Dr. Jillian Horton is an internist and writer in Winnipeg. Her forthcoming memoir, We Are All Perfectly Fine, will be published in February, 2021.
Two principles guide my medical practice. One is widely known: first do no harm. The second is a borrowed cliché, but I drill it into medical students: there is no free lunch.
In medicine, everything we do – or don’t do – involves risk. One of our most important jobs is to help patients make decisions based on the ratio of risk to benefit. A medication can cause bleeding, but a blood clot can cause death. Which one is more likely to happen in this case, with its infinite variables? And which one is more likely to harm this patient? It’s a way of looking at problems that becomes reflexive for doctors, and it informs our world view.
When I’m counselling patients about a course of treatment, I’m bound by law and ethics to discuss relevant side effects. This is the basis of informed decision making, and it matters whether patients are deciding if they’re going to have chemotherapy or take a pain reliever from the drugstore. That’s because – you guessed it – there’s no free lunch. I’ve treated patients who developed liver failure from vitamins they bought at health food shops. I lost hearing in one ear just by taking a medicine that is available over the counter. Every treatment confers risk. But the flipside of that statement is, every untreated or preventable condition also incurs risk. My most important job is often helping people understand the consequences of all aspects of their choices, including the ones it took me years of difficult training to be able to understand and treat.
Doctors also have a window into some very concrete things that, to many people, are just abstractions. What can happen if you don’t wear a seatbelt? What does a family go through when their child dies of the flu? Most of us pursue a career in medicine with the goal of relieving suffering, not simply being its chaperone, and bearing witness to the devastating consequences of preventable tragedies changes us forever.
I have another, perhaps even more meaningful credential that rounds out my perspective. My parents and both my sisters have had cancer, and one sister succumbed to its late complications. My brother, who suffered from an unrelated but lifelong catastrophic illness, died during this pandemic. To me, disaster isn’t abstract. Thinking it won’t come for us … that our genes, the colour of our skin, or our faith will protect us, is a form of delusion. Even when we laugh and say we’ll take our chances, what we really mean is we’re secretly sure that when the wheel of fortune stops turning, the arrow won’t be pointing at our name. We can’t fathom the real randomness of life and disease. I’ve sat by enough deathbeds to know how often people weep for their naiveté – the many opportunities they or others missed to intervene before their cancer or HIV or diabetes became untreatable. Choices had consequences. There was no free lunch.
But this is the incredible thing about COVID-19. In the past few months, it has become increasingly clear that there is one thing we can do that has no side effects for the vast majority of humankind. It won’t cause liver failure, it won’t cause hearing loss and it won’t give you anything other than protection. The universe has thrown us a featherweight bone in all of this, and you can hold it in the palm of your hand: a mask.
Why do I hope you’ll wear one? It isn’t political. It’s because I’ve seen too much suffering in my life. I’ve seen how even our smallest choices are consequential, especially when they are made consistently, and more so when they are embraced by enough people. I know, from professional and personal experience, that God doesn’t “favour” anyone. He takes children and pregnant mothers and motorcycle riders. He takes parents and he takes patriots. He takes people of faith and non-believers. I’ve spent enough time at the intersection of life and death to see good health as the miracle, not the given.
COVID-19 has given us one free lunch: It’s the fact that a simple cloth mask, worn constantly when we are around others, can have a dramatic impact on our risk of acquiring and spreading the disease. That free lunch may not be one we would have ordered, but it is hardly an impediment to anyone’s freedom. It is a pathway back toward the world we had only a few months ago, the one so many people have said was God-given, when actually, it was God’s gift.
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