I remember years ago, talking to a patient who had a very rare form of stomach cancer, and a tentative and uncertain treatment plan. She was lying in bed, very ill, playing with the edge of her gown. “I kind of wish I had something like breast cancer,” she said softly. “People know more about it and they march and everything.” She felt ignored, placed on a back burner, in her treatment and care. Likewise, some of the press around COVID may leave us forgetting that while we put all our attention and all our efforts on COVID, and for good cause, everything that was happening the day before COVID hit our shores is still happening. People have cancer. People have other diseases. They are just facing it in a much altered and limited landscape, with skeleton staff and few live appointments. Things are delayed, and there will be consequences. Some people without COVID may die from COVID.
So many people are involved behind the scenes in any service or product we use. I remember seeing a video where a person held a cup of coffee, and gave a monologue about where each item involved had been harvested, processed, warehoused, fabricated, and transported. From the paper cup to the plastic lid, the coffee, cream and sugar, the coffee machine that produced it, the water source, the little wooden stir stick, the story spread across the globe to metal mines and forests, sugar plantations and dairy farms, hillsides covered with coffee trees, urban plastics factories using petroleum products and more. Hundreds, perhaps even thousands of human hands and human minds had been involved. Each item involved had been processed and loaded onto trucks and ships, reloaded for delivery, bought, sold, and handled in countless ways before eventually ending up in the hands of the consumer. It was eye-opening to contemplate the vast resources and numbers of people it takes to accomplish the smallest and most ordinary of things – a single cup of coffee.
This week, I was with someone who was not looking for a simple cup of coffee, although he may have enjoyed it back when he was healthy. He needed something way more expensive, way more technological, involving many more expert hands and partners, something difficult to coordinate and carry out even in the best of times. He needed cancer treatment. Like many laborers, this patient suffered from symptoms for quite a long time, but not having a job that provided health insurance, and not being eligible for a government plan, he labored on in the hopes that his increasing symptoms would simply go away on their own, or with home remedies. They did not, and when he began spitting blood, he finally made it through the bureaucracy to a medical center and was diagnosed as needing urgent care for a very aggressive cancer. That was in February, just days before COVID hit our area. Now it is April.
His cancer is treatable, according to the doctors he saw in February. They started the usual steps in arranging his care. They did some scans and blood work and started to plan out what would be best as to chemotherapy and radiation. They even referred him to our cancer center for some of his treatment. But here is the thing. Because he was just getting set up for care right as the COVID crisis hit our area, many things have been put on the back burner. Not things, actually, but people. He is one of them. In the two months he has been waiting without treatment since his diagnosis, his health has declined dramatically. He has lost the ability to eat any food, even baby food, and is surviving on protein shakes alone. A strong and healthy 160 pound laborer is now a very weak 120-pound patient, who talks in a whisper and spits into a handkerchief. As COVID patients tragically die or heroically recover, he is still quietly waiting to start his cancer treatment.
The hospital is doing their best under the circumstances. They expect to get him in next week (on the severely reduced surgery schedule) and place a feeding tube into his stomach, so he can hopefully gain some weight while he continues to wait for treatment. They didn’t talk about when the chemo or radiation might start, or how much longer it might be delayed. I can only presume that they are not fully staffed, with people being moved around in response to COVID, and of course priority must be given to those already mid-course in their cancer treatment. One of the downsides of interpreting is that we don’t get to ask questions. We don’t get any backstory upon demand. And we don’t know outcomes, unless that information just falls in our lap in a future appointment. So I may never know what happens in this case. And by case, as always, I mean an actual person with their subjective experience taking place under these very harsh and scary circumstances.
Although I may never see this particular person again, I will continue to hold him in my thoughts. And I will continue to ponder how many people, what equipment, which factories and biotech companies, which truck drivers, and how many staff within the hospital, doctors, physicists, techs, nurses, schedulers and more, must all coordinate seamlessly without anyone dropping the ball or being absent in order for this patient to get the care he needs. And how many of these many people, human beings all, have had to step out of place due to illness, reassignment, closed schools, reduced hours, lack of equipment or other reasons. What pieces of the puzzle are missing, what has unraveled, that inhibits this patient from getting his care in a timely manner, and maximizing his odds for survival? Because he is literally losing himself as I write these words. He whispered to us that even his dear old dog doesn’t recognize him now, because the cancer has altered him so profoundly: “I am not myself anymore”.
To the people with COVID, my heart goes out. To the patients whose care is severely impacted by COVID, my heart goes out. To the workers trying to run faster, do more, track down the missing equipment that others are also trying to obtain, my heart goes out. To those in the fields and the factories, those waiting in isolation with no pay, to every member, every family, every thread of this precarious patchwork society, my heart goes out. We are truly interdependent, relying on uncountable visible and invisible people, places, and resources. Beyond what we can know, in infinitely expanding circles. Our healthcare, our food supply, even our cup of coffee, are in each other’s hands. Most vitally and fundamentally, our very lives are resting delicately in the overwhelming immensity of our collective hands. Let us keep them steady, as best we can.