At the front of the line for the covid-19 vaccine: Eric Kutscher on his survivor’s guilt

As Eric Kutscher receives his first dose of the covid-19 vaccine, he’s struck by the depth of his previous fear during the pandemic and the reality of his privilege

As the needle entered my arm, I felt an immediate sense of relief. Since the pandemic began, I’ve been caring for patients with covid-19 and, like other frontline providers, I’ve lived in constant fear of the virus. Within one second, that all changed. I could now imagine a future where I could do my job without worrying about my own death. I could now imagine being able to be physically present for my patients without counting down the minutes of exposure in their rooms. I could see a future without covid-19. I breathed a deep sigh of relief. 

As one of the first groups of people to be vaccinated against covid-19, I carry many mixed emotions. First and foremost is gratitude. Gratitude for the countless hours of research in the development of this new technology, and the thousands of volunteers who participated in clinical trials to make sure it was safe and effective. I’m thankful to work in a hospital system that is well resourced enough to receive supplies of the vaccine, and in a country able to earmark vaccines for use for its citizens. But perhaps most importantly, I’m overwhelmed with gratitude that I had survived to this point. 

Since the first days of the pandemic in New York City, my husband and I would lie in bed at night and talk out different scenarios. We knew I’d be at high risk of catching the virus as a doctor deployed to the covid-19 wards. We discussed worst case scenarios: that if I needed a breathing tube I would accept it, but that if I needed a surgical procedure (a tracheostomy) due to dependence on the breathing tube, I would decline. We realized that we were on different health insurance plans early on, and that if we were both sick we’d wind up in separate hospitals and isolated from each other. During the day I’d work caring for patients with covid-19, and at night I’d come home to hear the non-stop sound of ambulance sirens passing by our window. I felt surrounded by the virus, to the point that my own illness seemed inevitable. 

My distress over the risk of covid-19 worsened as I started working in the intensive care unit. I was surrounded by some of the sickest patients I’d ever seen, some my own age. A nurse at one of my hospitals passed away from the virus. Even though I was lucky to have enough personal protective equipment, the fear of running out caused me to ration it myself. I’d take a new N95 mask whenever offered, but would keep wearing my old one and hide the new mask in a back-up stash, just in case. I arranged increases in my life and disability insurance coverage. I told my husband that if I were to die, I would want to be buried in a Jewish cemetery. Not only did I see mortality—I felt it. 

Fear, it turns out, is not something that I ever learnt to process in medical school. Although I have faced fear personally in my life through homophobia and anti-Semitism, this new sense of trepidation in a professional space felt different. Allowing my own emotions to be present in the hospital felt like abandoning my patients and my duties to care for the public’s health. As my fellow New Yorkers would clap at 7pm every night, I would cry. I felt like an imposter—a doctor yes, but just as scared as everyone else. 

Once I was vaccinated, I was delivered from this fear, but for me it comes with the burden of survivor’s guilt. Why did I get to survive, while more than 300 000 Americans are dead? I think about the three patients who died from covid-19 in 24 hours under my care in April, and the many I have seen pass since. I wonder if my acceptance of the vaccine takes it away from someone who would have worse outcomes if they contracted the virus. I think of some of my primary care patients who won’t get the vaccine for months to come, yet are at a much higher risk of severe covid-19 if infected. I’m aware of the inequities in distribution; in a world of disparities, is my acceptance of the vaccine at a private hospital in the US, as a healthy, young, white male, also an act of complacency? I received messages from friends in Kenya after posting videos of my shot, asking about its side effects. I don’t know when a vaccine will be available to them. 

For me, being vaccinated against covid-19 is more emotionally complicated than biologically or scientifically. The breakthrough in scientific technology is incredible and unprecedented, and I have little doubt in the vaccine’s capability to help end this pandemic. Yet accepting my dose at the front of the line, I’m struck by the reality of my privilege. 

Despite my new protection, I must never forget the depth of my previous fear. Though my own relief has come, it is far away for billions of people around the world. With my immunity comes significant responsibility: to help eradicate covid-19.   

Eric Kutscher is an internal medicine physician in New York City with a passion for addressing health disparities. Twitter @ekutscher

Competing interests: None declared.