Book World: Fresh out of med school, they volunteered to fight COVID pandemic

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Life on the Line: Young Doctors Come of Age in a Pandemic

By Emma Goldberg

Harper. 295 pp. $27.99

As the coronavirus overwhelmed hospitals in New York last spring, some medical schools offered their final-year students an unusual option: They could graduate early to begin working as physicians on the front line of the pandemic. In her new book, “Life on the Line: Young Doctors Come of Age in a Pandemic,” Emma Goldberg takes us into the lives of six students who, despite their fears of contracting the novel virus (and in some cases, despite the pleas of their parents), felt themselves called for duty.

These students from New York University, Mount Sinai and Albert Einstein had already completed all the core requirements of medical school. Had the pandemic not disrupted social rituals, they would have spent the spring celebrating their residency matches and graduations, surrounded by friends and family. Instead, they chose to face the many challenges of being Day One doctors (even a simple Tylenol order prompts an anxious triple-check) amid a pandemic that was overwhelming their senior colleagues, killing hundreds of New Yorkers daily and isolating millions more.

In the opening pages we meet Sam, a gay NYU medical student who has been steeped in the history of the AIDS epidemic and how it ravaged queer communities. Sam joins the covid wards at Bellevue Hospital -which once cared for more patients with AIDS than any other hospital – with a sense of historic purpose.

As I read about Sam’s entry into Bellevue, I could feel myself standing in the eerily quiet, glass-encased lobby of that hospital. When the pandemic began, I was an internal-medicine resident at Bellevue. Like many health-care workers on the front lines of this crisis, the trauma of the spring surge – goodbyes over FaceTime, beds crammed into makeshift ICUs, endless alerts called overhead – has left me with scars. It has been hard to revisit that time in my mind without my heart racing and stomach clenching. I worried that reading this book would reopen those wounds.

But remarkably, with her sensitive reporting and deeply human portrayals of Sam, Gabriela, Iris, Elana, Ben and Jay, Goldberg has created a work that not just documents a significant moment in time but helps us heal from it, too. For anyone seeking to understand, or remember, what New York and its hospitals were like in the spring of 2020, “Life on the Line” is essential reading.

News stories from New York’s covid spring emphasized the medical interventions of intensive care: intubation, dialysis, CPR. The new doctors’ entry into the hospitals is steeped in war metaphors. The vice dean for academic affairs at NYU tells them they are joining the Covid Army. At Montefiore Hospital, they are dubbed the Coalition Forces. Like new military recruits, they don layers of protective gear, put their bodies at risk and witness a horrifying number of casualties.

But the stories in “Life on the Line” offer a refreshingly different view of the pandemic than those eye-catching headlines and talk of war. Given their inexperience and their institutions’ appropriate commitments to minimize their exposure to the virus, the interns are largely removed from the adrenaline-pumping action. In one scene, Sam literally has a patient’s door closed in front of him. Inside the room, the resident physicians perform CPR, trying to resuscitate the patient, whose heart has stopped. Sam stands at a mobile computer in the hallway, placing orders. His is a necessary job, but as Goldberg puts it, if this were a TV medical drama, Sam would be an extra.

The interns’ distance from life-or-death emergencies allows different, yet vitally important, aspects of pandemic health care to shine through. Iris cares for a man who survived the covid ICU but still breathes through a tube in the front of his neck and is barely conscious. Not sure how to act around him, she makes a point of cheerily introducing herself to him. After days without him ever seeming to register her presence, when she tells him that his family loves him, she sees a tear fall from his eye.

In one of the most moving passages of the book, we meet Manny, a 38-year-old man with Down syndrome and severe anxiety whom Jay is caring for. Manny initially came to the hospital because his father, his sole family member, was sick with covid. Manny had no one else to care for him, and so the hospital staff allowed him to live in the hospital while his father was admitted. When his father tragically dies of the virus, Manny has nowhere to go, so he is admitted to the hospital as a patient until Alicia, the social worker, can find him a safe home. Jay wholeheartedly devotes herself to Manny’s care, even accompanying him on a visit to a group home.

Goldberg skillfully places the hospital scenes in the larger context of American medicine and medical education. She is spot on in describing American medicine’s “devotion to elitism masked by meritocracy” and delineates how structural racism is embedded in medicine’s history. For example, while the 1910 Flexner report – which recommended, among other things, scientific standards and fewer medical schools – is typically celebrated as the spark that launched American medical education into greatness, Goldberg examines how after the Flexner reforms, only two of seven Black medical colleges remained open.

The students Goldberg profiles are not just brave in the face of the coronavirus but determined to imbue their work in medicine with a commitment to racial and economic justice, to care for those on the margins, and to truly partner with their patients. After such a challenging 16 months, their stories reminded me why I went into medicine. Feelings of guilt among those of us celebrated as “health-care heroes” are widespread. With such staggering death tolls, it’s sometimes hard for me to feel that what I did made any difference. The stories in “Life on the Line” reminded me that the little things – holding a patient’s hand, calling loved ones on FaceTime, finding out if someone was feeding the cats at home – were in many cases the things that mattered most. The fresh medical graduates to whom Goldberg introduces us give me deep hope for the future of medicine as we begin to heal from this devastating crisis.

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Colleen M. Farrell is a fellow in pulmonary and critical care in New York.