I’ve spent the last week hovering my mouse over various itineraries as I plan my holiday travel to see my family in upstate New York. I am vaccinated, boosted, and otherwise healthy (as are my immediate family, thankfully), but as our most recent data pours in, I can’t help but wonder what the right answer is. In recent days one of my colleagues (and her family of four) made the long drive back to see her family in New York, only to find that most of her family had just contracted the virus. “I think I would rather be at work”. I know I am not alone in this near-constant state of preemptive guilt and uncertainty.
As we are swamped by yet another surge, the familiar refrains of, “Mask up. Get Vaxed” are met with seemingly equally loud choruses of “My body, my choice” or some similar variant of resistance. A common line of questioning I see online and even hear from my patients goes something like this: “If you are vaccinated and boosted and believe that it protects you, why do you care what other people do?”
The first response that comes to mind is not new but worth repeating. We know, conclusively, that being vaccinated is an effective way to reduce the likelihood of transmitting COVID-19 — even more important to consider with the newer, highly-infectious Omicron variant which is doubling its numbers every two to four days. Scientists in the UK are finding that someone is twice as likely to be infected by Omicron and three times as likely to spread it to someone as compared to the Delta variant. By being vaccinated you reduce the likelihood that if you were to become infected that you might pass the virus (although only mildly affecting you) to another person who might be much more vulnerable. In other words, if not for you, do it for your neighbor.
My job as a Head and Neck surgery resident has brought me into contact with the consequences of COVID in different ways than the more commonly reported experiences of frontline workers and those in the Emergency Department and ICU. I have lost track of the number of times I have picked up the phone to hear from the ICU about another “previously healthy” person who now needs a breathing tube put in their neck. Even though the patient is no longer infectious, their lungs have been so ravaged that they will need a breathing machine to support them for the foreseeable future.
Almost all of the patients in this position were unvaccinated. I can’t help but wonder what they would say to themselves now — of course, they can’t tell me because they are medically sedated, dependent on a machine for their ability to breathe while their lungs recover. As a surgeon, this just means we are busier. Finding time to do these operations can be a challenge, but that’s ok. We–surgeons, anesthesiologists, OR nurses and technicians, respiratory therapists, ICU physicians and nurses–figure it out.
But there is a more insidious consequence that I’ve witnessed that needs to be discussed.
As a cancer surgeon, I’ve seen dozens of patients over the last several years who have delayed seeking care because of the pandemic. “Maybe it will just go away,” they say about their enlarging neck mass. “Should I really go to the Emergency Department for this? Now, of all times?” I know that when I tell a patient they have cancer their life fundamentally changes that day. I start a clock (which had already been ticking) in their life, counting down to their next appointment, their next CT or PET scan, their surgery, their chemotherapy, their radiation. I hear these clocks ticking in my own head for each one of them as we work to expedite their care — a challenging task even before a global pandemic.
Many of my patients require complicated operations to treat their cancer. As our hospitals become increasingly overwhelmed, scheduling these surgeries becomes progressively more difficult, as they often require prolonged stays in the hospital, often in the ICU alongside our COVID-19 cases. We have been tasked with redefining what it means for a surgery to be ‘elective’, finding ourselves needing to answer the questions of which surgeries really need to happen and which surgeries should wait because our ICU beds are occupied by COVID patients. Whereas in previous years we would just indicate that we need an ICU bed following surgery, now we find ourselves in a sickening game of musical chairs; wondering how we might allocate our few remaining ICU beds between many more critically ill patients who need them. Just last week I saw a patient who needed to be transferred to our ICU but there simply wasnt a bed available. Instead, the patient remained in their current bed while borrowing an ICU nurse and ventilator as they awaited a bed to open for them. This was achieved by cancelling another patient’s surgery. If it was you and your cancer, or your father or sister, how would you feel when I call to tell you that surgery is delayed not because of a lack of operating rooms, but a lack of beds for after we’ve treated your loved ones? I ask because this question is not rhetorical–my colleagues and I make these calls every week.
The cost of these delays in care compounds. Recent evidence has shown that my patients are coming in with more advanced diseases than they otherwise would have, as the cancer that could have been treated weeks and months earlier are left to grow and spread.. Like the virus, these consequences continue to evolve.
We will need more time to answer whether these months and years have changed survival outcomes for cancer patients, but I know first hand how horrible these “in-between” moments are with cancer care. Increasing the amount of time between a cancer diagnosis and beginning treatment for reasons entirely unrelated to the patient is cruel at best. These heartbreaking situations have made painfully plain how connected and inseparable our choices are. Outside of my life in the hospital I have close friends currently fighting their own battles with cancer — I know the way their lives changed as they are forced to live from appointment to appointment. Even the moments of reprieve while in between chemotherapy infusions or surgeries are stolen from them as they are placed in a position of constant uncertainty where nothing is promised. The reality is that nothing is promised to any of us. I know this not just as a surgeon but as a friend.
My final thought is probably better described as a plea. I have cared for many COVID patients and have seen the devastation this virus is capable of — but my encounters are often brief and limited to a specific question or procedure related to my sub-specialty. I feel spared from the heavy burden of caring for these patients day in and day out, of watching their bodies whither away. I am filled with a simultaneous rage and despair when I think of those who are now nearly three years into fighting COVID in the back of ambulances, in frantic EDs, in overwhelmed ICU departments. I have seen the look of exhaustion on the faces of respiratory therapists, nurses, and doctors alike. I know what it means to be tired, to be exhausted even, but this is a different, deeper type of fatigue. It’s a fatigue not just of the body but of the soul. There have been countless stories told about these heroes, and even these stories fall short of describing their courage and strength, their heartbreak and pain. We have only just begun to understand the toll this disease will take on all of us.
I have a sign in my kitchen — it’s one of those boards that you can pin letters on — on it I’ve written four of my ‘rules’ that help me focus each day.
Rule number number one is “Hope”. Rule number two is “It’s not about you”.I know, it’s quite cheesy, please forgive me. Also, I will give you one guess as to who wrote down these rules for me.
Through the pandemic, our global suffering has produced our global perseverance, and from this we ought to find our hope. Hope not only in a future free from COVID, but in a future that sees the restoration of our human closeness — the very closeness that we are now forced to fear. Shared meals and moments, embraces friends and family. Is that not a distillation of this holiday season? This sign right next to my door leading out of the kitchen so that as I scarf down my daily first cup of scalding black coffee I remember that why I — we — continue to press forward.
I plan on traveling home for the holidays. I look forward to being with my family who I have seen only a few times over the last 3 years. My decision to get vaccinated was personally an easy one — but I appreciate that this is not the case for many individuals and families. I know that for some, getting the vaccine seems to mean much more than an injection. As a doctor and public health professional I have always taken great honor in knowing that my words might weigh more than those of other strangers or lay-persons. So if you have a moment to hear this doctor’s advice, if you are unsure about the choice of vaccination for your own sake, consider that perhaps that it’s not just about you. These are the seams of our social fabric that we are all woven into — we have no choice in this.