By Sebastian Galbo, Co-Editor LitMed Database and Magazine
Daniela J. Lamas, MD, is a pulmonologist and critical-care physician at Brigham and Women’s Hospital in Boston, Massachusetts, and an Instructor in Medicine at Harvard Medical School. Her first book, You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and in Between, was published in 2018. Dr. Lamas has published in the New York Times, Miami Herald, The New Yorker, The Atlantic, Journal of New England Medicine, and the Journal of the American Medical Association. The following interview expands on Dr. Lamas’ recent New York Times opinion piece regarding the Covid-19 pandemic, “I Got Vaccinated. But the Shot Won’t Save My Dying Patients.” Her article considers the ongoing precarity of human life as the vaccination undergoes nationwide distribution. Dr. Lamas muses critically on the frustration of observing people who fail to practice social distancing; the vexed symbolism of vaccination selfies; and, ultimately, the measure of hope that the Covid-19 vaccination offers to people around the world impacted by the pandemic. Our correspondence occurred over several weeks in January.
The narrative captures a range of emotions following your Covid-19 vaccination. There is a dual sense of relief and ephemerality as you sit in the hospital’s waiting room for the fifteen-minute post-vaccination period. You reflect on your patients, illness, mortality, and the hope that the vaccine affords. What was unusual about these fifteen minutes? What made this period reflective?
In the fifteen minutes after the vaccine, we are quite literally told to sit on a small folding chair, together with and yet distanced from people who shared the same experience. I am rarely alone with my thoughts. In those minutes, it was impossible for me not to reflect on what this all meant, on the fact that in that very same hospital, patients were dying of the same disease that I had just been vaccinated against.
You express feelings of frustration and powerlessness as some people no longer practice social distancing, wear facemasks, or remain quarantined: “If only you could see what it is to be intubated if you could conceive of being suctioned through a tracheostomy tube while learning to walk again, you might make different choices.” That is, if people could witness the appalling ravages of the virus, they might embrace precautions seriously. Describe these feelings more specifically and how they have evolved over the course of the pandemic.
I have spent a good deal thinking of how best to change behavior. At the start, when there was so much doubt as to the severity of this disease, I do think that fear was an important component of behavior change. I remember walking outside my apartment in Cambridge, Massachusetts, along the Charles River. It was late March and I had just finished a stretch in the ICU and, as I passed people, even though we were outside and distanced, I panicked. I pulled my mask tight. I was more careful because of what I had just seen in the ICU. As time passed, I believe that people grew tired of feeling scared. I understand that, too. There has been a growing sense of exhaustion and, with that fatigue, a sort of giving up. If I get it, at least I can just get it over with. But then the data about the first vaccines came, and that gave us something that we had not experienced in so long, and that was hope. As I wrote in this essay, I wondered whether hope—just hold out because if you wait, things will be different—would actually be more powerful to change behavior than fear. I’m not sure. But, to speak of hope, I’m still hopeful.
Other than direct observation of seriously ill Covid-19 patients, what can be done to convey the critical importance of following public health guidelines? How can we balance hope and caution?
Of course, everyone cannot have a camera directly into an intensive care unit, thankfully. In a world with a robust system of public health messaging and trust in health authorities, it would be easier to convey the importance of following public health guidelines. I think we have learned so much in this pandemic about what not to do. About the dangers of politicizing science. About how fact can become distorted and the very ideas of illness and infection can take on a metaphorical significance. I would hope that, moving forward, we will benefit from a transparent public health authority that we can trust and reliable messages in the media across political affiliations.
The Covid-19 pandemic uses the graphic vocabulary of the selfie in interesting ways, moving from conventional self-portraits in favor of images that reveal everyday suffering and the exigencies of public health crisis. The bruised, exhausted face of the medical worker is now central to this social media language—your narrative, to some degree, celebrates this vocabulary. Yet you conclude that these images stir hope: “The vaccine selfies tell us to hold on.” Describe more specifically why these images are important.
I have wondered about these Covid-19 selfies. In those early days of PPE, I took a few of them myself, more as a way to remember than as something to share. I think that, at their best, these images serve to make the invisible visible because this pandemic in so many ways occurred outside of the public eye. This was not something that you could see on the streets. Yes, there were ambulances, but you couldn’t see the virus. In those early spring days, the world was beautiful and quiet and yet, inside the ICUs of our nation’s hospitals, something terrifying was happening. I think those early selfies were a way to show that the pandemic was real. As for the vaccine photos, I think of that a bit differently. I think there is a way in which these images are happy and performative, the equivalent of a birthday selfie with a bottle of champagne. But more than that, it is an endorsement of the vaccine to those who are concerned—watch me roll up my sleeve and show that I am not afraid. Beyond that, seeing that this is happening, that it is real, even for those who did not have, and still do not have, access to the vaccine might offer hope.
Some doubting readers (those who commented anonymously on the web version of your article) challenge your view that vaccination selfies inspire hope. One physician stated, “On a side note, call me old-fashioned, but I frown a bit on all of these healthcare workers, including many of my colleagues, plastering images of themselves being vaccinated all over social media like Facebook and Tik Tok. I feel that it’s a little vulgar, self-centered, with a touch of elitism.” How might you respond to this type of reader reaction?
Truth is, I understand it, but there is also a world of people who are scared to get the vaccine. For them, seeing healthcare workers choosing to get that shot might change their behavior and could even be the difference between life and death. Which is not to say that every vaccine selfie was taken and posted with public health in mind, but even when they were simply a celebration, that is something we also need.
Your narrative focuses on major themes of Covid-19 literature, specifically loneliness and the experience of suffering alone or watching others suffer in isolation. You write, “We are caring for patients who have sacrificed and taken precautions for months and now—bending under the pain of isolation, starved for human connection—might die simply because they decided to spend time indoors with people they love or to go out to dinner.” As you continue to witness the deep loneliness of isolated patients, how has your appreciation of human physicality and connectivity changed during the pandemic?
This is definitely something I think about. I have cared for patients, those who might not even have Covid-19 and, at some point, I realize that the medical procedures we are doing to them might be some of the only times that they have experienced physical touch in months. This is tragic. I suppose we all knew, at some level, that we are not meant to be deeply isolated, but this pandemic has made that clear. For people who live alone particularly, for those who relied on their daily interactions with the outside world to remain connected, this has been a desperate time. I think we are only now starting to see the consequence, especially with regard to patients who come to the hospital with overdoses, alcoholism, and depression. We have spent the past year talking about waves and surges of coronavirus cases, but I worry that this will be yet another wave to come, one we are no better prepared to handle.
Your narrative is beautifully written. Why do you feel that this was an important piece to write? What would you like readers to take away from your narrative?
Thank you. I really wanted to tell people to hold on, to know that it is worth continuing to sacrifice, and that this is not forever. In truth, when I wrote this piece, I did expect the vaccine to come more quickly for our most vulnerable patients, particularly in Massachusetts where our rates are in the bottom three-quarters of all states. It has been painful to watch people continue to wait and to grow sick while waiting. Even though this vaccine rollout has been slower than any of us would have hoped, we do have the power to end this pandemic. This piece and these vaccine selfies are all a promise—just hold on and we can make it through.