Doctoring is not that difficult: it requires a lot of patience and a dusting of skill. Regrettably, at the time of writing (November 2020) we might be about to lose our…sang froid. Every year, as the clocks fall back, people will phone the house, stop us in the hallway, or tug on our scrub tops. Normally that’s just fine. In other years it wouldn’t matter that it’s the same old pre-Christmas song, and we know what’s coming well before the tedious chorus. Perhaps you know it, it’s a seasonal classic, and it goes like this: “so should I bother getting this year’s vaccine?” We thought covid-19 would quarantine this silliness, but had forgotten how persistent a bad tune can be. To put it mildly, we’re a tad exasperated.
In previous years we would listen attentively and only when it was our turn would we politely give our recommendation: “yes you absolutely should.” However, in the year of covid-19 we have just about had it up to here. Sure, the erstwhile flu shot was never perfect, but we have always recommended it as a way to protect yourself, and to show others that you’re neither selfish, nor above everyone else. Even if the boffins don’t get the cocktail exactly right, let yourself be exposed to low doses of influenza’s H (hemagglutinin) and Ns (neuraminidase) well ahead of the next nasty HN combination. Well this year it’s less about the flu and all about corona, but the procrastination song remains the same. Seriously, folks, what is it gonna take?
We assumed back in March that a worldwide pandemic would silence anti-vaxxers and procrastinators alike, but no. Instead, in late 2020 we are hearing twice as much song, and witnessing twice as much dancing around the issue. The Christmas playlist is now flu refusal on side A, and corona procrastination on side B. As intensive care clinicians, we are truly at a loss to understand what hasn’t registered during nine excruciating months of lockdown. There is even a second wave underway to bring the issue home, and surely enough folks have already lost their livelihoods and futures. We appear to have a light at the end of this tunnel that many just don’t want to plug in.
If you are merely a vaccine doubter then you may take umbrage being lumped in tin-foil hat wearing conspiracy theorists. Ultimately this vaccine-no-vaccine highway has two lanes and each of us will need to pick one soon. Obviously, any vaccine needs full peer-review, rather than science by press-release, however cautious optimism is warranted that Santa may deliver a safe efficacious present soon. Whoever produces the vaccine, it could save countless lives, keep businesses afloat, permit patient visitation, allow travel, retain children in school, and combat crippling (deadly) social isolation…but only if enough of us take it. There are times when “uhms and arrs” are appropriate, but this is not one of them: seriously, folks, lives are at stake. Whether to get the covid vaccine simply isn’t a tough decision. Melodrama aside, who to give your last ICU bed to if people don’t, now that’s a tough question.
The other problem with procrastination is that doctors and nurses need your vocal support now. Some of us have already received nasty messages and others have been subjected to ludicrous accusations. Apparently, rather than being dispassionate advocates for scientific truth, we are “owned” by the vaccine manufacturers. As such, we are reportedly beholden to their nefarious ends: you mean preventing unnecessary deaths? Using this same logic, we must be in bed with the plastics companies because we sure have inserted a lot of endotracheal tubes. No doubt we are in cahoots with big-mattress, big-saline, and big-ventilation because of all the aggressive resuscitation, and from turning patients on their fronts to keep them alive. As Richard Dawkins once said, “By all means let’s be open-minded, but not so open-minded that our brains drop out”.
We have long argued that Intensive Care is nothing special and nor are its doctors. Much of the time we just maintain homeostasis while nature decides whether the patient will live or die. Giving yourself the best chance is also simple, even if keeping Modern Healthcare simple is most assuredly not. You can’t change your parents, so wear a seatbelt, put down those ciggies, eat right, exercise, sleep, wash your hands….and line up for your jabs. If you hate doctors and big pharma then put us/them out of business with your common sense. We all presumably agree that ICUs are best avoided and Christmas miracles should come down the chimney, not through ventilator tubing. Let’s also hope they don’t run out, like the oxygen very nearly did. The ICU may be our happy place, but we doubt it will be yours.
A book had been on one of our bedside tables for a while, and it was time to break the emergency glass. Authored by Will Storr it is called “The Unpersuadables: Adventures with the Enemies of Science”. Elsewhere on this apparently flat earth it is called “the Heretics.” Regardless, it emphasizes that while we are entitled to our opinions, too many have decided to have their own facts. Storr uses extreme examples of alternate thinking, but patiently illustrates how the stories we tell ourselves cement who we become. We have an insatiable “hero maker” inside us who can take delight in promoting partisanship and denial. That hero maker can also be used to bring people together, and despite our apparent vitriol, that’s really all we hope to do. Clearly, we two doctors have work to do in order to reclaim our patience. We promise to roll up our sleeves if you will please just do the same.
Peter Brindley, Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. Scholar, Peter Wall Institute for Advanced Studies. Twitter @docpgb
Matt Morgan, honorary senior research fellow at Cardiff University, consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination. Twitter: @dr_mattmorgan
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