Abstract
Disaster work is not new to me. In a variety of settings and through a number of organizations, I have had the privilege of working alongside many others in an attempt to bring help and relief to people devastated by hurricanes, earthquakes, acts of terrorism, and wildfires. Thankfully, most of the time we are able to provide some relief to people frightened and traumatized, many of whom have lost nearly everything. Rarely does it feel like “enough.”
In my day job, I work in a cancer center and have most of my long career. I have seen patients and their loved ones navigate the fear of diagnosis, the rigors of treatment, and the lucky ones move into long-term survival, often with a new perspective regarding life's priorities and preciousness. Many patients show us the best characteristics possible: grace, gratitude, humor, love, forgiveness, and reconciliation. The interesting “opportunity” that comes with this work, if one is awake to it, is that we can't help but have our own lives come into perspective as well. What is truly important in life is seen in sharp precision—when its very existence is threatened.
The COVID-19 pandemic has challenged all of us, locally, nationally, and globally—to adapt to a new world order, one that is unfamiliar and frightening, with no clear end of the pandemic in sight. Americans, so often given many choices, are challenged to restrict those freedoms for the greater good. That is a familiar ask in the public health world, less familiar in day-to-day life in America.
Many of us in the mental health field have been alarmed by the sharp rise in anxiety, depression, and suicide in the six months since the pandemic hit. People who are not normally prone to psychological distress are experiencing it at alarming rates. A recent Center for Disease Control survey indicated that one in four young adults between the ages of 18 and 24 years had considered suicide. This age group was already vulnerable, and were made more so by the pandemic. The same study found that 31% of unpaid caregivers and 22% of essential workers had considered suicide. Thirteen percent had begun or increased substance abuse.
The forecasts regarding psychological health remain grim for the next six months and/or until a vaccine is developed. The University of Washington forecasts that rates of depression and suicide will peak in the fall of 2020 and the winter of 2021, this coinciding with a change in weather and the holidays, times already known to be difficult for some people.
For people with cancer, navigating care during a pandemic has been challenging. Many health systems have restricted visitation policies, further isolating people when they are most vulnerable. Early in the pandemic, surgeries, procedures, and other treatments were delayed or cancelled. Even as hospitals and clinics gradually reopened, some patients expressed fear about returning to care, lest they be exposed to COVID-19. Some have even admitted that they would rather die of cancer than of COVID-19. In my setting, we have spent the past months navigating these issues—attempting to balance safety with the urgency to treat our patients.
Then the wildfires hit. This month, much of the west coast was devastated by wildfires. In the State of Oregon, 40,000 people were evacuated, 500,000 people remained in evacuation zones, and the death toll and missing persons are still being tallied. The economic and human toll of a pandemic at a cross-section with wildfires are stunning, let alone also dealing with cancer.
I see in my colleagues and some of my friends a great weariness. The unspoken and occasionally uttered question “How much more? How much more?”
Still, what is palpable is also humanity. I watched the nurses (themselves short staffed as their colleagues evacuated) organize resources for patients and staff affected by the wildfires. Neighbors helping neighbors. A group of 100 cyclists rode into a small town devastated by fire and cut off from automobiles, carrying cases of water in child bicycle seats. Others have organized food and clothing drives.
These are indeed difficult times. It is said that times of crisis bring out the best and the worst in people. Throughout history, we have seen examples of humanity, selflessness, and generosity. After 9/11 (ironically its 19th anniversary this month) we saw countless examples of generosity and kindness. Still, the trauma of so much loss and the fear of the unknown keep all of us on edge. Those trained to “serve” are also living the parallel traumas of a pandemic and wildfires, putting professional “helpers” at their own risk.
As I write this, I am aware of overwhelming sorrow accompanied equally by gratitude. Gratitude for health, safety, my home, and community. I remain inspired by the many patients whom I have accompanied on their journeys. I am humbled by the everyday heroes who show up in times like this.
On the other side of all this, we will rebuild, we will heal. Perhaps we will also learn some lessons about life's preciousness, and the need for community. At a time when our nation is so divided, perhaps we can return to values of compassion, kindness, and the need for collective wisdom, leadership, and humanity. Perhaps we can lead one another through the darkness into a brighter more hopeful world.