FROM THE EDITOR
Good Grief! By Louis L. Constan, MD
I
f you’re feeling a bit angry these days, just go to one of those social media sites, or to any media site for that matter, to see who people are blaming for the current virus mess. If you’re fair, as you surely are, you know that the blame-game will get us nowhere. For my part, I tend to take a clinical approach to all this; considering the whole controversy as all-to-be-expected when patients face the prospect of loss of life or health, as described so well by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying as the Five Stages of Grief. We’ve all seen these stages in our patients when they lose a loved one or receive a terminal diagnosis. In my opinion, Americans, as a society, are going through the Five Stages of Grief in an incredibly public way, displayed for all to see, every night on the nightly news:
clinic in Mexico, or take that experimental drug. COVID-19 Bargainer: We just need more ICU beds, ventilators, virus tests, contact tracers…then we’ll be fine. Or, maybe: I’ll take some hydroxychloroquine or swallow some hand sanitizer.
Stage One of Grief - Denial: No, this can’t be happening, you must be wrong. COVID-19 Denier: It’s just the flu. It’ll be over by fall.
As they say, we’re all in this together, and if together we all fully accept the reality of this situation, we can defeat the virus. But clearly, many Americans are stuck in one of those early stages. Why? One reason might be the lack of a realistic prognosis. Truth be told, we doctors are not always forthcoming with a realistic prognosis. And our message, just like that of the media, is sugarcoated to avoid shocking the patient/ viewer/customer too much. “We’re doing everything we can” is as meaningless as “we’re bending the curve.” “We’ve got the best doctors working on your loved one”
Stage Two of Grief - Anger: This is wrong! Somebody will pay for this! I’ll sue. COVID-19 Tantrum-thrower: It’s the (Democrats’…or Republicans’) fault. Kick-em-out! They’re taking away my rights! It’s a conspiracy! Stage Three of Grief - Bargaining: If only I, or you had done something different, things would have turned out better. Maybe if I pray more, or go to that
Stage Four of Grief - Depression: Don’t bother me. I’m done with everything. Maybe I’ll just end it all. COVID-19 Depressive: I’ve just lost my loved one, it’s hopeless; there’s nothing more to be done, my life is over. Stage Five of Grief - Acceptance: It’s bad, but I’ll find a way to go on. COVID-19 Accepter: This is a deadly disease, but there are simple steps that I can take to minimize my risk, and I am going to take those steps, and keep taking them until there is a vaccine.
is as meaningless as “heroes work here.” “There’s always hope” is as meaningless as “vaccines are just around the corner.” All ways of deflecting the patient/ viewer/customer from the grim reality of the situation and allowing him to remain in denial/anger/bargaining. What if all of us, doctors, hospital administrators, mayors, governors, community leaders, politicians, all spoke with one voice, bluntly giving Americans the unvarnished truth about just how bad things really are. What if all shared (and the media could surely help us do this) the grim reality of being a COVID patient; the horrific details of respiratory failure and intubation and perhaps lifelong COPD; heart failure; secondary infections; peripheral emboli leading to amputations; strokes leading to mental impairment; physical deconditioning leading to long stays in rehabilitation centers? Perhaps, if Americans could see and hear and feel what actually happens to these patients, they would be convinced to move out of their stage of denial, on to later stages. They would, of course, need equally clear, complete information from trusted authorities (put your name here) to learn what they need to get past the anger, bargaining and depression stages. Our hope is the stage of acceptance; where we gird ourselves with the knowledge and practices to keep us safe while we wait for the vaccine.
If you’re fair, as you surely are, you know that the blamegame will get us nowhere.
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The Bulletin | Fall 2020
