pandemic
The Covid pandemic – fact and fiction
It’s some years since I read a Jodi Picoult book, but this one, Wish You were Here, seemed to challenge me to overcome my personal reservations about fictionalising the horrors of Covid-19 – all that fear and death and loss and trauma. So I swallowed hard and bought it, and I read it immediately before I could chicken out. OK, yes, I have hangups here which might prejudice my review; I declare them openly.
The story is set at the beginning of the pandemic and features a couple separated by it. Diana, an art specialist, is marooned on an island in the Galápagos that has closed down almost completely against the virus, while her doctor boyfriend, Finn, is marooned in a hospital in New York City as Covid rushes through and over them like a tsunami.
Virtually cut off from her former life, Diana finds herself examining everything that has brought her to this point, and wondering just what the future holds.
… you don’t often get to pause and reflect on [your life]. It’s just really hard to sit in the moment, and not worry if pause is going to turn into stop.
In a strange way, being stripped of everything – my job, my significant other, even my clothing and my language – has left only the essential pert of me, and it feels more real than everything I have tried to be for years. It’s almost as if I had to stop running in order to see myself clearly, and what I see is a person who’s been driving towards a goal for so long she can’t remember why she set it in the first place.
Thus far, so Picoult! She’s famous for her psychological takes after all.
Half way through I’m getting bored. It all feels too contrived. The medical updates Finn sends to Diana smack of an author wanting to cram the facts she’s learned during her research into her story somewhere. We’ve all had our fill of what Covid did in real life and that so recently; we know the facts. And surely no man worth his salt would bore his girlfriend with so much inappropriate information in an email when she’s on holiday … would he? So I was beginning to consider abandoning the book … when, uh-oh, page 183, and Picoult changes the narrative in one fell swoop.
I won’t spoil the story-line for others, but suffice it to say the rest of the book gave me a second wind because I was mentally revising the impressions of the preceding half. But a big bit of me was thinking, Did she just commit the cardinal sin on a par with ‘It was all a dream’? Even if not, it’s the impact Covid has had on our lives that dominates. However, Picoult is adopting a fairly unusual angle – the psychological legacy, and this might well be appealing to readers coming from a different background from mine.
So, what did I conclude? Well, I was interested to read she too was reluctant to write during her time of quarantine and isolation, and I have to admire her ability and determination in rising above that resistance. But I’m afraid my personal reservations about making this real-life horror into a made-up story so close to the lived experience prevented me from really entering into it. The actual emotional and mental trauma has been too great. Sorry, Jodi, this one wasn’t for me.
Exemplary service
We all know about the devastating effect of the pandemic on NHS waiting lists, and doctors’ appointments, and cancer diagnoses and treatment. We’ve all been aware of the changed rules of engagement for going into hospitals; some of us even fell foul of the policies that kept us from visiting our loved ones in hospitals and homes, denied us opportunities to say those last goodbyes.
So I’ve been staggered by the ongoing care I’ve received as an outpatient myself. Four and a half years ago I was diagnosed with cancer and had two surgeries to treat it. Because it was one of the more virulent and life-threatening forms of malignancy, I was told I would be monitored closely for five years, and given contact details for specialists whom I could ring if I was worried about anything between appointments. Initially I was seen every three months, and then gradually the time periods extended. Then the pandemic struck and so many routine appointments were cancelled. But mine were continued. When complete lockdown was in place I was given a consultation by phone, but once restrictions lifted sufficiently, the team felt I should be seen in person, and real appointments resumed. Last week I had my penultimate consultation.
To be honest I should have been perfectly satisfied if they’d said, just contact us if you’re worried. Indeed, I’ve felt guilty about taking up a valuable slot in a beleaguered health service, and told them so. But they’ve been adamant; each check is important, my welfare is important. I am both impressed and grateful. They have done all the worrying for me.
So it was perhaps serendipitous that, this latest visit, I took with me to the clinic waiting room a slim volume about a woman who worries about everything! It’s The Purveyor of Enchantment by Marika Cobbold – an undemanding read, requiring little concentration.
Clementine Hope, thirty-six, large and newly divorced, is a piano teacher and pathological worrier. She inherits a house, a stack of unfinished fairy tales, and an inferiority complex from her Aunt Elvira. Her half-sister Ophelia is younger, smaller, calmer and saner, and she despairs of Clementine’s fears and negativity.
