Because I spent too long in Boston with its long and twisted streets, bikers and Priuses negotiating for space, college students converging at the end of summer, forming clusters along the Charles River, Birkenstocks in spring and Blundstones in winter. Because I was tired of texts from my mother asking if I wanted to pop out for a jog. And I’d had enough of eating with my partner at the same restaurants I’d dined in as a child, I found myself a newly-married twenty-nine-year-old, a doctor at Bellevue Hospital in New York City. Where people without homes spent the night on metal chairs in the lobby. Where patients always needed more than we had to give. And where the young, ambitious, and tired cared for the old and very poor. 

It was here, one year ago, after finishing medical school, I started my first job as an actual doctor. I was a resident physician, or more specifically, an intern. The most novice of all the doctors in the hospital. Within my first few months, I came to know the many faces of Bellevue. There was the pale man with a corduroy jacket who spent the afternoon pacing in the lobby and the evening requesting medication refills in the emergency room. There was the young woman who stood by the register asking staff if they had a few dollars for coffee, and the older woman who dragged a suitcase on and off the elevator asking visitors if they could tell her the time. One day, there were even a few evangelists pushing brochures into the hands of passerby, promising Jesus could save us all.

When I first started my intern year, I asked my patients, “Where do you live?” Some would say, “I don’t have a home,” or “Usually Penn station,” to which I would reply, “You’re homeless?” They would look at me like I’d said a bad word. It became easy to spot the ones without homes because they carried their belongings with them: the carts, shopping bags, or repurposed strollers. So, I adjusted my questions, instead asking, “Where are you staying at the moment?” 

As staff, we had running theories about the patterns of the homeless we served. Some said more patients came to the hospital when it was raining; others speculated they stayed away when it was cold, or perhaps showed up less at the beginning of the month when they had money from social security checks. None of these theories were proven, but it helped us to imagine we could predict the ebbs and flows of our work. We could anticipate when we’d need more clean socks or when the plastic-wrapped sandwiches would run low. One doctor, a broad-shouldered man who looked like he’d played college football, made deals with his patients who were looking for a place to stay, telling them that if they were quiet and didn’t bother anyone, they could sleep on a stretcher until the rain stopped. It felt like we all lived there together, the staff, the patients, all negotiating for limited space and even more limited resources.

I walked down the same halls that had seen New York City through the Great Depression of the 1930s, the AIDS epidemic in the 1980s, the Ebola scare in 2014, and eventually, even though I didn’t know it when I started, the COVID-19 pandemic in the spring of 2020. I cut off people’s clothes in the trauma bay and carried an IV kit in my pocket as if I was not a relatively new adult who had found herself very far from home. I ran away from my home in Boston, only to find myself in a place where there were so many with no home at all. And those with homes, the staff, talked at length about the upcoming holiday weekend, or the long-awaited vacation, as if our shifts together in the hospital were brief but necessary interruptions in a more leisurely life. 

When I applied for this position while still in medical school, it was my first of fifteen interviews at different residency programs throughout the Northeast. Every doctor I talked to asked the same thing: “Why Bellevue?” It felt like the whole interview depended on my ability to answer this one question. I found myself sitting up taller, saying things like, “I believe in the mission,” and, “The work has meaning here.” I said it because I meant it and also because I sensed it was what they wanted to hear. It was everywhere I looked, this overwhelming sense of sacrifice, inscribed in the plaques on the walls, woven into the furrowed foreheads of the people I spoke to. I felt a drive to do the work before I’d even been offered the job.

As an applicant on the tour, I walked through the entrance on First Avenue into an impressive glass atrium that sheltered the hospital’s 1930s brick façade. As we stood in front of the granite archway, I could barely listen to my tour guide’s words. I was struck by the grandeur of the place, the way the old pushed its way out beyond the glass, refusing to be contained by it. The word inscribed in the archway, Bellevue, spelled out in my mind as Bell-view, connoted some spiritual purpose, some duty or dignity reserved for the country’s oldest public hospital and the people who chose to work there. 

I imagined a hidden bell tower, the ringing heard only by the people who needed it most, calling them out of the wind and rain, to shelter and recovery. Later, when I googled it, I learned that Bellevue meant “beautiful view” in French and likely referred to its location on the banks of the East River. The name felt a little too romantic for the hospital given cigarette buts, abandoned food, and feces made an obstacle course on the sidewalk outside. Still, I believed in that bell and that it was ringing for me too.

