Aiming To Heal When There is No Cure: Doctoring and Our Pandemic FUTURE
In this episode, acclaimed author and pulmonary and critical care specialist Daniela Lamas and celebrated poet and radiation oncologist C. Dale Young join Fiction/Non/Fiction co-hosts V.V. Ganeshananthan and Whitney Terrell to discuss the sustained trauma the COVID-19 pandemic has already inflicted, as well as what is to come.
Lamas reflects on providing end of life care to coronavirus patients, and reads from a New York Times piece about the varied difficulties some survivors face on long journeys to recovery. Young reads from The Affliction: A Novel in Stories, as well as his recent poem “Adrenaline,” in which he describes wanting relief from being on constant alert; he also talks about watching Americans fail to consider the public good.
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This podcast is produced by Andrea Tudhope.
Selected readings for the episode:
You Can Stop Humming Now · What If We Have to Decide Who Gets a Ventilator? · In the I.C.U., Before the Coronavirus Storm · I’m on the Front Lines. I Have No Plans for This. · What if I Need to Go on a Ventilator? · They Survived Covid-19. Now They Need to Learn to Walk Again. · To My Patients’ Family Members, My Apologies · The Country Is Reopening. My Patients Are Still Suffering. · I’m a Critical Care Doctor. I’m Tired, I’m Mourning, I’m Bracing for More. · What Have We Learned About Reopening
“Adrenaline” · “Between Men” from The Affliction: A Novel in Stories · The Halo · The Torn · The Second Person · The Day Underneath the Day
Pedro Páramo by Juan Rulfo · “The Resident” – Television series
Part I With Daniela Lamas
V.V. Ganeshananthan: One of your expertises is critical care and end-of-life care, which you’ve written a lot about. And since the start of the pandemic, it seems like the experience of end-of-life care, from both the patient and the physician view, has changed a lot. Can you talk a little bit about that?
Daniela Lamas: I think before COVID and even since I trained, which isn’t that long ago, we’ve really had big moves toward having family in the ICU at the end of life and really involving family. We even sometimes, if it seems appropriate—if the patient is coding, if they’re in cardiac arrest, we’re doing CPR and the family’s around—we ask them, “Do you want to be in the room for this?” Because there’s a little data about the fact that that actually decreases post traumatic stress for families afterwards—seeing that we tried everything, seeing that we did everything possible for a loved one.
Ideally, if somebody is dying, we want it to be a more dignified, peaceful process, if it’s something that we can know ahead of time, and it’s unavoidable, but we have families at the bedside. And now that’s gone. We know facts that we did not know before, little things, that an iPad fits very nicely in a biohazard bag and that you can hold that iPad up to a patient’s face and have a family say goodbye on Zoom, which is weird and terrible. And in the height of the pandemic here, that is how people died. Our hospital has relaxed the rules somewhat. So, now you can have a family in at the time of death or in the most relaxed version, more recently, up to 72 hours before a patient dies as though we’re able to prognosticate that exactly. But all the weeks before death, all of the time that this patient spends sick, the family gets updates on the phone still. That is very lonely, it’s very isolating, and it really cuts them out of all this really valuable time that they have. And it’s been one of these really powerful, unanticipated and long-lasting consequences of this pandemic.
Whitney Terrell: That’s the thing, like imagining saying goodbye to my parents in the way that you’re describing is just incredibly devastating. That’s the thing I think about every day when I think about how I’m going to conduct my business and who I’m going to see and who I’m going to be around, but also, you know, it’s not like it’s fun for a young person to have this disease that can do terrible things. There’s clotting, you can get strokes. I just think people are failing to imagine how bad it is to get this. Everyone imagines they’re going to be the asymptomatic one.
DL: And that’s that human bias toward optimism. You ask people who are smokers what their chances of getting lung cancer are, and many believe that it is lower than the other smoker, that it’s lower than their actual risk, and there’s something sort of wonderfully human about being optimistic. These are unimaginable states. Very few people, thankfully, have been in ICUs, know what it is like to be in a long-term care hospital, so trying to protect yourself against these unimaginable states, it’s hard. It’s a hard thing for us to ask people to do, which is why I think we need default systems in place that push people to do the safe thing, instead of asking them to make that choice.
VVG: So Daniela, you were just speaking a little bit about the loneliness, patients saying goodbyes over FaceTime or Zoom. I feel like recently I saw a lot of my friends mark 100 days of social distancing. We’re living in this weird Twilight Zone-esque remoteness and isolation. Could you talk about how loneliness has looked for you and for your patients? Because it feels like we’re all just kind of alone together. Are there ways to mitigate or think about that?
