SAM, March 2020
The third Friday in March was Match Day. After four years of medical school, Sam and his classmates would be placed into residency programs for the next phase of their training. For Sam, the day held extra significance. His parents were supposed to meet his boyfriend Jeremy’s family—one of those gatherings that bore the peculiar quality of familiarity and awkward novelty all at once. Sam’s family would fly in from Ohio, Jeremy’s from Texas.
Match Day is when you find out which of the hospitals you’ve listed as your top choices has picked you too. It is the archetypal medical coming-of-age rite. On Match Day, the next three years of Sam’s life would take on distinct shape, contoured by the program and city where he would train (which he hoped would be at NYU).
The NYU match ceremony, which just Sam’s family would attend, was scheduled for Friday afternoon. Sam and Jeremy agreed that their families’ first meeting would be later that night, over Sabbath dinner at their apartment. They’d both grown up in Jewish families that marked Friday evenings with too much food and boisterous conversation. They knew there was no weighty interaction that the right menu couldn’t ease, and settled accordingly on handmade pasta from Raffetto’s, the luxe Italian grocery store two blocks from their apartment, paired with a classic Trader Joe’s spring mix salad.
If you zoomed out as though to see them through the long end of a telescope, just the faint edges of their lives visible, you’d glimpse a little Greenwich Village apartment as distinctly New York as a Noah Baumbach film. Two boys from Cincinnati and Fort Worth, bodies entangled on the couch. Jeremy is slim, with a square jawline and closely cropped brown hair. His face is small and his features delicate, which makes his big, warm eyes seem to take up even more space. He is well dressed, in a varsity jacket, a heather-gray T-shirt, and skinny jeans. Sam is slightly taller and broader-shouldered, his mouth fixed in a permanently impish grin. He has a crew cut and thick, dark brows, a silver piercing in his ear, and an ever-present layer of scruff on his chin.
Sam and Jeremy met marching in the New York City AIDS walk for their synagogue, a queer congregation called Beit Simchat Torah in North Chelsea. When they moved in together in Sam’s third year of med school, their life took on the firm architecture of a real relationship. Not the tentative will-they-won’t-they of mid-twenties dating in New York, the stomach-squeezing angst of unanswered texts, but the concrete quality of partnership. They shared a home. They divvied up chores and grocery trips. And on most days they balanced one another out; Sam could be more cerebral and wry, while Jeremy was sweet and earnestly enthusiastic. He had a tone of voice that made you think anything you’d just said was a good idea.Match Day is when you find out which of the hospitals you’ve listed as your top choices has picked you too. It is the archetypal medical coming-of-age rite.
Match Day was a validation of all that early adulthood work. Sam would find out where he would spend the next three years, his first phase as an MD. His family and Jeremy’s family would meet. Names would be put to faces. Conversation would bump along, then lift off. Inside jokes would take form, becoming part of their families’ shared history.
Like so much of the news around coronavirus, the sense of loss came gradually and then all at once. Sam got a call from his parents one afternoon. “What do you think will happen with Match Day?” they asked him. “How is this all going to work?” Sam’s mom was a planner. She was probably scanning the terms of the flights that she’d booked months ago on the other end of the line.
“I’m not sure,” Sam said. They were all holding out hope that it would happen, though this was partly shaped by the desire to cling to all the events surrounding Match Day, the Shabbat dinner and the family vacation to the Grand Canyon they had planned for the spring.
Sometime later, Sam got an email from NYU: the ceremony would be limited just to graduating class, faculty, and staff. Sam’s parents soon realized there would be no flight from Cincinnati to New York.
In the days that followed, the other normalities of their life evaporated so quickly that by the time the announcement came that Match Day would be virtual, it was no surprise. The NBA shut down; Broadway theaters went dark. By then, Sam and Jeremy’s once-full routine had condensed to near comic emptiness. Where their days had once been a jumble of alarm clocks and MetroCards, now it was just the two of them ordering takeout to the apartment. Every trip outside, even just for milk and eggs, felt fraught. The days took on a colorless congruity; Monday was the same as Tuesday, and Tuesday the same as Saturday. The apartment also became Jeremy’s office when his media company sent everyone to work from home.
