In April 2020, as coronavirus was ravaging New York City, a young medical student nicknamed Jay decided to take part in a program fast-tracking her graduation so she could start working in the Covid-19 wards. She was supposed to have a relaxing few months of celebrations before she started residency over the summer. Instead, she went straight from graduation to the crisis frontlines. And she had no way of knowing that there was one patient there who would alter the course of her life, leaving his imprint on her, indelibly, from the moment they met.
It was a slow morning and Jay was hunched over her computer in the workroom. When she heard shouting in the hallway she sprang up and ran outside, looking for its source. There was a Hispanic patient with Down syndrome, wearing the hospital’s typical blue striped gown, who was ripping binders off the nursing station and throwing them on the floor.
“Stop!” one of the nurses yelled, frantically grabbing the binders off the ground and setting them back in their place. “What are you doing? Stop!”
Her pleas went unacknowledged. The thud-thud-thud continued as the patient dropped reams of paper. He was wailing, his cries mounting to a crescendo that flooded the hall. A second nurse appeared and shushed the first. “He does this when he’s frustrated,” she said. “Don’t worry.”
The nurse put out her hand. The patient eyed her outstretched arm warily, then grabbed it. Slowly, he followed her back toward his room.
That was Manny. (The patient is being identified with a pseudonym to protect his privacy.) He was slight, just 5 foot 2, with dark hair, thick brows that curved downward, and a five o’clock shadow on his chin. He often got emotional, and sometimes disruptive, but usually all he wanted was touch—someone he trusted to grab his hand or offer a soothing word. Quickly, willingly, Jay would assume that role.
The patient was assigned to Jay’s care that week, and she heard his story in hushed conversations with the nurses on the floor. Manny was 38. He came to the hospital when his father, who was his only living immediate family member, was admitted with Covid-19, riding over with him in the ambulance. Manny’s dad soon coded with his son at his side and was put on a high-flow nasal cannula in the ICU.
The hospital bent its rules on visitors and allowed Manny to stay because there was no one else who could watch him. Manny’s mother had passed away a few years earlier. He and his dad had been living in a city housing project with little connection to the outside world. Now Manny spent his days pressed to a chair by his dad’s hospital bed. The nurses searched his face, wondering how much of the situation he could comprehend. His dad communicated with him in Spanish, so they weren’t sure how much English Manny understood.
“Is there anyone we can call to care for Manny if something happens to you?” the hospital social worker asked Manny’s father one afternoon.
Manny’s dad shook his head. “I’ve always planned on outliving him.”
One night, around 4:00 a.m., his dad’s heart stopped. The doctors rushed in and tried resuscitation with Manny lying there in the room. They did everything they could to no avail. Manny’s dad, who was in his 80s, was declared dead. The overnight staff wrapped up his body and prepared it for delivery to the morgue. Shortly after, Manny was swabbed, tested positive for coronavirus, and was admitted to the hospital as a patient. Manny was put on one-to-one care, meaning he always had a hospital staff member with him.
Down syndrome, a condition caused by an extra copy of chromosome 21, can cause a variety of disabilities, but Manny’s were severe. Some of the hospital’s doctors and nurses were frightened by his tantrums. The psych resident who worked with him reminded the others to show him empathy and not to get upset when he threw things on the ground.
Gradually, Manny became a favorite among the hospital staff. He was affectionate—when a nurse or doctor spoke to him patiently, he grabbed their hands, his warm eyes opening like a welcome mat. When he was assigned to Jay, the other providers warned her to “be patient,” or “don’t take it personally when he acts out.” But all Jay could think about was the relief on Manny’s face when the nurse in the hallway took him by the hand. Jay wasn’t too nervous about caring for him.
She stopped by Manny’s room to introduce herself. He was propped up in his small bed, which was just slightly wider than him. His room was sparse: a wall painted washed-out robin’s egg blue, a single brown plastic chair. There were a few toys scattered around—a plush football, a stuffed duck—donated by hospital staff. One of the doctors had bought him a mini basketball hoop, and his social worker had brought him Dora the Explorer picture books.
“Hola, Manny,” Jay said. He swiveled his head and eyed her cautiously.
