2020: A Deeply Rutted Road
Before the illness, We were all cogs in a wheel. Behold, the rutted road.
by Jodi Rothe, 2020
I had prepared this post, and then Jodi Rothe’s haiku came in an email today on a community group I’m part of. What the rutted road of 2020 has illuminated for us is profound, crushing and expansive all at once.
I’ve been working a Sound Medicine Podcast conversation with Rick Greene to kick off the new year. Rick (a.k.a. Frederick L. Greene, MD) was kind enough to take my new podcast for a test drive in September 2019, and we’ve been kicking around the idea of having a more regular conversation on the podcast, possibly picking up on things that catch our eye in General Surgery News (GSN, the co-producer of Sound Medicine Podcast) but also just talking about what we’re working on independently. My goal with the podcast is to create breathing room for physicians and to shine some light and sense of possibility into our work since so much feels predetermined and, frankly, stuck. Often oppressively stuck. I have several projects getting ready to launch that contribute to this dialogue and open avenues for change of mind, change of heart, and course corrections, and it would be nice to have ways of sharing that work, too.
So we decided to prepare this for the new year. Rick has an editorial coming out in the January edition of GSN that’s a bit of a twist on his annual January commentary. It’s about looking ahead, some prognosticating about what he anticipates in 2021, and maybe a bit of what he’s hoping for. We thought I should make a list, too, and then we could compare notes and dig a little deeper into our expectations. It’s been weighing on me, the making of this list, and I have subtly resisted finishing it. Then, this weekend as I was settling into Rachel Brathen’s (a.k.a. “Yoga Girl”) weekly podcast to keep me company during a 90-minute drive to a neighboring town, I suddenly figured out why I’m not ready to make that list. Rachel explained how she also changed up her usual end-of-the-year format which typically involves short reflection on the year coming to a close then setting intentions and dreaming into the upcoming year. Not this year. 2020 was a monster. Not only was it too big to shoehorn into the looking forward/intentions episode, but it has also at times seemed to be “a dumpster fire.” I turned off the podcast. I couldn’t move forward without processing 2020. So here’s that list.
I want to preface this by saying I entered 2020 in a nearly complete free-fall, so much so that my first response to the Shut Down was, “Pandemic, schmandemic. I’m already in the deep space of groundlessness. Bring it on.” As I’ve been detailing in other posts, a one-year journey that turned into five (and now six years) examining and reconsidering the culture of medicine, also included reorienting myself around my personal life and giving priority for the first time in my life to relationships. In early fall 2019, the wheels came off my intimate relationship in particularly spectacular ways, leading me to drive away in my car (which did have 4 working wheels) with 2 dogs and a cat and abandon 3+ years of hard work on a labor of love project meant to be the centerpiece of and home base for my work with physicians. Chestertown, Maryland was just too damn small to absorb what was unmasked. In some ways, the kind of simultaneous unraveling and emergence that captures 2020 for me was already well underway; it just felt like the world caught up with whatever vortex I was in: part dumpster fire, part miraculous opening. And there have been reiterations of some of this through the year, weird implosions, like after-tremors. Here are the themes that rise to the top for me in the monster wave of 2020.
How we define and recognize what is true and what is real is more amorphous and uncertain than it has ever been. There is widespread confusion about what to believe or trust. Persuasion, manipulation, fear-mongering, and flat out lying are not new in human communication, but the pace, volume, and sophistication have outstripped our evolutionary preparedness. We have a growing understanding of our hard-wired inclination to belong, to be in community (which means, as Malcolm Gladwell suggests in Talking with Strangers, that our default bias is believing we are being told the truth). This is pro-social behavior. We also have a greater understanding of our preference for the familiar and how we can feel threatened by the unfamiliar. We can add to this neurological mix that our attention is hijacked by novelty and threat, an alarm system that has given us survival advantage but now is harnassed to capture and market our attention--at least that’s what developers of social media tell us (see The Social Dilemma). Our pro-social longings and sense of threat are engaged in ways that amplify polarization and tailor what we are presented to perpetuate this dynamic. This shaking loose of confidence in shared perception has been happening for a while, but it accelerated during the pandemic and presidential election period.
Our entire planet is profoundly connected. The global disruption of the pandemic, from virus transmission to supply change interruption, reveals this as it never has been before. So does the improvement of air quality with the shut-down. It is humbling that the simple public health measures that are technically unsophisticated have been as necessary for technologically advanced, wealthy countries as more populous, poor countries. We have more efficacious medical treatment many months into the pandemic offering more promise of survival to afflicted in affluent places, but COVID-19 crosses all lines.
