The International Journal of Whole Person Care

Sharkawy, Abdu

	
VOLUME	8	●	NUMBER	1	●	2021	●	20-23	
©	2021	Abdu	Sharkawy.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	
	 	
EYES	CLOSED	
Abdu	Sharkawy	
Physician,	Infectious	Disease	Specialist,	Toronto,	Ontario,	Canada	
abdu.sharkawy@uhn.ca	
	
yes Closed. Heavy lids burn.  
The clock’s blue glows 4:38 AM through fluttering lashes. A moth to a flame. 
I stare blankly; lucid with exhaustion. 
Parsing through fractured pieces of dreams and vague recollections,  whispers inside an empty space with 
no walls to place them. No time to face them. 
 
My patient. Why is he so sick? Heart failure? Did he get enough Lasix? 
It haunts me. It follows me. It plagues me. 
The damp sweat on my backside makes my clothes cling tightly. A child’s hand clasped inside his mother’s 
palm. Desperate but welcomed.  
It’s just COVID-19. It has to be. 
 
The layers are peeled off one by one, shedding the message of torment. Slowly. 
Pneumonia? It’s been five days of antibiotics already. 
 
4:52 AM  
A blunt deluge of water batters my face in a shower stall colder than I expect. 
A blanket of pine needles hits me. My skin jolts at every edge. 
Am I awake now?  
What if it’s a pulmonary embolus? No. It’s just COVID-19. It has to be. 
E
Eyes	closed		
Abdu	Sharkawy	
	
21	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
5:08 AM 
I wipe myself dry and see in front of myself clearly.  
My focus is short-lived.  
 
5:27 AM 
My stomach turns in short and jagged circles. A chorus of nerves undulates inside me. 
Thoughts race randomly. Violently. Doubts linger. They intensify. A gag nearly chokes me when my electric 
toothbrush meets the far recesses of my hind molars. The gnawing buzz inside my ears is an unwelcome 
guest. 
 
5:49 AM 
Clothes on. Phone on. Pager on. Watch strapped to my wrist. Unstrapped. Don’t contaminate. 
I can do this, right? Can I? It’s not SARS. What is it then? What is COVID-19? 
I know I should but I can’t eat. Not now. Not yet. 
It has to be heart failure. I will add more Lasix. Soon. 
 
6:13 AM 
The stillness of a morning air heavy with mist erases my dry comfort as I lock my front door. 
It is replaced instantly as a sheet of sweat settles once again on the nape of my neck with stubborn 
determination. 
Will he be intubated today? Is it safe? What should I tell his family? 
 
6:29 AM 
I fumble with the radio tuner as I drive mindlessly.  
The crude assault of empty chatter vying for my attention is pitted against sobering news headlines. 
Everything is COVID-19. It’s universally spoken. It’s universally hidden. 
The bitterness of my coffee greets my stomach with inhospitable intensity. 
The road is quiet. I drive faster than I should. 
I’m barely aware of what is more than 500 metres ahead. 
He should be intubated today. It’s ALL COVID-19. It has to be. 
 
6:53 AM 
I find myself in the underground hospital parkade. I don’t remember the last 10 minutes. 
 
7:03 AM 
Scrubs. Surgical mask. Face shield.  
Eyes	closed		
Abdu	Sharkawy	
	
22	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
A calmness descends on me. I’m ready now. 
I have to be. I HAVE to be. 
My coffee is cold. 
I recalibrate. 
 
7:30 AM 
Rounds begin with military precision. The team is assembled. Doctors, nurses, PPE spotter, computer on 
wheels. Charts set. 
Donning PPE is tedious, unnerving and painfully deliberate in its expression. A ritual of tense rules in 
exactitude.  
The blue and red lines of tape on the floor demarcate the boundaries between competence and 
contamination. A crude test of caution and shame. Don’t screw this up.  
I’ll talk to his family.  
 
7:42 AM 
Hand rinse. Gown. Oh the gown. As a rule, it is impossible to tie from behind. Always. 
Hand rinse. Don’t touch your face shield. 
Right glove on extended cuff. Don’t touch your face shield. 
Left glove on extended cuff. Don’t touch your face shield. 
Spotter check. A nod of approval brings relief. Permission to enter. 
 
7:47 AM 
He is difficult to rouse.  
My voice is muffled by the mask and the face shield.  
87% on the oxygen sat monitor. 
His facemask compresses his face, probing desperately to find life inside the frail wetness of his lungs and 
the tightness that frames them. A strait jacket to every breath.  
This is ARDS. A gruesome cascade of inflammatory toxicity, unrelenting in its pace, unforgiving in its 
dialogue with therapy. 
The steroids aren’t working. 
I clasp his hand and squeeze it determinedly. It is cold and pliant like baker’s dough, swollen with the edema 
of 23 days. It falls uselessly.  
His legs are mottled and tense, colder than his hands, even more void of life, as if not his own. 
The foley catheter dangles from the bedside. Barely 20cc urine in almost 7 hours. Kidneys departed.  
Hope fades. It won’t be long now.  What will I tell his family? My mind scans frantically for a last minute 
strategy, any morsel of regenerative faith I can marshal. I come up empty. 
Eyes	closed		
Abdu	Sharkawy	
	
23	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
7:56 AM 
ICU is coming. My voice is loud now as I speak in broken Italian, his mother tongue, hoping this will 
somehow awaken the most primitive of instincts in him and engage even a token response. I yell through 
the mask I am wearing, but neither my words nor the oxygen he needs to sustain life can reach him through 
his own mask. The irony is callous and malignant. 
We stand here both together and apart wearing dueling masks - mine to protect me from him. His to protect 
him from… 
Neither one of us is safe. COVID-19 is a prison. 
 
