REPORT FROM THE HEARTLAND

 

 

 

It had been a long hiatus from medical practice for me; since Covid had struck in 2020.  I was resolved to pick up my stethoscope and contribute once again to my noble profession and my fellow human beings.

I met Mr Ford for the first time in February of 2022.  This was in an exam room.  I had a mustache, beard and pony tail.  This didn’t seem to phase him a bit.  After all, we were in Oklahoma and he was dressed quite casually in the local fashion, being bearded himself.  I felt comfortable and we proceeded through the ritual of history and physical exam.

We dug deeper into his life and circumstances.  He was in his 70’s as was I.  His wife had nearly died several weeks ago from Covid.  She had been intubated but now was breathing on her own, thank God.  She was slowly getting stronger and was deemed ready for placement in a rehab facility.  The problem was there were no such beds available just now.

“I’m very sorry to hear about your wife.  If she can’t find a rehab bed we can get home health for support when she comes out of the hospital.  That will make a big difference.  But to tell you tell the truth Fred, it’s you that worries me the most. You’re 74 and diabetic, your lungs have been weakened by years of smoking. You’re not svelte like the old days and these are all risk factors for severe Covid.”

He nodded knowingly.

“Your chart says you didn’t want the Covid vaccine,” I continued, “I do respect your right to refuse whatever care you wish. But I want to discuss this issue with you.  It’s likely to be the only time we meet.  Sometimes a special understanding and trust can form when people speak from their hearts.”

I had seen many a skeptical patient finally accept vital medical advice after years of resistance from other doctors.  It didn’t always happen.  But when it did it formed a bond.  It always felt as if the time and place, the doctor and patient were aligned by fate and that good changes could emerge from the effort.  It gave a sense of laying on hands, if I may wax poetic.

“Trust,” I said, “that is what is needed in this confused world today.”

He looked at me with a face that reflected respectful defiance.

“Who can you trust,?  That Fauci is the worst.  He says one thing and then another.”

I now knew this would be a hard case.  He was at high risk for death and his wife had nearly succumbed just two weeks prior.  It seemed the whole gamut of distorted medical advice had penetrated him to his core.  He was committed, out of reach of my efforts.

He didn’t understand that science changes as new facts emerge.  That evolution of thought and knowledge does not refute past competence but advances it.  We must simply proceed with the best information we have.  Medicine had long been evolving slowly on the wards and clinics with mainly professionals absorbing and applying the insights and discoveries made. The sudden devastating impact of the plague had necessitated rapid adjustments of advice as new evidence arose. The most vital medical issue of our time was being managed in the public square on television and other media outlets in real time.  The changes had confused and angered many.

What he said next astounded me.

“I have somebody I trust. My neighbor is a doctor”

“What kind of doctor is he?” I asked.

“He’s an MD.  He’s against the vaccine and he uses ivermectin. We believe in him, we’ve seen it work.”

So much for me trying to be a voice of reason.

“How old is he?” I asked, looking for a clue to his competence.

“Younger than us.”

Now I was seeing first hand that the misinformation had penetrated beyond patients to some of the doctors themselves.  I had seen outliers like this on television. Some medical boards had considered sanctioning them. These practitioners had been trained scientists who had abandoned the consensus of the renowned experts who closely weighed clinical evidence.

I had seen the occasional provider who had deviated from the mainstream to embrace odd theories throughout my years of practice.  Usually they were loners applying their own strange theories in a private office where no oversight occurred.  But in a crisis such as we were in, it was alarming to see how deeply the antiscientific sentiment had infected the public consciousness.  I should have known, but I had been out of circulation so long that the shock was palpable.  There was no hope or purpose in trying to convince Mr Ford.  It seemed rude to persist and I yielded to his defenses.

My country, which had seen the aggregate life expectancy of around 47 years in 1900 surge to nearly 80 in our time, was losing faith in science; the very science that was so largely responsible for this remarkable extension of collective life.  The progress made in virology and vaccines had been a vital part of this success and now scorn was being heaped by many  upon those who advocated its use.  Perhaps the fortuitous speed with which the new vaccine had emerged from the years of prior research made it appear suspect to the uninformed.  But the safety and efficacy in avoiding severe disease and death were incontrovertible.  It was true that long term complications from the vaccine might emerge in the future as unforeseen morbidities, but this was unlikely based on past experience.  Nearly a million US citizens had already died in the present.  Sadly, distrust was being stirred in a public cauldron by cynical politicians.  Many of these were well educated and, I suspect, knew better.  Yet they waved the flag of “freedom” in the face of common sense while their constituents died in droves.  Here, before me was the result of such misinformation and I could only hope that Fred would continue to survive.  His life, his choice.

I would not be deterred in my efforts to provide the best advice and care to each patient. But a cultural divide had arisen with a dark face.  It had to be accepted that this would not be an uncommon occurrence in the future.  I would need to adjust to this reality.  So many of my brave colleagues, who had valiantly attended the dying in the heart of the epidemic, had long ago been forced to accept this sad development. They had risked their lives without adequate protective equipment or the availability of the vaccine and had seen people insist on unproven treatments and refuse the vaccine when it had appeared.  It had taken its toll on many caregivers at the bedside.  It was a significant factor for many who had or were considering abandoning their careers.

That was just a  part of the lessons my journey to the heartland had revealed. I had many beautiful memories and admiration for the people I met and with whom I worked.  I knew that as the plague subsided, people would tend to forget that we had lived on the fault line of trust and ignorance.  When the danger from Covid finally subsided, it would no longer seem so relevant an issue and the chasm would likely fade toward a memory.

When I arrived home after the harrowing drive from Oklahoma to St Helena Island South Carolina; through ice storms pulling a U-haul trailer, the car packed with three cats, one large dog who hates the cats and of course my loyal and beautiful wife Lisa, I was exhausted.  Yet the azaleas knew renewal was beginning.  They were blooming, Spring was coming on and we were alive. We were home. We had done our best. It was time to rest and recover.

 

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