Slowing down, withdrawing from the social sphere is difficult on many levels but also revealing and sometimes opening. In this era, we crave distraction and are accustomed to working long hours in the United States and many other countries. Some of us have been alone a lot this year, and others have been sequestered with family or a partner. It can be challenging to be alone with our thoughts or unable to diffuse away from household tensions. Some partners and families have grown closer, and increases in domestic abuse have also occurred. Will we emerge from this placing greater value on family and home life, for those who are fortunate to have that experience? Have we proven that work and education can happen in different structures that we would ever have tested?
A deep, necessary inquiry into racism, power inequities, entitlement, and disenfranchisement has started. We are being called to consider who and what we identify as the standard against which others are measured, especially when that assessment favors the group(s) identified as the norm. The prospect of loss, accountability, and change incite hope, fear, and rage depending on where one stands. How will we move forward? What new order will emerge, and can we allow this process to help us evolve into something better? It is clear our work has only begun.
American democracy is being tested, and it has never been clearer that every vote counts. In 2019, friends who live in other countries asked me if the United States was going to have a civil war. I thought they had lost their minds. Now, I’m less confident about our fate. The divide is deep and aggravated by questions about truth, control of information, and real and imagined conspiracies. This remains another huge question mark and is unlikely to be resolved soon.
The meaning of a life well-lived is in question. The equating of wealth and power with success or a good life has dominated the American psyche for a long time. Do we all need a grand atrium in our home’s entryway, stainless steel appliances, and granite countertops? The slow down and economic consequences of the pandemic are affording us ample opportunity to reconsider this--and not just the young people but all of us. Who can forget the arias sung from balconies in Italy last spring for neighbors? We have an amazing opportunity to consider what we really need, what we want, and who we are. The derailment of ordinary life and exposure of weaknesses in our organizational structures invites this beautiful assessment. We can have strawberries and tomatoes every month of the year across the United States, but when was the last time we tasted a strawberry that was ripe and bursting with flavor? So many people in my life think I dislike tomatoes, but like the strawberries that are picked unripe for transport, the majority of store-bought tomatoes are ghosts of the real thing. What will we choose?
There has been a global financial disruption. Did we completely bust the piggybank? It will take time before we can fully appreciate the financial fallout of the pandemic. Fortunes will be lost and made. Some people have seized opportunities presented by it, using downtime to complete long-postponed projects. Many people have had time to reconsider the drive for productivity, income, and consumption. Priorities may shuffle out of necessity but also new choices.
What does it mean to be a doctor, a nurse, or other healthcare worker, and how do we Grow, Heal, and Thrive as a feature of our work well done? We have seen this year our people show up, to assume the risk of potentially fatal COVID infection whether there was adequate PPE or not, whether we knew how to best treat infections or not, whether payment was assured or not, and whether there were ways to accompany the dying in their final moments or not. We have seen health care professionals fired for disclosing the lack of PPE in their organization, even after making their case internally. A team of hospitalists in a major Seattle hospital was fired in the months after taking care of the sickest patients during the first wave of the pandemic, their jobs outsourced to another hospitalist group to save money despite the system’s receipt of enormous bailout funds. Some providers have been worked to the bone during the pandemic while others have been idling on the sideline. How can it be that doctors are going out of business during the biggest health care crisis in a hundred years? Our sacred intention--the humanitarian calling that gives meaning to our work--has been applauded, but we haven’t made adjustments to safeguard it. We lapse into a familiar but toxic “hero” identity that actually strips us bare and takes our pocket change. In a time of enhanced risk and stress delivering care, I have argued we should have asked for more help, worked shorter shifts, and insisted that no one die alone. We have a beautiful calling and rich opportunities in caring service, but my journey of the last several years has shown me that there is a Missing Curriculum and imbalances of our priorities that have devastating consequences for us. This patient work and unfolding are paving my way in 2021.
Now I am almost ready to make the 2021 list. I also want to recommend taking some time to process 2020. Of course we’ll be doing that for a long time, but it’s an interesting reality check on several levels to do this, and the act of writing down some things may provide an interesting reference point as we sort through the rubble in the pandemic’s wake. It’s such a kaleidoscope!
