These young doctors fought Covid. Their next battle is to change medicine
A conversation with reporter Emma Goldberg about courage in crisis, race and representation in healthcare, and whether doctors (and writers) can truly see people who are not like them
Do we look back on the plague, or do we move on?
I hear so many interesting versions of this question among writers and artists and others who right now face a real and practical decision about what to make. On one hand, we’ve been living through a rare and seismic event in history of the kind that needs, begs for, processing. On the other hand, for very good reason, not a lot of people seem inclined to relive this recent past. If we write about it, or stage a play about it, or solicit thousands of videos about it for a public art installation, will anyone take an interest? Will anyone want to look back? If not, should they anyway?
The brilliant New York Times reporter Emma Goldberg is among those writers who have made a bet that some reliving is important, and in her new book, “Life on the Line,” she uses verbal artistry to make what is important also strangely gripping.
I didn’t think I would be ready to relive the hand washing and PPE hunt and sanitizing and sirens of the pandemic’s early days. But in Goldberg’s compelling narrative of a handful of young doctors drafted early into the battle against Covid, before they were even supposed to have graduated, I found a calming, healing quality to the reliving.
It’s a fascinating book, beautifully, intimately told. And it’s more than a reliving, of course. At its heart, it’s about an audacious new generation of doctors who weren’t content to fend off Covid as best they could. They will not be satisfied until the medical profession they have just entered has changed, become less cold and emotionally removed, less patriarchal, less imperious, and less milky white.
My interview with Emma is below.
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“Reserves of courage”: a conversation with Emma Goldberg
ANAND: This is, in many ways, a pandemic-in-review book. At this moment of re-emergence, it looks back at what we lived through. But it takes a very particular thin slice of experience and time and occupation. How did you decide to tell the particular story you did?
EMMA: Last year, New York was in a challenging time. The streets were very empty, the hospitals were very full. And I just remember that, all day and night, all you could hear was the sound of sirens. And you would just see these dark headlines, like the New York City body count mounting. It felt like it was really a city on its knees.
I was wondering in the midst of all that, who were the people who were really mobilizing to make a contribution? And in this moment when everyone's lives were being upended, who were the people who were really tapping into reserves of courage and jumping to the front lines?
I reported a story for the New York Times in late March about how medical schools decided to allow their fourth-year students to graduate early and volunteer to treat Covid patients. The minute I started speaking with the students, I knew it was a story that really intrigued me, and that I wanted to keep following. These were young people, people who are pretty much exactly my age — who are just starting out in their careers, just starting to put all their skills to the test — and suddenly they're finding themselves in an impossible situation. What struck me the most is that the medical students I spoke with who were graduating early, and who were basically signing up to go to the front lines, didn't seem at all sucked into the gloom and doom.
They were finding opportunities to be the type of doctor they'd always wanted to be. They were finding opportunities to give really high-quality care, to build deep relationships with their patients. That was harder than ever to do in the context of Covid and in the midst of the pandemic, and they were doing it anyway.
I just wanted to keep following their story, and I wanted people to know about it. It's a story about what it really means to tap into reserves of courage that you didn't know you had, and to change your field in a state of emergency.
ANAND: Being up close with these doctors, what did you learn about courage? Is there such a thing as permanently courageous people, or is it situational? What puts people into that mode, if they're not in that mode before?
EMMA: One of the things that really struck me about the group of doctors I followed is that they realized that the aspects of their situation that frightened them weren't necessarily things they could have anticipated as they were diving into the work of treating Covid patients.
Very few of them were really worried about their own health. They were telling me they knew when they signed up to be doctors that to go into this profession, that ultimately meant putting their patients’ first. They were not really questioning whether this was the right decision or whether it was the moral decision. The really frustrating part of the real test was when they actually couldn't save their patients’ lives, because the scale of what they were facing was too big.
