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From the moment Laura Dean decided to become a doctor, she did not do anything halfway. She plowed her way through Harvard as an undergrad, then medical school at Brown, and when it came time to pick a specialty, she chose the hard-charging field of emergency medicine, accepting a residency at Mass. General and Brigham and Women’s. Her job, as she saw it, was simple: Help as many ailing people as she possibly could.

And as the coronavirus began its march through Boston this month, she found herself uniquely positioned to help stem the coming tide.

And yet, here she was, on the phone March 18 with supervisors from her residency program, stumbling over her words as she tried to provide an answer to their simple question: Did she want to be reassigned during the crush of COVID-19 cases expected to flood Boston’s hospitals in the coming weeks — pulled from the front lines in order to avoid contact with infected patients?

The thought, ordinarily, would have been laughable. She knew how strained the country’s health care system was likely to become as the number of cases spiked, that there could come a point when every physician in the United States would be needed to stem the coming tide of patients — particularly those in the nation’s emergency rooms. Even as some doctors had died treating the sick in China and Italy, the risk to her own well-being was of little concern. As she put it, “This is what we train for.”

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But there was something else to consider: She was nine months pregnant.

Though little is known about the coronavirus’s effect on pregnant women or their unborn children, Dean knew that every minute she spent in an emergency department during the outbreak could pose untold risk.

She knew, too, that there really was only one correct answer to her supervisors’ question.

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All she had to do was say yes. No one would blame her.

So why couldn’t she bring herself to say it?

* * *

There is never a perfect time during a medical residency to have a baby, but when Dean and her husband, Jay Kelly, found out in August that she was pregnant, they figured they’d timed it just about right.

With a due date of April 22, the baby would arrive just as Dean’s second year of residency was drawing to a close.

She had always wanted to be a mother. When she was 3, her newborn brother had barely come home from the hospital when she’d commandeered parental duties. Already, she knew the kind of parent she wanted to be: the kind comfortable with her kid eating a little dirt from time to time.

Through the first few months of pregnancy, she and Kelly ticked off all the benchmarks of approaching parenthood: ultrasounds and doctor’s appointments and parenting class sign-ups. Slowly, the guest bedroom in their Cambridge apartment filled, with a high-chair, a car seat, a very cute stuffed bunny. When they couldn’t settle on a name, they began to refer to the baby as “TH."

Tiny Human.

In mid-February, about 29 weeks into her pregnancy, Dean found herself with a two-week break from work, and she and Kelly decided to make the most of it — one last excursion before their lives indelibly changed. For 10 days, they hiked their way through the Canary Islands before making a final stop in Sicily, joking all the while about their new travel companion.

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While abroad, they remember seeing headlines about the coronavirus’s spread in China. And at the airport, they noticed officials taking travelers’ temperatures.

But back at work in Boston in late February, everything seemed as it always had.

It took only a week for that to change.

It started as a trickle, one or two patients per shift, complaining of fevers or coughs.

The numbers increased after a conference at the Marriott Long Wharf, when a meeting of Biogen executives allowed the coronavirus to spread rapidly.

During her shifts, Dean took steps to protect herself. She read the e-mails that arrived each day from hospital officials, detailing a quickly evolving list of protocols and guidelines. She was diligent with new daily rituals, wiping down her computer keyboard. For the first time in her life, she stopped wearing her wedding ring — on the small chance that trace contamination could come home with her.

But even as the number of coronavirus-related patients at the hospital continued to swell, the threat felt distant, impersonal.

It wasn’t until Governor Charlie Baker declared a statewide emergency on March 10, as the number of confirmed cases in the state climbed to 92, that, for the first time, she felt afraid. Colleagues were coming to similar realizations, each in their own time. Dean now wondered what it could mean for the health of her baby.

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The thought clung to her. Walking out the door each morning could feel excruciating. She stopped listening to news reports of the virus’s advance. She sought out data for any evidence of the virus’s impact on unborn children, turning up precious little.

She had always loved the unpredictability of her work, the thrill of handling whatever calamities came through the emergency room doors. Now, that same unpredictability could seem sinister. Each exam room she stepped into posed a potential threat; each new patient she saw was a possible carrier.

Why are you still working? friends asked, incredulous.

The answer was duty. To turn her back on her colleagues was to turn her back on the very ethos of the profession. How many of her co-workers, many of them parents themselves, had put their own concerns aside while continuing to show up to work? How many were risking their own well-being to care for the stream of new patients arriving each day?

As a doctor, she’d taken an oath. This was exactly what she’d signed up for.

And yet, how could she live with herself if something were to happen to her child?

At a meeting of her program’s 60 or so residents March 17, someone raised the possibility of moving pregnant and high-risk residents off the front lines and into behind-the-scenes roles.

She was at home the next day when the call came from her supervisors, asking if that was what she wanted to do.

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Typically poised, she suddenly heard herself rambling, talking around their question, unable to bring herself to say it out loud until, finally, one of her supervisors stopped her.

We need an explicit answer, Dean recalled her saying.

She was near tears when she said that, yes, it was her preference to step back from direct clinical care during the final weeks of her pregnancy.

Then she put the phone down and cried.

* * *

Somewhere, deep down, she knows it was the right decision. But that hasn’t made it easy.

On Monday morning, as her colleagues tended to the fallout of an unprecedented pandemic that showed no signs of slowing, she was working from home, trying to settle into a new role that’s still being worked out, some mix of telemedicine and “whatever I can do to support my colleagues.”

There is a part of her that feels some sense of relief. Her family, certainly, is happy with her choice.

But the guilt — that her colleagues remain in harm’s way while she is not, that she was given a choice they weren’t — has not subsided.

She is not sure that it ever will.

“I could’ve said, ‘I want to keep going,’ ” she said. “And I didn’t.”

“I don’t think I will ever be totally at peace with that decision.”






Dugan Arnett can be reached at dugan.arnett@globe.com.