A Date Which Will Live In Infamy

My daughter was born on December 7.  

Does that date ring a bell?  Here’s a hint.  It’s “a date which will live in infamy,” the day in 1941 that the Japanese air force bombed Pearl Harbor.  My mother was ever-grateful that she was born on December 8.  And I am thankful, for obvious reasons, to celebrate my birthday on September 10. But her birthdate is no big deal for my daughter.  Most everybody who remembered exactly where they were and what they were doing on that awful day in 1941 is gone now.  

One of these days the Covid pandemic will fade from memory too.

In one year we’ve already lost to that tiny virus many more Americans Than the 400,000 troops who died in the world war we fought from 1941 to 1945.  We’ve been locked down and masked(or ought to have been) for a year now. Everybody from school age on will remember for the rest of their life at least something about this extraordinary period.  Years from now psychologists, sociologists, economists, political scientists and historians will still be studying the lasting effects of the pandemic on Americans’ psyche, society, economy and body politic.  At this stage we know only that things will be different but can’t foresee exactly how. (As far as healthcare goes I can tell you that telemedicine will be a lot more prominent than it was before the pandemic.  But that’s the only prediction I feel confident about.)

How to make a record of these exceptional times while they are happening is an urgent question, for the sake of the social scientists of the future, as well as for our children and grandchildren, not to mention for ourselves as our immediate memory dims.

An organization I’ve worked with for decades, Centennial Area HealthEducation Center (CAHEC), in Greeley, Colorado, took the bull by the horns(a fitting phrase since CAHEC serves 11 mostly rural counties in northeast Colorado’s High Plains cattle country) and initiated a project to record video interviews of rural people, focusing on the shape of their professional and personal life during the pandemic.  We Think it’s especially important for us to capture something of how Covid-19 has affected rural areas because the lives of country folk tend to be underrepresented in the public sphere.  

CAHEC send interviewees a list of possible questions in order to give them a sense of the ballpark of the conversation. Interviewers aim, though, for a free-ranging discussion.  We are not gathering data.  That will be up to the researchers who we hope will wring data out of our rich resource. We aim for stories.

Does this sound familiar?  

If you’ve read some of my other stuff you’ll recognize “data versus story” as a recurring theme.  A chapter in my book, Digital Healing:  People, Information and Healthcare, is even titled “Data versus Story.”  That chapter is about the need for healthcare providers and institutions to appreciate the patient stories that have been squeezed out of our medical records and our consciousness by the modern obsession with data and the electronic systems we use to record and manipulate data.  Stories capture us as human beings:  our values, our suffering, and a good deal about how to make us better.  Each of us is so much more than masses of data to be captured and processed in order to spit out the right treatment.

CAHEC has gathered so far nearly one hundred interviews from a wide range of people. I’ve done about two dozen interviews myself, including nurses, doctors, office and nursing home managers, a pharmacist, and even a veterinarian.  It’s been a privilege, at such a turbulent time, to be let in on the lives of these dedicated professionals for a whole hour.

Here are a few of the things I’ve learned.

  • Denial of the seriousness of the disease (not among professionals) was especially high early on, before the illness had taken hold in rural communities.  Mask wearing never has become de rigueur in our region.
  • From the outset, well before a Covid-19 had ever been seen in some towns, the medical facilities--clinics, nursing homes, hospitals--made extraordinary efforts to prepare.
  • Getting ready was an ulcer-inducing process, with recommendations and protocols for disease management changing literally daily, all in the context of shortage of protective equipment and testing.  The stress was met with an surplus of can-do, communitarian spirit that carried the harried workers along.
  • No matter how frontier their location, thanks to electronic communications, every health professional has had easy access to reliable information about Covid-19 and to experts to help them interpret it.  Unfortunately, it took a few months for recommendations coming from different organizations on how to manage the illness to settle into basic agreement.
  • Most all health workers rushed toward the flames.  A few, afraid for themselves or their loved ones, ran away.
  • People pulled together to support patients and healthcare community.  For example, lots of free meals were delivered to locked-down nursing home staff.  Regular parades marched by patients’ windows.  These efforts faded as the pandemic wore on.
  • From the outset, everybody used a lot of telehealth.  Now that Medicare and other payers are covering it, telehealth has been understood to include phone calls (service I provided free to my patients for hours every week, back when I was in practice long before the pandemic).  
  • In rural areas, which are plagued by bandwidth and other technological challenges, the telephone has been the primary instrument for remote care.  Practices Have developed creative ways to use the telephone in delivering medical care.  Pictures of skin lesions and rashes, taken with a smartphone, are a big, simple, cheap enhancement.
  • Everybody misses face-to-face contact
  • Though they’d settled into a comfortable practice routine, later in the pandemic the folks who had initially run toward the viral flames shouting, “bring it on!” were getting pretty tired.  Frontline workers got sick and tired of donning and doffing protective equipment. Managers worried a lot about money.
  • Now that vaccines are here there is a new set of challenges, including seeing to it that the underserved population (in our region,much of it Latinx, as well as Africans who work in the beef plants) get immunized.  In some ways immunization has been an easier process in the country than it has been in cities with their huge populations.  On the other hand, reaching the diffuse population (less than one person per square mile in Washington County, which lies in CAHEC’s service area) presents other challenges.
  • Healthcare folks are relaxing a little now that effective Covid vaccines have brought the end in sight.  We’ll see how it goes.  
  • I could go on about things I’ve learned doing these interviews.  I believe fabulous riches await anybody, researcher or curious layperson, who delves into the videos, whether they concentrate on the data or the stories.  I sincerely hope people pay attention to both.
To see the video interviews CAHEC has released so far, go to: CAHEC VIDEOS
March 7, 2021
 in the
Digital Healing
Written by
Marc Ringel, MD

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