Seven O'Clock
Authors: Kunal K. Sindhu
Journal: Annals of Internal Medicine (2020)

On Being a Doctor18 August 2020Seven O'ClockFREEKunal K. Sindhu, MDKunal K. Sindhu, MDIcahn School of Medicine at Mount Sinai, New York, New York (K.K.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-2347 Audio Reading - "Seven O'Clock" Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads "Seven O'Clock" by Kunal K. Sindhu, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Every night, at 7:00, it begins.It starts slowly, heralding its arrival with the sound of a single clap or cheer. On streets devoid of their typical pedestrian and vehicular traffic, the noise carries far, attracting the attention of millions of New Yorkers sheltering in place. Enticed by its allure, others soon join in.As the volume rises, the constant daytime blaring of ambulance sirens is temporarily forgotten. Everyone has a different role to play: while some bang pots and pans outside of their windows, others play music from their balconies. Drivers honk their car horns. Everybody is cheering.The melodies harmonize, and what began as a scattered cacophony soon becomes an orchestra. The skies fill with encouragement as tenants from townhouses and residential towers alike join in. The energy is electric. For a few minutes, the gloom that has overtaken the city is cast aside.Yet, the peak soon passes and is succeeded by a disheartening decrescendo. Cookware disappears, songs end, and cars scatter. Cheers die down, replaced by the eerie silence of a city laid low by a black swan. Neighbors retreat to the safety of their apartments. New York returns to its surreal status quo.In the span of a few weeks, COVID-19 has upended life in New York City in unprecedented ways. Buses and subways are abandoned. Restaurants and bars are closed. Masks and social distancing are omnipresent. And hospitals are packed. The City That Never Sleeps has become a city under siege.As New Yorkers have hunkered down in their apartments to slow the spread of the virus, the nightly 7:00 cheer has become a cherished tradition. It brings structure to days in which time no longer seems to matter. It is an act of solidarity, allowing otherwise isolated neighbors the opportunity to briefly and safely connect with one another from afar. Most important, for just a few moments the economic, health, and social crises simultaneously engulfing our city are forgotten, replaced by an extraordinary show of gratitude for the workers who continue to serve in the midst of a deadly pandemic: the delivery drivers, firefighters, grocery employees, police officers, and frontline health care workers.I am one of those health care workers.As a radiation oncology resident, I had not expected to be one. However, as the crisis intensified in New York, the inevitability of my redeployment became clear. A few weeks ago, I was temporarily reassigned to an internal medicine service at the same hospital where I completed my internship nearly 2 years ago. I am now managing a surge of patients, many of whom are suffering from COVID-19, and the hospital bears only a passing resemblance to the place that I left.Although things seem to be slowly improving, New York City remains the epicenter of the pandemic worldwide. Over 10,000 New Yorkers have lost their lives to the virus, and many have lost their livelihoods. Now more than ever the city needs its physicians, and I—like others—have felt a moral obligation to help. I am proud to be able to serve my fellow New Yorkers.That said, no one planned or wished to send scores of dermatologists, ophthalmologists, radiation oncologists, radiologists, and others to the frontlines to help manage the COVID-19 outbreak. It was, by its nature, a fundamentally undesirable outcome, a concession that the city's existing public health infrastructure could no longer manage the devastation wreaked by the virus. As such, redeployment has proved to be a challenging experience.The transition to becoming an intern again has been jarring. Since I completed my internship, my life has dramatically changed. I have gotten married. I have moved to a different neighborhood. And I have completed nearly 2 years of training in my specialty of choice.Despite these meaningful signs of progress, I now find myself reliving many of the same challenges I faced on July 1 of my intern year. I am learning once again how to use an unfamiliar electronic health record, navigate existing hospital logistics, and locate necessary supplies. My diagnostic and therapeutic skills as they relate to internal medicine are admittedly rusty, and I have sometimes felt less than comfortable operating in an environment where the knowledge I spent nearly 2 years accumulating in radiation oncology is largely irrelevant. My career and education, once both progressing, now suddenly feel stalled.Moreover, treating patients with COVID-19 has proved mentally and physically taxing. The specter of an abrupt decompensation lingers over hospitalizations that are frequently long and arduous. Deaths are all too common; however, little time is left to emotionally process them during long and busy shifts. As a result, the specter of moral injury hovers over everything we do, even as the fear of personally contracting the virus and spreading it to our loved ones lingers.Then there is the gnawing uncertainty about the future. As the crisis has begun to abate, calls to prematurely reopen the economy have grown. Although my reassignment may soon end, the possibility of a catastrophic second wave of infections in the coming months looms large. Will I, along with my colleagues, once again be called upon to help manage another crisis? Will we once again be asked to risk our health and that of our families?I did not pursue medicine for gratitude or recognition. Instead, I was and remain drawn by an impulse to help others. Nonetheless, in the face of the challenges I have experienced during my redeployment, the nightly 7:00 cheer has meant the world to me.For those of us managing patients with COVID-19, so many aspects of our lives are now completely defined by the virus. It has affected our emotional and physical health. It has altered the course of our training and worried our loved ones. It is all we ever talk about.The cheer is a respite from all of this. It allows us to forget about the virus, if only for a few minutes each day. It has proved personally therapeutic, easing my anxiety and stress. And it has encouraged me to keep going, even on days when my enthusiasm has waned.Over the course of its history, New York City has had to repeatedly reinvent itself in response to a series of existential crises, in each case revealing its collective resiliency, grit, and determination. Although I cannot help but worry about the city's future in light of the COVID-19 outbreak, the sight of its residents once again coming together as a community in response to yet another tragedy is incredibly inspiring. I have never been prouder to call myself a New Yorker.I am not sure when the pandemic will end. But the 7:00 cheer gives me hope that we can, and will, get through this crisis together. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Icahn School of Medicine at Mount Sinai, New York, New York (K.K.S.)Corresponding Author: Kunal K. Sindhu, MD, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029; e-mail, kunal.[email protected]org.This article was published at Annals.org on 19 May 2020. PreviousarticleNextarticle Advertisement Audio Reading - "Seven O'Clock" Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads "Seven O'Clock" by Kunal K. Sindhu, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byThe Phone: Communication in the Age of COVID-19 18 August 2020Volume 173, Issue 4Page: 313-314KeywordsCOVID-19EmotionsForecastingGratitudeHealth care providersHealth economicsHospital medicineSafetySleepSocial distancing ePublished: 19 May 2020 Issue Published: 18 August 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...