As COVID-19 began infiltrating Boston hospitals in March of 2020, I was a fourth-year medical student finishing my last clinical rotation. Back when the efficacy of wearing masks was under debate, I was instructed to follow patients coming into the emergency room for complaints that weren’t respiratory in nature. On my way to each shift, I watched as the provisional testing area grew like a pregnant belly in the hospital lobby, gaining more official-looking opaque windows to shield all the activity within. “Patients with suspected COVID will be attending-only,” the chief resident told the house staff one night, as she was wiping down her monitor, mouse and keyboard with multiple disinfectant wipes—a new ritual that would mark the change of shift.

Each day in the emergency room felt like dancing with the inevitable. As more medical schools canceled curricula, every patient encounter felt like it could be my last as a student. Did I consider all the causes of abnormal uterine bleeding for a woman who almost fainted while on her period? Did I miss asking a critical question of a patient coming in with sudden back pain? And yet, it was impossible to focus solely on these clinical questions without some piece of my mind distracted by the pandemic. Shrouding these fears of graduating medical school without learning everything were the questions virtually everyone in the hospital was worried about: would I catch the coronavirus? Will I transmit it to my loved ones? And for me, more selfishly—what would this mean for my June wedding?

When my rotation was eventually canceled later that month, no one was happier than my dog. (My fiancée was a close second.) Returning home after every shift, his furry face would emerge from the crack of the front door as soon as it opened, tail wagging, feet pouncing, as I wrestled off my scrubs and hopped in the shower. When that ritual ended with the suspension of medical school rotations, our puppy was quite pleased to have both of his humans home with more time than we had ever had. My partner, an M.D.-Ph.D. student, had just taken her qualifying exams to begin her field research—work that now was indefinitely on hold due to the pandemic. With our newfound time, we found ourselves walking the dog for miles while learning how to properly social distance. It was on these walks where we labored over the tenuous details of what was becoming an alarmingly complicated, bicultural wedding.

With each of us having a pediatrician for a mother—and each of us inheriting the other as a second—there were a lot of opinions on how best to celebrate the union of their children. What once was a nondenominational wedding gradually morphed into an intricate balancing act of honoring my partner’s Pacific Northwest and Protestant roots and my own Sri Lankan/Buddhist heritage. When we wanted a friend to officiate a single ceremony, we instead were offered at one point three different ministers to oversee two separate religious services. The question of which ceremony would be the official ceremony wasn’t so much implied as asked outright. The hours spent poring over various color schemes, family accommodations and dress attire were enough to make us wonder who this wedding was actually for.

The pandemic hit at a time when my fiancée and I were exhausted and already looking for an out. The stress of qualifying exams and residency applications grew heavier at each contentious crossroads of wedding planning. On our walks with the dog, we would joke that our families’ craziness would drive us to get married on a whim at the city courthouse. But as lockdowns proceeded and cases climbed in March, we saw the likelihood of our June wedding narrow. A weeks-long choice materialized during these treks outside, as we struggled to keep the puppy six feet away from passersby. Do we wait until the pandemic is over, not knowing when that would be? Or do we get married now and hope there’s a party later?

What drove us to a decision was when my partner started having nightmares in which I was hospitalized from COVID-19—including one where, after days of respiratory support in the ICU, family members were weighing whether or not to take me off a ventilator. As I was approaching graduation and internship amid an endless stream of health care workers and patients dying from the virus, my partner was adamant that we think about such a scenario. “I want to make those decisions. And I think that means we need to get married—now.”

And so we did. On a frigid Boston morning, we walked to City Hall to fill out our application for a marriage license ahead of an impromptu wedding a couple days later. Looking at the weather for the week, we set the date for a Tuesday where the chance of rain was lowest. We sent a hurried e-mail to our guests announcing a virtual ceremony that could be streamed online. My fiancée’s godfather graciously agreed to officiate outside his home, and the three of us spent most of Monday night writing and rewriting vows and the ceremony procession. When Tuesday morning broke, we were tired but excited.