When Clementine, after a failed relationship, determines to take herself in hand, she goes overboard in the risks she takes. Why does she have to be so extreme? a friend asks. Her reply: ‘I think you have to be to arrive in the middle. It’s a question of adjustment. I’ve been living a life confined by petty fears. Now I’m trying to be magnificently bold in order to finally arrive somewhere in the region of normal and sensible.’ Magnificently bold or magnificently stupid it may be, but her homespun version of aversion therapy does the trick: her fears recede and she reaches for a different future where she is in control … in spite of Ophelia.
Needless to say, I didn’t read the whole book waiting for my appointment! Conscious of the importance of limited time and space in the socially distanced chairs, appointments are now super-efficient. Hats off to an excellent department and its team of committed staff. And the book? Well, it’s on its way to the charity shop. Not one for my shelves, I’m afraid.
Peace
Christmas blessings to you all and sincere thanks for visiting my blog
It would be all too easy to simply write ‘Happy Christmas, everyone!’ but I know that sadly this will not be a joyous time for many people. The wretched pandemic continues; lives have been wrecked by tragedy and injustice; mental health has suffered; and so it goes on. Shaky smiles have covered many a breakingheart. So instead, whatever your circumstances, let me wish you peace …
If you are currently facing devastating loss or grief,
may you be given the strength and courage to go on.
If you are caught in a spiral of stress and anxiety,
may you find a way through which guides you to a safer place.
If life is currently good and you have all you need,
may these blessings continue, valued and treasured.
If you are fortunate enough to enjoy a super-abundance of health and wealth,
may you have the wisdom, compassion and generosity to share wisely.
If you are in a position of power,
may you seek the humility and insight
to use it to influence others and effect change for the greater good.
‘Let there be peace on earth and let it begin with me.’
Life after Life
A bonus of lockdown was acquiring ‘new’ books from those donated to our outdoor bookshelf. One such was Life after Life by Kate Atkinson, about which I’d seen and read excellent reports. (I’m horrified to discover it’s eight years since it came out, and I’m only now getting round to reading it! Too many books, not enough hours in the day.) But somehow, living in this parallel universe of pandemic for the last eighteen months has made Atkinson’s premise – What if you had the chance to live your life again and again, until you finally got it right? – even more pertinent; so perhaps after all it’s a good time to read it.
The hook on the back cover is tantalising:
During a snowstorm in England in 1910, a baby is born and dies before she can take her first breath.
During a snowstorm in England in 1910, the same baby is born and lives to tell the tale.
What if there were second chances? And third chances? In fact an infinite number of chances to live your life?
An ingenious premise upon which to build a novel, huh? And it challenges us to think, What would I do differently, given the opportunity? Would I even want to change things?
Add to that the time period of the story – 1910-1967 – including two great wars, and the implications of a second chance assume even more momentous proportions.
What if a pretty English girl had shot Adolf Hitler in November 1930?
What if a pretty British girl was actually living in Germany when war was declared?
The historic detail relating to big events gives a solid skeleton to this story, but inevitably some factual accuracy is forfeited in the name of literature, as the author herself acknowledges: To find the truth as the heart of a book, a certain amount of reality falls by the way.
Ursula Todd, born in 1910, is a strange child with odd ‘powers’. Was it reincarnation, or clairvoyance, or deja vu, or living in a parallel universe, sixth sense, or what? Certainly her mother thinks she needs ‘fixing’. A Harley Street psychiatrist does his best when she’s 10, but as she grows up, and bad things happen to her, Ursula persists in wondering if death is the answer; she can then have another stab at life and hopefully a happier ending.
We follow her different lives through her rural upbringing with an indulgent father and a superior mother, adult life in London, during the Blitz, and in post-war Berlin. She goes from knowing child, to rape victim, abused wife, assassin, mistress, rescue warden. Back and forth. At times she doesn’t even recognise herself.
It was, I must admit somewhat discombobulating to live through a traumatic experience of the death of a child or young person, only to have them return later in the book very much alive because an alternative version of their lives is being narrated. Short of cataloguing each iteration, I couldn’t hold them all in my head, so went for simply enjoying the moment.
Something of the challenge underpinning this story is captured in these few lines of dialogue about half way through the book:
‘Don’t you wonder sometimes,’ Ursula said. ‘If one small thing had been changed, in the past, I mean. If Hitler had died at birth, or if someone had kidnapped him as a baby and brought him up in – I don’t know, say, a Quaker household – surely things would be different.’
‘Do you think Quakers would kidnap a baby?’ Ralph asked mildly.
‘Well, if they knew what was going to happen they might.’
‘But nobody knows what’s going to happen. And anyway he might have turned out just the same, Quakers or no Quakers. You might have to kill him instead of kidnapping him. Could you do that? Could you kill a baby? With a gun? Or what if you had no gun, how about with your bare hands? In cold blood?’
