Category: Reflections on Life, Being Human, and Medicine

Reflections on a variety of topics. My hope is to stir your thinking and perhaps even give you things to talk about in regards to what it means to be human, about life in general, and often times on the practice of medicine.

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Being human Medicine Reflections on Life, Being Human, and Medicine

A Year Later: The Third Wave, Vaccines Available, and Where Are We Now?

I launched my boat on Friday. Last year the boat launches were all delayed due to the COVID 19 restrictions. The water is still very cold, but I am quite happy to have our boat back in the water.

It has been a year. On March 21, 2020 I felt compelled to write a blog post as I struggled to understand whether COVID 19 was a serious reality or was being overblown.[1] At that time everything was shut down. We were all locked away in our homes but there had been just 12 confirmed cases in Kent County. None of us really knew what to expect or what was going to come. The experts (especially the Imperial College report) predicted 1.1 million deaths in the United States unless we did things like we had never done before. We did them. 

So, a year later where are we?  In the United States we have had documented:

  • 31,306,928 cases of COVID 19
  • 562,296 deaths attributed to COVID 19

It appears that the Imperial College report was correct. Our country did a lot. And with this we still had almost 600k deaths and we are not yet to the end of this.

This week I read the report from our health system about our current status. This made me feel like I should write something more. Here is what bothered me:

  • We are firmly in a 3rd wave. On Thursday April 15, 2021 Spectrum Health did 2537 COVID PCR tests with 21.1% of the tests being positive. This is one of the highest percent positive reports we have ever had.
  • They reported 282 patients hospitalized in a Spectrum Health Hospital.
  • In the Grand Rapids area, Spectrum Health had 61 patients with COVID in an ICU.
  • The demographic has shifted for this 3rd wave. It is hitting younger persons and they are seeing an increase in seriously ill pediatric cases.
  • Almost 1/3 of the patients who are being seen in the Emergency Department are being seen for COVID or COVID like symptoms.
  • At the same time, they have now reached a point where the capacity to give vaccines is more than the demand. That means that people can get a vaccine if they want one (or would be willing to get one).

People don’t seem to be as worried or upset this time.  Maybe we are just used to all of this? Maybe we are putting confidence in the vaccines? 

There is a disconnect and it seems odd to me. A year ago, there were 12 cases in Kent County and Sarah and I were locking ourselves away in our house. We got out the card table and set up a puzzle to pass the time.  We didn’t go anywhere. The 1st wave fortunately was not too bad for West Michigan. 

The second wave hit, and things were a little bit more open. Nonetheless people seemed to understand how serious it was. By then most of us knew people who had become seriously ill or who had died. Many of us got COVID and the experience even without hospitalization was not something we ever wanted to go through again.

Now the third wave has hit, and people seem to have become a lot more lax. I walk through the store and see variable use of masks. The parking lots at bars and restaurants seem very full. I can remember feeling concerned in November when the test positivity rate was more than 10%. Now it is more than 20%. And yet I am not hearing the alarms ringing like I did before.

At the same time, we have reached a point where the health system has vaccines to give but not people to give them to. 

Last year we dreamed about the hope of having a vaccine available. Maybe then it would make this nightmare go away. We had hopes that if we got enough people vaccinated the rate of infections would drop off. We hoped we would reach “herd immunity.” We just needed the scientists to somehow figure it out and get us all a vaccine.  

They did it.

What about the vaccines? There have been some interesting articles recently about effectiveness.  One report looked at the effectiveness in healthcare and other essential workers.[2] The volunteers in that study did a nasal swab every single week. The idea was to detect not just symptomatic infection but any evidence of infection. They found an 80% risk reduction (compared to those who were not vaccinated) after the 1st shot, and a 90% risk reduction after the 2nd shot. For those who did have a COVID infection detected after having been vaccinated the vast majority had no symptoms or only minimal symptoms. 

Another report looked on a population level at the odds of getting COVID in the US after getting vaccinated.[3] If you have been vaccinated you have these odds:

  • 0.008% chance of getting symptomatic COVID
  • 0.00056% chance of getting sick enough to be hospitalized due to COVID
  • 0.00001% chance of dying from COVID

Those are really encouraging statistics. 

How does that compare to other things in life?  You have a lifetime risk of:[4]

  • 0.94% of dying in a car accident
  • 1.02% of dying due to an opiod overdose
  • 0.009% of dying in an aircraft accident
  • 0.00055% of dying by being struck by lightning

The vaccines work.

