Life and Love: Acceptance in a time of Covid-19

It has been a long time since I've written anything resembling an academic, hamburger-style essay, but this is a conversation that requires clarity.  I have read several posts on social media about grief and trauma, and practicing self-love, or practicing discipline, which is relevant to the situation, but in the middle of the chaos of this traumatic event we're experiencing, I want to draw you aside.  We, as a species, are not doing well.  If I had to compare it to a patient, I'd say we're inserting an emergency airway, watching the screen throwing SVT, reading labs that say lactate is 8, hgb is 3, pH is 7.3, INR 7, EBL is 2 liters and going with blood and 0.9 NS wide open through IOs, hanging pressors, placing a fem art line, and getting ready to start CPR if the adenosine doesn't work, but that would all be assuming we had supplies and manpower--and we don't.  We don't have the robust support we need.  We don't have endless supplies of adenosine for the PSVT.  We don't have paddles.  We don't have tubing.  We don't have enough blood, or ffp, or platelets, or phytonidione, or vaso, levo, norepi, or epi.  At this point, I would be looking at my attending and expecting them to send their resident out to speak with the family about their options.  I would expect this conversation to have already taken place hours, if not shifts ago, and it's not because we're hastily trying to pull the plug, but because in the center of all of this is a human being who should have the right to dignity and respect and comfort in their last moments if that is something they would have wanted.  I know this conversation is hard to have, but I love you.  You don't get grief without love: love of your lifestyle, love of your family and friends, your freedom, your identity, your integrity, your city, your country, the species, the person attached to that vent, etc.  That is why I am grieving.  Even though we are, most of us, in my circle, okay, and alive I am grieving, and I only recognize it because I've lived it, but even in the middle of grief, I we still have life to live, decisions to make, and autonomy and dignity to preserve.

The concept of the Kübler-Ross' Five Stages of Grief are not new, but some of them may be difficult to recognize.  Denial: It's just the flu.  Or just flat out panic, or that hum of fear, anxiety, and uncertainty that never goes away.  Anger: What is this administration doing?  It's the fault of the wet markets.  The CDC is a mess.  How is our stockpile such trash? Etc. (I spend the majority of my time in this stage.)  Bargaining: Maybe there's a reason why this all had to happen.  Let me make cloth masks for everyone.  What if I'm just going out to a few places, or having a BBQ and we all sit 6 feet apart?  Depression: Overlaps with anger in that there is a lot of feelings of hostility and the repackaging of the fight of flight response into fawning.  Acceptance: Even if you reach this stage, you rarely stay here, and the stay is rarely peaceful.

I say this because I have personal experience.  From the moment I beat my doctors to my own cancer diagnosis, throughout preparations for treatment, through every cycle of chemo, and for all the days afterwards I have fought what we are feeling as a nation now.  I know what it is to fear the looming sight of a hospital and to, despite my best efforts, find my lizard brain kicking in and spiraling into a panic attack while I move towards inevitability.  I am intimately aware of the blend of feelings of fear, uncertainty, grim resolve, apathy, disassociation, anger, irritation, and indifferently pressing on, and suicidal ideation wildly swirling together like ingredients in a highball glass.  If God exists he's a shitty mixologist, but this is our drink, bitter as it is, and we have decisions to make, and autonomy and dignity to preserve.

So you should sit down (metaphorically--stay home, have this conversation by phone or email or video chat) with the person or persons who you trust to carry out your wishes.

I know most of you are safe and warm and fed, and you have governors who are working hard to protect you, but Covid-19 is here to stay, and in the long war to attain herd immunity, a lot of us will die.  The WHO estimates the mortality rate of Covid-19 is about 3.5% globally [1].  So far we haven't reached that rate in the US.  We're hovering around 0.027% if my math is correct [2, 5], although the veracity of that data is yet to be proven [3, 4], which is an incredible testament to our nation's medical and emergency staff, as well as a huge amount of credit to those of us who are staying home and observing social distancing.  Regardless, I had a sobering moment this past week thinking about you and realizing if not today, if not this cycle, there is a possibility one of your voices will fall silent in the next 16 months.  Life is full of fatal surprises.  GSWs, MVAs, MIs, burns, and strokes still roll through our doors--and once you enter, you are alone until we release you back to the living.  It is not a good time to have to be intubated.  Have the conversation with your person, soon.  Today.  Figure out what you want to do should you find yourself at that crossroads.  Here is a link to the Illinois advanced directives pdfs.  I know it's scary.  It took me months and several attempts and stall outs before I completed my advanced directive.  Know that having advanced directives is not a sign of giving up.  It means you have demonstrated love to those closest to you by taking the decision--and the associated guilt and agony-- out of their hands and with any luck, that will be one less thing they will have to carry when the time comes.

[1] https://www.livescience.com/is-coronavirus-deadly.html
[2] https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm
[3] https://www.washingtonpost.com/investigations/coronavirus-death-toll-americans-are-almost-certainly-dying-of-covid-19-but-being-left-out-of-the-official-count/2020/04/05/71d67982-747e-11ea-87da-77a8136c1a6d_story.html
[4] https://www.bbc.com/future/article/20200401-coronavirus-why-death-and-mortality-rates-differ
[5] https://ourworldindata.org/coronavirus