Pandemic stress: Patient with swastika tattoo pushes doctor to edge
A Jewish doctor, a Black nurse and an Asian American respiratory therapist stood over the patient on the gurney in the emergency room. “Don’t let me die, doc,” the man begged.
As the man struggled to breathe, the swastika tattooed on his chest rose and fell with each gasp.
Dr. Taylor Nichols promised the man he’d do his best.
But standing in full protective gear, readying for a pandemic procedure that could expose his team to the coronavirus, Nichols, for the first time in his
career, questioned whether he wanted to keep that promise.
“I don’t know if I care,” he remembers thinking. “I didn’t feel compassion for him in that moment.”
A Bay Area native, Nichols is exhausted. He’s a parttime doctor at UCSF and an emergency room physician at Mercy San Juan Hospital just outside Sacramento, where he treats COVID19 patients daily, and where the tattooed man arrived by ambulance two weeks ago.
For many health workers like him, the pandemic has weighed heavily for nine months, with no end in sight as a new surge pushes hospital workers to their limits. Statewide hospitalizations of coronavirus patients have also increased by 89% over the past two weeks to more than 7,700.
Every suspected case of coronavirus is a risk.
The work never ends. There is no lengthy time off for physicians. No visits with extended family. It’s alternating home isolation followed by work shifts where exposure to the virus is a possibility.
“I see no matter how much we scream from the mountaintops, we’re getting overwhelmed,” Nichols said. “I see COVID patients every day. It’s endless.”
The frustration, the stress, the isolation, the screaming into the wind about the dangers of the virus had built up.
On Monday, Nichols woke up at 4 a. m. even though it was his day off, thinking about the man with the swastika who rolled into his ER.
In 17 posts on a viral Twitter thread, he shared the story. Later Monday, he spoke to The Chronicle about his tweets and the man with the tattoos.
The patient looked sick,
Taylor said. He was scared. He likely had the virus. It would take a day processing the test to know for sure.
The man was “solidly built, his methamphetamine use over the years had taken its usual toll and his teeth were all but gone,” Nichols wrote.
The swastika as well as other Nazi insignia etched permanently on his torso were vivid, proud displays of white supremacist hate.
What would he think about a Jewish physician taking care of him now, Nichols thought, and would he care about my life if the roles were reversed?
The man’s condition worsened, his oxygen levels dipped. Nichols and his team suited up to intubate the man, to keep him artificially breathing and his body alive.
It’s one of the most dangerous procedures physicians can do in the pandemic, the maneuver spreading possibly contaminated aerosols into the room where the doctor, nurse and respiratory therapist work.
As Nichols stood outside the patient’s room, checking his protective gear, he paused. He never paused. He swore by the emergency medicine mantra, “Anyone, anytime, anything.”
Whenever the job got hard, he had simply told himself, “They came here needing a doctor, and dammit, Taylor, you’re a doctor.”
This time, it didn’t work. He stood outside the room of a man who, in a different decade, in a different country, would have sent his doctor to a death camp.
Nichols, a San Francisco native who grew up in Burlingame, had wanted to be a doctor since he was 7, after he was rushed to the hospital for emergency brain surgery to remove a tumor.
“I decided while I was in the hospital that I thought there was nothing greater in the world you could do for another human being than to dedicate your life to have the skills to save them,” he said.
He now works in a hospital that serves primarily Medicaid patients. Many are homeless, some are drug users. The forgotten people of society, Nichols said.
“That’s what I wanted to do,” he said.
He was trained to do that even under the worstcase scenarios.
“It’s hard to go from one room where somebody dies on you and go into the next room of the one who killed them,” he said. “I’ve always been able to keep going, close my eyes for a second and say to myself, ‘ If you’re not going to do it, who will?’ ”
He prided himself on caring about the people that no one else cared for.
As he stood outside the tattooed man’s room, in full protective gear, it was suddenly as if his doctor superpower of compassion and empathy for anyone and everyone had disappeared.
“We exist in cycle of fear and isolation,” he tweeted. “Fear of getting sick on the front lines. Fear of bringing a virus home
and exposing our families. Fear of the developing surge of patients. Fear of losing our colleagues. Fear of not having what we need to take care of patients.”
It is a shared sentiment. “None of what he wrote is unfamiliar to us in medicine,” said UCSF emergency room physician Dr. Jahan Fahimi, adding the pandemic has made a difficult job worse.
“When you make it infinitely harder to do that job, now all of a sudden it doesn’t take very much to make you feel a little broken at times,” said Fahimi, a mentor to Nichols. “I worry about how are we going to sustain people for a number of more months.”
At the same time, Fahimi sees Nichols as one of the most passionate physicians he knows, one not prone to selfdoubt.
“He’s so mission driven. He’s so committed to doing the right thing,” he said. “If you can break Taylor, then something horrible has happened.”
Nichols said he doesn’t feel irreparably damaged and he still loves what he does, but he worries some health care workers will be so broken by the pandemic that they will leave the profession.
“I think I’ll be OK,” he said. “I don’t know if I am now.”
Nichols doesn’t know if the tattooed man lived or died or if he ultimately tested positive for the virus — he did everything he could to save him and then moved on to the next patient.
He doesn’t even remember the man’s name. But he must now live with that pause, unsure if the pandemic has altered the doctor who would treat anyone, anytime and do anything necessary.
“You have the realization that maybe you’re not the same person that you started out as and that’s hard to swallow,” he said. “None of us wanted to be changed for the worse because of this.”