I remember there was this moment, about a week into one of them working in the Covid wards when a young woman named Iris called me and she had just lost one of her first Covid patients. A few hours after he came to the hospital, he died. She said that she felt this insurmountable grief, but she also felt like she didn't have the right to feel that grief, because she was there treating Covid patients entirely of her own volition.
Those were the moments when the scale of what they'd chosen to do really felt the largest. Because they were happy to sign up and to put their patients first, but I think what they didn't anticipate was that the real test would come when they actually weren't able to do anything for the patients whom they were serving. This was a novel virus, and it was a really deadly virus, and sometimes there was nothing they could do.
ANAND: What you're describing is a mass traumatic event for a lot of these doctors. They’re used to dealing with hard things, but this was just a hard thing unlike any other hard thing. Are they getting help in general? Is there some system to help New York's doctors and other doctors process what they went through, or is it all on a case-by-case basis?
EMMA: This last year was a reckoning for mental health in healthcare. My conversations with the dozens of doctors who have worked on the front lines pointed to the fact that we don't talk enough about how to care for our caregivers. In fact, seeking out mental health help in the healthcare profession is often stigmatized.
ANAND: It hurts you professionally?
ANAND: One of the things you show through a lot of these characters is that there's a new generation of doctors who are not just young in the way that new generations are, but are more diverse than the doctors who are retiring today. Tell us about the patriarchal, white-male-dominated world of medicine that they are entering, and how they are aspiring to change it.
EMMA: There are certain stereotypes you think about in medicine. Like you said, an old-school, often white male doctor who was a little bit removed emotionally, and just told the patient what they needed to do or what they thought was best.
It wasn't a real relationship. There was no real effort to cultivate trust. One thing I found fascinating is that there's a lot of history in the medical profession of how the whiteness and the patriarchal aspect of the field was set up by design. It's not incidental. It was very much an effort to make this a profession that was elite and that was high-paying.
About a hundred years ago, there was actually an effort to make the medical field a lot more restrictive. There was an effort, in a report commissioned by the American Medical Association, to shut down a lot of Black medical schools and a lot of rural medical schools that trained lower-income doctors. So from the start, this field was designed in the U.S. specifically to be a homogenous, elite, slightly removed group of professionals. And it's only in the last few decades that there's been a real effort to think about how to build a more emotional and personal bond between doctors and patients.
ANAND: I have to say, I experienced the downstream effects of that, but I had no idea of this history you tell of, basically, rigging medicine as a bro cartel.
EMMA: Yeah. And you saw the wages rise in the early 1900s and you saw the effects of making this field really restrictive. It made it a profession and not just a trade, and patients bore the effects of that. In some cases, you can argue it's had health consequences.
ANAND: You see this certainly in the misdiagnosis, under-diagnosis, and ignoring of Black patients’ pain, and Black women's pain, in particular. This ignoring of conditions has gotten a little bit more of a spotlight in recent years. Tell us about Gabriela, and why her mom drove her far out of town to see a certain doctor rather than someone who may have been closer.
EMMA: Gabriela is one of the central doctors in the book; that's her on the cover. It really stuck out to me that she told me her mom would drive her far out of town to see the only Hispanic pediatrician in their area, which I think she only came to make sense of as she was growing up and seeing how underrepresented people like her were in the medical field.
Fewer than 6 percent of doctors are Hispanic. Only in recent years are we starting to have real evidence and studies looking at the fact that when patients are seen by doctors who look like them, they often have better health outcomes.
So when we talk about representation in the medical field it's not a nice-to-have; it's something with health consequences, even life-or-death consequences. There's a study that I talk about in the book that was one of the most fascinating ones I came across. Doctors Owen Garrick and Marcella Olsson in Oakland set up a clinic that was staffed by Black doctors, and they measured the effects of Black patients who were seen by Black doctors versus white doctors. And what they found is that when a Black patient is seen by a Black doctor, they're more likely to agree to elective measures, like a cholesterol screening or a diabetes test.
