Life on the Line: A Q&A with author and journalist Emma Goldberg

In one of countless catch-your-breath-in-your-throat moments in Life On the Line: Young Doctors Come of Age in a Pandemic, by New York Times journalist Emma Goldberg, readers sit with Gabriela, a young doctor who graduated early to provide care in a New York hospital during the coronavirus pandemic. She describes feeling “like a correspondent from hell” when she calls home, balancing the need to stay in touch with her family with the overwhelm of her own job. As Gabriela tackled complex questions from patients—is it possible they could’ve exposed their family members? What happens if their oxygen levels drop again?—Gabriela’s mother spent three hours trying to apply for the government’s Paycheck Protection Program, only to have the website crash.

It was a scene that encapsulated the frustration, anguish, and strain of the pandemic, and underscored a critical theme of Goldberg’s book: Doctors working on the front lines are people, too, trying to navigate life-and-death care and define their professional identities in a field they hadn’t even formally entered yet.

Life on the Line is an examination of the pandemic in real time; an intense, deeply reported account of medical students who went from taking the Hippocratic Oath via Zoom to serving in New York hospitals that were coronavirus epicenters. As Goldberg reported on the pandemic, endless sirens whirring in the background, she found it empowering to talk to people her own age who were mobilizing a powerful response to a crisis. It gave her hope, she says, to talk to people who had chosen to make a real contribution. Life on the Line captures that contribution, and deepens it within the historical context of a crisis often called unprecedented. Going beyond the coronavirus pandemic, the book examines stark disparities in health care access and treatment, challenges stereotypes of who gets to wear a doctor’s white coat, and illustrates what a new generation of medicine can be through the experiences of six young doctors.

Goldberg spoke with DAME about the experience of reporting the book, how the doctors were impacted by disinformation, and more.

DAME: Tell us about the six doctors you followed for this book. They are so different from each other, but [all] have this incredible commitment to service.

EG: I knew that I wanted the group of doctors I followed to represent the new generation of medicine, and the new types of perspectives and identities that are coming more and more into the medical field.

My interest with that started because, in November 2019, I did a story for the Times about all of the hidden costs of becoming a doctor. We all know medical school is expensive, but then there’s all that underlying, almost visible cost of hundreds of dollars spent on study guides, thousands of dollars spent on exam fees, thousands of dollars spend traveling to different medical schools. So I wanted to look at all of the different subterranean forces that keep medicine such a white and wealthy field. I got really interested in all the people who are pushing back against that and who are pushing to change the face of medicine. I wanted to connect with people who were drawn to medicine by a desire to have real, close relationships with their patients.

DAME: How do you think medicine needs to shift coming off this year?

EG: One thing I found fascinating in talking not just to the six young doctors in my book but to dozens of other more senior physicians who worked during COVID—one thing so many of them shared with me is that during the COVID crisis, there was a scrambling of the norms of medicine, and there was a little bit of an upending of some of the hierarchies. There were really high-level doctors who were jumping in and helping with any task they could, even if it was changing bedpans. There were the most junior, low-level doctors who were coming in and treating COVID patients right alongside the most senior doctors. I think there were a lot of ways in which the kind of rigid hierarchies of medicine were tested.

It was such an all-hands-on-deck situation that there was a real spirit of collaboration and generosity that I heard about going on in the hospitals. I think the doctors all really appreciated, about one another, the sacrifices they were making, and [being] in it together in terms of the grief and the loss and the devastation they were witnessing. I hope if there’s any silver lining to come out of all of this, it’s that spirit of collaboration and generosity that could be carried forward. I think it would be a real service to the whole medical field.

DAME: Something the book captured well was how it seems like, historically, when something is affecting the most vulnerable populations of people, it’s also going to receive the least investment of time and resources. Was the fact that we’ve seen that before part of how you thought about this crisis and this reporting?

EGL: I think we even saw this with the AIDS crisis, people in government—the president of the United States wouldn’t even say the name of the disease for years. I think a lot of that was because it was very clear that was impacting queer communities, Black communities, and low-income communities. There were so many really vulnerable people who were being affected by the HIV crisis, and I think you saw that reflected in some ways in the government’s lack of response. I think having doctors who are there because they are deeply rooted in their communities and caring for their communities is just critically necessary in order to make sure patients get the best care.

DAME: How did having so much historical background and research inform the reporting you did?

EG: I think this has definitely been repeated and said, but it’s so important that it bears repeating: it’s so clear that the pandemic hit hardest in communities of color. In New York, I think that was really obvious from the start, even weeks into the first wave of coronavirus; it was clear that Black and Hispanic New Yorkers were dying at twice the rate of white New Yorkers. I think when you saw those higher case rates, one of the drivers of that was that Black and Hispanic New Yorkers were more likely to be working frontline jobs where they couldn’t socially isolate. The pandemic just put a real spotlight on glaring existing inequalities. I think it also just pointed to the fact that all of our health is bound up in one another, so every New Yorker, their health was completely reliant on their most vulnerable neighbor’s health.

