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First Person

First Person

A Nation Infected

Mosley, Mark MD, MPH

doi: 10.1097/01.EEM.0000731716.76748.2d
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    COVID-19, coronavirus, pandemic
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    Figure

    I am three days in the belly of this beast. But I am no Jonah. I am not anything out of the ordinary—just one on the other side of four million in the United States who were ahead of me.

    I have diagnosed some cases. I have even intubated a couple of them. I am on the front line as an emergency physician, but I did not get it—until I got it. This is definitely not the flu.

    I know that my chance of dying before this is published is less than 0.2 percent. And my chances of being hospitalized and placed on a vent are less than five percent. Trust me, alone at night, I hold on to those numbers. But there is no one, no matter how good the odds, who doesn't think about the possibility of death with COVID-19. This one truth among so many people makes this disease different.

    If someone says, “I think it would be better if we just let everyone get infected so we can go on with our lives and get the economy back,” I will bet you they have not had this disease. Or they heard it was mild for a lot of people. Maybe they don't know that younger people with mild infection pass it to older people who die from infection. Death, even the thought of it, when it is real and feels close changes you. Death motivates you to feel differently.

    I hope you don't get COVID-19. I too had heard the stories of infected people who said they were so tired. But as a fit emergency physician, I have smugly worn fatigue as a badge of my profession. I eat fatigue for breakfast. Make no mistake: This is not fatigue. Whatever word you try to find, you have not experienced this before. This dark beast that comes to you at 3 a.m. is chained not only to your muscles but to your mind. And when you are at your weakest, it whispers the word death in your ear.

    I have listened to it. I hope by hearing my story that you too will hear it. I pray that doesn't scare you, but that you know it is always there. It reminds us how unimportant most things that upset us really are. It begs us to love our family more, to be more understanding of others, to start more conflicts with “forgive me,” to be more empathetic to those patients whose lives are falling apart in our emergency departments, to be less the accuser of ourselves and others and more of the healer, to find hope and love. If you don't feel it, then pray for the gift of it. I am, of course, isolated now in the small church of my head. I am really the only choir I can preach to. Death will be my closing hymn. I hope you will listen to that song.

    ‘I Can Breathe’

    Death may be the necessary dark lament for the people of our nation to want to change their beliefs and to heal. There are other voices and other songs being sung in the background. If you believe that Black Lives Matter is just a historical accident happening at the same time as COVID-19, you should listen to the voices more closely.

    I am in the top one percent of being fortunate with this disease. I have separate alternate housing. My family has more than one car. I have health insurance. I have a well-paying job. I am beyond privileged to have many friends in the medical community who pulled strings for me, like getting tests so I can have information to make good decisions and bring comfort to ease the minds of my family. I have no chronic illness. I have never been in prison. And I am white. I can breathe. The course of my illness and the color of my skin are not disconnected in the United States of America. I am for the first time beginning to know that song.

    Our nation is infected. It is infected with a virus. It is infected with racism. This morbidity and this mortality are part of the same pathology that exists within the body of our people. But this disease did not start in 2019. We must look at history if we are to have any hope of implementing a therapy that heals. Within the past few weeks, a famous American physician was asked whether it was appropriate for the president to make a speech on the 60th anniversary of Ax Handle Saturday, and he said, “We need to move away from being offended by everything, of going through history and looking at everything, you know, of renaming everything.” This stunned me; it was one of the most dangerous statements I have ever heard. It was even more painful and disturbing that it was spoken by the only Black man appointed by the president to his cabinet: Ben Carson, MD, the Secretary of Housing and Urban Development.

    COVID-19 and Black Lives Matter are the direct descendants of the story of Columbus, smallpox, indigenous peoples, and the African slave trade. The only successful slave revolt in modern history occurred in the Americas, in Haiti in 1791. When global powers place their political and economic interests above humanitarian ones, the price is paid in blood by those deemed weakest by race or morality.

    Our trade wars with China and our desire to win those at any cost destroyed relationships between the United States and Chinese public health agencies. When a virus, referred to as the China virus or a kung fu virus by the president and others, comes to the United States, it is not treated like malaria or tuberculosis or the measles. It is not a scientific discussion between professional public health experts of two countries. The virus was made into a political weapon, and political and economic conspiracies dominate the interpretation of the disease and deaths that begin to occur.

    An Iron Chain

    Tens of thousands of American citizens have been sacrificed unnecessarily for the political and economic sustenance of those in power. The colonists of Hispaniola were unaware they inadvertently infected the inhabitants, but today's devastation comes with the complete knowledge of germ theory, though many disavow this knowledge by their behavior or symbolic measure of its importance.

    In geographic regions where Black Americans are 31 percent of a population, they make up 77 percent of hospitalizations and 71 percent of the deaths. (CDC. July 24, 2020; https://bit.ly/2DdJQR3.) Statisticians rightly point out that this is not genetic. We do not see the same thing in Black people with COVID-19 in other parts of the world. But here we see a disproportionate amount of COVID-19 because of the many social determinants of poverty, especially in the inner city. The statisticians know these are confounders, but we as an infected nation must ask the less statistical question, “Why are these confounders?”

    There is a direct iron chain that connects Haiti to Hattiesburg to Ferguson. It is dragged by a political and economic locomotive of American hubris and industry that spew viral infection at the cost of winning. Maybe some of you in health care know a little bit about the tradeoff between using the best science to heal human lives and playing the game? Even the best among us are chained to corporate ships where science is opinion up for reimbursement from the fatherland.

    May death help us to be honest, motivate us to feel the need to heal. May it help us to be more kind. May we prevent death by keeping our distance, to understand that wearing a mask is an act of mercy. May we have the courage to use the truth of science. And when we hope for healing, it cannot be just for the person but for the people. There is a freedom greater than walking outside in the sun for the first time after a long illness; it is the freedom to love when you wonder about the end of it.

    Dr. Mosleyis an emergency physician in Wichita, KS.

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