Atul Gawande

The Wrong Question

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I’ve been thinking about this for days, weeks, maybe months. As the number of days since the first COVID-19 lockdown in what – March 2020? – continues growing, I’ve found myself becoming annoyed, often angry, about all the talk on radio, TV, in newspapers of the wave of growing depression, mental illness, whatever; about how difficult these days are for so many people. The questions people keep asking are “When will this be over?” “When can I just forget about Omicron and get on with my life?”

It’s perfectly clear – NOT GOING TO HAPPEN. The current “wave” will peak, the number of new cases, of hospitalizations, of deaths, will decline slowly (maybe more quickly ?), but some form of COVID-19 is going to be with us for the foreseeable future. Vaccines are helping ameliorate the severity of the disease; new treatments are becoming available. However, COVID-19 will continue affecting our lives.

People’s heads are in the wrong place. They’re focusing on the many brick walls they’re contending with, butting their heads against them. What we need is a public reframing of the situation. Our discourse needs to change.

The Right Question

Atul Gawande’s 2014 non-fiction book “Being Mortal” is about living better with age-related frailty, serious illness, and approaching death. It’s subtitle “Medicine and What Matters in the End” directs you to consider important questions about end of life issues and maybe consider how current western medical practice might have this all wrong. Being Mortal is a book about end of life; but it’s more than that.

Everyone dies.

In our current world that day could unexpectedly come sooner than anticipated. Every day in our local news the number of COVID-19 related deaths is announced – some are old people, others are middle-aged, and even some much younger. None of us knows when that day will arrive.

The announcement is followed by reminders to follow public health guidelines to keep ourselves safe, to think about the public good, to do what we can to avoid the spread of the disease. Then there are the radio talk shows, the TV programs about how depressed everybody seems to be, how difficult a time people are having.

Right now, Gawande’s book applies to all of us – all of us are mortal. As he works through the book he describes how as a practicing physician/surgeon he comes to see living as a series of decisions – for me the focusing question he asks is “How do I live the best possible day today given the constraints/the reality the world is forcing on me?”

What small pleasures would make this a good day? I ask myself. In no particular order – a visit to my 92 year-old friend Joan; a kibbitz with Ruby; a walk in the snow; my morning aquacise class; that small piece of dark chocolate; a small magnum ice cream bar; some fried liver for supper; getting a new sewing project underway or making progress on something I’m already working on; a chance to sit and read; adding another 20 rows to a pair of socks; a cup of tea with Deb or MaryAnn; things that catch my eye as possible photos (whether I take out my camera or not); watching a well done drama on TV (while knitting), actually getting the laundry done or cleaning away the dinner dishes, crawling into a bed with fresh sheets…. Those are the kinds of things on my list – what might be on yours?

An Anthurium and a Clivia in front of Deb’s window yesterday

Life is a succession of moments – some stand out, others are fleeting. We all have potential time to notice the small stuff around us, to see the pollen grains on the anthurium flower, the way the light shines through the Clivia bloom, to savour the taste of a cup of ginger tea.

I understand how lucky I am. I haven’t had to home school three young children while trying to work from home and keep everything in the house and family functioning. I haven’t lost my job or constantly had to worry about whether I was being exposed to the virus. As difficult as those situations are, with help from the rest of us, it is possible to get through each day. We haven’t really helped one another enough, taken time to pitch in when we see someone else is overwhelmed. That’s part of the problem – our constant attention to “me”. It’s a tiny thing I do a couple of times a week – spending three hours putting together rapid testing kits – 40 kits an hour is as fast as I can go – but it’s something, and I find it a satisfying way to spend time even though I’m tired at the end of a shift.

I’ve been keeping an eye on our local hospitalization counts – as soon as they start declining noticeably I will have the knitting ladies in for an afternoon of conversation and laughter. What we’re all missing most of all is companionship. We can still see individual friends for short periods of time, safely distanced; we can talk to them on the phone (much more satisfying than texting). As soon as it’s possible I will make sure the group convenes and we can enjoy knitting and being together for an afternoon.

What small pleasures would make this a good day?

That is the question – today and everyday.

