Friday, November 27

Proverbs 17:22 – A cheerful heart is good medicine, but a crushed spirit dries up the bones.

Recently one of my partners and I were talking over coffee about the upheaval that COVID has brought to our professional and personal lives. He asked me how many pandemics we had lived and worked through. I answered two - COVID and the 2009 Swine Flu pandemic. He reminded me that the real number is three - the third is the HIV pandemic which I first encountered as a medical student in 1982 in Chicago and is still ongoing. For perspective the 2009 flu outbreak resulted in somewhere around 575,000 deaths worldwide. HIV related deaths were approximately 1,000,000 for the year 2010 and around 700,000 in 2019. The worldwide death toll from COVID is 1,300,000 as of Oct 2020. In 2009 - 2010 the majority of deaths and serious illnesses from flu were among the young. Older folks had preexisting immunity. This time the tables are turned. As of this month there has been one death ever from COVID in the under 18 age group in California - a state of 40 million people.

The common theme I observed in 2009 and now is fear - fear not just among lay people but among physicians and other medical professionals. Some have reacted by closing their practices and holing up at home. Others have reacted by donning hazmat suits and treating every patient visit as the second coming of Typhoid Mary. The vast majority of us have carried on much as usual. My world is almost exclusively cancer medicine, and cancer has not taken a break for COVID. There is concern that many people have postponed their cancer screenings, with some even sitting on obvious tumors for fear of entering the potential COVID zone that is a hospital or clinic. We observe the precautions that out institutions mandate - masks and eye protection. We require testing for new patients before they enter our clinics. From then on it is life as usual, and we turn away no one. I am not trying to build the case that we are a group of martyrs. We assuredly live in denial that if we are careful and do the right things we will be spared. We trust in God and PPE.

For the mortally ill this has been an awful time. Many have endured terrible illness and death whether from COVID or cancer without a familiar hand to hold, or loved one sitting nearby, or Father Al or Father Paul to visit. My patient who was sick in COVID isolation even asked me to stand in the driveway below her 9th floor room to wave at her. If idle hands are the devil’s playground, then physical and emotional isolation is the continent of despair.

That is all the bad I am going to mention. I have also observed tremendous resilience in patients and their families that all of us will endure and persevere, and eventually the clouds will lift, and it will be sunny skies and clear sailing ahead both for their cancers and for COVID. Faith in God and better times has been the order of the day, and this is in folks who have a lot more on their plates than COVID fear. I have also observed a trend in young folks to do the “right things” to protect their parents and grandparents, learning that it’s not “all about me.”

This month has been a little different. There is real hope that effective vaccines will be available in the next few weeks - not years. My son Jeff, an immunologist, tells me that the science is good and they should work. Local hospitals have been emptying, and one where I work has had no COVID cases for better than 3 weeks now. Thanks be to God, and this is a very good Thanksgiving present.

The early 20th century father of the modern Royal Navy, Admiral Lord John Fisher, incorporated his motto “Fear God and Dread Nought” into his coat of arms when made a Peer of the Realm. For our current age I would modernize this to Love God and Fear Nought for it feels like better times are arriving very soon.

“God heals, and the doctor takes the fees.” ― Benjamin Franklin

Kaye Kawahara