DAME: In the book, there were so many nuances that spoke to the flaws in the system as a whole, like somebody asking about when they’re going to be discharged because they know every additional week runs up a medical bill that is a month of rent. How did that shape experiences doctors were having as caregivers?

EG: I think that for the young doctors, a lot of them knew these realities already, and they’d been working at hospitals that do have patient populations that tend to come from lower-income communities, and communities of color. I think that during a pandemic, those disparities were clearer than ever, because there were people who were able to isolate inside their homes and hoard toilet paper and work on Zoom, and other people who had to be out and about, working their jobs. They were living in multigenerational homes, and there was a real risk to their lives and health.

DAME: Is there one individual or one moment that stands out to you from your reporting of the book?

EG: There was one young character in the book who really stuck with me and kind of broke my heart in the moment of reporting. But since then, he’s actually been in a much better situation. It was a young man who had Down syndrome, and he came to the hospital when his father got COVID. His father passed away, and this young patient with Down syndrome was orphaned, and had COVID. This was a young man who was having real challenges processing and comprehending everything that was going on around him, and he just lost his only living family member. Doctors and nurses were struggling to communicate with him and to figure out a plan of where he could live after he left the hospital. One of the most touching things, for me, was seeing how the doctors and nurses and PCAs and everyone went way above and beyond their day-to-day work to make this young man feel cared for. They would come to him on their lunch break, they would bring him clothing and stuffed animals and puzzles and books. Just the depth of care that they brought to that situation, even when they were burnt out and working 12-hour shifts and exhausted; they were giving absolutely everything to try and make this young man as comfortable as possible.

DAME: I want to ask about something I’ve heard frequently: that even doctors themselves were failed by our government and by systems of power. How did you feel about that after spending so much time in conversation with them? Did we fail the medical community in this country?

EG: I tried not to get too much into the political conversations with the young doctors while I was following them, but I do think, just as a reporter who is following all of this, that the level of disinformation that was circulating, the easing of lockdowns and restrictions, as they were still going into work and risking their lives… All of that was really disheartening to see. I remember talking to some of the young doctors about the visceral pain they felt seeing people start to lift restrictions and throw away their masks [long before we had vaccines] while they were still seeing patients on ventilators and patients who were coming in unable to breathe.

DAME: I can’t imagine the pressure of trying to keep yourself alive, trying to keep your patients alive, and also knowing a large swath of the population doesn’t believe it’s happening.

EG: Right, and that disbelief and that distrust was being encouraged, in some instances, from high levels of people in power. That’s so disheartening. When you are a person, a doctor, who’s giving everything on the front line, you want to know that people in positions of authority have your back 100%.

DAME: I loved how the layers of identity showed up in this book. How did you decide to illustrate these doctors as the people they are, even beyond their careers?

EGL I felt personally that I wanted the book to be a compilation of portraits of both ordinary and extraordinary people: People who were completely relatable, who you might know or be friends with or lived next door to you and have grown up with, but who were doing work that was pretty extraordinary and courageous. I think there’s a real power in knowing what makes someone tick, what they’re like outside the context of their life-saving work. I also think that’s important, because medicine can be this field that seems very daunting, and it can be the type of work where, traditionally, there have been a sort of relationship where patients feel that they just have to unquestioningly accept what their doctor says, or that they can’t really engage with their doctor in real conversation. I think the best kind of medical care comes when there’s real trust between the patient and the doctor, and I think that requires some level of humanization of doctors and painting them as full people, and in some cases like just ordinary people who are willing to do life-saving work. So, I really did want to capture that sense of normalcy, and that sense of them as full humans. For me, that meant going beyond their day to day work to encompass their childhoods and their families and their aspirations beyond medicine too.

 

DAME: Is there anything about the book you haven’t gotten to talk about yet and would like to?

EG: One of the questions that I’ve heard some people ask is, will the kind of work that doctors were doing during COVID lead some people to burnout or to leave the field or to leave bedside care to pursue something else? And what I found fascinating was that, at least the six doctors I followed, I think it just deepened all of their commitment to the work, and it reaffirmed for them why what they were doing mattered so much. That was the case even for doctors who were doing completely [different] work—like one of them is a pediatrician. So, they were all doing things that were a little bit outside their comfort zone during COVID. But it reaffirmed for them that they were in the exact right place, and they were doing the work that they were meant to be doing. For me, that was so inspiring to hear, because there’s nothing more amazing than hearing from someone that went through a really challenging period, but it showed them that they were doing everything that they have been meant to be doing. I think as a reporter, even, it can sometimes feel like journalism is really tough, and there are moments that test your resolve to do the work. But it feels good to know that you’re writing about people who feel like they’re doing exactly what they want to be doing, and are able to make a real contribution. For me, that was a sort of hopeful sense I came away from the book with.