Donald Trump considers himself a wartime president battling an invisible enemy. Reporters bring harrowing tales from the front lines and close the nightly news with casualty statistics. Hospital systems conscript physicians from narrow subspecialties to redeploy them into COVID units. Humanity’s history of weaponizing disease has infected our discourse of illness, which falls in formation with the beat of a martial drum. Asked to comment about the expected peak in the COVID crisis, our surgeon general said it was “our Pearl Harbor.” No, this was our Somme, the bloodiest battle of World War I. And by this summer more Americans have died of COVID than were killed in that war, underscoring the point.
This summer feels like our second time “going over the top,” only to see there’s still a vast no man’s land. It’s a war in which old allies and enemies still eye each other warily, withholding information, manipulating production lines and demonizing one another. Physicians are under a tension that shell shocks the conscience, and when this is over, it just won’t be doctors’ lungs that are scarred, but also the profession’s covenant with the community that we serve. We choke lying in entrenched animosities and outmoded frames of reference, and I don’t have a gas mask for the corrupt leadership and the indifferent public. Few American doctors had ever faced The Great Lack – lack of everything from supplies to solidarity. This second wave is driven by a lack of community. Individuals are putting not just their lives but also the lives of their fellow Americans at risk by choosing to not wear masks, choosing to congregate, choosing to ignore that the world is a different place. While the people stand too close, our leaders remain out of touch.
All predictions about the length of wars have always been too rosy. One of the great misconceptions is that much is changing in our ICUs and hospitals. For months fundamentally nothing is different. Day in and day out it is trench warfare. We face a foe unyielding and capture ground slowly. Change of shift at dawn and dusk can feel like a sort of stand-to-arms, waiting and watching, exposed on the step where the weapons are fired. We wait to hand off the pager and pray it doesn’t go off until it’s in the next resident’s hand. One would think with so fast striking a contagion, the feeling has been of being overtaken by a surprise attack, but it has actually been more a siege mentality of fearing the long-predicted worst-case scenario smoking us out of our foxholes, as America grasps how vulnerable our bloated health care system really was without doctors and patients at the center of it anymore.
The public’s hunger for reports makes anything believable, while rumor within hospitals runs rampant. Weekly telecast town halls of hospital administrators rattled off statistics that don’t seem to align with our lived experience, and the same distrust soldiers felt for the field reports sets in, and we become susceptible to rumor, too. “I heard the nurses have a stash of N95s. … I heard we’re on deck to be drafted to the COVID unit next. … I heard they can’t make this floor into an ICU because they can’t buy doors that fit the open-faced bays.” I heard becomes an all-too-common replacement for the facts. This combination makes our war both ever-present and remote – just at the point of flattening that curve, and yet it is certain we will be fighting for many months to come.
The propaganda by political and health care leaders dissuades the public from concerns about clinicians’ treatment and safety, and the distorted information undermines the morale to fight for the profession that stewards the public’s care. Those in comfortable power tweet about clinicians’ heroism, but dead heroes are useful to no one. Much as mankind has weaponized infection, the same predatory system of the self-interested, interlocking directorates of health care executives, insurance companies, manufacturers of devices and drugs, and medical schools that perpetuate a teetering system also weaponize the discourse of professionalism and sacrifice without maintaining the deeper responsibility of leadership that such heroism is due. One of my colleagues complained, “Our leaders wear scrubs in the office while I need scrubs on the floor. It’s like wearing a helmet in the war-room for the cameras. If I go, I want to go as a doctor who willingly volunteered as part of my practice to answer that call. I want to enlist as a doctor, not be conscripted as a soldier.”
Another poignant similarity with World War I is its unfulfilled, shattered reshaping of what is left behind. When this is all over I think physicians will have much in common with Trench Poets like field doctor John McCrae of “Flanders Fields” renown. Both the Trench Poet and the Trench Doctor are unable to return to those previous ideals and forms so clearly exposed as anachronistic or imaginary, both forced, if our respective arts are to continue, to compose a fundamentally different view of the world and awaken in others this realization. Doctors are already beginning to speak out and shape that narrative, but will our prescription for the future prove curative or palliative for an ailing system? I fear this war, too, will emphatically not be the war to end all wars.
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