7:57 AM 
Oxygen 74%. My thoughts turn to his family. What kind of husband was he? What kind of father was he? 
How will he be remembered? How will I face his family? 
It’s quiet. His breaths narrow, then slow in exaggerated, feeble articulations like an accordion barely able 
to expand.  
His breath stills.  
There is no music. 
Eyes closed.■	


English

Eyes closed

Moore, Sarah

	
VOLUME	8	●	NUMBER	1	●	2021	●	54-56	
©	2021	Sarah	Moore.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
ESSENTIAL	SELF-CARE	FOR	DOCTORS	
DURING	THE	PANDEMIC	
Sarah	Moore	
	
General	Practitioner	Obstetrician	and	Medical	Educator,	Busselton,	Western	Australia	
sarah.j.moore@rcswa.edu.au	
	
 am a General Practitioner Obstetrician and Medical Educator in Busselton, Western Australia. I live in 
one of the most isolated and safest places in the world given the context of the global pandemic. In 
March 2020 I observed from a distance the terror and destruction that unfolded as COVID-19 spread 
through Asia, Europe, and America, anxiously waiting for the inevitable tsunami to hit Australian shores. 
But I did not wait idly, I took action.  
First, I checked in with myself. As they say, apply your own oxygen mask before helping others apply theirs. 
As a frontline worker, I knew I needed to be in excellent health if I was going to get through this pandemic. 
I prioritised my self-care routine with militant resolve: daily yoga, meditation, nutritious food, immune-
boosting supplements, adequate sleep and of course, good hand hygiene. I also ensured my family stayed 
safe and healthy too. I decided to keep my two primary school daughters home before the official school 
closure occurred, partly to demonstrate to fellow parents and teachers at the school that I was taking the 
pandemic seriously, and partly because my husband was able to be at home with them while I continued 
to work on the frontline.  
I have valued self-care as an indispensable part of my life for many years. I practice yoga and mindfulness 
meditation daily. I became serious about mindfulness following the birth of my second daughter in 2013. I 
quickly realized that I was going to need reliable survival tools to balance my work as a doctor with life as 
a wife and mother of two young children and keep my head above water. I started out with some one-on-
one meditation classes, then enrolled in the Mindfulness-Based Stress Reduction program. Since then, I’ve 
continued my meditation practice and developed my own online mindfulness program for medical students, 
which I’m now evaluating as part of my Masters by Research. Although I never envisaged that I would be 
I 
Essential	self-care	for	doctors	during	the	pandemic	
Sarah	Moore		
	
55	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
using my mindfulness skills to cope with stress associated with a global pandemic, I do feel incredibly 
grateful that I have invested time and energy into integrating this into my life.  
Next, I considered what I could do to best serve my community. At my general practice, we began meeting 
every Monday evening to consider what changes needed to be made in order to provide safe and 
compassionate care to our patients while ensuring the safety of our staff was not compromised. We were 
the first practice in our town to start offering telehealth consultations and carpark consults. Community 
feedback was supportive. At the hospital, the medical staff began meeting weekly to receive updates on 
the changes that were occurring locally as well as state-wide. I was involved with the COVID-19 planning 
for our hospital maternity services unit and became acutely aware of the challenges of providing obstetric 
care in a small rural hospital with limited resources during a pandemic. I helped establish a working group 
of general practice physicians with an interest in palliative care to brainstorm how we could provide end-of-
life care in the community in the event that hospice beds were no longer available in our hospital. We set 
up WhatsApp groups for our general practice and maternity services teams to provide ongoing emotional 
support to one another, anticipating the impact that this stressful time would have on our mental health and 
the importance of checking in with each other regularly to prevent burnout. I shared guided meditations with 
my colleagues, encouraging them to pause and take time for themselves amongst the craziness. 
One of the most challenging changes to our maternity service provision was the restriction of one support 
person to each woman who presented for care during her labour and birth. For many women this did not 
affect their birth plan significantly, but for our most vulnerable women whose wellbeing while in hospital was 
dependent on having at least two support people present, this new rule left me wondering about the 
potential harm we were doing by enforcing these restrictions on pregnant women. Before we had a single 
case of COVID-19 in our region, we were counselling women with significant social and mental health 
difficulties that they had to choose between their mother and their partner.  
One Friday evening while caring for a distressed woman on labour ward I made the decision to allow her 
to have her mother-in-law and partner present for her birth as I believed that the risk of asking one of them 
to leave outweighed the potential risk of spreading COVID-19. Although I knew I was breaking the rules, I 
felt this decision was the most compassionate one given the circumstances. The following week, I had to 
confess my choice to my manager. She was disappointed and upset. I felt the need to defend my actions, 
arguing that this patient needed extra support. We left the meeting with mutual sense of dissatisfaction. 
The stressors and strain that the situation was having on previously well-functioning relationships between 
staff and patients were palpable. The cracks were starting to show. Over the following week, I reflected on 
the lessons I have learned through my mindfulness practice: acceptance, honesty, compassion and 
forgiveness. When I met again with my manager, we shared our frustrations and acknowledged that we 
were both just trying to do our best during a time when we were being tested. In many ways, this incident 
has strengthened our relationship and become a source of growth for both of us.  
Essential	self-care	for	doctors	during	the	pandemic	
Sarah	Moore		
	
