Barriers

The homeless man, whom I’ll call Gerald, hunched on the end of my exam table, gingerly picking at the metal shield taped over his left eye. “It happened like this, see, I was out panhandling, and with this new virus thing I’ve been trying to keep to myself, so I moved down the block from my usual spot. I’m standing there with my sign and my can for maybe five minutes, and a guy I’ve never seen before comes up, says I’m in his space. Before I can say anything, he lands a shot, right here. I think he was wearing a heavy ring or something, because I feel a pop and a squelch, and blood starts pouring from my eye socket, and right away I know my sight is done.” He sighed. “I was trying to do the right thing, stay apart from people as much as possible, you know? Because of that I lose my eye.”

I lean forward and sigh, too, trying to express as much concern as I can with just my eyes above the line of my mask.

The Oxford English Dictionary lists a number of definitions for the word “mask,” beginning with this:

—from the French masque: a covering for the face, and related senses.

—A covering for the mouth and nose made of fibre or gauze, designed to filter dust, microorganisms, etc., from air inhaled or exhaled, esp. by theatre staff during surgical operations.

I’m a nurse practitioner, and I’ve been working with homeless people at Boston Health Care for the Homeless Program for twenty years. I’m astonished at the speed with which my clinical world has been transformed since mid-March, as the program geared up for a wave of COVID infections to sweep through our vulnerable homeless community. BHCHP administrators and clinicians worked around the clock with city and state agencies to set up a new tent-based testing center in a parking lot next to our main building, and procure unused blocks of rooms in nearby college dormitories and hotels to house people needing to be quarantined.

I recently turned sixty, and Health Care for the Homeless management has determined that older clinicians like me, who are at higher risk for serious complications from COVID-19, won’t be working as frontline caregivers in this unfolding crisis. So I’ve been part of the support team, caring for our “regular” patients recovering from hip surgery or receiving breast cancer treatment, freeing up younger clinicians to prepare for the storm of COVID infections. In the early days of the crisis, when institutions were frantically scrambling to stock personal protective equipment, those of us who were seeing non-COVID patients were mostly mask-less as we went about our work, wearing gloves only for procedures. I washed my hands thirty-plus times a shift: between each patient, every time I pulled a door handle or moved an equipment cart—or at least I tried to. I talked to patients from a respectful distance, laying hands on them or listening to their heart and lungs only if really necessary, scrubbing down my stethoscope afterwards with antiseptic wipes. It was exhausting to maintain a hyperawareness of every surface that I touched, of the safe distances I needed to keep between myself and others as I moved around the clinic.

Starting on Monday, March 31^st, all clinical staff members were each issued one surgical mask to wear for the entire shift. At that time, at that rate of use, our program had on hand a sixteen-day supply of masks for the two hundred or so essential on-site staff members. Since then, we’ve procured more surgical masks, and more protective equipment for our frontline clinicians: gowns and face shields and the more secure N95 masks, but on that day, I appreciated how precious a thirty-five-cent pleated surgical mask can be. The sheer close physical presence of this thing on my face, molded over the bridge of my nose and the swell of my cheekbones, helped me to remember in each moment that we were moving into a deepening health care crisis. I was aware of each breath circulating through the narrow space between my skin and fabric, growing sweetly stale by shift’s end. The crinkly fabric was a physical reminder that I couldn’t touch my face, something I realized I did compulsively when I was mask-less. I kept the mask in place except for a quick lunch break, when I carefully removed it by the ear loops and placed it, outside fabric face-down, on a clean sheet of paper on my desk beside me while I inhaled my food, then picking it up again only by the ear loops, to set it back over my face, followed by yet another thorough twenty-second handwashing.

 

—A grotesque or comical representation of a face, made of pasteboard, plastic, or other material, and worn at carnivals, parties, etc.

It’s only been a couple of months, but it seems like a decade since I attended the sprawling AWP (Association of Writers and Writing Programs) convention in San Antonio at the beginning of March. Early reports of clusters of U.S. citizens coming down with a deadly novel coronavirus, on cruise ships and in West Coast nursing homes, were just beginning to emerge in the weeks leading up to the convention, and organizers chose to go ahead with the program. About a quarter of the anticipated 12,000 participants made last minute decisions not to attend. I opted to go, and although I was disappointed by the scores of cancelled readings and panels, and the many absent editors and literary figures I’d hoped to meet, I did have a pleasant time strolling along the Riverwalk, meeting up with far-flung writerly friends, sitting outside in the soft Texas spring air while nursing margaritas and trading stories. The cavernous convention center seemed both eerily empty and strangely intimate, as we didn’t have to fight our way through tight throngs of high-strung literati to find our way around. Most everyone adhered to the brand-new social distancing guidelines: no handshakes or hugs, but elbow bumps were okay. The sour pungency of hand sanitizer wafted through the convention center halls, as organizers had placed Purell dispensers every twenty yards or so.