For me this book came into its own in the section A Long Hard War, where Ursula is a warden dealing with the aftermath of the bombings in London. It poignantly captures the fragility of life, the human tragedy on both sides, the courage and stamina people can find within them, and the importance of small things.
When asked what the book is about, Atkinson says, It’s about being English. That’s not what I took from it. For me it’s about something much more complex; an unravelling of our multi-layered selves, who we are in our imaginations as well as in different circumstances. And how our destiny can be determined by an accident of birth, or a chance conversation, or a seemingly casual encounter or decision. I’m still mulling over all that … and isn’t that one measure of a successful story?
Caring in a time of Covid
Yes, I know, I know … I went to sessions on this topic at the Hay Festival, and here I am again, attending more of the same at the Edinburgh International Book Festival. Sad soul. But for me it was well worth the element of repetition to hear the important messages spelled out so clearly by those who really know. We do have to learn from the horrors, and now is the time to do so. Just this week our First Minister, Nicola Sturgeon, has announced concrete plans to begin a judge-led inquiry into how things were managed in Scotland, by the end of this year. Sometimes, though, in the face of relentless coverage of the statistics and long term consequences, it can be hard to see beyond the negativity.
The line up of panellists included Dr Rachel Clarke (palliative care specialist and ex-journalist) and Kate Mosse (novelist and unofficial carer of three elderly relatives) again, but joining them was Dr Gavin Francis (Scottish surgeon and GP). The two doctors have both been working actively on the frontline throughout the last eighteen months, and deserved the spontaneous applause from the live audience. But they were quick to identify the reality: caring is a privilege.
Nevertheless, the deficiencies in the response to the impending crisis, and the slowness of the powers-that-be to mobilise appropriate measures to deal with it, did stir their anger. Indeed it was this pent up frustration that led to the books they wrote.
Much of what they said was known to me, but still shocked. And I was horrified to learn that, not only has the number of unpaid carers escalated colossally during the pandemic, largely because almost all official care stopped, but that they were left largely unsupported. As were young people with special needs, and those with dementia. What kind of a price have vulnerable people paid for this failure? The toll on mental health especially has been devastating, as we know.The full consequences will only emerge gradually.
On the other hand, it was heart-warming to hear that frontline workers had themselves been buoyed up by witnessing the best of human nature too. And as Kate Mosse said, it’s what we all want: a society that looks after each other, that cares, that pulls together. Dare we hope lessons will have been learned for next time? Those who work in the medical world seem sure of one fact: there will be a next time. Sobering thought, huh?
It’s been great to be part of this iconic Festival once again, albeit in a hybrid form this year. A big step up from the cancellation in 2020. And I personally salute all the teams working behind the scenes to make it work – almost without a hiccup this time for me! I guess the person who inadvertently broke a connection will be hiding their mortification in a dark corner somewhere. Come out, come out, whoever you are; all is forgiven.
Love, life, death in a time of pandemic
Rachel Clark was a television journalist before training as a doctor – that probably helps to explain her brilliance with words and her laser focus on exactly what happened, and when, in the early days of the pandemic.
Her latest book, Breathtaking, spans the first four months of the ongoing Covid-19 pandemic, January to April 2020. At its peak, during that first wave, a thousand people were dying each day. And every single day the grit and devotion of colleagues astounded her. She says she has never been prouder of, or more humbled by, the NHS and its people, but that doesn’t stop her probing beyond the heroism, the sacrifices, to the core of what went wrong.
She knew it would be impossible, and probably inappropriate, to try to convey her inside experience to non-medical friends and family, so she used her laptop to vent her feelings. Writing became an anchor, helping to distil her fears, a compulsion that took her through the night and into the early hours of many a morning. Looking back over her insomniac’s diary much later she discovered that what she’d thought of as an unrelenting stream of darkness was actually illuminated by pinpricks of light. Acts of kindness and solidarity, altruism and selflessness, resilience and decency, shone through the storms, and they glimmer throughout the book which evolved from her midnight ‘scribbling’.
Rachel Clark graciously acknowledges the public’s generosity and sacrifice in withdrawing from the public sphere, foregoing so much that makes society and relationship valuable, in order to protect NHS resources.
Invisible threads of everyday sacrifice tie the world outside to the one within the hospital.
