Self-Help in the Time of Corona
My war against the notion of conjuring wartime imagery to fight covid-19 is neither linguistic nor tactical. As a physician who is tackling the various ramifications of this crisis, I can tell you that we do not have the luxury of metaphors.
In trifling and brutal and sometimes inimical ways, we are trained to live crisis, without even thinking about it. No disease or infection is an “enemy” or even a “dangerous or unwelcome guest.” For that very reason, we never become warriors or soldiers.
We never pledged to fight for better or worse, we never pledged to lay down our lives in our service. Heck, we do not even pledge allegiance to societies or nationalities or geopolitical issues. We simply show up with the task of serving the one individual in front of us. Any imagery is only a hindrance, a distortion, and what we need is singular focus.
The current pandemic places our patients on a conveyor belt, and the intimacy of that singular relationship fractures — the sheer volume and the unrelenting life and death decisions we make every second of the day — the speed of this roller coaster ride, the unforgiveness of the ticking clock assaults us in a way that we are not prepared for; military trainees, we are not.
When we show up at the front lines without proper protective gear we hear the not-so-subtle murmurings of our own safety and the safety of our families and children and parents in the deep crevices of our stunned minds, but we show up nonetheless.
Capable we are of handling the physical strain and the sleepless hours — the grueling training part of our internship and residencies were secretly meant to bolster us for such unforeseen situation. We get it.
Sure, we suffer from depression and anxiety and PTSD (Chinese studies from Wuhan show dire mental toll for the health care workers) but we show up nonetheless.
I am currently not in the front lines yet — the surge is always around the corner here in California — consequently I am listed to be on call, and am currently being trained in ventilator settings and acute care scenarios to rise to the occasion for the impending upsurge of medical emergencies. After years away from acute care and practicing office-based care (which is going through its own trauma of restructuring on a daily basis) I am ready to don and, with any luck, doff every day.
But, I DO know frontline work. I have done it. I remember the experience with the insistence of a scar tattooed on my heart.
During the AIDS epidemic, during which we made decisions that the psychiatrist Jonathan Shay has since said caused “moral injury” — the rationing of care, the torment of prioritizing services. We make such choices all the time, but the difference is that these decisions are informed by the biology of the particular medical situation, in the absolute inevitability of an end-stage disease dictating the terms of when a curtain gets drawn on a life — not on a sliding scale, not on the contingency of who else is presenting with more salvageable medical issues, who is exhibiting more or less distress in the emergency room, who has crashed on the floor — this is Sophie’s Choice, this juggling of a false hierarchy and this, this is not our strength. Yes, we do know how do it, but we also know that we will be dealing with depression and anxiety and PTSD — those of us who make it out alive. We are not bleary-eyed about what awaits us as we walk into the raging flames of post-event burnout. So why do we do it?
I often wonder why I did it.
The closest to a convincing answer I have is that we are particularly qualified to play this role. We are not outfitted, physically and psychologically, mind you, we are not, and no one can be. We are simply just capable of doing so. A muted voice inside us whispers incessantly — If not me, then who?
The risk of burnout — the PTSD — might be unavoidable. Under emergency circumstances, we cannot possibly self-calibrate. What we do need are candid conversations with ourselves. Let’s not walk on eggshells, or posture to present, we don’t have the luxury of time. For once we can be brutal and clumsy. And admit that we are unreservedly frightened.
Thaila Ramanujam is a physician in private practice in California. Raised in a literary family as the daughter of a prominent Tamil author, she developed a passion for Immunology early on and moved to the University of Washington to pursue research. She writes both fiction and non-fiction, and her work have been published/ or won awards in Nimrod, Asian Cha, Glimmer Train, and Readers. Her translations have appeared in International Literary Magazines. She is a columnist for a Tamil literary magazine, Kalachuvadu with international readership and has an MFA from The Writing Seminars at Bennington College, Vermont.