56	International	Journal	of	Whole	Person	Care	
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In my role as medical educator I appreciated that my students were also experiencing the tremendous 
impact of this pandemic. I piloted a program that I discovered during my sabbatical in Montreal, Canada, 
last year. With the support of my mentor, I was able to deliver the Mindful Medical Practice (MMP) course 
to ten medical students via videoconference. The MMP course is designed to teach students skills and 
impart ways of being that can help them deal with the potentially overwhelming clinical experience of 
clerkship. It aims to prevent the decrease in empathy and ethical reasoning often observed at this stage in 
their training. It appeared especially relevant during this unprecedented time of uncertainty. By the final 
session, I felt deeply connected to the students.  I experienced intense gratitude for the opportunity to 
facilitate a unique and valuable course. My own mindful practice was reinforced; this was as valuable to 
me, the teacher, as it was for the students. 
Furthermore, I started sharing posts on social media and sending emails to my patients to explain in simple 
terms what I understood to be happening and provide advice on what they could do to stay safe and prevent 
the spread of the virus. I responded to emails from patients asking for advice on what action they should 
take to protect themselves and their family members, commending them for being proactive and taking the 
situation seriously. I shared podcasts and poetry that I found helpful for dealing with my anxieties during 
this time of great upheaval.  
And I prayed. 
Thankfully, in Western Australia, our State Government leaders were pre-emptive in closing state and 
regional borders to minimize spread, particularly to our most vulnerable communities. Currently (as of the 
1st December 2020) we have had very few active cases of COVID-19 in our state, with the number of new 
cases remaining well controlled since mid-April. Our national borders remain closed and our restrictions 
have been cautiously lifted over the previous months. Consequently, we have slowly been returning to a 
more normal way of life.  
Nonetheless, the long-term implications of this pandemic remain to be seen. There is no doubt that I will 
remain as busy as ever, attending to my patients with mental illness and chronic disease who were 
neglected during the period of lockdown. It is uncertain how long our borders will remain closed, protecting 
our nation from the world outside. We will not be immune to the inevitable global recession that knows no 
borders.  
What I do know is that I will continue to prioritize self-care. I will remain committed to maintaining the health 
and wellbeing of my family. I will stay connected and serve my community the best that I can. I will 
endeavour to accept the things I cannot change while having the courage to change the things I can. This 
is what brings me peace when so much remains unknown.		


Essential self-care for doctors during the pandemic

COVID-19 government regulations resulted in increased social isolation, risk of stress, depression, anxiety, cognitive decline, and re-hospitalization. Telehealth has been highlighted as a potential bridge for healthcare needs, especially in the COVID-19 context. In response to this need our group developed a multicultural, intergenerational, community-based psychosocial intervention. We trained more than 300 volunteers who were able to provide friendly phone support in more than 17 languages to more than 600 older adults across the Greater Montreal Area who could benefit from social connection and support to access community resources. The experience has been heartwarming and facilitating enriching life experiences for seniors, volunteers, and clinicians alike. Furthermore, some preliminary observations suggest that this intervention might have positive effects on the seniors’ mental health

Berkani, Sonia

Bukhari, Syeda

Rej, Soham

Lavin, Paola

	
VOLUME	8	●	NUMBER	2	●	2021	●	7–11	
©	2021	Sonia	Berkani,	Syeda	Bukhari,	Soham	Rej,	Paola	Lavin.	This	article	is	distributed	under	the	terms	of	
the	Creative	Commons	License	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	2	(2021)	
	
CONNECTING	AGAIN	WITH	ELDERS	IN	
OUR	COMMUNITY:	A	PROGRAM	TO	
STAY	TOGETHER	DURING	COVID-19	
RESTRICTIONS	AND	BEYOND	
Sonia	Berkani1*,	Syeda	Bukhari1,	Soham	Rej1,	Paola	Lavin1,2	
1*Corresponding	author:	GeriPARTy	Research	Group,	Jewish	General	Hospital,	Montreal,	QC,	Canada	
sonia.berkani.ccomtl@ssss.gouv.qc.ca	
2	Douglas	Mental	Health	Research	Institute,	McGill	University,	Montreal,	QC,	Canada	
	
ABSTRACT 
 
COVID-19	 government	 regulations	 resulted	 in	 increased	 social	 isolation,	 risk	 of	 stress,	 depression,	 anxiety,	
cognitive	decline,	and	 re-hospitalization.	Telehealth	has	been	highlighted	as	a	potential	bridge	 for	healthcare	
needs,	 especially	 in	 the	 COVID-19	 context.	 In	 response	 to	 this	 need	 our	 group	 developed	 a	 multicultural,	
intergenerational,	community-based	psychosocial	intervention.	We	trained	more	than	300	volunteers	who	were	
able	to	provide	friendly	phone	support	in	more	than	17	languages	to	more	than	600	older	adults	across	the	Greater	
Montreal	 Area	 who	 could	 benefit	 from	 social	 connection	 and	 support	 to	 access	 community	 resources.	 The	
experience	has	been	heartwarming	and	facilitating	enriching	life	experiences	for	seniors,	volunteers,	and	clinicians	
alike.	Furthermore,	some	preliminary	observations	suggest	that	this	intervention	might	have	positive	effects	on	
the	seniors’	mental	health.	
	
