Treating the Societal Body

I need to publish a Mea Culpa.

As a primary care doctor, I consider it the most important part of my job to understand where my patients are in their lives – mentally, relationship-wise, financially, educationally, etc – and tailor the treatment to fit the whole person. And I have failed to do this for you all in this Time of Corona.

The world I live in is one where I am watching young, healthy colleagues die. Where doctors from China to Italy to New York whatsapp each other traumatized by the deluge of people suffocating before their very eyes. If you were part of my world, you too would resign yourselves to months in your homes to avoid this fate for our community. But I forgot, you are not.

You are stressed. Out of work with rent to pay and a family to support. Trying unsuccessfully to work from home with the guilt of your children in front of the screen all day. You are alone, unable to hold your loved ones close. You are without the schedule that kept your depression at bay.

The argument that equal or more deaths will be caused by socially isolating is a false one. Flooding public spaces by returning to normal at this point will cause thousands or tens of thousands of deaths in numbers that would demonstrate the power of our distance up until now. But deaths may not be the bottom line.

In the clinic, I have to consider the life of the person I am treating. If my patient is ninety years old and tells me that wants to enjoy sweets and not take pills, she may simply decline treatment. Yes, she may die sooner, but she accepts that trade-off for enjoyment and freedom. If my patient needs insulin by syringe but is so phobic of needles that he feels he cannot face a future of injections, we may compromise and give him pills. It would be a less effective or less life-saving treatment, but the patient’s psychological health needs to be considered.

The difficulty here, is that the body we are treating with social isolation is made up of millions of individuals. Some feel one way, some another. Some are suffering greatly, others are managing. If as a society we are coming to a point that the treatment is too painful and we would rather suffer the disease, it is legitimate to voice that. And as people leave their homes for further walks and reopen their business despite the policies, we see that the society is coming to the end of its patience.

Ideally, this would be treated by government breaks as is being done in Europe. Forgiving rent and utility payments, broadening who qualifies for unemployment, expanding access to mental health services. This would allow us to remain home but with better support.

Short of those things though, society may decide that we have to begin slowly opening up. We must do this with eyes wide open, knowing that we are allowing preventable deaths. We must do this while diverting as many resources to population health as possible. I personally, as a doctor with my particular set of life circumstances, feel the pull to safeguard lives first and foremost by staying home until more testing and treatment is in place. But in the end, the ideal treatment regimen is not always possible.