They're actually more likely to agree to these important preventative measures if they're seen by a doctor who looks like them. There's just a certain baseline of trust that might not be present when they're seen by a white doctor.
ANAND: As I was reading through this critique of the old patriarchal model and representation in medicine, it made me think of a tension in the book. Your book is a great work of narrative non-fiction, in the sense that it's not just interviews or from a distance. You really are trying to capture the interiority of these people. Most of them are diverse young doctors; most of them are from different backgrounds from yours.
Your journalism shows that it's possible to do that. You make a Chinese character and a Latina character visible and vivid, and you go inside their families. You are able to make that identity leap. Yet the book is skeptical of the possibility that doctors can do that in their profession. It seems optimistic that writers can do that.
I wonder what you think about the possibility of a writer making that empathic leap beyond your community, but why do you think it's hard for doctors to do that?
EMMA: It's something that I thought about, not exactly in those terms, but definitely it was on my mind as I was reporting and writing this. And I think where I came down was that I did not feel like I could write this book or tell this story without showing the real breadth of the people who were on the front lines and the new generation that's coming into medicine. I did not want this to just be a book about young, white, Jewish doctors, because there's a million of those and people know that story.
One of the ways that I try to do that is just by listening and trying to make this book a platform for these doctors. Not my projection, but their voices and their experiences. I was learning every single day from these doctors, and I was just trying to take in as much of what they were telling me as possible to share it with readers.
ANAND: Like you do, I feel very strongly both ways about this issue. Our profession of writing has been so harmed by the lack of representation, particularly among editors and important decision makers. I can't celebrate enough having not just more of that representation, but having things like the “1619 Project,” having different lenses and centers of storytelling.
At the same time, I was teaching a journalism course a couple of years ago, and this new generation of students I was teaching was almost of the view that people should only report on communities that they belong to: the white students should only write about white people, and Black students should write about Black people. It was coming from this progressive place and intention.
Maybe I'm just getting old, but I was very disturbed by it. I thought it would not be good for any of those communities not to have people from any other community care about them. Some of the best things I've ever read were from people making those empathic leaps.
I think of Katherine Boo, one of my favorite non-fiction writers, and the interiority she has with Indian characters. In “Behind the Beautiful Forevers,” she describes this poor woman from a slum walking into a fancy hotel in India and she writes about her seeing all these rich ladies in the hotel “carrying handbags as big as household shrines.”
The amount of work you have to do as a white woman living in India to de-center your own perspective and describe a handbag from the point of view of that woman — I want that work to happen. I want people to be making those leaps. I want more voices to be telling those stories. Your book really made me think a lot about that in writing and in medicine.
EMMA: It's something that I want to continue wrestling with, and it's something I wrestled with in my reporting for The Times. I wrote a piece last summer about the microaggressions that Black women doctors face as they're going through their medical training. It definitely made me more attuned to all the behaviors that I am probably complicit in, and it was eye-opening.
It's a complicated relationship, and journalists have to tell these stories — and sometimes have to draw the line where maybe there's someone better who could be telling the story instead of us.
ANAND: I remember when Covid started, I happened to be in between books and thinking about what my next book was. Everybody in the book world I talked to, even in the early days of Covid, was like, "Stay away from Covid, don't write a Covid book. There's going to be 50,000 of them. No one's going to want to read them because people are just going to want to move on."
Now here we are, everyone wants hot-girl summer to start, and Biden wants us to be grilling on July 4th, just having fun. You feel this almost physical desire of people to just shed the snakeskin of the past, and move on. You made a bet with this book on the desire of people to relive this past year, or at least the importance of their doing so. How did you think about that?
EMMA: We're already seeing that in New York City. I've been thinking so much about the contrast between the streets right now and the streets a year ago, where you're literally seeing people walking around unmasked. For those of us who remember last year in New York City, there's a weirdness to it, to this rush back into normalcy.