KEYWORDS:	COVID-19, Telehealth, Social connection, Elders  
Connecting	again	with	elders	in	our	community	
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Our story is relatable because, like the rest of the world, our community and clinic were 
unexpectedly hit by the COVID-19 pandemic. Overnight, it was no longer safe to see our patients 
face-to-face or serve them as we have always done. Our clinic, which overflowed with active 
clinicians, students eager to learn, lively academic discussions, and wonderful regular patients, 
became like a silent desert. The confinement measures, along with the cut in multiple in-person 
social services, further increased the isolation that many seniors were experiencing[1], along with 
the risk of increases in stress, depression, anxiety, cognitive decline, and re-hospitalization.[2-4] 
Other international groups responded to this crisis with initiatives such as the Telehealth 
Intervention Program for Seniors (TIPS), a community-embedded program targeting low-income 
older adults, which provided weekly assessment of vital signs, subjective wellness, and wrap-
around aging services[5]. A national group, such as the Friendly Neighbor Hotline[6], started a 
large community-based program to connect seniors to a network of volunteers throughout Toronto 
who assisted by delivering groceries, household essentials, and food bank items. 
As frontline clinicians in mental health, we identified the urgent need for low-cost, scalable, and 
convenient intervention to mitigate the deleterious effects of fear, anxiety, and depression on our 
already vulnerable geriatric population. We realized that it had the potential to lessen the burden 
on healthcare infrastructure by managing and preventing common mental health issues. Initial 
responses in similar settings involved the transition to virtual interactions, however, one limitation 
faced by our elderly patients was a relative lack of comfort, skills, and access to digital technology. 
Therefore, we designed our Telehealth Intervention Program for Older Adults (TIPOA)[6], a 
pragmatic approach that used telephone service. It was inspired by a sense of solidarity in our 
Quebecoise community, as well as our clinicians’ and researchers’ experience in mental health at 
the Psychogeriatric Clinic of the Jewish General Hospital. Table 1 outlines the steps taken to 
develop the program. 
 
 
 
 
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Table 1 Telehealth Intervention Program Structure 
Research 
Development 
A team of clinicians and scientists developed and submitted the Telehealth 
Intervention Program protocol, which was approved by the Ethics Review Board. 
The aim was to assess whether a community-based phone service could 
prevent/mitigate the deleterious effects of fear, anxiety, and depression on our 
geriatric population. 
Community and 
Outreach Team 
A group of research assistants, social workers, and graduate students worked on 
developing an extensive and updated list of community resources. 
Recruitment We recruited (>300) volunteers from multiple academic, professional, linguistic 
(17+) and cultural backgrounds and generations. Every candidate went through 
interviews and background check.  
Matching Seniors’ needs and preferences were matched with volunteers’ levels of skills and 
languages spoken. 
Training 1-2 weekly training sessions in English and French were led by 2 clinicians. The 
scope included a full description of the program, psychoeducation about mental 
health, common geriatric issues, trouble shooting and resources sharing. 
Follow-up Support 
Sessions 
Volunteers had access to 2 drop-in sessions per week with a clinician or trainer to 
discuss cases.  
Hotline Services A group of 7 clinicians (social worker, occupational therapist, neuropsychologist, 
nurse practitioners in mental health, etc.) are on 4-hour on-call shift to provide 
service to volunteers and patients when experiencing a concern. 
Quality Assurance 
System 
 
Client Support System  
Dedicated phone number for clients (e.g., to discuss issues with their volunteer, 
or to request delivery of the service). 
Quality Assurance Calls  
Patients were called on a regular basis to seek their feedback about the program. 
Volunteer Call Log  
Volunteers reported their calls and issues through a confidential weekly log 
system.  
 
Program Evaluation  
Qualitative research (e.g., interviews and focused groups) with patients, 
volunteers, and community stakeholders. 
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The volunteers were well equipped to provide a safe, high-quality service that included connecting 
seniors with social programs from our community partners and the government. To date more than 
600 older adults over 60 years old have participated across the greater Montreal area.  
To illustrate how this intervention has been perceived here are some testimonials from our 
clinicians, volunteers, community partners, and clients: 
“The calls are the best thing in my life. She is always there. We both really love each 
other. It is a perfect match. Right now, I need someone and there she is. She’s always 
ready to listen, she’s the rock in my life right now.” 
TIP-OA Client 
“I would pay a thousand dollars for this...I am so alone...my friends don't call me 
anymore because they're sick and can’t get to the phone.” 
TIP-OA Client 
“To know that you're making a difference in somebody's day, that you're making an 
impact definitely helps my [own] mental health.” 
TIP-OA Volunteer 
“Well, some of the clients actually use the word joy. It has brought joy to their life. 
Yesterday I was talking about one of our members who is also receiving the TIP-OA 
calls. He was hospitalized. Knowing that he would get a call from his volunteer made 
him feel so much better when he was very ill. Just knowing that he was going to get that 
good time help him go through all that difficult time that he was having at the hospital.” 
TIP-OA Community Partner 
“TIPOA has been an exciting opportunity to respond in a timely manner to seniors 
who have been experiencing acute mental and/or social concerns while experiencing 
limitations to access their usual services due COVID19”. 
TIP-OA clinician  
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“During the last year, I found my experience volunteering with TIP-OA to be both 
enlightening and enriching. This program gave me the opportunity to support patients 
in their time of need and help to decrease their isolation. Throughout my experience, I 
enjoyed the time exchanging with patients and offering them motivational support.”  
TIP-OA Volunteer 
Based on these testimonials and our observations, we plan to continue serving our seniors in this 
way, thereby supporting those who have built our province and country. Thus far, more than 100 
patients have participated in the research component of TIPOA. These data will provide insight 
about whether TIP-OA can be model for large-scale public mental health interventions that address 
both the prevention and mitigation of mental health conditions in our older community.
 