On my interview day, when I told the Bellevue doctors, “I believe in the mission,” they nodded their heads like they already knew what I meant. But what did I mean? It was an updated version of a phrase my parents used to say to me: “Work hard so you can give back.” Give back. I heard it whispering through the pages I turned, the tests I prepared for, the papers I wrote. As I grew up, it was a compelling idea, that I could consume it all, the comfortable house, the college education, the close-to-new car, then eventually, give it back through my work. But how could I give back something I had already consumed? It was in me. 

I was made of the very advantages that fed, clothed, and protected me my whole life. The unfairness of what I received relative to my own patients, or my fellow healthcare workers, would only consolidate over time.  No matter how many hours I spent at Bellevue, or at any other job, I could never spit it back out. My family’s whiteness and wealth positioned me in the world, propelled me forward. It would never go away, never metamorphose into something just or good. That realization appalled me. Still, I was determined to give back. 

I worried I had no experience with the kind of scarcity that would prepare me for this place and connect me to my patients. In spite of that, or perhaps because of it, driven by a compulsion to fix things, a craving to use my privilege for good instead of evil, I found myself at Bellevue, in a place that broke and emboldened and tired me. I finished medical school and became a doctor, never again a student, in a hospital that was always in need of repairs, where the people who lived in the lobby were like my neighbors who were just a little too close and who I never fully understood. 

I grew up in a house on a cul-de-sac where I played t-ball using gold and white Volvos as first and second bases, commuting to a quaint, all-girls school across the river. For my mother’s birthday each year, my family took the three-and-a-half-hour train to New York City for the weekend. To me, the city was a place where there was always a little bit too much of exactly what I wanted, and more than enough of what I didn’t want. Even as a kid, I recognized there were multiple New York’s pressed up against one another, dirty streets leading to glittery windows, where there was the potential to have everything and nothing at all. 

I didn’t realize many New York’s existed inside of Bellevue. There was the Bellevue that belonged to the poor, their used napkins and morning coffee cups left in unswept corners on the first floor. There were the young ones that woke up in our emergency room, still drunk, wearing last night’s winged eyeliner, vomit down their lacy tops. Then there was us, the newest additions, the trainees, coming with our big ambitions and student loans, our brand-new leather bags and receipts for $17 salads, stopping here on our way to something bigger. 

The curious thing that I never anticipated was how, halfway through intern year, Bellevue would come to live within my nervous system, in the cracks of my shoes and the way I hustled down the hallways. It lived in my body, in the knots in my neck, the aches in my arches, the gray hairs in sneaky patches along my scalp.  I imagined it would be a place I visited, passing in and out every day, returning home to leave my shoes outside the door, my badge hanging on a hook. I thought I would be like a tourist, taking it all in, and leaving with my worldview fundamentally unchanged. Instead, I was a worker pushing against an endless flow of forces trying to bring us all down. 

There were the sounds of Bellevue, the worst of which were the screams of someone put in restraints, nylon straps around wrists and ankles, our words of ease, “No one will hurt you” and “It’s for your own safety” lost to this person who has been temporarily stripped of freedom. There were the moments I rushed into a hospital room dreading I would be the first to find an old man, eyes closed, limbs limp, my fingers on his wrist, not sure if what I felt was the blood moving through my fingertips or his own pulse. The relief when someone more senior arrived, box of supplies in her left hand, scrubs puffing out around a pregnant belly, so grateful there was someone to tell me what to do so I did not have to decide if this man needed fluids or chest compressions or imaging. There was the part of Bellevue where we tapped veins, and drew blood, and listened for heartbeats, and learned to say, “I’m sorry I can’t help with housing” and “I’m sorry, but you can’t stay;” or, if we were frustrated, “This isn’t a hotel.”

There was another side of the hospital, behind closed doors, in our resident rooms, where we laughed until our eyes teared up. We laughed at the mess. We split candy bars from the vending machine. We zoomed in on pictures of our pets and babies. We rarely touched but felt held up by one another.

As people returned from a rapid response or a code, describing the blood running across the floor or the smell of diarrhea, we listened. We shook our heads. “So ridiculous,” we would say. “Unbelievable,” as if, after all this, there was still something we expected, some way we thought things would go. I used to worry I was losing my humanity. I could no longer count on myself to cry at a death or feel fear when a heart stopped. But, if anything, in those back rooms, laughing through overwhelming tragedy, we revealed just how human we really were. Once we returned and were finally safe, we needed to laugh until we cried because we were unable to say the truth which was, “Did I do enough? Will I be okay?”

