Health of the People and Star of the stormy Sea
In the midst of another COVID19-related novelty I realized one of the ways some of us will look back on 2020. I was reviewing our hospital’s plans for giving a new COVID19 treatment, bamlanivimab, with one of my new colleagues. As we walked through the “COVID tent” he began sharing his memories of the first COVID patients he’d cared for, months earlier, in this tent. He spoke of how ill this elderly couple had been and the intuition he had that these two would test positive for SARS-CoV-2 after many who had tested negative. The memory of his first COVID patients had obviously made a strong impression. My thoughts immediately turned to the first COVID patients I had seen, many months ago which feel like years ago, in mid-March. The conditions where I first encountered COVID were a bit more austere — far out in the southern New Mexico desert in the tents of a far-flung outpost. It was a week or two after I’d gotten word that the deployment I was all geared up for would not occur. I was soon to be homeless and had just borrowed a car from one of my co-workers. So when Rupal, the other infectious disease physician whom I’d worked with during my years in El Paso, asked if I would accompany her to assess some COVID19 patients I said yes. Thankfully, the patients we saw that day were younger and not very sick — some were asymptomatic. The impression made by these first encounters reminded me of the indelible impressions many of us have of when we first heard the news on September 11th, 2001.
In the weeks after I’d seen those first patients out in the desert I began caring for much older, sicker people admitted to the hospital. Those early days of giving hydroxychloroquine and even an HIV medication, Kaletra, seem so distant and foreign now. While in hindsight it does not appear that those therapies did any good for those patients, I am also confident that among the handful of patients I cared for who got what are now thought of as outmoded therapies no harm was done. The care of COVID19 patients rapidly evolved to include such therapies as remdesivir, tocilizumab, convalescent plasma, corticosteroids and now, monoclonal antibodies like bamlanivimab. I, of course, view all of this from the perspective of an infectious disease doctor but my pulmonary and critical care colleagues were also instituting new therapies and practices which helped to improve patient outcomes.
In August I returned to my hometown of Battle Ground, Washington to visit beloved family whom I’d not seen since Christmas. The weeks leading up to this visit had been stressful — my last weeks in El Paso, driving up to Colorado to reunite with Alex, preparing for the big move to Hawaii. And I think it was because I was thinking of so many other things that I hadn’t thought much about the possibility that I, even being asymptomatic, could bring COVID19 to my parents. After arriving at the home I grew up in that worry grew in me to the point I began having nightmares about infecting my parents. For a time I regretted even coming to Battle Ground. Ten days after leaving home, I was quite relieved when my parents were still feeling well.
This past week, on Wednesday, things seemed to come full circle when I received a jab in my arm — an injection of lipid nanoparticles containing mRNA with instructions for my own cells to make SARS-CoV-2 spike protein. An immune response is currently developing against that spike protein which should protect me in the future if I am exposed to COVID19. Hopefully it will also protect people, like my parents, from having someone like me bring COVID to them. I am grateful to have received this vaccine and I do feel somewhat guilty about being in line in front of so many others who are more likely than me to have severe COVID19. I hope that this vaccine and others are the beginning of the end of the reality we’ve found ourselves in for most of the past year.
When I consider the most important thing I’ve done over the past year in relation to COVID19, one patient stands out to me. I remember an elderly woman whom I’d cared for over a number of weeks in the ICU. She was a very sweet lady, “pleasantly demented,” as we sometimes say. Every morning we would have the same conversation about why she was in the hospital. And every morning I reminded her that she had the coronavirus. She would give me a brief look of mild surprise and concern. She would then ask me to make sure her children knew she loved them. And I did my best to convey to her children whatever my patient had asked me to tell them. Despite the most aggressive treatments we could offer, her condition progressively worsened, following a typical course seen among severely-ill COVID19 patients. I remember a hot El Paso day, late in the afternoon in the ICU when I knew that her time to depart was likely near. I called her son with a specific question, almost embarrassed that I had not asked it earlier. I asked him whether his mother would desire Last Rites from a priest. At this point I don’t remember how I knew she was Roman Catholic — perhaps it was something we spoke about at some point, maybe I saw it in her demographic records. I also remember having the distinct sense that her son was not Catholic so I was a bit nervous about bringing up religion with him. But I immediately sensed his appreciation and even urgency when he told me that yes, his mother would most definitely want Last Rites. So getting a priest to that ICU became my mission. Thanks to a helpful ICU nurse we made it happen and through a glass window my patient, no longer conscious, received a priestly blessing and, I believe, grace from God.
On March 27th, 2020 Pope Francis gave a beautiful and profound address to an empty St. Peter’s Square in Vatican City. He compared our current situation to the experience of Christ’s disciples on the Sea of Galilee, in a boat, caught off guard by an unexpected, turbulent storm. I can’t think of a better description of the past year than “an unexpected, turbulent storm.” Pope Francis went on to say, “We have realized that we are on the same boat, all of us fragile and disoriented, but at the same time important and needed, all of us called to row together, each of us in need of comforting the other.” He spoke of a storm that “exposes our vulnerability and uncovers those false and superfluous certainties around which we have constructed our daily schedules, our projects, our habits and priorities.” Ultimately, the Holy Father directs us to the One who calms the storm, Jesus:
“‘Why are you afraid? Have you no faith’? Dear brothers and sisters, from this place that tells of Peter’s rock-solid faith, I would like this evening to entrust all of you to the Lord, through the intercession of Mary, Health of the People and Star of the stormy Sea. From this colonnade that embraces Rome and the whole world, may God’s blessing come down upon you as a consoling embrace. Lord, may you bless the world, give health to our bodies and comfort our hearts. You ask us not to be afraid. Yet our faith is weak and we are fearful. But you, Lord, will not leave us at the mercy of the storm. Tell us again: ‘Do not be afraid’. And we, together with Peter, ‘cast all our anxieties onto you, for you care about us.’”