 
REFERENCES	
1. Public Health Agency of Canada. Physical distancing: how to slow the spread of COVID-19 [Internet]. 
2020 [accessed 2021 May 29] Available from: https://www.canada.ca/en/public-
health/services/publications/diseases-conditions/social-distancing.html. 
2. Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. Health & 
Social Care in the Community, 2015;25(3):799-812. 
3. Domènech-Abella J, Mundó J, Haro JM, Rubio-Valera M. Anxiety, depression, loneliness and social 
network in the elderly: Longitudinal associations from The Irish Longitudinal Study on Ageing (TILDA). 
J Affect Disord. 2019 Mar 1;246:82-88. doi: 10.1016/j.jad.2018.12.043.  
4. Vigo D, Patten S, Pajer K, Krausz M, et al. Mental health of communities during the COVID-19 
pandemic. Can J Psychiatry. 2020 Oct;65(10):681-687. doi: 10.1177/0706743720926676.  
5. Hamilton  T, Johnson L, Quinn BT, Coppola J, et al. Telehealth intervention programs for seniors: an 
observational study of a community-embedded health monitoring initiative. Telemedicine and e-Health. 
2020;26(4):438-45. http://doi.org/10.1089/tmj.2018.0248. 
6. NORC LAB. Friendly neighbour hotline [Internet]. 2020 [accessed 2021 May 29] Available from: 
http://uhnopenlab.ca/project/hotline/. 
7. Dikaios E, Sekhon H, Allard A, et al. Connecting during COVID-19: a protocol of a volunteer-based 
telehealth program for supporting older adults' health. Front Psychiatry. 2020 Dec 2;11:598356. doi: 
10.3389/fpsyt.2020.598356.  


Connecting again with elders in our community:  A project to stay together during COVID-19 restrictions and beyond

Dobkin, Patricia Lynn

	
VOLUME	8	●	NUMBER	2	●	2021	●	12-15	
©	2021	Patricia	Lynn	Dobkin.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	
	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	2	(2021)																																																																																																																																																																												
	
WHAT	SILENCE	HAS	TO	OFFER	THE	
CLINICAL	ENCOUNTER	
Patricia	Lynn	Dobkin	
Programs	in	Whole	Person	Care,	Department	of	Medicine,	Faculty	of	Medicine	and	Health	Sciences,	McGill	
University,	Montreal,	Quebec,	Canada	
patricia.dobkin@mcgill.ca	
	
Keywords: Mindfulness, Silence, Clinical encounter, Cross-cultural 
 
awabata, a Japanese writer, won the Nobel Prize for literature in 1968. Four years later, at age 
72, words from his short story “Silence” were quoted in his obituary: “A silent death is an endless 
word”[1]. That story and my travels to Japan inspired this commentary. Remarkably, the story, 
while written more than a decade before Kawabata’s protégé took his life in the traditional and dramatic 
samurai manner, foreshadowed the Nobel laurate’s death.  To the chagrin of his readers and fellow citizens, 
the former suicide apparently triggered Kawabata’s. 
Japanese attitudes towards death interested me as I was traveling to Japan to teach palliative care 
clinicians Mindful Medical Practice[2]. I sought to understand how 21st century healthcare professionals 
who faced death daily integrated traditional values into their work. Thus, I read Japanese literature and 
articles on the topic. I was curious about their perspectives on sudden death (self-induced or illness-related) 
which is generally viewed positively. Studies showed differences in ideology across Asian physicians 
(Korean, Taiwanese, and Japanese) regarding the role of religion (low in Japan) and autonomy (patient 
informed first; high in Japan)[3]. When I queried workshop attendees what they considered to be a “good 
death” they described their own (e.g., reconnecting with ancestors) rather than their patients’. “Dying on a 
tatami”[4] refers not only to taking one’s last breath at home (on a futon, stretched out on a traditional tatami 
K 
What	silence	has	to	offer	the	clinical	encounter		
Patricia	Lynn	Dobkin	
	