The absurdity of the choice to boil this milestone from months of planning and 200 guests to a small ceremony to be aired on spotty Wi-Fi might best be exemplified in our search for flowers: the best we could find was a cactus from a CVS. Luckily, that was the only snag of the day (some neighbors had collected daffodils from the local church). With only a couple socially-distant people physically present and despite our families and loved ones being miles away online, we were overwhelmingly happy—elated that we had somehow turned the stress of complex wedding planning, compounded by the anxiety and destruction of COVID-19, into a day where we could move forward. In his processional remarks, my partner’s godfather quoted from a recent article by Arundhati Roy, who noted, “Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next.” 

We referred to that portal assiduously in the days after the wedding, hoping that by taking these tremulous steps through it, we were acknowledging the chaos and disproportionate loss left by the coronavirus—but not allowing the pandemic to hold us back completely. Hesitant throughout that process, we prayed we were doing the right thing.

When I finally came down with COVID in November, my partner was almost 30 weeks pregnant. Coming off a particularly heavy hospital day during my first couple months of residency, I felt achy and feverish, and got tested the next day. When I was called back with the positive result, self-isolating on an air mattress in what would become the nursery for our newborn, I cried alone, my partner and dog on the other side of the wall in our bedroom, trying their best to stay away from me.

We were lucky. With data suggesting that COVID could lead to greater risks and complications among pregnant women, my partner was able to stay virus-free. Through our privileges of resources, information and networks, we got her out of our apartment while I completed my quarantine. My course was benign and self-limited, and I came nowhere near to requiring a ventilator. Ten days after my symptoms started, I was cleared to return to the wards.

What lingered wasn't any shortness of breath or muscle fatigue, but the weight of the decisions we made. Coming off the high of our haphazard wedding, we looked ahead to what the future might look like. Entering our 30s with an impending dual-physician household, we saw a flexible window beginning to close. The prepandemic plan was to try having kids soon after marriage, taking advantage of a situation where only one of us was in the grueling years of residency at a time. As COVID-19 grew more widespread, we paused and revisited this timeline.

Could we really do this? Should we do this? At that time, there was no end to the pandemic in sight, and we weren’t sure if the waiting would be months or years. In the absence of a formal national guideline to delay or pursue conception, experts had recently suggested that what we know about COVID-19 might not warrant a formal, blanket recommendation on whether or not to get pregnant during this time. If we could be careful and responsible, we rationalized, then maybe it wouldn’t be unreasonable to at least start trying? If we overcame the tribulations of our families to get married during this turmoil, then maybe we could take the next steps in our life together despite the continued uncertainty of the pandemic?

As many could have predicted, we had no idea how hard it would be. Protecting my partner with me going to the hospital each day became increasingly nerve-racking. Every subtle cough became cause for concern. A sudden panic would grip us when we passed neighbors who weren't wearing masks, or during the times we forgot to hand sanitize when entering our home. With all the necessary precautions to keep pregnant women safe, including at appointments, it was difficult to not be present at my partner's ultrasounds and tests—though waiting in the parked car with the barking dog made me feel somewhat connected. Managing the expectations of our families—quite used to being involved—was also made harder when our primary communication became virtual rather than in-person. Our landlord deciding to do a sudden renovation in a unit within our multifamily house also added to our stress.

But by far the most painful thing was knowing I had exposed my wife and unborn child to COVID-19 and its labyrinth of winding pathology and sequela. The weeks we spent apart during her third trimester were dedicated to virtually checking in on her symptoms, anxiously awaiting test results and ticking down the quarantine days until we could be together again. When her last nasal swab came back negative, we had never felt more relieved, and more exhausted.

As we counted down the days before we met our son, my partner and I weren’t so sure we'd do this again. He arrived in early February, whole and intact as far as we could tell—perfect in our eyes, if imperfect in the manner he arrived. Though we are excited and grateful to be parents, we learned it's far easier to say "I do" in a pandemic than to do the hard work of growing a family within its wake. And when so many people have lost so much, there is some guilt in adding a human to our lives. As the pandemic’s tide continues to ebb, flow and evolve, we hope the exit of this portal is within sight. As people across the globe reckon with how the coronavirus tilted the axes of their respective worlds—and reckon with the decisions, indecisions and nonchoices made in the pandemic's shadow—we will continue to weigh each action and push cautiously forward, now baby steps at a time.

This is an opinion and analysis article; the views expressed by the author or authors are not necessarily those of Scientific American.