There is more than one thunder

Sunny Kung, a resident in internal medicine at a teaching hospital in the US, has authored a piece in STAT News about her experience dealing with people with COVID-19, and with other people who deal with people with COVID-19. I personally found the piece notable because it describes a sort of experience of dealing with COVID-19 that hasn’t had much social sanction thus far.

That is, when a socio-medical crisis like the coronavirus pandemic strikes, the first thing on everyone’s minds is to keep as few people from dying as possible. Self-discipline and self-sacrifice, especially among those identified as frontline healthcare and emergency services workers, become greater virtues than even professional integrity and the pursuit of individual rights. As a result, these workers incur heavy social, mental and sometimes even physical costs that they’re not at liberty to discuss openly without coming across as selfish at a time when selflessness is precariously close to being identified as a fundamental duty.

Kung’s piece, along with some others like it, clears and maintains a precious space for workers like her to talk about what they’re going through without being vilified for it. Further, I’m no doctor, nurse or ambulance driver but ‘only’ a journalist, so I have even less sanction to talk about my anxieties than a healthcare worker does without inviting, at best, a polite word about the pandemic’s hierarchy of priorities.

But as the WHO itself has recognised, this pandemic is also an ‘infodemic’, and the contagion of fake news, misinformation and propaganda is often deadly – if not deadlier – than the effects of the virus itself. However, the amount of work that me and my colleagues need to do, and which we do because we want to, to ensure what we publish is timely, original and verified often goes unappreciated in the great tides of information and data.

This is not a plea for help but an unassuming yet firm reminder that:

1. Emergency workers come in different shapes, including as copy-editors, camerapersons and programmers – all the sort of newsroom personnel you never see but which you certainly need;
2. Just because it’s not immediately clear how we’re saving lives doesn’t mean our work isn’t worth doing, or that it’s easy to do; and
3. Saving lives is not the only outcome that deserves to be achieved during a socio-medical crisis.

A lot of what a doctor like Kung relates to, I can as well – and again, not in an “I want to steal your thunder” sort of way but as if this is a small window through which I get to shout “There are many thunders” sort of way. For example, she writes,

Every night during the pandemic I’ve dreaded showing up to work. Not because of fear of contracting Covid-19 or because of the increased workload. I dread having to justify almost every one of my medical decisions to my clinician colleagues.

Since the crisis began, I’ve witnessed anxiety color the judgement of many doctors, nurses, and other health care workers — including myself — when taking care of patients.

Many of us simply want to make sure we’re doing the right thing and to the best of our ability, that to the extent possible we’re subtracting the effects of fatigue and negligence from a situation rife with real and persistent uncertainty. But in the process, we’re often at risk of doing things we shouldn’t be doing.

As Kung writes, doctors and nurses make decisions out of fear – and journalists cover the wrong paper, play up the wrong statistic, quote the wrong expert or pursue the wrong line of inquiry. Kung also delineates how simply repeating facts, even to nurses and other medical staff, often fails to convince them. I often go through the same thing with my colleagues and with dozens of freelancers every week, who believe ‘X’ must be true and want to anticipate the consequences of ‘X’ whereas I, being more aware of the fact that the results of tests and studies are almost never 100% true (often because the principles of metrology themselves impose limits on confidence intervals but sometimes because the results depend strongly on the provenance of the input data and/or on the mode of publishing), want to play it safe and not advertise results that first seed problematic ideas in the minds of our readers but later turn out to be false.

So they just want to make sure, and I just want to make sure, too. Neither party is wrong but except with the benefit of hindsight, neither party is likely to be right either. I don’t like these conversations because they’re exhausting, but I wouldn’t like to abdicate them because it’s my responsibility to have them. And what I need is for this sentiment to simply be acknowledged. While I don’t presume to know what Kung wants to achieve with her article, it certainly makes the case for everyone to acknowledge that frontline medical workers like her have issues that in turn have little to do with the fucking virus.

In yet another reminder that the first six months (if not more) of 2020 will have been the worst infodemic in history, I can comfortably modify the following portions of Kung’s article…

They were clearly disgruntled about my decision not to transfer Mr. M to the ICU. I tried to reassure them by providing evidence, but I could still feel the tension and fear. The nurses wanted another M.D. to act as an arbiter of my decision but were finally convinced after I cited the patient’s stable vital signs, laboratory results, and radiology findings.

Everyone in the hospital is understandably on edge. Uncertainty is everywhere. Our hospital’s policies have been constantly changing about who we should test for Covid-19 and when we should wear what type of protective personal equipment. Covid-19 is still a new disease to many clinicians. We don’t know exactly which patients should go to the ICU and which are stable enough to stay on the regular floor. And it is only a matter of time before we run out of masks and face shields to protect front-line health care workers. …

As a resident in internal medicine and a future general internist, it is my duty to take care of these Covid-19 patients and reassure them that we are here to support them. That’s what I expect to do for all of my patients. What I did not expect from this pandemic is having to reassure other doctors, nurses, and health care workers about clinical decisions that I would normally never need to justify. …

There is emerging literature on diagnosing and treating Covid-19 patients that is easily accessible to physicians and nurses, but some of them are choosing to make their medical decisions based on fear — such as pushing for unnecessary testing or admission to the hospital, which may lead to overuse of personal protective equipment and hospital beds — instead of basing decisions on data or evidence. …

… thus:

The freelancer was clearly disgruntled about my decision not to accept the story for publication. I tried to reassure them by providing evidence, but I could still feel the tension and resentment. The freelancer wanted another editor to act as an arbiter of my decision but was finally convinced after I cited the arguments’ flaws one by one.

Every reporter is understandably on edge. Uncertainty is everywhere. Our newsroom’s policies have been constantly changing about what kind of stories we should publish, using what language and which angles we should avoid. Covid-19 is still a new disease to many journalists. We don’t know exactly which stories are worth pursuing and which are stable enough to stay on the regular floor. And it is only a matter of time before we run low on funds and/or are scooped. …

As a science editor, it is my duty to look out for my readers and reassure them that we are here to support them. That’s what I expect to do for all of my readers. What I did not expect from this pandemic is having to reassure other reporters, editors, and freelancers about editorial decisions that I would normally never need to justify. …

There is emerging literature on diagnosing and treating Covid-19 patients that is easily accessible to reporters and editors, but some of them are choosing to make their editorial decisions to optimise for sensationalism or speed — such as composing news reports based on unverified claims, half-baked data, models that are “not even wrong” or ideologically favourable points of view, which may lead readers to under- or overestimate various aspects of the pandemic — instead of basing decisions on data or evidence. …

More broadly, I dare to presume frontline healthcare workers already have at least one (highly deserved) privilege that journalists don’t, and in fact have seldom had: the acknowledgment of the workload. Yes, I want to do the amount of work I’m doing because I don’t see anyone else being able to do it anytime soon (and so I even take pride in it) but it’s utterly dispiriting to be reminded, every now and then, that the magnitude of my commitment doesn’t just languish in society’s blindspot but is often denied its existence.

Obviously very little of this mess is going to be cleaned up until the crisis is past its climax (although, like ants on a Möbius strip, we might not be able to tell which side of the problem we’re on), at which point the world’s better minds might derive lessons for all of us to learn from. At the same time, the beautiful thing about acknowledgment is that it doesn’t require you to determine, or know, if what you’re acknowledging is warranted or not, whether it’s right or wrong, even as the acknowledgment itself is both right and warranted. So please do it as soon as you can, if only because it’s the first precious space journalists need to clear and maintain.