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mat); it implies being embedded in an extended family – those who are alive and dead. Thus, even though 
religion does not play a role in hospital care, ancient beliefs remain central. 
The story “Silence”[1, p.153-73] relates an exchange between the narrator (a writer) and his 66-year-old 
mentor who had chosen to remain silent following a debilitating stroke. The narrator is disconcerted by the 
formerly prolific author refusing to write even a single kanji character. He is at loss regarding how to interact 
with his unresponsive old acquaintance. He wished to save the novelist from “verbal starvation” viewed as 
“something intolerable.” Awkwardly, the narrator fumbled with his own words as he said too much or as he 
put it, “babbled.” The narrator was able to reflect on his own behaviour and ask, “Wasn’t what I was doing… 
like violating the sanctuary of silence? … Perhaps he had chosen to remain silent, chosen to be wordless 
because of some deep sorrow, some regret. Hadn’t my own experience taught me that no word can say as 
much as silence?” Later, addressing his friend’s taciturnity with his own words, the narrator muses, “No. 
Silence is certainly not meaningless… I think that sometime before I die, I would like to get inside silence, 
at least for a while.” Finally, when it became clear the patient-novelist would not respond to any of his 
utterances the narrator states, “Here you’d gone to all the effort of achieving silence, and then I come along 
and disturb you.” 
How does Kawabata’s story relate to medical encounters? When I teach Mindful Medical Practice[2] 
clinicians become more reflective and self-aware. They engage in “deep listening” during dyadic exercises 
and experience what it feels like to be heard without the other person interfering with the process. With 
meditation practice what silence has to offer is discovered. They become more perceptive, noticing body 
language and tacit forms of communication (e.g., tone of voice, pace of speech). This counters physicians’ 
inclinations to push through checklists or fall into the habit of interrupting patients. Such behaviours can be 
modified with regular meditation practices and acting with awareness during routine activities (e.g., washing 
hands prior to examining a patient).  
While traveling via subway, buses, and trains in a completely different world, I was struck by how quiet 
people were. No one spoke on their mobile phones. There were pictograms instructing travelers to keep 
their thoughts and words to themselves. Smokers were directed to not walk and smoke simultaneously. 
Eating and drinking were restricted to sitting or standing still. Despite masses of people moving to various 
destinations, silence promoted calm. I realized that the Japanese social norm of restraint contributed to the 
wellbeing of the community. It reflects the importance of being considerate of others first. My inability to 
converse with Japanese people heightened my awareness of other forms of communication (e.g., smiles, 
hand signals). 
These experiences led me to consider my ethnic background, one that encourages questioning, expressing 
views and sentiments openly, with little reserve. Japanese people tend to be subtle, even among 
themselves, expecting others to be insightful. Young children are instructed regarding this type of social 
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intelligence. For example, I observed a father teaching a 3-year-old to girl to bow wordlessly at a shrine 
after dropping coins in a donation box. In Kawabata’s novel, The Sound of the Mountain[5], the ageing 
patriarch, distressed by his adult children’s complicated lives, hesitates to contribute his thoughts and 
feelings despite the importance he attributes to the problems they face. Even though it is his traditional role 
to promote harmony in his family he held back. Kawabata wrote, “At night he heard only the sound of death 
in the distant rumble from the mountain.”[5]. 
One of my Japanese hosts who had studied in Canada explained to me that because Japan was isolated 
for centuries and remains a homogenous society there is less need to state directly what one thinks. He 
said that multiculturalism, common in Canada, renders it more difficult to understand “the other.” For that 
reason, Westerners need to speak openly and directly. During my early training in pain management, I 
observed that some cultures allow and encourage overt expressions of suffering whereas others do not. 
My experiences in Japan mirrored that. Traveling from Tokyo to Osaka we barely missed a typhoon, one 
that stopped bullet trains in their tracks. When it struck, contingency plans were rapidly put into action and 
citizens helped one another through the natural disaster. Japanese people have endured hardships during 
their storied history for centuries with individual resilience and collective cooperation. 
While visiting Kyoto, I strolled through the Nanzenji Temple gardens whose spacious grounds included the 
placement of rocks suggesting mountains and ocean waves represented by sand raked to perfection. 
Nothing more was needed. Understatement spoke volumes. The exquisite attention to detail, where 
everything has its place was astonishing. Standing motionless, I witnessed a grey heron with its wide-
spread wings swoop down to land on a branch overlooking a lotus-filled pond. From there I followed the 
Philosopher’s Path, walking mindfully (as did Kitaro, one of Japan’s most famous philosophers on his way 
to Kyoto University) for two kilometers along the canal where leaves flowed upwards, north bound. The day 
was stifling hot, but the beauty manifest in ordinary places awakened in me a sense of joy and gratitude. 
ACKNOWLEDGEMENTS 
The author would like to thank Dr. Satoru Tsuneto for his invitation to teach in Japan and the Japan Hospice 
Palliative Care Foundation for their generosity. 
REFERENCES 
1. Kawabata Y. Silence in First Snow on Fuji. Translated by Emmerich, M. (1999). Washington D.C.: 
Counterpoint; 1959. p. 153-73 
2. Dobkin PL (Editor). Mindful Medical Practice: Clinical Narratives and Therapeutic Insights. Switzerland: 
Springer International; 2015. 
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3. Morita T, Oyama Y, Cheng SY, et al. Palliative care physicians’ attitudes toward patient autonomy and 
a good death in East Asians countries. J Pain Symp Manage. 2015;50(2):190-9. 
4. Long S. Cultural scripts for a good death in Japan and the US: Similarities and differences. Soc Science 
and Med. 2004;58:913-28. 
5. Kawabata Y. The Sound of the Mountain. Reprint eBook. Translated by Emmerich, M G New York: 
Vintage International (Division of Random House); 1996. 
	


What silence has to offer the clinical encounter

Dobkin, Patricia

	
VOLUME	8	●	NUMBER	1	●	2021	●	1-3	
©	2021	Patricia	Lynn	Dobkin.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	
	CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
INTRODUCTION	
Patricia	Lynn	Dobkin	
Clinical	Psychologist,	Programs	in	Whole	Person	Care,	Department	of	Medicine,	Faculty	of	Medicine	and	
Health	Sciences,	McGill	University,	Montreal,	Quebec,	Canada	
patricia.dobkin@mcgill.ca	
	
