Reclaiming Hidden Smiles and Absent Hugs: A Reflection on the COVID-19 Vaccine

On December 11, 2020, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for the Pfizer-BioNTech COVID-19 vaccine, the first vaccine to prevent the 2019 coronavirus disease. Just one week later, the Moderna COVID-19 vaccine received the second approval from the FDA. Both vaccines have demonstrated 95 percent effectiveness in preventing COVID-19 in adults. The vaccines have been shown to be safe, with severe reactions occurring in 11.1 cases per million doses. As of January 17, 2021, a total of 12,279,180 doses have been administered in the United States.

The beeping notification of an incoming email on my cell phone was a thousand times louder in my memory than how it must have sounded in reality. I remember the moment with photographic clarity, sitting six feet away from my co-fellows, each breath I took fogging up my tightly fitted face shield and obstructing my view of the attending physician’s diagram on the whiteboard. I felt nauseous, almost drunk, from the freshly distilled moonshine smell of my generously slathered hand sanitizer.

The deafening beep redirected my attention to my phone and my eyes darted to its screen, my pulse quickening as I read the email. I was frozen in that moment, simultaneously staring at the message inviting me to register for the COVID-19 vaccine, and at my laptop screen displaying the open chart of my patient with progressive lymphoma after his transplant. I was just about to give him the very bad news.

As I sat there, torn between two messages, one of hope and one of despair, the previous 10 months flashed in front of me, wrapping me up all over again in all the emotions that I had experienced during the pandemic: denial followed by anger at being so vulnerable; helplessness while caring for patients with COVID-19 who had no good treatments; sadness for those who fought this horrible disease without family standing by their side, and who often died alone; frustration that my fellowship training was being affected; isolation from living away from my family during my work on the front lines to protect the health of those dearest to me; fear of contracting and transmitting the disease; and uncertainty when my own mother was hospitalized with COVID-19.I continued staring at my cell phone, a turbulent wave of emotions rushing through my head. I had been waiting for the day when a safe and effective vaccine against COVID-19 would become available. Now that this day had arrived, what did I feel?

Fear.

I had rehashed the vaccine safety literature at least a dozen times. Despite my decade-long medical training and the expertise I have developed in interpreting medical literature, I winced at the human weakness that made me question the vaccine’s safety. I forced myself to step back and reason that the risk of a severe reaction is higher for penicillin than for either of the COVID-19 vaccines. And with this realization, my personal fear of serious harm from the vaccine vanished. With this fear assuaged, another type of fear set in — the fear of not knowing how my patients would feel about getting the vaccine, fear of the antivaccination movement and the influence of social media, and fear that the public wouldn’t accept the vaccine. Alternately, what if people started easing up on social distancing and stopped wearing masks, thinking that the vaccine would give them an impervious shield of protection?

Guilt.

I felt guilty for the privilege of receiving the vaccine before my immunocompromised patients, who could die if they became sick with COVID-19. I also felt guilty that I had the opportunity to receive the vaccine much earlier than my fellow trainees, physicians, and frontline workers in lower-income countries around the world, where medical staff often had to work without proper personal protective equipment.

Admiration.

I felt in awe of all the scientists who worked so hard to deliver this groundbreaking scientific feat in such a record time. I admired all the brave volunteers who participated in the vaccine clinical trials to bring this day to us. I was grateful to the infrastructure and institutions that provided this vaccine to us on the front lines, and to the medical staff who administered the vaccines daily.

Responsibility.

I felt immense responsibility to lead by example. I felt an overwhelming duty to demonstrate that I believe in science, to help dispel the fear of being vaccinated, and provide clear messages to my patients, friends, and family.

Sense of time.

I reminisced about all the people who lost time by not travelling; by not sharing intimate moments with family and friends; and by being sick, in isolation, and worried.

Value of life.

I thought about lives lost to COVID-19 and lives that will be saved with the vaccine. The value of life is at the forefront of my chosen profession of hematology and oncology, but COVID-19 added a whole new dimension to my work, threatening the lives of patients who are already bravely fighting their devastating, life-threatening cancers.

Giving hugs.

I realized how much I miss hugs. Hugging family, hugging friends, and hugging my patients when delivering news of disease remission or a failed treatment. I thought about the power of human touch and its necessity in everyday life.

Smiles.

I thought about all the smiles locked away and lost behind the masks — smiles delivering happiness, gratitude, and joy. I also wondered about those smiles in the times of despair and sadness.

Hope.

I had hope in humanity to embrace the vaccine and support each other through this pivotal time. And I hoped that no one would ever have to die alone again.

On January 4, 2021, I received my first dose of the Pfizer-BioNTech COVID-19 vaccine. I had no immediate or life-threatening complications. I was observed for 15 minutes after the vaccine was administered, and then I returned to my life as usual, smiling just a bit more behind my tightly fit mask and fogged-up face shield. Freshly slathered with hand sanitizer, I hoped for many hugs, soon.