On Match Day, Jeremy ran to the corner liquor store to buy champagne. Then he ran over to Posh Pop Bakery, the little shop on Bleecker that had miraculously stayed open as the rest of the city shut down, and stubbornly purchased just as many pastries as he would have if both his and Sam’s families were in town. Sam didn’t bother turning on the virtual ceremony; he was too nervous about actually getting his match. He FaceTimed his parents and maniacally hit refresh on his email.
It came at 11:58 a.m. “It’s NYU!” It was the hospital’s primary-care internal medicine program, Sam’s top choice. Jeremy popped the bottle. And for a moment there was just the soundtrack of an otherworldly celebration—the cheers of his mom and dad on the phone, the hiss of champagne, and somewhere far away the blare of the city sirens.
After all the stress of medical school—the late-night cramming, the ungodly early wake-ups, the Step 1 exam, the Step 2 exam, all those endless exams—this was supposed to be a spring of unwinding, before residency started in July. Sam was going to brush up on his medical Spanish, but he and Jeremy could also do what other less busy couples did. What did other twenty-something couples do? Bake sourdough? They could bake sourdough. Some of Sam’s classmates called this term, their second half of fourth year, “the most expensive vacation you’ll ever pay for.” But this vision of a relaxing few months was quickly evaporating.
The coronavirus had bulldozed its way through cities and populations and headlines and cable news, and by now some of its early myths were fading. It was clear that this was not just a disease of the old and sick. New York wouldn’t contain it, couldn’t contain it. And many people would die.
NYU decided to make an offer: Sam and his classmates could graduate a month early, if they wanted to, and work for several weeks in NYU-affiliated hospitals overwhelmed by the surge of Covid patients. They would be sent into the hospitals where they had done their advanced med school rotations, meaning Sam would go to Bellevue. Regardless of these early graduates’ specialties, whether pediatrics or psychiatry, they would help in the internal medicine units, which were most feeling the crunch.
Confined to their apartment and reading apocalyptic news stories from Milan and Wuhan, Sam and Jeremy felt the weight of the situation. To Sam, starting his hospital work three months early to help tend to Covid patients seemed like a responsible choice. He was young and healthy. This was the point of his medical education: to be of use in times of crisis. He’d even sent emails to his research mentor asking about opportunities to volunteer. But both he and Jeremy realized the risk. There was so little known about the virus. Some of his classmates whispered worriedly about the infection rates among health care workers in China, where more than three thousand medical workers had been sickened with Covid.
Besides all that, Sam and Jeremy were young queer men raised just after the HIV crisis. Much like the children of Holocaust survivors who were born years after the war but inherited trauma from the camps, people who came out as gay in the 2000s inherited their own kind of anguish. Theirs were the films and the songs and the diatribes of the AIDS epidemic. All those photos of people who died in their early twenties, groups of friends wiped out in San Francisco and Chicago and New York. Right where Sam and Jeremy now lived, in the Village, whole blocks of boys had vanished. The most painful thing was thinking about the way that virus lodged itself in relationships, like a cudgel. If you were sick, then your partner was likely sick; if you took a risk, then you could kill the person you loved.The coronavirus had bulldozed its way through cities and populations and headlines and cable news, and by now some of its early myths were fading.
Sam and Jeremy came out in an age of condoms and nonabstinence sex education. In his sophomore year, Sam played in the ensemble band for a performance of Rent at his high school, which was one of the first in the country to stage the show. During college, he worked at a campus wellness center testing students for chlamydia, gonorrhea, and HIV. He even gave a TEDx talk to classmates on destigmatizing preventive health measures like taking PrEP to prevent HIV infection.