s an introduction to this special volume I will toggle between Camus’ words from The Plague to 
the evolution of the COVID-19 pandemic as it is spreading across the globe in real time. So as not 
to confuse the reader, given the uncanny similarity between what Camus describes and our current 
reality I will put Camus’ Dr. Rieux’s observations and reflections in italics. You, the reader, may wish to 
compare these with those of the physicians and health care professionals who have generously shared 
their own stories as they bravely worked on the front line during the progression of the COVID-19 health 
crisis in 2020. I simply invited clinicians to describe their experiences in 1,500 words employing narrative 
medicine techniques. Narrative medicine is a methodology that utilizes people's stories in clinical practice 
to promote healing.  In doing this, narrative medicine aims not only to validate the experience of the patient, 
but also to encourage creativity and self-reflection in the clinician.  
Fictional Dr. Rieux, the equivalent of a family doctor today, works in an ordinary, ugly, dry colonial port in 
Algeria in the 1940s. Typical of Camus’ writing style, all senses are evoked (e.g. “[rats] emerged in long 
wavering files into the light of the day, swayed helplessly, then did a sort of pirouette and fell dead; listening 
to the curious buzzing sound that was rising from the streets as if in answer to the soughing of the plague; 
an oily, foul-smelling cloud of smoke hung low”) as the epidemic migrated from rats to humans. The volatile 
climate foreshadows what awaits the population; for example, “feverish air” and “incarceration under the 
blue dome of sky, already beginning to sizzle in the fires of the summer.” Eerily, Camus notes that the main 
preoccupation of the inhabitants is commerce – much like 21st century economic concerns.  
Dr. Rieux serves as the author of stories from the frontline in a sleepy town that was rudely awakened by a 
widespread calamity. He is the doctor who sounds the alarm to the health authorities who resist creating 
A 
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panic in the population (recall Dr. Li Wenliang, in China; President Donald Trump in the USA). The first 
death Dr. Rieux encounters is that of his concierge, M. Michel. The doctor’s reflections vacillate at first – 
How serious is this really? He responds to the concierge’s wife’s question, “Please, doctor. What is it?” 
with, “It might be almost anything. There’s nothing definite yet.” He subsequently rang up a colleague to 
compare notes. As the number of deaths increase Dr. Rieux reflects on his own “nervous exhaustion” 
followed by, “it was high time to put the brakes on and try to get his nerves into some sort of order.” 
Suppression of emotions is a psychological defense used with the mistaken idea that by turning away from 
one’s own feelings one will be able to cope better with exposure to patients’ suffering. 
Do the stories in this volume show how distress is experienced by those at the frontline in 2020? Dr. Rieux 
recognizes that “everything points to it being plague.” He is torn between conflicting fears and confidence, 
at least early on. Meanwhile the townspeople carry on with their usual business, plan trips, visit cafés as if 
their lives were not altered (as was the case in 2020 until confinement was ordered). As hard evidence 
points to the worst, Dr. Rieux thinks, “The thing was to do your job as it should be done.” He is alarmed 
when he discovers that medications are unavailable. He stands his ground when the authorities minimize 
the situation; he insists that the risk of spread calls for “taking precautions.” He points out, based on data 
at hand, that if they fail to alert the public, “there’s a risk that half the population may be wiped out.” 
Camus wrote, “No one had yet really accepted the idea of disease. Most were chiefly affected by whatever 
upset their habits or touched their interests.” Sound familiar? The townspeople were advised to practice 
“extreme cleanliness.” While the town awaits the serum from Paris, Dr. Rieux doubts that it will be much 
use; “This bacillus is such a queer one.” i.e. he recognizes that this disease is different, somehow. 
“Throughout the day the doctor was conscious that the slightly dazed feeling came over him whenever he 
thought about the plague was growing more pronounced. Finally, he realized that he was afraid.” As days 
became weeks his relationships with his patients were altered by the gravity of the situation “his profession 
weighed on him heavily.” Treatment facilities were inadequate; makeshift hospitals were erected.  
Much like international border closings in 2020, the town gates were sealed; sentries stood rigidly on guard. 
Mailrooms were shuttered – communications were truncated to 10-word telegrams. Love letters were 
relegated to dusty desk drawers. No internet services existed to break the isolation. The townspeople were 
“prisoners of the plague.”  Dr. Rieux’s mind occasionally drifts towards his wife who was at a sanitarium 
outside of town for an undisclosed ailment. He mused that in the case of parted lovers, “minds were prey 
of different emotions, notably remorse.” In the meantime, “commerce, too, had died of plague.” Crowds 
lined up to buy dwindling supplies. 
Dr. Rieux oversees three hospitals: one being a requisitioned schoolhouse. He personally supervises 
reception of new, infected patients (gloves are not mentioned!). The demands are relentless. He admits 
that the work was beginning to put a great strain on his endurance, despite his robust constitution. He feels 
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pity yet rationalizes, “But what purpose could it serve?” After countless encounters with desperate cases, 
“only one factor changed, and that was Rieux himself… all he was conscious of was a bleak indifference 
steadily gaining upon him…And this feeling that his heart had slowly closed in on itself…” Before the 
disaster, the doctor’s encounters with his patients were compassionate. He tended to the poor (at no 
charge), elderly, strangers and suicidal alike, conducting house calls with generosity, late into the evenings. 
The doctor is a righteous, albeit not self-righteous human being, easy to be fond of and respect. While 
bearing witness to miserable, lonely deaths, this trait is not lost. For example, Dr. Rieux abhors the idea of 
conscripting prisoners into the grim service of “heavy work” (collecting corpses?). He states, “I loathe men’s 
being condemned to death.” Death and suffering were painful before the plague; during it Dr. Rieux 
considered the battle as “A never ending defeat.”  
The cracking of the good doctor’s heart is muffled by the moans of dying patients and the screams of a boy 
he is attending to months into the plague. Up until this point, Dr. Rieux has been stoic, determined, and 
logical – but this particular death defeated his defenses. The doctor took the boy’s pulse, “less because this 
served any purpose than to escape his utter helplessness, and when he closed his eyes, he seemed to feel 
its tumult mingling with the fever of his own blood. And then, at one with the tortured child, he struggled to 
sustain him with all the remaining strength of his own body. But, linked for a few moments, the rhythms of 
their heartbeats soon fell apart, the child escaped him, and again he knew of his impotence.”  His body 
expresses his feelings: his hands were gripping the rail of the bed, his jaws were clenched, his eyes shut – 
dazed with exhaustion and disgust. Here we see the whole person of the physician – suffering with his 
patients and feeling “mad revolt.” 
While the novel is not based on a pandemic, what we are living through in 2020 is. The true stories you are 
about to read may or may not remind you of Dr. Rieux. His morals and determination to do the right thing 
rings true today, even if some of his reflections and discussions with fellow citizens imprisoned by the 
plague are fictional. 
The quote “Never let a crisis go to waste” (attributed to Churchill) may be apt. By sharing what these brave 
professionals experienced on the frontline we may learn from them how to be fiercely engaged in fearsome 
work.■ 
 
