COVID has made a home on my computer’s desktop. Every morning, there is a repetitive chirping with headlines that describe the vaccine trials and testing. My second reminder is more personal – a file titled, “Dear Kimmy …,” locked in the center of my screen. I’ll explain:

It’s 7:30 p.m. I’m the resident on call in the surgical ICU, and I was just paged: There is a patient with perforated appendicitis being admitted. He is COVID positive.

This will be the first patient I care for with COVID. My mind is racing. Specific questions come first: “Is it gloves first or gown first? Where is my N95? Do I have another one to wear for the rest of the night after I go to see this man?” I have many questions like this. But these questions have answers, and in that way, they are somewhat comforting.

As I start digging through updated policies and care algorithms, my thoughts shift. “How common is it for residents to get sick? What happens if I get sick? What happens if I get really sick?” I have a vague recollection of a narrative written by a physician who got sick and was intubated before he could speak with his family. Thankfully, he recovered. But he wrote about how terrifying it was to think that he might not have had the chance to tell them how much he loved them and how grateful he was to be their husband and father. He wished he had written them a letter when he began to care for patients with COVID.

The thought that my job might put my life in danger has never crossed my mind before. Not when I was six years old and proudly showing my friends the stethoscope my father brought home. Not in college when I knew I wanted to be a doctor but didn’t know if I wanted to work so hard. Not as a post-bacc student trying to stay awake while learning organic chemistry, or as a medical student closing my first wound or as an intern holding a woman’s hand as her husband passed away. I never imagined this.

But this reality now rings true for health care workers throughout the world. The Kaiser Family Foundation’s Kaiser Health News and Guardian U.S. have identified “922 health care workers who likely died of COVID-19 after helping patients during the pandemic” in the United States. This translates to approximately ten deaths due to COVID-19 contracted through patient care per 100,000 health care workers per year. To put this into context, the Bureau of Labor Statistics estimates the average risk of work-related fatal injury is 3.5 per 100,000 workers. COVID-19 will be the most common cause of work-related death in 2020, and health care workers will bear the brunt of it.

At that moment, I pull out my laptop. I am newly aware of how heavy my chest feels. I open up a new document and write, “Dear Kimmy,” at the top.

Kimmy and I have been married for seven months. We are still in our “honeymoon phase,” even though we had to cancel our actual honeymoon. A couple of weeks earlier, we had nervously opened her e-envelope to learn that she matched to the residency at the hospital where I work. We were so excited to live together again after being apart for two years. Our birthdays were coming up. We discovered that we shared the same birthday on our first date. I liked to say that “I had it first” because I was born a few years before her. This year, our birthday would be extra special because we were scheduled to close on our first home. There was so much we were looking forward to.

I think of all of this as I stare at her name. There has been so much talk about the future that it makes the reality of the present hit that much harder. My job tonight is to take care of this man, and that job may put all of our plans in jeopardy. I have felt powerless in my job as a resident many times before, but this feeling is new. It is humbling.

I begin to type. I tell her how I never would have guessed that I would have to write this letter. I make an abbreviated list of all the things I want to do with her, and how happy the thought of getting to be next to her the whole way makes me. I try to put into words how happy she makes me. I tell her about the lump in my throat. A few sentences stick out to me:

I feel like I have so much I couldn’t bear to lose. And yet, here we are – both of us having decided that taking care of sick people is how we will spend a significant portion of our lives. The consequences of that decision have never felt so real.

I smile to myself as I go back in the text and delete a properly placed “o” at the end of “too” and then leave a “PS” at the bottom to make sure she knows I did it on purpose. Kimmy loves to correct my grammar, and she’s almost always right.

I click save. A window pops up and asks where on my computer I want to store this document. I haven’t thought of this yet. I hope Kimmy never has to read this, but god forbid the time comes, I want her to be able to find it. I save it to my desktop, right in the middle of my screen.

That patient never came to the SICU. He was sent to a team that had much more experience caring for patients with COVID than I did. But other patients did come. That letter is still on my desktop. I had hoped that by now, I would’ve been able to delete it, but it is clear that COVID-19 will be a force for many months. The stress that we all hoped would fall away as quickly as it arrived remains. The virus is tearing through the southern part of our country, and as schools reopening and mask-wearing become more of a political divide than a public health crisis, we in the rest of the country brace ourselves for the next wave.

We are facing the reality that pandemics like this one can transform and consume our world.  This is likely not the last time that those of us joining the hundreds of millions of health care workers across the world will have to grapple with our own mortality. I didn’t have to face the gravity of a pandemic when I made the decision to apply to medical school, but applicants from this point forward will reflect on how their choices to pursue careers in the hospital may claim their lives.

I see “Dear Kimmy” in the middle of my computer screen, and I am reminded of my colleagues who gave their lives caring for patients who needed them. I wonder how many other desktops are home to letters like mine. I wish they could stay safe there, but I know that’s not possible.

Samuel M. Miller is a general surgery resident. 

Image credit: Shutterstock.com