I figured out a way today to describe what the pandemic is like from my perspective. It’s a slow-motion mass casualty incident. To explain why this framing feels so accurate to me, I need to share some of the events that shaped my understanding of crises.
Past Experiences
Early in my career, I worked for the surgical division of an air ambulance service. I experienced things most people couldn’t imagine. My first night alone in the hospital I was called to the ICU because a patient who had undergone a byapss procedure needed to return to the OR and was in bad shape. At the bedside, the cardiovascular surgeon cut the sternal wires that were holding the patient’s chest closed and straddled that patient to do an open massage of the heart as we rushed them back to the OR.
I recall another incident where I was running a machine in the OR to salvage blood from the operative field for reinfusion to reduce blood loss. They developed something called disseminated intravascular coagulopathy, a paradoxical condition where the clotting system of the body becomes hyperactivated leading to dangerous bleeding. I couldn’t process the blood fast enough. I had 10 3-liter reservoirs full of blood to deal with. We wiped out the blood supply in the entire metro area and were emergently getting some flown in from another metro area.
I’ve been in the trauma room for gunshot wounds, motor vehicle accidents, massive burns, and other horrors.
On one fixed wing patient transport, we were getting thrown around by thunderstorms in the most frightening flight I’ve ever been on. The pilot yelled back to us that they were going to see if they could spot a road to land on. I learned that the international airport had closed to commercial flights because the weather was so bad. We also didn’t have our pressurized aircraft because that one was getting a patient up in Alaska at the time, so our ceiling was about 12,000 feet for oxygen, which put us in some of the worst of the storms. I will never forget how pale the copilot was when we landed and they came back to open the door for us to get out. When someone like that is scared, my fears were completely justified.
I’ve also bagged numerous patients and have done CPR plenty of times.
Later in my career, I taught pathology residents to do the dissections for postmortem exams. The hospital I worked at didn’t have peds, so most of the decedents were elderly or infants. However, one shook me. It was a 12-year-old boy. I remember after we were done just standing in the shower in the morgue and crying. It was so hard.
While I was in grad school, I worked as a transplant coordinator. I was speaking to family members almost immediately after the death of their loved one. Generally, the process was that someone from the hospital had already talked with the family. One time there was a breakdown in communication and the family didn’t know about the death until I started talking to them. I pushed through, but that was one of the toughest conversations I’ve ever had.
Since that time, I’ve been involved in both simulated and real mass casualty incidents and disasters. I was boots on the ground in Puerto Rico right after Hurricane Maria. I was moving power lines by hand and got caught in a flash flood one day. There is something I can’t describe other than a high sense of anxiety about driving through streets when there is no power and not being able to speak the language at night.
I was a responder to a school shooting and to the 35W bridge collapse in Minneapolis. I’ve been adjacent to a few other mass shootings in my life as well.
A Mass Casualty Incident
All of this is to say that I have felt what mass casualty incidents (MCIs) feel like. It dawned on me today that the COVID pandemic is just another MCI, but in very slow motion. There is a huge difference though. In traditional MCIs, the adrenaline can push one through because there is light at the end of the tunnel and it can be done in hours, days, or weeks.
The pandemic is different. It’s been six years without a break. In other MCIs, people generally are grateful to have people trying to help them. There is some of that with the pandemic, but just as many sending threats of harm and death. I never expected that would be the case. All of the misinformation and lies being spread by people who are trying to make a buck off of this makes things worse. Toss in people like RFK Jr, Jay Bhattacharya, Vinay Prasad, and other minimizers who have held federal roles and mitigating disease and death becomes a Sisyphean task.
I had an ER doc who led the response at a hospital in New Orleans speak at a conference I organized 1-2 years after Hurricane Katrina. I watched his affect while he gave his presentation. He clearly was still suffering PTSD and I approached him afterward to encourage him to seek help.
I think that those of us who can see where the pandemic is heading are facing these kinds of emotional responses as well. The acute illness early in the pandemic was bad. That’s just the tip of the iceberg of suffering and death. Most of that still lies ahead and most people don’t seem to understand it or choose to ignore facing that reality.
It’s not just the medical consequences alone though. There will likely be additional suffering and death as other services fail. A good example is the sudden cut of USAID by the current administration. That alone is projected to lead to over 14 million deaths, 14.5 million of those among children under five years of age. It’s not surprising that 1930s Germany learned their ideas about eugenics from the US.
We are past the tipping point of a collision course with global disaster. People simply do not grasp the scale of the results of unmitigated spread on the world economy.
Reality
There currently is no light at the end of this tunnel. It just keeps getting darker and longer. The global recovery won’t happen during my lifetime, and perhaps not during that of my kids. It’s really disheartening.
It is times like this that I cling to books like Man’s Search for Meaning by Victor Frankl. It provides a framework for how people can still continue under very difficult circumstances.
