I am not sure what to feel today. So far three of my office staff are out due to positive COVID tests or exposures. One of my fellow physicians is working remotely because she on quarantine for COVID but feels fine. Hospital admissions seem to be holding steady or increasing slowly. This is the time of year when I cover while my partners are on vacation and I am swamped with surgical cases. I sneezed three times last night so I swabbed myself when I got out of bed. I am not sure if I am relieved or disappointed when the swab comes back negative.

I did a procedure on a critically ill patient last week. He was negative at that time but when I open his chart today I see a red “C” indicated that he now has COVID. He has had two doses of the Moderna vaccine but he also has a severe underlying medical condition. A booster shot, or a lockdown that slowed the spread may have saved him. As it is, I think is unlikely that he will survive.

I open up my list of “people I know who have had COVID-19” again for the first time in a while. I’m up to 45 but I can’t find the energy to think of who else should be on it. I don’t know why I keep a list like this. Maybe it’s a memento, my own private data point of how bad this thing really is.

It’s hard not to compare this to the first wave in March 2020. When I close my eyes I can see that emergency room through a hazy mist created not by the passage of time but by the fogging of my glasses by my mask and the smudges on my face shield. I feel the heat, the sweat. I feel my heart pounding, my pace quickening as I pass by stretchers with patient grouped too close together, stretchers in the hallway, stretchers going out of the door. I am afraid to look too closely at those faces and I scurry by with my head down, looking for the patients that need me to do their procedures. I find her, oxygen mask dangling from her face. I check her wristband to confirm the name because she can’t talk. She is intensely focused on breathing but starting to lose consciousness. I worry about the cloud of virus that washes over me as I do the procedure. I am drenched in sweat and move on to the next patient. Later, I’m alone in an empty operating room. I scrub my face shield with soap and water and methodically wipe it with with a germicidal cloth that stings my nose, even through my mask. I wash as much of my arms as I can in the sink, wetting the short sleeves of my shirt.

It’s not like that now, not at all. I am working, even busy, with surgery that has not been cancelled due to hospital bed shortages. People do not seem afraid to leave their homes. My vaccinated, COVID positive coworkers are quarantined but with mild or no symptoms. I know other parts of the country with lower vaccination rates are back to March 2020 but as for now this area is only under siege. The castle has not yet been breached.