But from the outset, she and her colleagues watched with growing horror and incredulity, the UK’s casual approach to the coming tsunami … the effects of deficient supplies of PPE … delayed restrictions … the exposure of the elderly and vulnerable to risk … the appalling gulf between public rhetoric and supplies on the ground … the Prime Minister’s defence of indefensible behaviour when his chief adviser flouted the rules he’d helped to devise … And she’s haunted by the sense that we are all complicit in the betrayal; the alarm should have been raised sooner, been more insistent, more strident.
She is shocked too, by the spin put on the tragedy. When the UK had the third highest death toll from Covid in the world, and was the worst hit in Europe, senior government figure were trumpeting ‘success’!
How very cheap, how spectacularly expendable, one human life must be to them if the avoidance of tragedy is consistent with the deaths of nearly 27,000 people.
(Since then, of course, the death toll has risen vastly – currently in excess of 128,000.)
For this palliative care specialist every person, every loss, every family, matters. And in her view, the only reason the NHS was not officially overwhelmed was because so much of its function was suspended. Real people suffered the consequences. Many felt abandoned.
The professional workforce too paid a heavy price. Entering the personal spaces of strangers steeped in the virus again and again involved massive risk.
The Covid ward is humid and restive. We are on the move, no pausing or lingering, with strained expressions and a twitchy hypervigilance that is as exhausting and stifling as the masks we wear. It is all around us, the virus. It coats our clothes, our hair, the backs of our necks, the keyboards we type on, the surfaces we touch. It hangs in the air, it drops on to our shoes, it floats and waits, ready to be inhaled by anyone too unwell to be masked up in a hot zone.
They endured appalling working conditions, worked ridiculously long hours, put themselves through agonising processes. Their own families suffered. Some professionals lived in hotels rather than put their loved ones at risk. Some gave their very lives.
And on top of that they were unable to relate as normal to those in their care.
Kindness, undeniably, is the glue that ensures patients feel safe and hospitals humane.
But now, everything human was taken away – contact, personal details, names, faces, relatives (the cruellest feature of all).
Covid, in short, necessarily compromises every instinct to deliver humane and compassionate care. It violates something at the heart of good medicine – and the cost to the team is profound.
All they could offer from behind the layers and layers of protection seemed …
grotesque, a parody of communication. It could not be less warm, and more wrong.
And even in extremis, as death approached, they could only clutch at the remnants of human contact, to ensure no one was alone for that final stage.
In the end, as death bears down, there is almost no situation that cannot be made better by someone reaching out, with love and tenderness, towards one of our own. What we have, in our grief, is each other.
Rachel’s own compassion and care and humanity, perfect attributes for someone dealing with people at the end of life in palliative medicine, pervade the book. And for her, words are the most powerful drug used by mankind.
No one knows this better than a palliative care doctor. When drugs run dry, when cure is no longer an option, I deal in words like my patients’ lives depend on it. Words build trust, allay fears, dispel myths, inspire hope. They clarify, challenge, encourage and console. Words leap beyond the constraints of masks and gloves and gowns. Titrated carefully, dosed just right, words can take a dying patient all the way from the depths of despair to a place of hope and even serenity … Above all, our word must be our bond.
In the midst of this revelation of the flaws and deficiencies that have characterised the pandemic, the pain, the frustration, the humility, the dedication, glimpsed in this soul-searching book, are themselves evidence of what is right with the practice of medicine. Beyond price, beyond value.
Decision making on the Covid frontline
Jim Down is an anaesthetist and intensivist in University College London Hospitals. He was working as a consultant there when the Covid pandemic hit this country, and in his book, Life Support, he has captured the slowly emerging horror. We all know so much more about it now, but back in March 2020, not even those at the front line were fully up to speed with what was required. Reports were patchy and conflicting; provision was far from satisfactory; knowledge rudimentary.
By his own admission, Jim Down is a worrier, so what should he do in the face of this emerging crisis? Should he go home to his young family? Should he visit his elderly parents? How close should he get to people? Should he wear a mask? In many ways he felt safest at work protected by layers of suffocating PPE.
I confess, the work of an anaesthetist is much more far-reaching than I was aware of. (Apparently 50% of the country still believe they aren’t doctors!) But in reality, as Dr Down says himself, there are few departments anaesthetists don’t support in one way or another. And throughout the pandemic, it’s been the tribe of c11,000 anaesthetists around the UK who have been vital to the Covid response, converting all available space into fully-functioning Intensive Care Units in record time, delivering care to eye-watering numbers of patients, and designing protocols for some of the most dangerous procedures.
Amongst his other responsibilities Dr Down was given ethics to oversee. Forgive me if I home in on this aspect of his roles – it’s part of my personal raison d’etre, as you know. He set up a ‘three wise people system’ for all major and controversial decisions, and established an Ethics Group for the Trust. But questions and dilemmas presented at every level.
