Gabrielle Dawn Luna sees her father in every patient she treats.
As an emergency room nurse at the same hospital where her father was dying in Covid last March, Luna knows firsthand what it is like for a family to cling to each new piece of information. She became extremely aware of the need to spend extra time explaining developments to a patient’s relatives, who are often desperate for updates.
And Ms. Luna is willing to share her personal loss if that helps, as she recently did with a patient whose husband died. But she also learned to contain it in order to respect each person’s distinct grief, as she did when a colleague’s father also succumbed to the disease.
It is challenging, she said, to allow yourself to suffer enough to help patients without feeling overwhelmed.
“Sometimes I think it’s a big responsibility,” she said. “But this is the job I signed up for, right?”
Lunas are a nursing family. His father, Tom Omaña Luna, was also an emergency nurse and was proud when Ms. Luna joined him in the field. When he died on April 9, Ms. Luna, who also had mild symptoms of Covid-19, took about a week off from work. His mother, a nurse at a long-term care facility, spent about six weeks at home afterwards.
“She didn’t want me to go back to work for fear that something would happen to me too,” said Luna. “But I had to go back. They needed me. “
When her hospital in Teaneck, NJ was filled with patients with viruses, she struggled with stress, burnout and a persistent fear that left her pain an open wound: “Did I give it to him? I don’t want to think about it, but it’s a possibility. “
Like the Lunas, many of those who treated the millions of coronavirus patients in the United States last year come from families defined by medicine. It is a vocation passed on from generation to generation, which unites spouses and brothers who are in a separate state.
It is a bond that brings the help of the shared experience, but, for many, the pandemic has also introduced a series of fears and tensions. Many are concerned about the risks they are taking and the ones their loved ones face every day. They worry about the invisible scars left behind.
And for those like Mrs. Luna, the care they give patients with coronavirus has been shaped by the beloved healer who lost to the virus.
Working through grief
For Dr. Nadia Zuabi, the loss is so new that she still refers to her father, a fellow emergency room physician, at the present time.
Her father, Dr. Shawki Zuabi, spent his last days at his hospital, UCI Health in Orange County, California, before he died from Covid on January 8. Young Dr. Zuabi almost immediately went back to work, hoping to continue going through his colleagues’ purpose and camaraderie.
She hoped that working alongside the people who cared for her father would deepen her commitment to her own patients, and to some extent it does. But mostly, she realized how important it is to balance this draining emotional availability with her own well-being.
“I always try to be as empathetic and compassionate as I can,” said Zuabi. “There is a part of you that may, as a survival mechanism, have to build a wall because I feel it all the time, I don’t think it’s sustainable.”
The work is full of reminders. When she saw a patient’s fingertips, she remembered how her colleagues had also pricked her father’s to check insulin levels.
“He had all these bruises on his fingertips,” she said. “It broke my heart.”
The two were always close, but found a special connection when she went to medical school. Doctors are generally descended from doctors. About 20% in Sweden have parents with a medical background, and the researchers believe the rate is similar in the United States.
The oldest Dr. Zuabi had a gift for talking and loved to talk about medicine with his daughter while he sat in the living room chair with his feet supported. She is still in her residency training, and throughout the past year she would seek him out for advice on Covid’s difficult cases she was working on and he cleared his doubts. “You have to trust yourself,” he told her.
When he caught the virus, she took time out to be with him every day and continued the conversation. Even when he was intubated, she pretended they were still talking.
She still wants to. After difficult changes, she turns to her memories, the part of him that remains with her. “He really thought I was going to be a great doctor,” she said. “If my dad thought that about me, then it has to be true. I can do this, even if it doesn’t seem like it sometimes. “
Love tempered by risk and horror
Just as medicine is often a passion that grows out of a set of values passed down from one generation to the next, it is also shared by brothers and unites healers in marriage.
About 14% of doctors in the United States have siblings who also graduated in medicine, according to an estimate provided by Maria Polyakova, a professor of health policy at Stanford University. And a quarter of them are married to another doctor, according to a study published in the journal Annals of Internal Medicine.
In interviews with a dozen doctors and nurses, they described how helpful it has been to have a loved one who knows the rigors of work. But the pandemic also revealed how frightening it can be to have a loved one in danger.
A nurse’s brother took care of her when she contracted the virus, before volunteering at another viral site. A doctor had a stimulating conversation with her children about what would happen if she and her husband died of the virus. And others described the silent crying during a conversation about wills after putting their children to bed.
Dr. Fred E. Kency Jr., a physician in two emergency departments in Jackson, Mississippi, realized that he was surrounded by dangers when he served in the Navy. He never expected that he would face such a threat in civilian life, or that his wife, an intern and pediatrician, would also face the same dangers.
“It’s scary to know that my wife, every day, has to go into patients’ rooms that have Covid,” said Kency, before he and his wife were vaccinated. “But it is gratifying to know that not just one of us, both, is doing everything we can to save lives in this pandemic.”
The vaccine has eased fears of being infected at work for medical workers who have been vaccinated, but some express deep concern about the tribute that work during a year of horrors has caused to their closest relatives.
“I worry about the amount of suffering and death she is seeing,” said Dr. Adesuwa I. Akhetuamhen, an emergency physician at Northwestern Medicine in Chicago, about her sister, who is a doctor at the Mayo Clinic in Rochester, Minnesota. I feel like I learned to cope, working in the emergency department before Covid started, but it is not something that should happen in your specialty as a neurologist. “
She and her sister, Dr. Eseosa T. Ighodaro, have been talking regularly on the phone to compare notes on the care they are taking, provide updates on their family and offer mutual support. “She fully understands what I’m going through and encourages me,” said Dr. Ighodaro.
The seemingly endless intensity of work, the increasing deaths and the arrogant attitudes that some Americans exhibit regarding safety precautions have caused anxiety, fatigue and exhaustion for an increasing number of health professionals. Almost 25 percent of them probably have PTSD, according to a survey that the Yale School of Medicine published in February. And many have left the field or are thinking of doing so.
Donna Quinn, a midwife at NYU Health in Manhattan, fears that her son’s experience as an emergency physician in Chicago will lead him to leave the field he recently entered. He was in his last year of residence when the pandemic started and offered to serve on the intubation team.
“I worry about the price this is causing him emotionally,” she said. “There were nights when we cried talking about what we found.”
She still has nightmares that are sometimes so scary that she falls out of bed. Some are about her child or patients that she cannot help. In one of them, a patient’s bed linen is transformed into an imposing monster that expels her from the bedroom.
The purpose of a nurse
When Mrs. Luna returned to the emergency room at Holy Name Medical Center in Teaneck, NJ, after her father died, she felt like something was missing. She had gotten used to having him there. It was desperate when every urgent call from the intercom for a resuscitation made her wonder, “Is this my dad?” But she could at least stop now and then to see how he was doing.
More than that, she never knew what it was like to be a nurse without him. She remembered him studying to enter the field when she was in elementary school, painting almost all the lines in her big books with a yellow marker.
During breakfast last March, Luna told her father how upset she was after holding an iPad for a dying patient to say goodbye to a family that was unable to get into the hospital.
“This is our profession,” she recalled that Luna said. “We are here to act as a family when the family cannot be present. It is a difficult role. It will be difficult and there will be more times when you will have to do this. “
Kitty Bennett contributed research.