A Must Read by Atul Gawande

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I’ve passed on bits of information about the COVID-19 pandemic before. I just read this article by Atul Gawande – a surgeon and medical writer – which I’ve summarized; however, I really recommend reading his whole article if, for nothing else, than to enjoy the clarity of his writing (click on the title to get to the article).

Amid the Corona Virus Crisis,
A Regimen For Re-Entry

Atul Gawande

The New Yorker, May 13 2020

________________________________________

[I’m both quoting and summarizing Gawande’s discussion in what I’ve shared below]

“… Hospitals have learned how to avoid becoming sites of spread. When the time is right to lighten up on the lockdown and bring people back to work, there are wider lessons to be learned from places that never locked down in the first place.

These lessons point toward an approach that we might think of as a combination therapy—like a drug cocktail. Its elements are all familiar: hygiene measures, screening, distancing, and masks. Each has flaws. Skip one, and the treatment won’t work. But, when taken together, and taken seriously, they shut down the virus.”

  1. Cleaning your hands is essential to stopping the transfer of infectious droplets from surfaces to your nose, mouth, and eyes. Frequency matters – The key, seems to be washing or sanitizing your hands every time you go into or out of a group environment, and every couple of hours while you’re in it; plus disinfecting high-touch surfaces at least daily (like your phone). BTW environmental transmission (i.e via touching things) may account for as little as 6% of COVID-19 infections, he says.
  2. The virus spreads primarily through respiratory droplets emitted by infected people when they cough, sneeze, talk or simply exhale (singing in a group is very hazardous!). That’s why physical distancing is so important – the six foot rule. While not perfect (some people’s sneezes can travel up to 20 feet!), it helps a lot since most droplets seem to fall within a 6 foot radius.
  3. COVID-19 is not actually crazy infectious – an infected person might infect 2-3 people while going about ordinary life but that means the disease spreads. Exposure time matters: less than 15 minutes with an exposed person makes spread unlikely. Again, the 6 foot rule goes a long way to shutting down this risk.
  4. In the health setting daily screening of all employees, patients, and visitors for symptoms of COVID-19 is crucial for preventing the spread of the disease. People are asked to confirm that they have not developed:
    a new fever,
    cough,
    sore throat,
    shortness of breath,
    loss of taste of smell,
    or even just nasal congestion or a runny nose – [My take-away from this, is we need to monitor ourselves for these symptoms constantly and keep away from other people should we experience any of them and stay away for another 72 hours after we’re feeling better.]
  5. The critical thing about COVID-19 is that the virus can make people infectious before they develop any symptoms of illness.
    That’s the reason for MASKS! Combining social distancing with masks can block the spread of respiratory droplets from a person with active, but perhaps unrecognized, infection.
    The cloth masks, while not as effective as surgical masks, can block droplet emissions, as well. (And the virus does not last long on cloth; viral counts drop 99% in three hours.)
  6. “Culture, is the fifth, and arguably the most difficult, pillar of a new combination therapy to stop the coronavirus….It’s about wanting, among other things, never to be the one to make someone else sick.” [It’s all about social responsibility – accepting that my actions can have serious (even lethal) consequences for other people.]

The first of the official guidelines in the US for re-opening is at least 2 weeks of very low to zero new cases! This is most difficult – waiting for the number of new cases in the community to drop to zero (or almost zero) and stay there.

I was explaining to someone the other day it’s kind of like the difference between setting off on a car trip to Chester (NS) vs a car trip to Vancouver! You’ve got a very different mind set when you start out to go to Chester (from Halifax) – it takes an hour and the trip’s over before you know it. The mind set for a car trip to Vancouver is a committed undertaking – you know it’s going to be a long, uncomfortable, inconvenient, sometimes boring, haul. 

Well, we’re all taking that long slow car trip to Vancouver right now – we need to accept the expectation that our commitment to – frequent hand washing, self-monitoring, social distancing, wearing masks, and remembering each of us does this not just to keep ourselves safe, but to keep others safe – will have to go on for a LONG time. The better we are at following the full regimen the safer we all will be and the faster we can experience the world beyond our homes safely again.

[Click here for the original article by Atul Gawande]