By virtue of the decade he was born in, Sam wouldn’t have to carry the pain of losing his whole community, or the all-consuming fear of losing his own life. Sam’s would be the generation that lived without a death sentence.
Until coronavirus. All those years of fervently preaching safe sex, and here Sam was in danger from an unknown disease. And worse still, possibly putting Jeremy in harm’s way. Sam knew that he could, more likely than not, be exposed to coronavirus. Its viral particles would be everywhere as Sam leaned over patient beds to draw blood or take medical histories. The contaminated elastic of his mask could brush against his eyes as he pulled it off.
One evening they talked out their options. Jeremy’s parents had just called in a panic to ask if he had considered moving out of the apartment while Sam was working at Bellevue. The two discussed it as Sam cooked dinner and Jeremy lay on the couch nearby.
“I could apartment-sit,” Jeremy mused. He had a coworker with a studio a few blocks away who was staying with a boyfriend in Brooklyn.Confined to their apartment and reading apocalyptic news stories from Milan and Wuhan, Sam and Jeremy felt the weight of the situation.
“There are those hotels offering free rooms for health care workers,” Sam said. “I think the Four Seasons in Midtown is doing it.”
But Sam didn’t want to spend the next two months alone; neither did Jeremy. They wanted to debrief their days and watch Tiger King and cook together.
They agreed that Sam would develop an elaborate routine to douse himself in sanitizer and try to prevent any possibility of taking the virus home. They said they would see how it went for the first few days and then reevaluate. But Sam knew, realistically, that he wouldn’t weather the weeks ahead on his own. The most insidious part of the virus was not just the dread it sparked, but that its nature meant you might have to face that dread alone.
Among Bellevue doctors, the first formal mention of the coronavirus came on January 24, in the weekly staff email: This is a novel coronavirus with its epicenter in Wuhan, China, with a ~14-day incubation period and potential for person-to-person transmission (though limited). . . . Risk to New Yorkers is considered low, and there have been no known health care worker infections.
Fast-forward seven weeks. As the virus began spreading across American states, shuttled on airplanes, transmitted at bars and bachelorette parties, the uneasy question of what space there was for medical students in this crisis hung over the hospitals.
The fourth-year medical students were untried. They had worked in the hospitals during rotations, but only under heavy supervision. Some school administrators felt a protective instinct toward these rookies. At the same time, they were also only three months away from beginning their careers, and it was evident that the hospitals would soon be overwhelmed, especially in New York. There was barely time to wrestle with these choices anyway. Crisis warps the speed at which time passes, every second both fleeting and costly. The siege was coming.
At first, on March 17, came an advisory from the Association of American Medical Colleges (AAMC), the main research and advocacy group for medical schools and teaching hospitals. The group recommended pulling all students out of their normal clinical rotations until at least the end of March. That would give medical schools time to develop safety protocols and learn more about this novel coronavirus. It would also allow hospitals to conserve protective equipment, which was in alarmingly short supply.
Fourth-year medical students around the country issued a rally ing cry. They wanted to be useful. Ejected from clinical settings, they turned to other tasks. NYU students held a drive collecting surgical masks (8,200 of them) and N95s (700), plucking the rare goods from veterinarians, dry cleaners, nail salons, and tattoo parlors. University of Colorado students deployed to staff Covid call centers. A group of medical students at the University of Minnesota set up the MN CovidSitters so they could babysit for the children of overworked doctors.
But across the Atlantic, as the virus devastated Italy, European governments turned to more extreme measures. In March, Italy announced that it would send its final-year medical students into hospitals months ahead of schedule. British medical schools like Lancaster, Newcastle, and the University of East Anglia also accelerated graduation.