DL: I think that’s a really powerful question. I like The Twilight Zone-esque framework. I hadn’t thought of that myself, but that is the way it feels. In a way, for me, working in the hospital actually mitigates loneliness to some degree. I realized with my residents and the nurses and other doctors I was working with that we were social. We were able to be in-person and work together as a team in-person—in a horrible environment, clearly—but everyone else had to retreat and we had this ability to go to work, and there were some things that were paradoxically fortunate about that.
I think seeing all of these patients behind closed doors, talking to families on the phone, knowing that they’re all alone, it is this sort of shared feeling. I hope not to be inappropriately optimistic as we just kind of talked about, but you wonder about post-traumatic growth, you think about patients who’ve had an ICU stay and then are able to make some meaning afterwards. I’m not sure what we will collectively take from this loneliness and what we can make of it. But I think we are in a really weird place together and I feel that and I’m not sure quite what to make of it.
WT: The loneliness of the disease is unique. You were talking about the loneliness of care earlier. The thing is, I will also see my right wing friends, or not friends, comment about like, “Well, there’s going to be an increase in suicides.” I think Vice President Pence was talking about this—there’s bad mental health effects for everyone staying inside, and I get that. I understand that. However, you know, the loneliness of having this disease also creates tremendous mental health issues even if you do survive.
DL: No, that’s a great point. There are people who have not seen their families who are getting better, but have not seen families for weeks and weeks and weeks. That leads to increased delirium, and even once they see families, once they’re back in their world, there’s this experience that they had of being lonely, of being scared, of being in a room with doctors who enter, and you can tell—I know this because I’ve been that doctor—they want to get out of that room as fast as possible. Everyone is scared. And this idea that you’ve been alone and that you were in some way like poison to others, potentially, I don’t know what that does in the long-term. But that surely does something. Thinking about that is sort of heart-rending.
Part II With C. Dale Young
Whitney Terrell: You’re a radiation oncologist, so you’re not working directly with COVID patients, but you are in hospitals. And we just wanted to ask how the pandemic has been affecting your daily life at work and also whether or not it’s been affecting your writing or your writing practice.
Dale Young: I have to be honest, the first month COVID really became something palpable to us in mid-March when the cruise ship docked and unloaded its patients, and they transferred without warning, to almost every hospital in the Bay Area, COVID positive patients. So, essentially mid-March, March 14, we suddenly had to face the fact that we had COVID patients at almost every hospital in the Bay Area. And it was pretty scary at first. I will tell you that the guidelines that we received, they seem to change almost daily at the beginning, and certainly weekly after a little bit of time.
I think as a radiation oncologist what scares me the most is for roughly two months, most elective procedures didn’t happen. So, women weren’t getting mammograms. People weren’t getting colonoscopies. There’s even a fear that there have been a lot of cardiac event deaths, because people are afraid to go to the emergency room. They’re dying at home. So, as an oncologist, anytime you’re faced with something like that, your worry is, “Does this mean I’m going to see people later on with more advanced disease that I now can’t cure?” I have patients who are afraid to come to the hospital for follow-up, and I have to say things like, “You know you’ll see less people here than you do at the grocery store, right? That there’s virtually no one here, it’s pretty empty.” I have to force myself not to say it’s a graveyard, because no one likes to hear that expression when talking about the hospital.
With writing, it’s been interesting. I’m working on a novel manuscript that I actually left alone for about a year. And during the pandemic, I went back to it, and I realized after a while that I think I went back to it because there was a strange comfort in just being lost and looking at paragraphs and cutting things, honing things, doing the sentence work… that I could lose hours where I didn’t have to think about this virus. I, at first, thought that it was just doctors, but I’ve learned by talking to other people that virtually no one sleeps through the night anymore. So, if I can find four hours to just play with words, it’s actually been kind of a huge relief to have that.
V.V. Ganeshananthan: You wrote The Affliction long before we’d ever heard of COVID. And yet for me as I read it, there were a lot of moments in the book that chime with our current circumstance. I was thinking of “Between Men,” which is about a man who’s choosing to die alone, not of COVID but of cancer.
