thursday, because I wanted so badly to have the coming weekend off. To have at least that to look forward to.

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