Mid-May 2020

Omar

If you feel everything intensely, ultimately you will feel nothing at all - Elizabeth Wurtzel

As I walked to the lab I thought about how Madi's words from that morning had felt like I was being pushed deeper and deeper into darkness.

"You're not going to like this, but your request to take leave was denied..."

I honestly didn't know what was happening to me. Even when things were at the worst point in my life before I had never had these feelings of despair and complete hopelessness before. It was like everything around me was collapsing on itself and the more I tried to hold it up the faster it collapsed.

Every morning I had to literally force myself to get out of bed, which had become a sanctuary for me. In bed, in the darkness of my room, nothing could touch me. Not the dying patients, or Madi's tears, or my parents' hateful words. In bed I could just get a break from the tragedies that surrounded me every single day.

All the residents and interns that I had become friendly with over the last few months, Jake, Elijah, Kylie among others, were feeling the weight of this pandemic. In the past we had all learnt to dissociate ourselves from our work and have some light moments at work, even while taking care of sick patients. Now, there was just an eerie silence on the wards, only punctuated by the beeping of monitors, and the Code Blue signal going off frequently. (Code Blue is a sign that a patient is in cardiac or respiratory arrest, and help is needed immediately)

The only silver lining was the sense of camaraderie between us. We were all going through a collective, once-in-a-lifetime experience, and will probably all have PTSD (post-traumatic stress disorder) from it but at least we were together. Which was a lot more than what I could say for Madi and I.

In fact, and I hated to admit this, it was almost easier to not think about Madi now. I had gone to her house everyday while she was in isolation because she needed me, but everyday was a reminder of what I couldn't have with her. She was so close, yet so far, and unlike the camaraderie with my colleagues there was no silver lining to our situation. The only thread of hope I had been hanging onto was a quick trip to Pakistan. When that too was denied, for a split second I really did wish that I had never fallen in love with her.

But the look in her eyes, and panic in her voice had immediately made me regret that I had blurted out what was on my mind. And reminded me that she was going through the same ordeal as me, and I owed it to her to hang on to that thread of hope. As I walked away from her this morning I couldn't help but say a silent prayer.

'Oh Allah please giving us Your blessings. I can feel it at the core of my being, that she and I are meant to spend the rest of our life together. So please, please let us find a path to make that a reality'

I didn't know whether it was a heavenly sign or not, but when I got back to the ICU, the nurse for our 70 year old patient who had been on the ventilator for almost 40 days informed me that he had been trying to open his eyes and was breathing on his own with only minimal support from the ventilator. We had all but given up hope for Mr Kelly, so his improvement was a moment of celebration for all of us.

To top it all, Kylie let me talk to Mr Kelly's family and deliver the good news. I smiled thinking about the exchange I had with the family on the Ipad.

"Mr Kelly is having a great day today. If he keeps this up we may be able to take him off the ventilator soon", I had said.

Before anyone else could answer the 10 year old grandson appeared on the screen, and with tears in his eyes asked "So Grandpa will be ok? He'll be able to come home soon?"

And even though I was wearing my full protective gear, I could not help but grin behind the mask, and reply to that little boy, "Yes, I think he will be able to..."

That brief exchange may not sound like a big deal, but when all we did day-in and day-out was deliver bad news to desperate families, giving good news was an experience worth savoring.

I vowed then, that I was going to seek out and focus on the positive news only. Madi and I may not make the cut, but there were other things that seemed to be going in the direction I wanted them to.

Like my research.

Dr Sanders and I had been busy with our experiments and with the help of her lab's other members had just published a paper in one the of the most coveted journals in the medical field: Nature Medicine. We had shown that immune cells from patients with severe COVID released certain chemicals that created widespread, unchecked inflammation in the whole body. A phenomenon known as a cytokine storm. In some patients that correlated with the amount of SARS-CoV-2 virus in their lungs, but in other patients it did not. Which made us believe that the virus may be altering the immune cells ability to respond appropriately.

That may also explain why this disease was so deadly in the elderly, who already have a dysfunctional immune system. And this paper had now become the basis of a clinical trial led by another group where, in addition to the anti-viral treatment, patients were also being treated with Tocilizumab, a drug used to target the chemicals that were involved in producing a cytokine storm in the sickest patients. It remained to be seen whether or not Tocilizumab was effective or not in actual patients. But this bench-to-bedside work is exactly what I had always aspired to do.