At the end of the four-day convention, my friend Rex gave me a cloth facemask with a goofy cartoon smiley-mouth stenciled on it to wear in the confines of the air cabin on my flight home. I accepted it as a joke gift, and stuck it in my pocket, not realizing how soon it would become a required accessory for routine activities: grocery-shopping, walking the dogs around the neighborhood. How quickly our social norms have changed.

 

—A facial expression assumed deliberately to conceal an emotion or give a false impression; an outward appearance which belies a person’s true nature.

Of course, we’ve all been on edge, hunkering down in our homes, wondering what comes next for the world in this moment of climbing infection rates, plunging employment, and gyrating economic markets. I tell myself I’m fine, and on the surface it’s true: my wife and I both have secure jobs for now; we have a roof over our heads, and a well-stocked pantry. Most everyone I know, my family and friends, are healthy and secure at this point. The people I know who have succumbed to COVID-19 are not part of my immediate life: distant relatives of friends; my high school math teacher. So, I put on a calm demeanor and focus on getting through each day, looking to the immediate tasks at hand, avoiding unnecessary drama. But each night I wake up in the predawn and lie there for an hour or so, wondering. I’m not paralyzed with dread, but I’m not calm, either.

Early in April, I received a call from my medical director. He informed me I had an exposure, that one of the patients I saw the previous week had tested positive for COVID-19. He said that it was likely not a significant exposure, as I was following our clinical care protocols, and I was wearing a mask, but that I should be scrupulous about social distancing for the remainder of the fourteen days after the exposure. If I had any symptoms—fever, dry cough, or severe fatigue—I should come in and get tested.

After I hung up the phone, I realized this was not surprising news; I’d been expecting such a call at some point. I told my wife, and we rationally ticked through the household changes we’d already been thinking we might have to make at some point: I would move out of the bedroom and sleep on the sofa in the study; I would cease involvement in food prep; I would steer clear of our daughters as much as possible, shower in the downstairs bathroom, take my temperature every morning. I looked out the window. It was a beautiful spring day, the forsythia was blooming out back, and I felt fine. But the “what-ifs” hung in the air: what if at some point I didn’t feel fine, or Anna, or both of us, or all of us? What then? I took a breath, slipped on my calm demeanor, washed my hands again, and set about moving my clothes and toiletries into the study.

 

—A likeness of a person’s face in clay, wax, etc., esp. one made by taking a mould from the face itself.

From the late Middle Ages up into the twentieth century, a death mask, cast from wax or plaster that had been molded directly to the newly-deceased person’s face, was a significant form of commemoration for kings and nobility and other eminent persons. Such renowned figures as Dante Alighieri, Henry VIII, Beethoven, Voltaire, John Keats, and Stalin all had death masks taken and cast, so that their features would be permanently fixed, to be remembered by successive generations. In the nineteenth century, death masks were sometimes cast of unidentified bodies so that family members might be able to identify them later on. Now, ICU nurses hold up iPhones to FaceTime a last glimpse of a dying COVID patient to their family sequestered at home. I think of these families, with so little to carry forward with them, no last words or touch to commemorate the loved one they lost so suddenly to this virus. And I think of them cooped up in their separate homes, unable to come together to grieve their loss as a community. I think of my homeless patient, Hugh, who once told me his biggest fear was dying by himself. “It can get crazy out there, Rob, but in the end, we all look out for each other. Nobody, I tell you, nobody wants to die alone.”

 

One night, I took the dogs out for a late loop around the block. The full moon was luminous, mostly hidden behind clouds. Beyond a line of trees across the street, spring peepers were chiming at full volume, a joyous chorus of frogs seeking mates as they carried their life cycle into another season of renewal. For a moment, the world was so achingly beautiful that it masked the human suffering and loss I knew was unfolding farther out there in the night. Suffering and beauty. I had no idea which side of the barrier I might be standing on.