I'm in the last of five days caring for patients at rural clinics in western DR, along the Haitian frontier.

Tierra Nueva, miles from anywhere, is a collection of clapboard shanties and shacks scattered along a dusty, unpaved road that dead-ends at the border. People survive here by coaxing vegetables out of the earth via scratch farming. The lucky ones have a goat and maybe some hens. The women take in wash or sell produce. The men cut sugarcane. Life here takes a toll on people eking out a hardscrabble existence without healthcare. Most adults look ten years older than their chronological age.

It's been five months since I left my position as a psychiatrist and medical director, and like everyone, I'm wrestling with questions about how COVID-19 has changed our lives, maybe forever. As I read the news and hear from my former colleagues, who've had to quickly ramp up to deliver telepsychiatry, I feel a mixture of emotions: fear and concern for my former patients; guilt that I've left my colleagues behind to fight on without me; and uncertainty over how I can best help out in this crisis.

If helping were as simple as picking up my old job again, that would be an easy call. Unfortunately, it's not that simple. Whenever I try to imagine going back, I'm flooded with memories of the severe burnout that forced me to retire.

In thirty years as a practicing psychiatrist, I often treated patients (including healthcare providers) who were suffering from burnout--that dreaded combination of mental, emotional and physical exhaustion, brought about by prolonged or overwhelming stress. But I never thought that I would fall prey to it myself.

When a code is called in the hospital, it means two things: A caregiver's day is about to be turned upside-down, and a patient's world is about to fall to pieces. If you're a caregiver, when a code is called you look up from your own work and wonder who'll be sprinting through the halls and whose story is unfolding.

This time, the story was ours.

I was a third-year medical student, and I'd just finished my first morning in the neonatal intensive-care unit (NICU) as part of my pediatrics rotation.

The NICU team had welcomed me warmly at the start of morning rounds, but I couldn't help feeling overwhelmed as the unfamiliar acronyms and measurements flew over my head. Starting a new rotation is always disorienting, but in this unfamiliar acute-care setting, I felt I had even more to learn than usual. I listened attentively, but it was like trying to follow a conversation in a foreign language that you're only just beginning to learn.