This had been my professional dream: to become a physician-scientist. A physician that uses their scientific research expertise to unravel the mysteries of diseases that were pertinent to the patients we took care of.

I had meant to tell Madi this exciting news when I went to her office this morning, but as had always happened with us, none of our happy moments ever lasted long.

When I reached my lab I took a deep breath trying to get rid of the negative memories, just for now. It broke my heart that Madi was part of those negative memories, but just for a few hours I needed a break from it all...and a break from thinking about her.

It was 5:15 pm on my watch and I wouldn't have thought too much about it except then I remembered something else about Madi, that made it on the top of the 'negative news of the day' list.

She is meeting with Faraz right now...

I must have looked quite unhappy because as soon as I reached my desk I heard Elijah's voice say, "What's gotten into you? You seriously look depressed..."

Elijah was my African-American co-intern with whom I had first worked with in the ER, the day that Madi had to deal with the white supremacist patient. Ever since then we had a couple of other rotations together and had bonded over being a minority in the academic setting even in a city that boasted multiculturalism.

"I probably am...in fact according to my psych textbooks from med school, I have an adjustment disorder"

My self diagnosis was based on the fact that people with adjustment disorders had symptoms of depression, such as not being able to get out of bed in the morning, but were still functional to a degree. And those symptoms were usually triggered by some event. In my case, the amalgamation of falling in a love with a woman who was way out of my league, having obnoxious parents, and being in the middle of a freaking pandemic...without anyway to get out of either of those situations.

My stars aligned in the worst possible way...

Elijah laughed politely, "We probably all have a component of adjustment disorder these days, but I bet being with Madi helps..."

"Yes, it does..", I replied, she was the only thing that kept me going at times. But on the flip side thinking about what we can't have and that she was with that idiot Faraz right now made my blood pressure go up.

"Anyway, what are you doing here?", I asked him. He didn't typically work in this lab.

"Oh I was hoping to catch you here actually...I wanted your honest opinion about these new mRNA vaccines that are in phase 1 and 2 trial. You've done some vaccine work before, right? Are they safe?"

Typically, vaccine development goes through 3 different phases of clinical trials. Phase 1 is when a small number of healthy volunteers are given the vaccine to make sure that they are safe, phase 2 is when different doses of vaccine are given to a number of people to see which dose is the most effective. Finally, phase 3 is when hundreds to thousands of people are given the effective dose (determined from phase 2).

Because of the urgency to develop a vaccine against COVID the research groups that were studying mRNA vaccines had combined phase 1 and 2 studies together. That wasn't a short cut per se, rather it was a way to take the help of willing volunteers like us healthcare workers who were desperate for someway to protect ourselves. And giving the different doses to a number of volunteers at the same time, knowing that some people may have more side effects that others.

"I have done vaccine work. Not directly on mRNA vaccines, though, those have been used in cancer research only up until now. But I have worked with the mRNA technologies that these research groups are using and the use of nanoparticles in which the mRNA is packaged is pretty well studied"

He contemplated on what I said for a few seconds and then replied to me, "So you're saying that these vaccines are essentially a combination of two methods that separately are well established and probably safe?"

"Exactly...I would sign up for the vaccine trial in a heartbeat if our institution was part of that clinical trial", I answered truthfully. I trusted the science behind these vaccines.

"Well...my friend", Elijah slapped me on my shoulder, "You may be in luck! I just heard through the grapevine that we will become a site and enrollment is opening today. But so many people are interested that they'll probably fill up soon"

This really was the best news I had heard in a while. If I could get the vaccine, and was lucky enough to get the dose that was effective, it would make my plane travel to Pakistan that much safer.

I couldn't contain my excitement, "Are you serious? I'll be first in line then...are you interested too?"

"I am. You know, historically African-Americans have always been excluded from life-saving research, while being subjugated to life-threatening research techniques in the name of science. My people have born the brunt of exploitative medicine and science, without reaping much of the benefit. I intend to change that...", Elijah said in a defiant tone.

I knew exactly what he was referring to. The medical misuse of African-Americans, especially when slavery was still legal, was well documented but only now coming to light. Examples included, but were in no way limited to, the Tuskegee trial (1932-1972) which was conducted by the US department of public health and the CDC, in which African-American men with Syphilis a deadly bacterial infection were purposely not treated to see what the natural outcome of the disease would be.

