"April is the Cruellest Month." Or is it? Journal of the Plague Year: Week Four
It’s Holy Week—and it’s been quite a roller coaster ride already.
The week began with Queen Elizabeth giving a televised speech to the British people. In it, she recalled a similar speech she made along with her sister to the children of Great Britain in 1940, during the darkest days of World War II—a time when the world’s entire order seemed at risk. It’s truly extraordinary to think of that moment, 80 years ago now, and to recall all the human race has endured during that span, from World War II and the atomic bomb, through the Korean War, Vietnam and the upheaval of the ‘60’s, men landing on the moon, the AIDS epidemic, the fall of the USSR, 9/11, the two Gulf Wars--and now this, the coronavirus pandemic. Time marches on, relentless. It’s the way it has always been.
As I write this, people of the Jewish faith are celebrating Passover. Easter is this Sunday. Both of these are spring holidays celebrating freedom and rebirth—the Jewish freedom from slavery in Egypt, and the Christian freedom from sin and death through the redemption of Christ.
It is somewhat ironic, then, that the COVID 19 pandemic is projected to peak in the United States this weekend. The IHME projections (https://covid19.healthdata.org/united-states-of-america) anticipate the peak in daily deaths from the pandemic for Sunday, April 12, with an anticipated 2212 deaths in our country on that day from the virus.
That’s Easter Sunday.
It’s a grim statistic. The whole thing reminds me of T.S. Eliot’s 1922 poem “The Waste Land” which began:
April is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.
Certainly, for this pandemic, April is indeed the “cruellest month,” for we will see the worst of this pandemic in the next few weeks.
One of the more difficult things for us to deal with as a society has been the social isolation mandated by the campaign to stop COVID 19 from spreading. Human beings thrive on contact. We long to connect with others. We enjoy the gregarious exchange of ideas. We share meals and play sports and worship together. It’s human nature for us celebrate our lives’ events with one another. And yet the COVID 19 virus thrives on that, attacking us in the relative vulnerability of personal interaction. If you hug your grandmother, you might just end up killing her. The pretty bridesmaid you danced with at the wedding? The touch of her hand could be your doom. Now, we sanitize anything and everything, wiping things down, spraying them and washing them as we wear our masks and stay apart and just hope to God that we don’t get “the virus.”
A professional colleague told me a story this week about an elderly patient he’d taken care of for decades who was admitted to the hospital. She was diagnosed with COVID 19 and was dying. He wanted to go visit her in the ICU, but her family members, with whom he is very close, said to him, “Don’t go. It’s not worth the risk. She won’t know you anyway, and if you go see her, you could infect someone else—or yourself.”
He was heartbroken.
Another physician friend who is a critical care specialist echoed those sentiments, saying that COVID 19 patients who are intubated often fail to get off of the ventilator. Their families, for their own safety, are kept away. Often, they don’t get to say goodbye.
That fact haunts my friend.
“The last little bit of humanity, the last human connection each of these patients may have is looking into the eyes of the person intubating them. And a lot of the time, that person is me,” he said.
He’s been having nightmares. That’s not a good thing when you’re not sleeping much to begin with. Worse still, in those nightmares, my friend keeps dreaming that he is the patient—intubated, watching his own numbers worsen, seeing his oxygen saturations decline and his blood pressure fall, knowing the inevitable is coming for him. He even dreamt of seeing a shroud-draped skeleton astride a pale horse waiting silently in the shadows of his ICU room.
“Do you know who that is?” he asked.
The Book of Revelation contains a reference to the Four Horsemen of the Apocalypse. The first three horsemen are Pestilence, War and Famine, all harbingers of the Last Judgement.
The Fourth Horseman, a skeletal rider on a pale horse, is Death.
There are the sorts of things physicians and other health care workers must push out of our minds in times like these. You can’t dwell on them. You can’t even think about them. Because thinking about them interferes with each of us being able to do our job—and our job is to get people well.
I begin my inpatient hospital week at St. Joseph’s/Candler this weekend. I will certainly see COVID 19 patients during my week there, and that’s OK. We take care of who we’re asked to take care of. That sort of thing goes with the territory. Although I’m very cautious, I’m not scared of it. And while I know we can’t save everybody, we’re damned sure going to try.
I’ll take this as a good omen: I have a friend in Atlanta who has been hospitalized with COVID 19. He’s been on a ventilator for two weeks, sedated, and has had a pretty rough time. But the latest message from his daughter, this Thursday, was this: “My dad beat all of the odds. He is successfully off the vent, extubated and breathing on his own!”
As we move into what looks to be a stressful Easter weekend, that’s the kind of news I desperately needed to hear.