Recently, I came onto a night shift in the ER at the hospital where I work to pick up the baton after a particularly heavy COVID-19 day. The staff was tired, beleaguered, defeated. During sign-out, a physician recounted with a slight smirk a few of the recent COVID patients they had admitted, all unvaccinated (some of whom were hardened COVID deniers), who had died within days of admission. Throughout the night, comments from staff regarding unvaccinated patients struck similar tones: “Idiots.” “Serves them right.” “What did they expect?”
I get it. We’re exhausted from something that we, as scientists, view to be a largely preventable cause of over 670,000 deaths in this country. We are unconsciously grieving, if not overtly. But I would posit our grief is not just for the death or suffering we’ve encountered from COVID, but also for the larger death rattles of the country’s faith in medical science — something for which we have each sacrificed tens of thousands of hours, hundreds of thousands of dollars, time with family, and our own mental health. With grief comes blame, and the unvaccinated are easy targets. This is the year of schadenfreude.
I have made it my practice not to belittle unvaccinated patients. Instead of telling them what they should do, I ask them, “What questions do you have about the vaccine?” Or “What’s keeping you from getting the shot?”
The response has been eye-opening. First, it’s clear that patients have come prepared to defend themselves against a verbal assault for not being vaccinated, and the response to these questions is a dropping of their guard, sometimes with a visible wave of relief. Second, and most important, it has given me insight as what is really on their mind — which for most is confusion. One unvaccinated, COVID-symptomatic patient told me, “I just don’t know who or what to believe.” Naively, I replied, “Trust the doctors and scientists,” before realizing that, of course, that’s the problem. Naturally, his response was, “Well how do you know which ones to trust?”
Physicians and health care providers have lived and breathed science for so long that we risk losing the view of the average patient. Scientific literacy in this country is mediocre at best. On top of that, medical practice optimization occurs largely behind the scenes. The battle against COVID has forced the scientific discourse and debate into the open for a population that has, for the most part, previously seen only the final product. Add to that the urgency of COVID treatment and the lightning speed of research that is being released sometimes in advance of the usual peer review processes for the sake of time, and we have a recipe for confusion and distrust. It is therefore natural for one to seek some form of clarification or for someone to put COVID-related science into some degree of context.
And where does the average person go to find this information? Not to the technical medical journals. And therein lies the issue: In times of crisis, people seek counsel from family and the familiar. And Google, Facebook, YouTube, and TikTok. They try to do their own research while having only basic scientific literacy. Enter the grifters. Enter those with a political agenda. Enter the physicians on the fringes who ignore the science in favor of their platform of deworming agents and proprietary supplements. Enter the realm of pseudoscience and rhetoric. This is the year of the anecdote.
For the most part, people are looking for answers, but the cards are stacked against them in this digital world. Every health care provider has had that one ardent unvaccinated conspiracy theorist who refused to believe that COVID is real despite showing them their trashed lungs on the CT scan, all while they’re on high-flow oxygen. Anecdote holding the power that it does, that patient runs the risk of coloring our perception of all unvaccinated patients in this same light. But, instead, my charge to health care providers is this: Take a meaningful pause and ask, “How did this person get to this point?” And understand that their condition is in part due to the challenges of the common person trying to understand complex medical science and being influenced by those with alternative agendas.
That same night, I diagnosed a young woman, with three young kids, with lung cancer. She was a smoker, and she knew that smoking can cause cancer. How is her situation any different from an unvaccinated person with COVID? How many of us would stand at the bedside in her tragic hour and berate her for smoking? How many of us would, upon learning of someone’s death from cancer, say flatly, “Served her right”? If she said. “I didn’t think it would happen to me,” would anyone really say,“Whelp, I hope you survive” as we walked out the room? These are statements I have heard said to or about unvaccinated COVID patients in a recent week. Clearly, this does nothing to foster that trusted relationship between a physician and their patient.
When I asked my unvaccinated COVID patient what was keeping him from getting the shot, he said he had read online that the vaccine gets into your DNA and he was afraid of what that would mean. So I sat down on his bed and spent a few minutes drawing a picture of a cell and nucleus, and explained in simple terms how mRNA works and why his DNA is not at risk. His next question was, “How soon can I get the vaccine?” He then called his kids and told them the same, and they asked where they could get the vaccine. While not successful in every encounter, I’m optimistic about the ripple effect that these little wins may have. And damn it if we don’t need a win now and again. In our most fundamental charge, “doctor” means “teacher.” This is the year where we understand. This is the year where we teach.
Dr. William Boroughf is an emergency medicine physician and medical toxicologist in Littleton, Colo.