Medical Examiner

Graduating Medical School Early Wasn’t Anything Like Going to War

My first weeks as a doctor, during a pandemic, showed me how much we struggle to appropriately appreciate public service.

A gloved hand holding an older patient's hand
Photo illustration by Slate. Photos by Getty Images Plus.

In late March, I made the choice to graduate early from NYU Grossman School of Medicine to join the workforce just as the surge in COVID-19 patients hit New York City’s hospitals. After years of training, I knew I couldn’t live with myself if I failed to step up in this time of need. But even as I felt a sense of duty, I’ve been surprised by how it’s been framed. Two days after my graduation from medical school, Jim Dwyer published a piece in the New York Times comparing my decision to that of a group of soldiers enlisting for the war in Iraq. In an attempt to rally its staff, NYU branded all of its employees part of a “COVID army,” and my fellow early graduates and I have been referred to variably as “redeployed” or “reinforcements.” This mirrored the military jargon our collective language had already been deploying to talk about the crisis— the fight on the front lines against the invisible enemy.

Perhaps it is my peacenik Upper West Side upbringing, but something in the comparison did not sit right with me. Yes, my peers and I had assumed personal risk in making the decision to enter the hospital. But we needn’t resort to war metaphors to describe any public-spirited civic choice; not all dangers faced need to be thought of as soldiering. And after six weeks on the wards treating patients, I’ve realized that there is a harmful imprecision in the analogy between fighting a war and withstanding a global pandemic. What we should recognize and take away from this crisis is not that our doctors and health care workers heroically charged into the heat of battle, but that all of us—essential workers and those staying at home—have embraced our collective civic duty and rapidly and fundamentally changed our lives to stem the tide of COVID-19. This pandemic has highlighted our deep civic interconnectedness, not a small cohort of individuals’ heroic bellicosity.

The war metaphor fails in obvious ways. War deals with the infliction of harm and health care with the provision of healing. The day-to-day care of patients is a complex psychological task as well as a medical one. Preoccupation with the virus as an invisible enemy shifts focus away from the personhood of the patient who is afflicted. My role as a physician is not to fight an enemy but to care for a patient holistically. The first patient I treated as a newly minted physician was a homeless woman with schizophrenia. She died suddenly and unexpectedly of complications from COVID. The patient’s condition was obfuscated by her underlying mental health issues, but treating a patient is often complex and challenging—all the more reason we can’t have our scope narrowed by conceiving of our task as merely a battle with an enemy pathogen. After the patient’s death, her family talked to me about the rich life she had led. She had remained particularly close with her siblings, who described their sister as incredibly stubborn but clever and resourceful. Every doctor probably remembers their first patients in a particular way, but I remain haunted by this case, fearing that my implicit biases and early conception of COVID might have affected the care I gave her.

The soldier/essential worker analogy is also used to suggest sacrifice and heroism. In Dwyer’s piece about my class’s graduation, he writes about the first soldier in the 101st Airborne Division who landed in Iraq, reportedly a 20-year-old man who was tragically shot and killed. Dwyer alludes to the rashness of young soldiers. The implication is that my peers and I, young and galvanized like these soldiers, signed up for a dangerous, potentially mortal appointment. But I was not drafted or conscripted, nor was I seeking glory. This was a choice made willingly and without imprudence, grounded in the foundational values of my medical training—compassion for suffering, a desire to heal, a responsibility to mankind. Not all selfless decisions need to be framed by the metaphor of war.

I’m not a soldier, a martyr, or a hero, and I have no interest in dying with glory. To NYU’s and Bellevue Hospital’s credit, I have been compensated and felt adequately protected in the workplace. If these protections had not been afforded me, I would not have felt compelled to work. The supposed praise suggested by the military metaphor rings hollow when so many essential workers haven’t been granted the same protections I had. Moreover, the military metaphor suggests that it is impudent and unpatriotic, a shirking of duty, to advocate for these protections, to protest inequities, and to demand dignity for all. That robs each of us of rights that ought to be inalienable.

A mentor physician who is intimately involved in training medical students said to me recently that he is considering adding some exercises from military officer training programs to the student curriculum. His idea is that, given how unprepared we were for the COVID pandemic, we need to train more doctors with leadership and disaster preparedness skills. Maybe that would help with logistical issues. But given my experience on the wards thus far—filled with difficult end-of-life decisions, a staggering amount of untimely death and futile attempts at resuscitation—my sense is that the skills I need bolstered are more likely to be found in the humanities than in war games and disaster strategy. The deeper challenges that this crisis has confronted me with relate to life’s fundamental questions—those of philosophy and the arts. How do I persist despite immeasurable human suffering? How do I cope with repeated confrontation with the limits of my power to help? How do I find comfort in all this uncertainty?

There is one important way in which I believe the military metaphor is apt. Both soldiers and essential workers suffer at the whim of those with power. Soldiers are often victims of governments’ mistakes—they were in the war in Iraq. Today, essential workers are at the whim of government and business powers. Some of them have paid a drastic price for their leaders’ failures. Despite all the talk of honoring the heroes in the war against COVID, so far there is little indication that such honor will include the creation of a more compassionate, egalitarian, and just society. Doing so would require a radical restructuring of how we compensate workers, since jobs we have deemed “essential” in this moment—care workers, teachers, food services—are often poorly paid and worked by groups of people—women, people of color, undocumented immigrants—who are most exploited by our businesses and most marginalized by our body politic.

Working at Bellevue Hospital, which is the country’s oldest public safety net hospital, I have been able to see firsthand how insidious the military metaphor has been for our patients. Many of Bellevue’s patients are undocumented and uninsured, a population that has been disproportionally affected by this pandemic. Many of the patients I have cared for work in “essential” but low-wage jobs that did not allow them to stay home and to stay safe. But even now, the honor of the military metaphor is not usually extended to them. And indeed, if they are soldiers, they are treated shamefully, as cannon fodder, expendable, as some states rush to reopen.

One such patient, Mr. T, was transferred to my team during my first week on the medicine floors. For the preceding days, Mr. T had been in the intensive care unit intubated, but was improving—a glimmer of light amid much despair. My daily rounds to Mr. T’s room became my favorite part of the day, and as his oxygen requirements diminished and he regained strength, we were able to have longer conversations. Mr. T told me that he works in the food industry. He had been compelled to continue working by his bosses and because of financial need—his wife had lost her job and with it the family’s health insurance during the pandemic. Each time Mr. T returned home, he was meticulous about taking the necessary precautions, since his whole extended family lived together in a multiunit building. He recounted a routine for returning home that had become familiar to me: removing his clothing, washing his hands, showering, wiping down his phone—all these things we’ve quickly adopted as the new normal.

Mr. T described feeling proud when, at 7 p.m., he heard the eruption of cheers in his neighborhood. In a city that can sometimes be coldly impersonal, it was nice to feel part of a community with a higher cause. Despite his best efforts, though, nearly every adult in his extended family contracted COVID. Three of his family members passed away while he was intubated. Like countless others, he didn’t have the chance to say goodbye to his loved ones.

Toward the end of my month on the wards, Mr. T was discharged home. Jay-Z’s “Empire State of Mind” played on the PA system as he was wheeled into the elevator. Outwardly, he projected a graceful poise. After 24 days in the hospital, he was most excited to take a shower. As I watched him go, I couldn’t help but wonder if he shared any of my righteous indignation. I wondered how much comfort he would find in being told he’d been brave. Wouldn’t it be preferable to live in a society that paid respect to all its members in a more regular, quotidian way? Perhaps I was just projecting.