March 23, 2021

 “The best thing for being sad,” replied Merlin, beginning to puff and blow, “is to learn something. That’s the only thing that never fails. You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins, you may miss your only love, you may see the world about you devastated by evil lunatics, or know your honour trampled in the sewers of baser minds.”…

My series of interviews with family doctors has been uplifting. The pandemic toll has been significant. Doctors have been recurrently exposed to the virus and some have been infected and devastated by its effects. They have withstood fears about their own health and that of their friends and families. They have lost patients and colleagues. They have lost income and staff members. But, for the most part, they seem upbeat. Most consider their loss of income trivial. They mourn the losses of their patients and friends but exhibit resilience. They are not envious of their more glorified colleagues. I sought some common threads that support their relative optimism. Their ability to adapt their work and fill critical roles is a common theme. They also transmit a paradoxical joy of learning about this disease despite the damages caused by the virus.

Learning about disease may seem somewhat macabre to people who view healthcare from a distance. But learning about disease presages learning to help and heal. Historically a patient’s clinical course of illness was usually well-known long before the etiologies were discovered and treatments made available. Abiding doctors sat at bedsides with suffering people and painstakingly recorded their symptoms, signs and disease trajectories. Case reports were circulated and observations analyzed so that descriptive diagnoses could be made long before lab testing and imaging technologies were invented. The causes, diagnostic tests and treatments for hyperthyroidism, smallpox and heart failure all followed this typical evolution. The disease COVID 19 has forged a different pathway.

The genetic template for the SARS-CoV-2 virus was delineated before the clinical courses of its consequent illnesses were thoroughly described. Accurate diagnostic tests and vaccines have become available before the range of prognoses is evident. Observations are ongoing and case histories burgeoning, but typical commonalities and timelines are not nearly elucidated. Precocious laboratory knowledge has complicated editing the clinical story in some ways. Awareness of people infected but asymptomatic ads range to the infection’s possibilities. Family doctors are wrestling with the variable outcomes. Such variability went unrecognized during previous plagues when the illness was only recognized in the extreme. One doctor ruefully acknowledged that previous baffling syndromes such as chronic fatigue and fibromyalgia might someday be elucidated because of lessons taught by COVID. Another humbly admitted that maybe his periodic tinkering with therapies for his frail patients suffering with other illnesses were not as important as he imagined. He frequently telephones patients that he has not seen in sometime and most seem to be doing well without his ministrations. All of my sample doctors reported a dramatic reduction of influenza and other respiratory infections in 2020. When people do present with respiratory symptoms now, they almost always test positive for the new coronavirus.       

All of the doctors I talked with are perplexed by people who refuse to accept the reality of the scourge and any good advice of how to defeat it. Most are particularly discouraged by people who will not wear masks in public places and reject vaccines. Many have been surprised that children do not appear to be the primary vector for this infection. The annual epidemics of influenza were significantly curtailed when we began vaccinating children who usually experienced only mild symptoms, but provided transportation for the ever mutating virus.

The rapid development of incredibly effective vaccines is a medical and industrial miracle. In an essay titled Natural Science included in his marvelous book The Lives of a Cell, Lewis Thomas addressed the magic of scientific discovery. He pointed out that collective curiosity drives individuals who seek answers to perplexing questions. He noted that it cannot be planned and organized, but proceeds relentlessly as if it is a fundamental need like oxygen, water and food. He wrote, “I do not know of any other human occupation…. so driven beyond their strength and resources.”

I predict that pursuit of the secrets of COVID-19 will continue without need for governing directives. We will soon understand small particle transmissions, super-spreader events and individuals, biologic variability of response to the bug and we will undoubtedly solve other medical mysteries in the process. Despite the many impositions of the last year, “this too shall pass”.  For those of us who have suffered with loneliness and depression, we would do well to remember the words of T. H. White.      

…“ There is only one thing for it then — to learn. Learn why the world wags and what wags it. That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting. Learning is the only thing for you. Look what a lot of things there are to learn.” T.H. White from The Once and Future King

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