We sipped the coffee still hot in our thermoses, our conversations moving to the banal. “What’s for lunch? Will we get out on time today?” or “Is my co-resident annoyed with me?” At times, it felt like our strength was not in our ability to run towards a dying patient, but in our capacity to turn away as soon as it was over, to go back to the computer and the bag of chips and the text from my partner asking, “How’s your day going?” To lie and say, “It’s fine,” because until I walked back out that front door, it had to be fine. I had to be okay because I chose this. I had exchanged comfort for something I couldn’t live without, a forward momentum, a precious meaning to my life.  

In the hospital, right beside our patients’ frail bodies and our tired ones, was a force that did not care about our laughter in the back rooms, our medications, our constant efforts. It was a force that grew stronger as COVID-19 came closer, that sucked out to sea and never came back. That was the force of death. If there was one power that loomed greater than all the rest in this haloed hospital, it was the defeat of death. Or, if not defeat, then momentary relief. That inevitability was never more real than during the pandemic when we didn’t know who would die or why. In this year of learning to live beside death, I never considered it would come for me too. Death was coming for other people, not for us. 

In the beginning of intern year, “Will I be okay?” was a silent question, conveying a lack of confidence in my own resilience. By the middle of March, when the Coronavirus cases rose and I was on an inpatient medicine rotation, “Will I be okay?” meant something very specific. It meant, “Will I get the virus? And if so, will I recover?” 

Even as it became clear New York City would be the epicenter of the crisis, we tried to stay logical. When they said doctors in their thirties were dying in Wuhan, we thought of all the reasons it wouldn’t be us. When the restaurants closed, we discussed the expired yogurt in our fridges and stale crackers in our cabinets, debating whether or not we could still get take-out. I did okay when there were pages to return and labs to review, but when it was just me alone at the desk, I was scared. 

I was used to feeling protected from the problems of my patients. Their illnesses were primarily those that came with scarcity and years of chronic disease. Temporarily, this virus wiped away the rationale that there was some boundary between what could infect and affect me. Whatever grandiose visions I had about giving back were gone. I just wanted to survive. I felt I had no way out. It didn’t make me feel brave or heroic, as people were starting to say. It made me want to run.

I got sick at the end of March with what I later found out was Coronavirus. It was the sickest I’d ever felt, but I didn’t need to go to the emergency room and recovered at home. By the time the cases peaked in April, I had shifted to a new rotation on psychiatry and wasn’t at Bellevue. It didn’t feel right that my co-residents were going through this and I wasn’t there to help. But I didn’t volunteer to go back. I didn’t have it in me.

When I returned to Bellevue at the end of May, the city had passed its peak. I went through the glass doors on First Avenue, waved my ID badge, and had my temperature checked by a woman in full PPE. The chairs in the atrium were gone and no one was allowed to linger, let alone spend the night. There was a large billboard displaying the number of patients with COVID-19 who had been successfully discharged home, at that point upwards of nine hundred. There were posters of encouragement and thank you cards from New Yorkers covering the walls. The same woman worked the register at the coffee shop, this time with three-foot-high plexiglass protecting her from us. When I saw one of the emergency room nurses coming in for the day drinking a giant iced coffee, I smiled under my mask. I didn’t know him by name but was reassured he was okay. He’d made it through what would hopefully be the worst of it.

At the end of the day, I walked back through the archway, through the lobby with the ceilings four stories high, past the man in a wheelchair, his mask pulled down to smoke a cigarette. I drove along FDR Drive, the East River on my left, and the Williamsburg Bridge in the distance, letting the hospital fall far behind me. Slowing down and taking it all in is the scariest part of the job. I know turning away is what the lucky do, the ones who get to live beside the mess instead of directly in it. Still, I turn away, even now, towards the song on the radio, towards the overwhelming view, the thoughts of my tidy apartment. I want to withstand the chaos without sacrificing my sense of safety. The only way I know how to turn towards it is to get familiar with all the ways I try to turn away.

-Lila Flavin

Lila Flavin is a writer and psychiatry resident in New York City. She has published in Embark, Torrid, and Evocations. She lives in Brooklyn with her wife and their chihuahua. She is working on her first novel, a queer love story set in New York.