What about harm from the vaccines?  Let’s face it. You might have some symptoms from the vaccine. The CDC reports that about 10-15% of people who get vaccinated have some side effect. These are most commonly arm soreness, fatigue or body aches. A smaller number of people get low grade fevers or nausea. The majority of these symptoms resolve completely within a day or so.  With any vaccine there is a risk of a serious side effect.  Fortunately, the number of people with serious reactions has remained low.  The current rate of experiencing a serious adverse effect from the COVID vaccine is about 0.005%.[5]  

We are having a third wave of COVID infections and deaths. I wondered how that compares to the 1918/1918 influenza pandemic my grandfather lived through.

This graph shows that they went through three distinct waves. Fortunately, the pandemic eventually resolved and then they were into the “roaring 20s”.  

Our graph for the state of Michigan is here:[6]

It looks very similar. We are not however through our 3rd wave yet.  I sincerely hope that our third wave deaths don’t go as high or higher than the other waves. 

What am I saying?

  1. COVID is real and continues to be a big problem.
  2. It is disturbing to see a very large 3rd wave hitting Michigan.
  3. It bothers me to think of children becoming seriously ill. I sincerely hope and pray that COVID does not become a big issue in children.
  4. Vaccinations are available.  They work. 
  5. The vaccines create real hope that we can get past this.
  6. If you have not yet been vaccinated, please do so. They are available. They work. 
  7. Continue to be careful. There is a LOT of COVID in our community. The risk now is as high or higher than ever. Please be careful.

I really hope that our COVID graph tails off. I hope that with mass vaccination and time we will get past this. Maybe then we can move into our own “roaring 20’s.” I am so ready to move on. I am ready to be able to be together in groups again. I am ready to go linger in a coffee shop. I am ready for our own version of the 20’s to start. One hundred years ago it was fast cars, jazz music and flapper dresses? Anyone up for that now?

[1] https://manmedicineandmike.com/is-it-really-worth-all-the-fuss/

[2] https://www.cdc.gov/media/releases/2021/p0329-COVID-19-Vaccines.html

[3] https://www.cnn.com/2021/04/09/health/covid-vaccines-adverse-reaction-rare-trnd/index.html

[4] https://www.iii.org/fact-statistic/facts-statistics-mortality-risk

[5] https://www.latimes.com/projects/covid-19-vaccine-safety-side-effects-risks-reactions/

[6] https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html

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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

Compartmentalization: How Putting Thoughts Aside Can Be Both Constructive and Destructive In Your Life

Compartmentalization. That is a big word. It is an important concept we were taught in flight training.  The idea is that you can block thoughts from your mind so that you can focus on what is important in the moment.

Let me share an example. We were doing our preflight for a helicopter flight from Norfolk to Camp Lejuene. The pilot I was flying with mentioned that he had a headache. We finished the preflight and had a nice flight. We landed, taxied to our space and shut down the helicopter. Once we were shut down I asked him then how his headache was. He seemed confused for a minute and then remembered. “Oh. My headache! Ow!” He pulled a packet of Goody’s powder out of his flight bag and downed it. 

During the preflight he had done as he had been trained. There was no room for him to be distracted while flying. He needed to be completely alert and focused on the flight. Once the flight was completed, he had the “luxury” of being able to feel and notice his headache again. That is compartmentalization.

This can be a valuable thing for a pilot who has to focus on his mission. In life it can be either good or bad.

I know people who are terrible at compartmentalization. They don’t have just one storyline running in their head. They may have 3, 4 or even dozens of thought-lines running simultaneously. When something bothers them, it can be very hard for them to focus or rest. When they lay down at night, they can’t just decide to turn off the bothersome thoughts. The thoughts just keep going and going. Sometimes the thoughts are intrusive and are about things that cannot be fixed. In that setting I wish for them the ability to compartmentalize.

We talk about techniques to help them do this. Journaling can help. Another technique is to write things down so that they can be temporarily put away. “I can’t fix this now. I will write down reminders so that I can shift my attention and do what I need to do now.” 

A corollary to this is, “Not my circus, not my monkeys.” In this version, the problem is truly about something that is not your responsibility and something that you cannot fix. In this setting, you hopefully can acknowledge those facts and then move on with life. You might not like what the monkeys or the circus are doing, but whether you worry about it or not really isn’t going to change anything. You might as well push that over to a corner of your brain called the “not my circus” area and go on with your life.

