In the Valley

“Mommy, will you sing the valley song?” my three-year-old daughter asks. We came across this folk song a few months ago, and it has become one of her favorite lullabies. She is curled up next to me on her bed.

“Down in the valley, valley so low,” I begin singing.

“Hold me,” she says, and I wrap my arm around her. The soft light illuminates her nose, her round cheeks. It reminds me of the nights I crept into her room after a long shift, peering through the crib slats to watch her sleep. Now in the final months of my residency, I see the immense growth in us both.

“Come closer, Mommy,” she pleads. I move my body closer but keep my face turned away. I’ve been caring for patients with COVID-19 for weeks now, and, despite my thorough decontamination routine, I still worry about the risks to her health. But the thought of physical separation for an indefinite length of time feels unbearable. We have chosen instead to measure the distance between us in inches, not miles.

She again moves her body closer, trying to narrow any remaining gap between us. I close my eyes and begin to reconnect with my body. There is an ache in my legs, a heaviness behind my eyes, a quickness to my pulse that has persisted for weeks.

“Mommy,” she whispers, “what does died mean?”

I open my eyes.

“You said that to Daddy tonight. That your patient died.”

I am quiet. It is hard to acknowledge that my job puts her at physical risk for illness. Now I see the risk for a different type of exposure.

She asks again.

How do I talk to my child about death? This part of my life remains hidden. My grief is often expressed in bathroom stalls, in silent stairwells, in dark call rooms. I know that grief is meant to be shared. It is easier when it is shared. Even so, I am part of a group that strives to never burden others with the weight that we carry. We as physicians learn to bear our grief alone.

“Well honey,” I finally muster, “when a person gets really sick, sometimes their body stops working. And then they aren’t around anymore.”

“Why don’t they go to the doctor?”

“They do. But sometimes even doctors can’t keep a person from dying.”

“Really? Even your patients, Mommy?”

“Yes, even mine,” I say. I swallow hard. “One of my patients died today. Her name was Annie.”

“Annie? What happened to Annie?”

“She was sick, dear, she was very sick.”

My daughter continues asking questions, but I no longer have the energy to answer.

“We can talk tomorrow, okay?” I kiss her head. She’s tired, and I’m relieved she accepts this conversational pause. She rests her head back down, and I pull the blankets to her chin.

I begin singing again, Down in the valley,”

My mind turns from my daughter to Annie, sitting alone in the darkness. Her body is hunched forward slightly. There is a far-off look in her eyes. I watch each breath enter and exit, with a heaviness.

“Valley so low,”

I walk closer to Annie. My breath is warm beneath my mask, my goggles fit tightly around my eyes. There is a voice in my head that says, “Get out. You don’t need to be here. Each minute is a risk.” Yet I continue walking forward.

“Hang your head over,”

I pause at Annie’s bedside and reach for her hand. I curl my fingers around hers and feel the cool skin beneath my gloves. I see her nails, painted coral. The new growth has pushed the polish out, signifying the length of her illness.

“Hear the wind blow,”

Her four weeks in the COVID intensive care unit had been defined by a series of events: intubated, proned, paralyzed, extubated, re-intubated, extubated. When her breathing worsened again, we discussed those same actions. She shook her head. No more. No more.

“Hear the wind blow dear,”

Annie spent a lifetime with her husband, and said goodbye to him over a screen. She blew a kiss to her granddaughter with a tremulous hand. I could hear the love in her daughter’s voice as she said, “What a gift you have been to this world, and to me, Mom.”

“Hear the wind blow,”

I stand by Annie’s bedside, bearing witness to these final moments. The monitor behind her flashes silently in red, as numbers trend ever-downward. It feels so unfair, all of it. A life taken too soon. A goodbye over a screen. A woman dying without her family by her side.

“Hang you head over,” I sing, and my voice cracks. As I lie in bed, grief hits me like a wave. Tears stream down my face and my breathing quickens into sobs. I look at my daughter, now fast asleep. I keep holding her, tightly.

“Hear the wind blow.”

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Correspondence to Laura B. Vater MD, MPH.

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This essay is a fictionalized account of true events. Names and details have been changed to protect patient privacy.

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Vater, L.B. In the Valley. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06501-x

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