Amor Fati: On Selina Mahmood's "A Pandemic in Residence"
Selina Mahmood | Pandemic in Residence: Essays from a Detroit Hospital | Belt Publishing | 2021 | 144 Pages
As I write this review, COVID (as a term, a concept, a universally cursed disease) is well into its third year. Between talk of waves, the rhythms of life are settling back into their familiar tracks. COVID feels like it is fading from a deafening roar to a background rumble. As an Emergency Medicine resident working in NYC’s ERs, for me, fear is no longer the dominant emotion that COVID provokes. I see my lack of fear in the ease with which I default to a plain surgical mask for the majority of my shifts, my N95 now hanging around my neck, ready to be swapped in only when I move from the general patient area to the covid isolation areas. I see it in my lack of hesitation to pull down my mask to help hard of hearing patients read my lips. Whatever fear I feel is for the future—for the next wave, for the next surge where the ER is overwhelmed and the back-up for the back-up sick call is activated. But for now, what I feel is resignation, impatience, acceptance, and a thousand other feelings, the nuances of which I am still teasing out. How appropriate it is then to have read Selina Mahmood’s Pandemic in Residence, a thoughtful reflection by a neurology resident in Detroit about how the sudden appearance of COVID shaped her intern year.
The amount of figurative ink already spilt over COVID is undoubtedly staggering. In this sea, Mahmood’s short volume stands out. Longer and less charged than the many articles and think-pieces that were quickly churned out in the early days of the pandemic, it feels more like a meditation than an essay. Mahmood writes, “If you can’t remember an event as it unfolds you can’t remember it afterward,” and it does feel like Pandemic is intended as a primary source. There is no hypothesis being argued, no grand claims being made. Instead, Mahmood shares her sliver of reality from those early days of the pandemic.
That sliver of reality is beautifully messy. Medical residency, and intern year in particular, is inherently messy, and Mahmood doesn’t shy away from sharing unpolished thoughts. This is not an over laudatory account of the heroism of frontline workers. Mahmood herself writes, “I’ve seen posts about being out on the front lines that have literally, physically made me cringe: an overdramatization that’s become a caricature.” Rather, this is a young doctor laying bare her struggle to make sense of the search for meaning. In that search, Mahmood grapples with the writings of Joan Didion and Noam Chomsky, and the Stoic principle of amor fati, the love of fate.
Mahmood is honest about how thin the veil between meaning and meaninglessness is in the daily grind of hospital labor. Residency is a “monotone existence of eighty hour work weeks” spent “in a universal system deeply flawed in many terrifying ways.” Doing no harm can feel Sisyphean in healthcare systems that (despite lip service suggesting otherwise) have allowed the demands of bureaucracy, administration, and billing to influence every aspect of patient care. COVID, for all its pain, offered a relief from the meaninglessness. “This feels like what being a physician should be like: the chance to feel meaningful.”
Like Mahmood at the outset of the pandemic, I am an intern. For all the ways that our specifics differ (I specialize in emergency medicine, she in neurology; I am in New York City, she in Detroit), the shared experience of residency trumps them all. I felt a certain twisted pleasure in reading the chapter “Sleep” at 3 am, during a slow moment on my own overnight shift. When she wrote “the orthopedic surgery residents are now running their own covid floor (much to the amusement of almost everyone in the hospital),” I shared in that amusement. I found comfort in seeing my own experiences reflected in her words, because it suggested that while COVID may have heightened and exaggerated the experiences of intern year, perhaps it did not fundamentally change them.
I began my intern year in July of 2021, with COVID feeling firmly defanged in the wake of mass vaccination campaigns. And while I am grateful to have been spared the uncertainty and fear that consumed hospitals and doctors in early 2020, I can’t help but wonder—what would I have done, felt, and become had I been there? Did I miss the defining moment of a medical generation? It feels a bit like going to Normandy on June 7th, 1944. Mahmood, too, is drawn to the wartime analogy. She describes how pandemic residents were “redeployed,” and observes, “I can’t believe this sentimentality is spewing from my mouth—but damn, it really feels like we’re going to war.”
It bears repeating: Mahmood is an intern, meaning she was in her first year as a doctor. She does not have years of experience through which to frame and contextualize COVID. Her first death is a COVID death. What does that mean? That’s the question at the heart of Mahmood’s efforts: what does it mean for these formative moments to all be laced with COVID? Two powerful contributions to this question come from Mahmood’s own family. After finishing the death note for her patient (the demand for documentation is relentless), Mahmood calls her mother, who shares a story about one of her own patients years ago. He was young and had been stabbed. While they were able to control the bleeding from the wound, the patient had gone into acute respiratory distress and “at that time there hadn’t even been one ventilator in the hospital, and they had watched as this young guy died. You never forget.” Mahmood’s grandmother was in medical school during the partition of India and Pakistan. During that bloody conflict, she was “redeployed to sift the alive from the dead in the trainfuls of humanity arriving.” Death is death, whether it is the first one or the umpteenth, whether it is from COVID, from a lack of resources, or from geopolitical upset. As Mahmood simply writes, “It happened. It was devastating, it was, it is.”
Pandemic is caught between two styles. One is personal reflection, with passages feeling as though they traveled in an unceasing flow from her mind’s neurons to her body’s fingertips, where they were transcribed unrevised: “Leave, forever, go back, an account at its best, here’s the rosary, I’ll hold it while you climb back, here’s the story, I’ll hold it back, here’s the end, I’ll hold it back[…].” At times, her phrases and chapters feel unfinished, but I mean that as a compliment. The great strength of Mahmood’s work comes from its ability to convey the fever dream state that marked the early days of COVID.
In contrast there are other passages that feel like the first drafts of formal historical or philosophical essays intended for an academic audience. Mahmood jolts her readers when switching from formalized geometric diagrams of thought experiments, references to “powered epistemology,” and secondary source references to casual offhand remarks. For example, a multi-page overview in the broadest strokes of non-Western medical history ends with the sentence, “Anyhow… it’s time to get a coffee and move elsewhere.” While this contrast seems deliberate, my initial reaction, as a reader, was one of frustration. Pick a voice, pick a style, pick a tone, stop forcing me as a reader to readjust the lens through which I am reading your words.
By the conclusion, however, this dissonance felt like a further reflection of the unique place this book holds in the body of COVID literature. At its core, Mahmood’s book is a diaristic reflection on the pandemic edited and published barely a year after COVID appeared. What diary, what personal reflection, does not carry some level of desynchrony? Who amongst us knows exactly what to say and feel about COVID and the unique (and yet simultaneously ubiquitous) mark it made on our lives? A more polished, less raw version of Mahmood’s work would ring hollow, a performance rather than a confidence. In Mahmood’s own words, “There is power in gentle digression, in talking a subject matter its way to silence instead of decorating said subject matter with blood and confetti.”