WT: When I’m jogging through the city now, I see people at a distance. I’m watching them. I don’t want them to talk to me. I don’t want them to interact with me. And yet there’s this kind of pervasive sort of loneliness of that movement through the city that feels like what I think it’s like for most people to walk through the city now. You obviously weren’t predicting that there was going to be a pandemic, although you did call the book The Affliction, which always makes it kind of interesting to me. But I do believe that our committed act of writing can and sometimes sense things that aren’t totally manifest in reality yet, but might be on its way. Do you ever feel that way?
CDY: I don’t know if I feel it in quite that way. I think there are different traditions and if you look at an Anglo or Germanic tradition, people have been conditioned to think of time as linear. And if you look at other traditions, if you look at, say, the Vedic tradition from India, or some of the pre-contact traditions of South America, they don’t see time that way. They see it as something cyclical.
WT: Or Juan Rulfo’s book Pedro Páramo, which is a really interesting book.
CDY: It’s a book I love, and it was a huge influence on me. But the thing that is interesting is that if you’re within a cyclical tradition of time, everything has happened before and everything will happen again. So, I am old enough to have lived through a different pandemic and watching people die. And I’m sure, whether I consciously or subconsciously do it, I draw from things that I’ve experienced in my life. And it can seem in a moment like this as if it’s predictive, but it’s that there are only so many emotions we feel as human beings, and there’s only so many things that we face as human beings.
I’m not going to be Russian and say “to be human is to suffer,” but to be human is to experience certain things over and over again. So I think some of some of what you sense is that. That fear or anxiety about mortality is something many people live with. I’m always amazed when I meet people who practice some of the Eastern religions like Buddhism, and they say that they’ve just let everything go. And I just think, “How does one do that? How do I sign up? How do I know that it won’t work for me?” But I do think that the job of any good writer or artist is to pay attention. And if you’re paying attention, then you’re trying to capture the world for someone else, or a facet of the world, or how one sees the world, these works that you produce always become larger than anything that you can do.
VVG: [I’m also thinking about] this kind of American narrative of exceptionalism, thinking about American narratives that we have about ourselves: that we think of ourselves as the best or the most advanced, we’re so exceptional, American lives, let’s set the standard. Everyone wants to live in California… But we can no longer get into Europe due to our poor response to the coronavirus. We are now exceptional in how much we have failed with this virus.
CDY: It’s very true. It’s very true.
WT: Maybe it’s a good thing for the end of the American exceptionalism narrative, for that to go down. But the other thing is, I think about what kind of economic difference that’s going to make. People come here to America, which enhances America—although the President just stopped giving a bunch of visas this week—because it’s a place people want to be, and that makes America a better place, a better country. California is a perfect example of that. Look at all the different kinds of people that live in San Francisco. But if that goes away, that changes the country in some profound manner.
CDY: It does. I think there’s something very sad about the fact that we aren’t doing better, and I think it’s easy to say, “this leader isn’t doing their job” or “this person isn’t saying enough.” But I’m a little bit concerned that, as a society, we don’t seem to be as empathetic as we thought we were. In places like Italy and Spain—I have friends and family in Spain—they wouldn’t go out, because they were worried about their friend’s grandmother or their friend’s friend’s grandmother. And when I asked a friend of mine how people were managing, he said, “Well, it’s hard, but we know we’re all in it. We know we have to do this. If we don’t do it, too many of us will die.” And yet, when I turn on the news, and I see a ton of people not wearing masks, I just think, “What’s wrong with us? Why can’t we think about the public good? Why can’t we think about society?” And I don’t have an answer for that actually.
I know that a lot of doctors have been feeling both worried and somewhat angry, because we know what our job is, we took an oath to do that job. But, at the same time, we just want someone to say, “Okay, we’re going to make sure that you don’t get overwhelmed. Okay, we’re going to make sure you stay safe.” And then we turn on the news, and there’s like 500,000 people on a beach all hugging and playing volleyball. And we’re like, “Great, so we’re going to be totally screwed.” I guess you could call it an American exceptionalism, but, I don’t know, I feel like something has changed over the past 50 years. I worry that as a country, we no longer see ourselves as a collective. And, as a consequence, it’s harder for us to make sacrifices because it’s so much about “us versus them,” that, unlike in other countries, they don’t want to make sacrifices for the good of the society, because they don’t see us as one society.
Transcribed by https://otter.ai. Condensed and edited by Dylan Miettinen, Whitney Terrell and V.V. Ganeshananthan. Photo of Curtis Sittenfeld by Josephine Sittenfeld.