Covid-19, the Literature of Illness, and Hope

Theresa Brown, RN

            I really wanted this column to be about something besides covid-19, but I couldn’t get my mind off covid, so this Med-Hum post considers covid in the context of writing about sickness, and the possibility of hope, even amid a pandemic.

            The literature of illness is not large, but I have my favorites. Camus’ The Plague is one of my favorite novels, believe it or not. I love how the doctor in the book grapples with the randomness and unfairness of bubonic plague. He hates the disease and mostly feels powerless against it, as a clinician and a human being, and yet he continues to treat patients because that is his job, and it is all he can do. Continuing to practice is the doctor’s version of hope, at least in my reading of the novel.

            More recently, in Station 11, Emily St. John Mandel explored the remaking of society in the wake of an apocalyptic virus. After the virus, one survivor, who is part of a community living in a defunct airport, starts an ad hoc museum of how life used to be, with exhibits made of smartphones and laptops. Another character remembers that small pieces of technology enabled communication with people around the world in real time, capturing how high pressure our too-connected lives could be, and also how marvelous. The book ends with a view of a different city, farther away, and a restarted electrical grid. Hope in the form of light and heat, a possible return to modernity.

            Covid-19 is a pandemic, but not on an apocalyptic scale, not even on the scale of the 1918 flu. That is also something to feel hopeful about. But it has still uprooted our normal lives, plunged countless people into joblessness and hunger, taxed our profit-focused health care system, and killed, as of today, 50,000 Americans, an unduly large proportion of whom are black and Latinx.

            That is a lot to absorb. In general, the writing I find most helpful when thinking about illnesses and their meanings is the work of Susan Sontag. The ideas from her book Illness as Metaphor and its intellectual sequel AIDS and its Metaphors, anchor me when I get lost in panic about covid-19. In these books, Sontag explores what certain illnesses stand for at certain moments in time. Tuberculosis was seen as a disease of sensitive artist-types: consumptives. As such, it had a mystique, or even appeal, though probably not to actual patients who found themselves coughing up blood and struggling to breathe. Cancer, she says, like covid-19, is burdened with battle metaphors. AIDS was described as a modern-day plague before drugs that could more or less control the disease were developed.

“PPE is a metaphor for safety and protection, but also disposability, similar to health care workers who try to protect patients from the ravages of covid-19, while being treated as disposable by not being given sufficient PPE.”

            I have been considering the metaphors for covid-19. The first one that strikes me is Zoom: the technology that has allowed millions of people to connect without leaving their homes. The name feels like a cruel paradox—in zooming together, we literally go nowhere. Personal protective equipment (PPE) and its lack also seem like metaphors. PPE is a metaphor for safety and protection, but also disposability, similar to health care workers who try to protect patients from the ravages of covid-19, while being treated as disposable by not being given sufficient PPE. Toilet paper shortages could be another metaphor, or maybe just a symptom of people’s anxiety about the disease. Poverty, alas, is not a metaphor for, but a consequence of, covid-19 for many people around the world.

            In my view, the best metaphor for covid-19 is simple and linear: the ubiquitous graphs charting numbers of cases and numbers of deaths, all kept as current as possible due to constant updating. These graphs now govern our behavior in that we are told to “flatten the curve” through social distancing. Understanding them is important enough that tutorials on what “exponential growth” means can be found across the internet. And we study these graphs with the penetration of an ancient priest examining the entrails of a butchered chicken. What can we see of the future in them? Do they tell us when we can return to the gym, safely meet up with friends? How many future cases, and deaths, do they reveal? No one knows, really. We have models that we can apply to the data, study, think about, and analyze. We can guess and hope we are right. But there is still a lot of uncertainty.

            However, what the graphs most importantly show, is that eventually, with social distancing, the lines do begin to trend down. The virus becomes controlled and also controllable because health care systems are not overwhelmed, and staff have the equipment they need to keep patients and themselves safe.

            So, people will live. Most of us in fact. That may not feel comforting right now, but hold onto the thought. Most of us will get through this. Our lives will not be the same afterwards, and some will even be tragically altered. But we will be alive—not a metaphor in this case, but true. And hopeful.

Theresa Brown, RN, is a clinical nurse, a frequent contributor to the New York Times, and author of The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.