We have to think about who is able to resume a normal life, who doesn't stand to gain from resumption of normal life, and how we can wrestle with all the ways that our lives were upended over the last year. It's understandable that some people want to jump back into the joys of pre-pandemic life, but that's not accessible to a lot of people, including most people in the world.
It would be a real mistake not to stare down some of the narratives from the last year, and just continue to do the big-picture thinking about what they mean and what their implications are for all of us. I wasn't consciously taking that up with this book. I was just hoping that people would be willing to — for many years to come — keep wrestling with the experiences of the last year, thinking about what they mean for all of us, and what they call on all of us to do.
ANAND: The sanitizing of things, the handwashing, running out of toilet paper, the loss of smell and taste that people had — these were such universal, shared experiences. I thought that I would not enjoy reliving those things, but I actually really enjoyed it with this book.
Do you think there's value in that rehashing for people, almost in the way soldiers with PTSD sometimes play video-game versions of their battles and get to do it over? Is there some value in going through the memory of the past year in some concerted way, whether it's through reading, whether it's through art?
EMMA: I certainly hope so. The last year, and particularly the early months of the pandemic, were such a time of disconnect when so many of us were processing what we were going through on our own, and we were separated from family, we were separated from friends. People were living in their own little bubbles in different ways. There's a real opportunity to process what we went through in relation to what our city went through, our community, and the healthcare workers who were really in the thick of it.
I'm sure people remember the news stories that were talking about hospitals as a war zone, or even just the really dark Twitter feeds that everyone was scrolling through. But there's value in taking a wider lens, including processing the young doctors who were making sacrifices, the people who were upending their lives the most, working 10 to 12 hours a day, treating patients. There's value in reading their experiences, and processing them in parallel with our own, and tapping back into that.
ANAND: One of the strands of the plot is the history of medical racism in this country, and the way the medical system and doctors have treated Black patients. How did that history play out in Covid, from the beginning to vaccines and onward?
EMMA: The pandemic certainly devastated communities of color the most in the U.S. and abroad. In the early weeks of the pandemic, Black and Hispanic patients were dying at twice the rate of white residents of New York City. It was hitting the hardest in those communities for a lot of different reasons, but particularly because people in communities of color and the people in lower-income communities were not able to socially distance and socially isolate in the same way. You were seeing that born out in the hospitalization rates, the case rates, and the death rates.
The grief of that was the sharpest for doctors of color who had maybe set out to serve these communities and then were seeing the virus devastate these communities — and sometimes their families — in a really personal and visceral way.
ANAND: Over the past year, you and I probably shared a problem which is that we normally tend to report in person: see people, and go to meals with the people we’re writing about, and watch them do their jobs.
I always know the writing I do that comes from hangouts is so much better than the writing I do that comes from interviews. You were quite limited in the way all of us were, and yet this manages to be gripping and feels like you're in the room. Tell us about the process of doing this reporting with the limitation of Covid, and trying to overcome that limitation.
EMMA: It was frustrating early on. A lot of journalists saw that it was going to be challenging to get access, or be able to do their stories in the way that we are used to doing. Partly, it was for good reason that the hospitals were under siege, and they needed as few bodies in the room as possible, for the very basic reason of exposure and limiting risks for health care providers, journalists, and patients. That was a real practical constraint.
I was really grateful to be able to talk with these doctors really frequently on the phone, and I asked them to set a time to talk with me whenever they had any free time in their schedule. That was tough because they were working long shifts. I feel really grateful that at the end of really long days at 9 p.m. or 10 p.m., they would make time to call me, to just share the details of their day.
ANAND: I wonder if you can share one story of one of these doctors that maybe says something about how people are able to rise to a moment in ways that perhaps they would not even expect for themselves.
EMMA: One particular doctor met a young patient who had Down syndrome, and this patient had Covid. The patient had arrived in the ambulance at the hospital with his father, who also got Covid. But then the father passed away, and the patient was orphaned.
He was a young man with severe disabilities. He was pretty much non-verbal and now had no parents. In the beginning, some of the doctors told me it was hard to know how to treat him.Not all of them were fully trained for that.
