Discomfort of the Unquantifiable: On Selina Mahmood’s “A Pandemic in Residence: Essays from a Detroit Hospital”

THE CONTRADICTORY NATURE of time during the pandemic has been a shared phenomenon. It has simultaneously crawled and flashed by. It is within this contradiction that Selina Mahmood’s debut collection of essays, A Pandemic in Residence, exists. Mahmood, a Pakistani American in her first year of neurology residency in a Detroit hospital, contemplates the brain and the soul, history and the present, in an array of pieces written and revised during the height of the pandemic last spring and summer. The musings of an exhausted frontline worker, the book is served in fragments, rarely lingering in one place long enough to give a complete picture of what’s going on. In its form, A Pandemic in Residence reflects the nature of the pandemic itself.

Some of Mahmood’s dispatches from the hospital are things we may have seen in the news, like struggles for PPE (a now ubiquitous acronym not typically on a layperson’s radar pre-pandemic), isolating from at-risk friends and family, the last-minute scrambling of departments in an effort to open up beds, hospital staff saving masks in brown paper bags for reuse. Some of what she writes is reminiscent of everyone’s tweets: “Trump’s press conference today was a joke (as if anything else was to be expected, with the CDC budget cuts and the disbanding of the pandemic response team in 2018).” But other incidents Mahmood recounts are things we didn’t get to see, like discharging a patient who didn’t have a home to be discharged to, or what exactly they were doing in the ICU with the critically ill. Mahmood provides jarring moments of insider knowledge that are unsurprising alongside the experiences the rest of us lived:

A few hospitals in our county decided not to heed the WHO notices. […] St. Bartholomew’s admin also didn’t heed the Surgeon General’s advice to cancel all elective surgeries. So now, St. Bartholomew’s decisions have led it to the brink, ready to overflow with infected patients. This pandemic has shown what complete lack of common sense can look like — the initial rush for toilet paper in our country becoming a world mockery.

The hospital scenes are enough to whet the appetite for some level of enlightenment about a field that can be obscure. As a new resident fresh out of the didactic portion of medical school, Mahmood expresses criticism of the medical system, but also a deep reverence for it. She begins with faith in the safeguards of the “Swiss cheese model,” but that faith degrades as she observes: “People are dying not just because of COVID but because the system has shifted, the holes in the Swiss cheese model are aligning.” Though we suspected this, in those words, it is an almost cataclysmic admission of the failings of a monolith that people often either mistrust or follow blindly. But elsewhere, Mahmood provides a high-level overview of the history of medicine from mummification in ancient Egypt all the way to the development of the chemistry behind the vaccines that have given us a way out of this catastrophe — the chapter elicits a sense of awe at our human timeline. As a vaccinated citizen watching the case counts tick lower and lower, I felt the overwhelming impact of reading such a succession of advancements over thousands of years that have now led to the impending reopening of the United States after so much suffering.

The trouble with a book written in and about a particular moment is its incompleteness. Mahmood positions us against what and where we were before, telling us what was hot on the Billboard charts on March 11, 2020, or remembering sitting in a Panera Bread café to read. But we are now poised to return to a world that allows laptops in coffee shops. So when she writes, “it really feels like we’re going to war,” she references a reality we’ve already been saturated in, igniting a craving for new information, something else that we haven’t seen or heard for the past 14 months.

Mahmood’s commentary at times is poignant: “Say we come up with a vaccine. Fifty or seventy or a hundred years down the line, this pandemic will no longer be fresh in living memory. We’ll relive the same story of people refusing vaccination.” This was an insight tucked into a chapter entitled “March,” the month that brought our first lockdown in the United States. Our collective amnesia about trauma and disaster is something Mahmood anticipated before we could even conceive of what to forget. This collective or generational forgetting, as we’ve often heard referenced with regard to the Spanish Flu pandemic of 1918, is a theme reiterated when Mahmood examines her position as the daughter of immigrants: “First-generation immigrants view immigration differently from their second-generation progeny. There’s an unquestioned linearity of progress that comes for the first. […] Second-generation children, on the other hand, are projected to live in a dream that they never dreamt.” It is a reflection of a thread Mahmood begins weaving when she discusses Frankl’s imagination of time (“a circular creation of looking into the past from a future moment to create the present”) and ties up when she closes: “If it feels like the end, it isn’t the end.”

A Pandemic in Residence will likely find itself being compared to Paul Kalanithi’s When Breath Becomes Air. Both books are authored by neurology residents from South Asian backgrounds examining the meaning of life in the midst of crisis. Both involve philosophical explorations of literature and the writings of existentialists, as well as skepticism of the paradigms of medical care. But Mahmood’s writing often lives in the realm of the esoteric, much like the world of medicine can often feel. Her prose is internal to the point that it can feel enigmatic to a person without a medical background. Mahmood diverts away from her own feelings in response to the terrifying: “I returned to the hospital the next day to learn that a nurse on another floor had died of the virus. She’s dead and we went on and are here.” This is perhaps her training, a necessary defense built up by incessant danger, but the reader may yearn for a deeper exploration.

When Mahmood does dig deep, however, she occasionally delves where we can’t follow. On many occasions, she starts in scene and then pivots sharply out into abstract without explaining the connection:

I put on my parka and went on a drive to get coffee from Tim Horton’s and sat in the parking lot going through my social media, where the sole topic of conversation is this pandemic. Emotions can either be refined or dramatized, and there’s a pretty bold line between the two.

As such, the essays can read as a series of free associations, with one sentence not relating to the one before in any manner that the reader — a stranger — can discern. But then, in the middle of it all, we might catch a glimpse of something fascinating, whether about the development of medical technologies or why COVID-19 patients were developing pulmonary emboli.

In desiring more stories, more detail from the author, I felt responsible for asking myself what kind of details was I hoping for. Did I want even more information about what COVID-19 is, can be, or has been from someone inside the hospitals who has seen it? If we’ve been inundated with information about this virus and what it looks like, we’ve also been starved for it. A wishful part of me hoped for clarity, a clarity that the author also illustrates a struggle to find.

In fact, if one pays attention, clues about how to consume this book come from the author herself: Mahmood argues against the pursuit of a goal in that “the more you want it, the more allusive it becomes. The way to get what you want is to stop wanting it.” She concludes: “The solution to meaninglessness isn’t to search for meaning. The solution is to realize the inherent flaw in the quest itself.” In order to take in what Mahmood offers, a reader must stop wanting a pandemic memoir, a book of prose poems, a philosophical examination, a discussion of books and art as in Teju Cole’s Known and Strange Things, a linear sequence of thoughts, because this book in separate moments embodies each of those things, but as a whole is none of those things. Removing expectations or the need for a “point” is what must carry a reader through these pages. If the pandemic has forced us to do one thing consistently, it is to sit with the discomfort of the unquantifiable.

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Pallavi Yetur is a Licensed Mental Health Counselor and Professional Clinical Counselor. She lives in Los Angeles with her husband and writes about pop culture and mental-health-related topics.