The cost of a day on ICU is approx £1700; what benefit does that need to accrue to be cost-effective? What constitutes a meaningful quality of life? When does a therapy become futile? What risk/chance of disability or suffering makes life not worth living? What constitutes meaningful life? Who decides? When resources are stretched beyond capacity in a pandemic how do we compare relative benefits between patients? All questions that haunt medical practice, but with Covid there were three new crucial differences from the normal balancing acts: the sheer number of patients, the flimsy knowledge of this new disease, and the unusual speed with which decisions might need to be made.
Ethical dilemmas presented too around how far to go, when to stop, when to call family in, in situations where so much was unknown. Then there was the matter of how to effectively deploy limited resources – equipment, drugs, people. The staff themselves were suffering from emotional and physical exhaustion, giving them a diminished capacity to empathise with others, poor concentration, irritability, feelings of helplessness, frustration. Not a good foundation for making sound judgements – thereby increasing stress still further.
Dr Down himself adopted a benchmark: What would I do if it was my brother, sister, mother, father, wife, child? It felt like as good a test of a decision’s rigour as he could muster.
But the personal toll was colossal; the work loads unprecedented. One trained ICU nurse to up to six patients instead of the usual one! One consultant to 42 patients. Teams of medical students and surgeons roaming the units twice a day just to turn people from supine to prone or back again. So much was unknown and unknowable. The patients were extremely sick, for a long time, very fragile and unpredictable, and denied family support. With no simple solutions, very few fixed protocols, the staff constantly questioned themselves, worrying about the repercussions of what they were doing.
We are all acutely aware that something could go wrong for any of us at any time. When it happens to a friend we are reminded of our vulnerability.
They were caring for
the biggest cohort of the sickest patients we’d ever seen, and we were desperately trying to work out how to manage them.
And at times they were treating their own frontline colleagues. Sobering indeed.
This book captures the everyday reality, the swing from the sheer mundanity of meetings and conversations at one end, through the anxieties that proved to be damp squibs, to the overwhelming responsibility of far too many competing demands, the crises at all hours, the inability to support everyone all the time. The frustration of insufficient staff or equipment to carry out the fundamental tasks. The constant questioning.
It underlines the enormous debt the whole country owes to the key workers who bore the heaviest burdens for us all.
Hay Festival: second instalment
They say authors should wait a decent interval before starting to write about pandemics. Well, who exactly are ‘they’, these authorities who know such things, huh?
Even before Covid struck, Val McDermid had already written a radio play about a scenario where a pathogen appeared which no drugs could treat, so she was way ahead of the game. Didn’t stop her publishing it. As she said: There’s nothing more dramatic than the end of the world as we know it.
She then collaborated with a graphic artist, Kathryn Briggs, to produce a graphic novel based on the play: Resistance. Their discussion at the Hay Book Festival with Louise Welsh about how they worked together, was both insightful and humorous. When Professor Welsh said that no person had been left unchanged by the experience of the last fifteen months, she hit on a fascinating fact leading into a fertile line of thought.
Lionel Shriver had just started her latest novel when the pandemic struck, and she’s woven topical lines and references into her story of a couple in their fifties, both medical professionals, contemplating a joint suicide when they reach 80. What would they miss/be spared? What possibilities might present? Dementia? A nightmarish Cuckoo’s Nest retirement home? The end of civilisation? A cure for aging? She has written, and included in the book, twelve alternative scenarios, all with different but parallel endings. As you know, assisted suicide has been an issue very much in my sights for many years, so I’m looking forward to reading Should we Stay or Should we Go. I loved the bit she read aloud, and reviews tell us it’s packed with humour as well as provocative thoughts.
And the pandemic theme even cropped up in a session where comedian/actor Frank Skinner was interviewed by fellow comedian/actor/satirist Marcus Brigstocke about his book, A Comedian’s Prayer Book. Skinner is a devout Roman Catholic and spoke movingly of his commitment, and response to taunts, revealing wide reading and studying alongside much heart-searching. Brigstocke said at one point: ‘I think you are this pandemic’s Galileo!‘ Skinner certainly had clever answers for anything thrown at him, chortling at the excitement of not being quite sure where any sentence would end up, but he came across as respectful of others’ opinions, non judgemental, eloquent and measured, whilst openly sharing his own moral code. The whole event was a magical mix of laugh-out-loud fun with serious and warming reflection. And a fitting ‘last Hay event’ for me this year.
Massive thanks to all who brought this fantastic festival to our homes. I for one, hope it will continue to offer an online version.