And prior to that there was J. Marion Sims, also called the father of modern-day gynaecology, who in mid-1800s perfected his surgical procedures on women's private parts by practicing them on slave women, that too without anesthesia.

"That is very noble Elijah. Let me know as soon as you hear more. And I will come with you to get that vaccine..."

Elijah agreed to inform me as soon as he heard something and left the lab. I pulled out my phone to make sure that Madi hadn't messaged me. It was 5:35 pm. There was no message from her, but unfortunately my phone was at 3% charge, and I had not brought my phone charger.

I bet forgetfulness is also a sign of depression. I really should seek professional help...

For a moment I considered going to see if Madi was sitting with that IF (Idiot Faraz...that is what I am going to call him from now on!) in front of the hospital where they had met before. But then decided against it. That place was a good 20 min walk across campus and I had a ton of work to catch up on in the lab.

Besides, I trusted my Madi...even if I could never trust IF!

But I did text both her, in case IF bothered her, and Elijah, in case he heard about the vaccine trial, to let them know that my phone was dying and to call my lab instead.

I was all suited up and in the BSL-3 space within the lab when I heard my phone ring but then it abruptly stopped, probably because the battery had run out. There was no call on the lab phone inside the BSL-3 space so I kept working.

Half and hour later the BSL-3 phone did ring, and I immediately picked up.

IF had better not have made Madi uncomfortable!

But instead of Madi's sweet voice, it was Elijah's excited voice, "Omar, they just opened recruitment in the trial. The research coordinator said that they are only enrolling 40 patients from our hospital. There are already 25...no make that 26 people in line to volunteer. Come quick if you want to sign up!"

"Aahh...ok, ok coming. You get in line. Don't let your opportunity go!", I told him as I hurriedly put everything away.

At 6:15 pm, I waved to Dr Sanders who was talking on the phone and dashed out of the lab heading straight to the clinical research center where the vaccine trial recruitment was happening.

At 6:25 pm, I was in line as the 39th person to sign up for the phase 1 and 2 trial of the new mRNA vaccine, which I bet everyone of us in that room silently hoped would harbor the end of our nightmarish life.

Elijah waited for me as I filled out the bazillion papers given permission to the research group to take my blood, and give me the trial vaccine, and that I understood that their may be side effects associated with it. The vaccine itself was a needle poke like any other vaccine, but when we both stepped out of that building there was an instant feeling of exhilaration in the air, and even though we were supposed to maintain our distance, we hugged instinctively.

And then Elijah yelled out, "Woohoooo...Oh my God dude, do you realize what we just did? We may very well be the first humans to get a pandemic-stopping vaccine!"

"I know...feels great! Doesn't it?", I replied to him equally excited at the thought of the scientific milestone that we had just participated in.

"Hey listen...I know you don't drink alcohol. But what do you say to Tacos and Ice cream for dinner? I just saw some food trucks a few blocks away"

I thought about Madi, and that I hadn't been able to get in touch with her about her meeting with IF. But then I reminded myself that I was going to focus on the positives only for today. IF was a huge negative, so I agreed to Elijah's plan and we spent at least a couple of hours just joking around, enjoying the cool Chicago air as we scarfed down our food and then enjoyed some delicious, homemade ice cream. Even Jake, my co-intern from my pre-pandemic ICU days joined us at one point, turning our meal into a true bro-fest.

I missed Madi...I really did. I wished we could share these carefree moments as well. We deserved them, after everything we had gone through. But lately, it just seemed that every joyful moment had an unspoken dark undertone to it. Because we both knew that every moment we shared, could be our last one, if we couldn't figure out what our future would look like.

Though, if I had known about the message on my phone that was laying uncharged on my desk in the lab, I might have thought differently. I am glad I didn't though. I had desperately needed those two hours of laughter and good food, and a feeling of optimism.

Because that message nearly broke that last thread of hope that I was hanging on to.

I loved her, with everything I had. She was my life, the only one I wanted a future with. Without her, I knew I would plunge into a darkness I may never be able to come out of.

But some obstacles are too great even for two people who cared for each other as much as we did...or at least that is what I thought for the next few weeks.

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