It was another day and another mission. This time I was in control and practicing landing the helicopter in a tight landing zone. For this exercise, the crew chief in the back of the helicopter would call out instructions to me. Forward, back, left, right and so on until we were carefully landed. I completed the exercise without problems but felt tense the entire time I was doing it. I just wished there was not the loud buzzing in my ear. It was then that I realized that I had forgotten to cancel the low altitude warning. This was an alarm that was warning me that I was getting close to the ground. On landing you generally cancel the alarm. I had forgotten to do so. I was so focused on my task that I had ignored all of the alarms.

Sometimes we see people doing things that are nothing like what we would expect from them. Infidelity is one of those things. How could a man or woman after years of marriage forget all of the good that went before? Can they just ignore all of their shared experiences? Can they ignore the love that they shared? How could they become willing to sacrifice what had before been so very precious to them? 

I am convinced that compartmentalization plays a large role. They are able to push the thoughts of their past aside and focus on the new person or relationship that is in front of them. They lock the past away to a place in their brain where they do not have to look at it. They also lock away the ideas of the destruction and harm that they are causing to themselves and their family. 

The alarms are blaring, “altitude, altitude, altitude” and yet they ignore the alarms. They fly their lives, their marriage, and their families into the ground.

Compartmentalization is a tool. Like any tool it can be effective or dangerous.

Electric saws scare me a little bit. Every time I see the large spinning blade I imagine fingers cut off or worse. If you are building a house or doing other types of carpentry, they are necessary and effective tools. But they are also dangerous. You have to respect the risks of the tool. You need to know what precautions to take before you begin to use it. 

I am not as afraid of a chain saw. Probably because of my time using them on the farm, I am more familiar with them. I do know however to wear solid shoes, heavy jeans, leather gloves and generally I wear eye and ear protection. I also know about the risks of kick back and ways that I am comfortable using the saw and ways that I am not.

Compartmentalization is the same way. It is a powerful and effective tool to allow you to focus and achieve things in life. It can bring you peace in times when you do not have control. The ultimate compartmentalization is in trusting God.

As a flight surgeon I learned about a lot of the bad things that can happen while flying.  If I am not careful when I am sitting on a commercial airline I can imagine bad things happening. I have absolutely no control over what happens. As we approach landing in bad weather with a strong crosswind and poor visibility I could drive myself crazy. Or I can compartmentalize. The pilots are well trained. The rate of aircraft crashes is remarkably low. Whether I panic or not won’t change our odds of a safe and successful landing.  The dozens and dozens of aircraft crash stories get put away. I don’t need them in the moment. I trust in the ones who are in charge.

What about in life? Cancer certainly is a huge uncertainty. This past year has brought endless cycles of grief to people we know and love. How can you live in a world where there is suffering and injustice? 

One of my favorite quotes is this, “We can live in a world where there is violence and injustice because we know that God is in control and that His process is being worked out.  And in this – the righteous can live by faith.”  Another one is this, “God remains quiet. But it is not a cold and uncaring silence. It is instead as if He is saying, ‘Peace, child. You cannot understand.’”  It doesn’t have to make sense. But you can park it (for a little while at least) in the area that says, “I know that God is in control and I can let Him handle this.”

As in many things it comes down to balance. Compartmentalization is a powerful tool. It can also be dangerous. You need to make sure that you use it safely. 

Compartmentalize so that you can ignore a headache to focus on flying a helicopter safely and complete your mission? Yup. Use it to help you so that you don’t obsess over things you cannot control? Sure. Trust God even if you can’t control what is happening? Absolutely. 

Compartmentalize to enable you to ignore or betray the trust of your loved ones for a momentary gain? Nope. Neglect problems in your relationships because you don’t want to deal with them? Also nope. Ignore the alarms sounding in your head about the implications of what you are about to do? Never.

We climbed back into the helicopter to head back to Norfolk. We briefed on what was important. We talked about what we had to pay attention to. A lot of other things would be safely and effectively put aside for the duration of the flight. We knew what we were doing. We used compartmentalization to not be harmed by thoughts we didn’t need to focus on during the flight. We could pick those thoughts back up once we landed and shut the helicopter down again.