He would throw things on the floor or yell, and some of the doctors were a bit frightened by it. But the young doctor I was following named Jay really rose to the occasion. She would spend all of her extra time sitting at this patient's bed. She would hold his hand, let him nap on her shoulder. She told me she got embedded in his life in this deeply personal way. Even when she was transferred to a different unit, and he was no longer her patient, she would come back and visit him every day.
It reminded me that, even in a state of an emergency, when doctors feel like they have so little time to do anything beyond their immediate tasks, beyond just trying to save lives, there's still room to build these deep personal relationships that I think will change both Jay and the patient for the rest of their lives.
Emma Goldberg is a reporter at The New York Times. You can order her new book, “Life on the Line: Young Doctors Come of Age in a Pandemic,” here. This interview has been condensed and edited for clarity.
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Hi, Anand. Thank You for this wonderful interview. "Behind The Beautiful Forevers" is one of my favorite books, and I will be picking up a copy of Ms. Goldberg's book, too.
Did Ms. Goldberg write about nurses as well as doctors? I won't go to a doctor if I can help it; I always seek out Nurse Practitioners because they tend to have the respect and empathy that gets trained out of doctors. Nurses are more hands on caregivers, and nurses, including nurses aides, also risked their lives during Covid for far less money and prestige.
I liked your objection to "this new generation of students I was teaching was almost of the view that people should only report on communities that they belong to"
"Identity Politics" is the gift that truly keeps on giving. And taking. We really need to stop believing that any individual can represent a "community" or even connect to a "community". We are not wired to connect to "communities" we are wired to connect to unique individuals. Empathy is only possible one on one, which is why Identity Politics is so destructive to empathy.
As a homelessness survivor and homeless rights advocate, I don't connect to the homeless "community". I can't connect to the homeless "community" I can only connect to unique individuals who are experiencing homelessness. And they are NOT alike! At all. They don't even get along with each other. And being the same race does absolutely nothing to mitigate differences. Amaryllis ( a Black trans woman) and Beverly (who thinks Amaryllis is a narcissist which, in truth, she is) hate each other. Miss Margaret is an older Black woman who borders on sainthood - and she's a Trump supporter (kill me now). Beverly and Amaryllis are aghast at that. Kelly is a white woman, the most mentally disabled of the group, and she is also a Trump supporter. Everyone gets along best with Kelly, probably because of her mental vulnerability.
I'm a disabled white woman who escaped from poverty and homelessness because of white privilege (I inherited money my sociopathic grandfather made by constructing homes during the post WWII red lining years). But Kelly's white privilege has failed to deliver, just as it's failed to deliver for so many poor and working class whites who insist on clinging to their white identity. It's madness.
Anyway, thank you for bringing our attention to what sounds like a great new book!
Thank you, Anand, for covering this subject very alive for me as a brown immigrant, longtime citizen to this country. The last few years I have gravitated to female doctors for the same reasons mentioned in your interview. And the last year in Virginia I consciously prefer doctors from Southeast Asia or Asian generally and Middle East, the environment I came from. Easy to do as the majority of doctors available in the rural area I am in are from those places. Actually, it looks like white students stopped going to medical school in Virginia. Experience with white doctors in California left me perplexed that after decades of years attending to me, these doctors did not know who I was and where I came from, at least to the degree significant to my treatment. Did it matter that I grew up in the culture and diet of my European father? How could they be healing when they ignore the consciousness behind the body., and in my opinion a level of education greater than theirs? I guess medical schools do not teach that. I am not convinced by little changes, little improvements one hears about. This, my country now, must pass through painful political changes by mass political movements that bring it to question the structure of the 1789 American Magna Carta, which decapitated the king and placed all power in private-property barons supported by the necessary legal and medical estates. We either learn to grant the "unwashed masses" their genuine national government, or such changes will be imposed on us by a new Asian dominance on Earth.