Later, just before her shift ended, Jay stopped by his bed to say goodbye for the evening. He was sitting up and crying quietly. His hand was clutching an ID badge on a string around his neck, which he kept looking at while his eyes welled up. Jay stepped toward him, and he angled the badge so Jay could see the photo fixed to the back of it.
“Papi,” Manny said, pointing at it. It was a snapshot of him and his dad. The two were wearing matching shirts, white with blue stripes like Yankees uniforms.
That night, on the way home, Jay thought about Manny lying in his hospital bed alone, fighting to fall asleep. Then, she called her mom.
Patients who spent weeks in Covid wards liked to say that they found their hospital communities—the nurses they saw daily, the doctors who they nicknamed. But the providers needed this closeness just as much. Far from her own parents and limited to brief evening interactions with her med school roommates, Jay’s whole world was becoming the hospital floor.
Jay felt a certain tenderness toward the orbit around Manny’s room. Those were the staff members who worked overtime, who placed extra phone calls to make sure Manny was safe. They brought him new clothes and books. They found out his favorite foods and songs. One of the Patient Care Assistants (PCAs) had even started to research the possibility of adopting him. It reminded Jay why she wanted to go into the field in the first place, for the patients who weren’t just patients and the doctors whose work didn’t fall neatly within clinical lines.
Manny’s face brightened whenever Jay came by his room. He always instantly, instinctively reached for her hand. He liked when she stroked his back, too. When she tried to leave and return to other patients, he turned a set of eyes on her that made it hard to go.
“Oh my God,” Jay told his social worker one afternoon. “When he actually goes, I’m gonna miss him so much!”
Sometimes Manny had new acquisitions to show off—a blue collared shirt donated by one of the nurses, a stuffed penguin almost as long as his torso. He seemed especially delighted by this new guest, wrapping his arms around its flippers and patting its plush orange beak.
One afternoon, Jay was sitting next to Manny’s bed when a middle-aged man, maybe 5 foot 6, balding and tattooed, came by Manny’s room. “Papi!” Manny shouted when he appeared at the door.
Jay froze for a moment. She knew his father was dead. Could this be another relative, an uncle?
“Hey, papi,” the man called back.
Manny’s hand floated to the photo fixed onto his badge with his dad’s face.
“I’m one of the PCAs,” the man said, turning to Jay and nodding his head slightly. They couldn’t shake hands because of Covid. “He thinks I look like his dad,” he added quietly. Jay could imagine being disconcerted by the mix-up, but the PCA didn’t seem to mind.
That afternoon, one of the patients across the way from Manny got agitated. His nurse was trying to finger-stick him to monitor glucose levels and the patient began shouting racial slurs. As a second nurse ran over to calm him down, the man took off his pants and threw them on the floor.
Manny watched from afar. Jay positioned herself in front of him, blocking his view. She hoped that he couldn’t make out what the man was saying, which was mostly a stream of expletives. She tried to distract him by pointing toward the window.
When Manny came to the hospital, the branches on the trees outside were naked and frail; now they were beginning to burst into green, tipping their faces toward the spring sun. The city shimmered with a warm almost-summer glow, shrugging off the cold, cloudy days of March. Manny watched it all from his ninth-story window. It looked out mostly over another red brick building, but it could offer a glimpse of the park if you tilted your head.
Jay had hoped that over the course of her weeks working in the Covid wards, she might be able to help the hospital social workers determine a plan for Manny’s discharge. But his release from the hospital was more complicated than most. When he’d first arrived, he’d been in his father’s care. Now he had no one. Eventually, Jay’s weeks assigned to the Covid wards wrapped up, and she had to say goodbye to Manny so she could start her residency.
Later, over the summer, she heard the good news in a text from another doctor: Manny would be able to leave the hospital. He had been accepted to a home for the developmentally disabled in Far Rockaway.
On his last day—his 100th in the hospital—doctors and nurses from all over the hospital gathered to say goodbye. One of the physicians brought a guitar. He started strumming chords as Manny rocked back and forth. And for a moment, there was no sterility in those white hospital halls, no blaring alarms. There was just Manny’s face, lit up with bliss, glancing from doctor to doctor who’d become, somehow, like family.
Adapted from the book Life on the Line: Young Doctors Come of Age in a Pandemic. Copyright © 2021 by Emma Goldberg. Published on June 8, 2021 by Harper, an imprint of HarperCollins. Reprinted with permission.
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