As New York’s hospitals continued to brace themselves, city medical school deans began to reexamine their role in the fight. American hospitals had prepared for “discrete disasters” like mass shootings and hurricanes, but not for sustained periods of crisis like a pandemic. It was evident that staff would be overwhelmed. Texts went back and forth between students wondering whether they would soon be following in the footsteps of their European counterparts. There was no recent precedent for this kind of expedited move to hospital front lines. Medical school upperclassmen had been abruptly given the responsibilities of full physicians during the 1918 Spanish flu. Decades later, during World War II, schools created a fast-track program at the government’s behest while physician shortages mounted. But since then, the rules governing medical education had grown more rigid.
Dr. Steven Abramson, vice dean for academic affairs at NYU medical school, kept receiving emails from fourth-years who said they wanted to help out. After all, these students had been trained by the medical workers now under siege at Bellevue and Tisch. Mulling this over, Dr. Abramson realized that these students had already completed all the curricular requirements—why not take them up on their offer? NYU sent a survey to fourth-year students asking if they would be willing to start work in the hospitals early. These temporary assignments would last just a few weeks in April and May. Within twelve hours, more than half had replied with a resounding yes. Soon after that, the process to get state approval for NYU’s early graduation began. Other schools followed: Albert Einstein College of Medicine, Mount Sinai, Columbia.
Sam’s graduation was set for April 3. On the allotted day, Jeremy slipped outside to pick up champagne. Sam opened his laptop and pulled up Webex. It was more than a month before their intended graduation. The virtual ceremony opened with stilted speeches from deans and faculty. Dr. Abramson greeted the group as “members of what we now call the COVID army.”
Sam’s laptop screen glowed with the familiar faces of his classmates, the fifty-two of them who had decided to graduate early. Some were wearing their caps and gowns, and one had made a diploma out of a manila envelope. Rows of Sam’s friends dissolved into giggles as they stumbled through the technical difficulties of a graduation on Webex. Their voices bumped and tumbled over one another. No one was synchronized.
“I do solemnly swear, by whatever I hold most sacred—”
“I do solemnly swear, by—” “that I will be loyal to the profession of medicine and just and generous to its member”
“that I will be loyal to the profession—” “That I will lead my life and practice my art in uprightness and honor.”
They paused for laughter. They scanned their eyes over the grid of classmates in bedrooms and family basements, all ensconced in those last moments of preprofessionalism.
“That into whatsoever home I shall enter it shall be for the good of the sick and the well to the utmost of my power and that I will hold myself aloof from wrong and from corruption and from tempting others to vice.”
They couldn’t squeeze each other’s hands like in a normal graduation; there was for Sam no formal feel of a cap on your head, no thrill of a high-ceilinged auditorium. There was just his Greenwich Village apartment.
“That I will exercise my art solely for the cure of my patients and the prevention of disease and will give no drugs and perform no operation for a criminal purpose and far less suggest such a thing.”
There were Sam’s classmates reading too quickly, speeding through the final words of the oath as others stepped gingerly through. There were those reciting it steadily, like a heartbeat.
“That whatsoever I shall see or hear of the lives of men and women which is not fitting to be spoke, I will keep inviolably secret.”
There was the weight of the words—the way you heard the pulse of each line when you were the only one in the room reading it aloud. There was the mess of sounds, the beeps and dings of fifty-two laptops, a harmony of machines not unlike the din of the hospital floor.
“These things I do promise and in proportion as I am faithful to this oath, may happiness and good repute be ever mine, the opposite if I shall be forsworn.”
Sam heard Jeremy’s cheers, and those of his classmates coming from his laptop. That night, every New Yorker’s cell phone got an emergency push alert asking licensed health care workers to join the front lines and “support health care facilities in need.” Sam’s phone lit up with the message: “Attention all health care workers.” Well, he thought, I’m heeding the call. He’d become a doctor that afternoon in his apartment.
From Life on the Line: Young Doctors Come of Age in a Pandemic by Emma Goldberg. Used with the permission of Harper Books. Copyright © 2021 by Emma Goldberg.