January 5, 2022

Examining the Flower of Anger

Central, Clinical Partners

By: Jessie Roske, MD, Hospitalist, St. Cloud Hospital

Note: The patient stories referenced, including names and details, have been changed. However, they represent an amalgamation of common themes seen in multiple people during the pandemic.

I am a treating physician amid yet another COVID surge. This one is driven by Delta and now Omicron and my service area of Stearns County has a fully vaccinated rate for those ages 5+ just north of 50%; improving but still rather dismal. To say it’s punishing is a gross understatement. The federal government has sent a strike team of active-duty Air Force medical personnel to support our hospital in this crisis. While I am grateful to my clinical partners and these outsiders coming together to support each other and help every patient we can, I am so enraged at the misinformation leading to this preventable suffering. I recently told colleagues that I felt the only way to cope right now is to consider anger a luxury I don’t have. I have limited and precious energy and, to tackle another day, I must push the anger away for some other time. I’m smart enough to realize this may not be a good plan; it is quite possible that someday I will pay dearly for this avoidance.

We must examine our anger, accept, and forgive.

A friend told me to consider the wisdom of Thich Nhat Hanh:  anger is a flower among all the other emotions in a garden within us and we must allow the flower of anger to see the full light of day to cycle back to the earth. We must examine our anger, accept, and forgive. I have considered this advice carefully and have concluded I can examine and accept my anger, but I am not sure I can forgive. I damn sure won’t ever forget because wherever there is anger, there is pain underneath.  

Didn’t know what to believe

I had a patient recently named Ann, old for her years with many comorbidities. She was a skilled homemaker and farmer. She was brilliant in her sphere of life but not highly educated in medical science. When she was admitted with COVID pneumonia and rapidly escalating oxygen requirements, I asked her if she could help me understand why she wasn’t vaccinated. I do this with each patient, gently telling them we will help them just the same, but I would like the privilege of listening and understanding their viewpoint. My hope is that, ultimately, they will survive this terrible thing and perhaps reevaluate their decision with better information. 

Ann told me she wasn’t opposed to vaccination, that she had gotten the polio vaccine as a child and all her vaccines since. She also told me she simply didn’t know what to believe. She came of age in a time when Walter Cronkite and Dan Rather graced the news and were trusted sources of information. In her later years, she became a fan of Fox News and when the talking heads told her to be afraid of this vaccine, she was. Ann went on the ventilator with severe COVID three days into her hospital stay and, despite all the treatments we had to offer, suffered greatly through a week in the ICU and died. 

I asked her if she could help me understand why she wasn’t vaccinated.

Didn’t think he needed it

The day I admitted Ann, a patient came back to my service. I had admitted Jake about a month prior. He worked from home, was in his mid-40s, and typically healthy other than being borderline obese. He didn’t get the vaccine, he said, because he simply didn’t think he needed it. From what he had heard, this whole thing was blown out of proportion and not all that serious. He reasoned he was healthy and mostly stayed at home thus his risk was low. He didn’t really think it was some massive conspiracy, more that it simply didn’t affect him. After all, the hospital may be burning but the rest of the community was at the grocery store without masks and going about life as usual. 

He now told me he wanted to get vaccinated as soon as he could. His wife was ill at home with COVID and couldn’t come visit as he decompensated and ended up on the ventilator his second day. To say he was terrified in those moments is a serious trivialization of his distress. I met him again at day 31, after he had spent weeks in the ICU connected to tubes in every orifice, on high dose steroids and neuromuscular blockers, deeply sedated. This vigorous, productive, and active member of our society was reduced to the state of a child, confused at what was happening and trying to crawl out of bed convinced he was late for some engagement, vocal cords too damaged to project his voice as he cried out in terror, his body too weak to walk even as his mind told him to flee. Jake survived but has to relearn and regain everything. We talk of our nearly 800,000 dead. We don’t often talk of people like Jake. There are a lot of Jakes.  

Who do you trust?

To be clear, the vaccines that have been created are an extraordinary feat of modern medicine. They have taken decades of foundational research, billions of dollars invested in scientific infrastructure, and the collective knowledge, creativity and brilliance of hundreds of scientists who dropped everything to create a miracle within all our grasp. If you were waiting for God to intervene on this pandemic, this is it. I confess, I struggle mightily to understand why my neighbors and patients won’t roll up their sleeves. A few years ago, you trusted me when I said you had sepsis, that I had antibiotics to help, that I needed to call a surgeon colleague who could help by addressing the source. You trusted me to offer you medications based on all my training and the science to which I had access. You trusted the anesthesiologist to prepare you for the surgeon to cut open your body and remove the offending organ. Any mistake along the way could have been fatal but you trusted. I am so sorry that this trust is gone. I recognize that the fear and uncertainty that have undermined this bond have incredibly complex roots, many of which are opaque to me. But I know some of them.  

In the confusion of these times, I know there are medical or scientific professionals who sold their integrity for notoriety and dollars; leaders who stoked fears and uncertainty, turning this pandemic into a culture war that might win them votes; and public figures who traded likes and ratings for peoples’ safety. In my opinion, what they are doing is evil. These actions have deadly consequences; this is where my anger is directed. I won’t forget and they are not forgiven.There are other dangers closer to home and easier to understand; it seems to me, people are simply trying to advocate for themselves in uncertain times but misguided all the same. 

When someone you are “friends” with on Facebook says they had COVID and it was no big deal, it is important to remember that anecdotes aren’t data.

When someone you are “friends” with on Facebook says they had COVID and it was no big deal, it is important to remember that anecdotes aren’t data. It may feel validating and visceral to hear such a first-hand account. Perhaps you survive this infection unscathed. However, if infected with the Delta variant, on average you will infect 5-7 other people. What if they aren’t ok? True, most people at your age and with your health are fine if they get COVID. Are you prepared to say goodbye to your husband, wife, child if you are one of the unlucky ones? Maybe this person on social media is well-intentioned and sincerely believes this is an issue of personal freedom. I have sincere questions for you in turn:  When did personal freedom supersede all else? When did it come to mean more than our basic humanity, that we should care for our neighbors and the vulnerable among us? Are you choosing not to be vaccinated just because someone told you to? How are you able to disregard that it is an easy duty that might save someone’s life? 

Our individual duty

I realize this is your body; engagement, patient involvement, and healthy skepticism are crucial and appreciated. I know misinformation abounds. However, the evidence is clear:  vaccination is incredibly safe, far safer than contracting COVID no matter your age or underlying health. Never mind falsehoods about miracle cures or wishful thinking of “natural immunity boosting;” the vaccine is also, indisputably, the best way to protect our communities, hospitals, elderly, and medically vulnerable. Simply put, vaccination is the individual duty of us all because it is our moral imperative to consider interests other than our own.  

I said that I didn’t have the privilege of acknowledging my anger right now. To be clear, I have no anger toward people like Ann or Jake. On the contrary, I find their suffering the source of the most intense grief and regret and I consider them victims of false and dangerous narratives. I am so sorry the best treatments we have could not save Ann. Our oath is, into whatsoever houses we enter, we will enter to help the sick; but all our collective skill was not enough. I am so sorry that the treatments Jake needed to survive ravaged his body and mind and that the road back will be so difficult. First do no harm, but they don’t tell you that the path of beneficence can be ugly and hard. Most of all, I am so incredibly sorry that they didn’t trust us enough to accept the prevention we had to offer. 

Recently, another friend told me that Thich Nhat Hanh can be advising us to forgive ourselves, to treat ourselves with self-compassion. In this new year, I’m going to work on that.