	


Introduction

Dobkin, Dennis

	
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©	2021	Dennis	Dobkin.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	CC	BY.	
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COMMON	DECENCY	
Dennis	Dobkin	
Cardiologist,	Colorado,	USA	
ddobkinmd@gmail.com	
	
eing a physician who has provided medical and whole person care to patients and their families 
for over 40 years has transformed me into a fuller person and consequently enriched my life. 
Belonging to an incredible health care system has been a privilege that I never took for granted. 
Before retiring in February 2019, I was fortunate to be able to say good-bye to over 1,000 patients that I 
tended to for decades.  
After moving to Colorado an unplanned opportunity came my way. Citizens living in rural Colorado typically 
do not have easy access to a cardiologist; thus, when I was asked to attend one week per month I accepted 
with a curious, open mind. In fact, I was pleasantly surprised to care for an entirely different set of people 
who lived in circumstances new to me (e.g. ranchers, farmers). It turned out to be interesting and 
challenging – one could say I found novel ways to serve my fellow human beings, and that gave me a deep 
sense of satisfaction. 
You can be sure I never expected to be exposed to a pandemic at this final phase of my career. 
The events of the last two months have been truly overwhelming and have forced me to reevaluate my role 
as a health care worker in a new and unexpected light. Two months ago, I treated one of the first patients 
to die in the ICU in Colorado. I was exposed to numerous patients with COVID-19 wearing marginal 
protective equipment and I quickly grasped the nature of this extremely contagious and quite deadly 
disease. 
Given that I work part-time, I had time to contemplate the disease, my role as a caregiver, my exposure 
(i.e. chances for contracting the virus) before returning to the frontline one month later. By then, I had come 
to terms with this unprecedented situation.  I have observed my family, my community, responses by various 
B 
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levels of the government as well as the public health system. I have closely observed how the public, at 
large, has responded to this pandemic.  
Initially, I was proud of the American public and especially, the dedication and bravery of our health care 
workers. For example, a Physician Assistant I have worked with over the past year has volunteered to work 
full-time in the ICU; this means he cannot live with his young family for the foreseeable future. 
As a cardiologist, I have attended to patients with serious illnesses and those who die throughout my entire 
career. I am comfortable with both. Fortunately, cardiology treatments have progressed substantially over 
40 years. We have so much to offer and can keep people healthy and functional for decades where once 
they would have succumbed to heart failure, heart attacks and rhythm problems much earlier. We can 
comfort those who ultimately perish by making their final weeks and months more tolerable. We were able 
to console families as they lost loved ones. That was easy compared to the new set of circumstances.  
This pandemic is novel to me and all my colleagues. It is more contagious and deadly than anything we 
have ever witnessed. None of us were prepared to face this challenge. However, we are well prepared to 
cure those that we can, and comfort those we cannot. We have trained for this and I am confident that we 
will adjust. That is the easy part. 
Currently the question, “How will this situation affect my family and me?” is a major preoccupation. It is 
personal and acute; more so than during all the years of service behind me. Will I get sick? Might I die? Will 
I threaten my family members? My son is to wed in one year. Will I be here to attend the ceremony? These 
concerns are new and impossible to ignore. 
I have addressed this challenge on various levels. Over the years, my professional experiences have deeply 
affected deliberations concerning my own mortality. I am confident that I will face death with less fear than 
most. I see it as part of nature and the circle of life. My philosophical worldview reinforces this professional 
perspective. There is an element of fatalism which can be healthy since we all must face mortality. 
Trained as a scientist, I relate well to numbers. Here is what is known: eighty percent of those with 
symptoms have mild disease. Most who contract the virus are asymptomatic. Twenty percent of those with 
symptoms are hospitalized, twenty percent of these patients will die. These facts suggest that my risk is 
low. Right?  
Perhaps not. Let us add personal facts to the numbers. I am 67 years old with co-morbid conditions. Thus, 
my risk is higher; by how much? I do not know. No one knows. But does knowing or not knowing change 
my decision to carry on?  No. This is what we who work on the frontline confront daily and I have little 
hesitation to return to the hospital. 
Heath care workers as a group are like others in our desires to remain healthy, enjoy our families and not 
suffer as we approach death. But our identities as doctors or nurses and as human beings change our 
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commitment to promoting health; moreover, our self-images drive our willingness to serve. We know that 
no one else can do this job. We are essential; I say that without pride. All our training has led us to this 
moment. The government and our public health officials play important roles, but ultimately someone must 
take care of the sick and dying. As I see it, it is not about being a hero. It is our duty. Does this sound 
dramatic? There are other professionals who also face risks. 
Police officers expose themselves to danger in zones of violence.  Firefighters run into the burning buildings. 
Soldiers hardly relish deployment but go when called to protect their country. It is not a choice. It is their 
destiny. We must live up to our own values and expectations of who we are.  
When I returned to the hospital following a one-month hiatus the scene had changed drastically. The ICU 
capacity had doubled. There were COVID-19 and non-COVID-19 units. There were many new protocols to 
follow keeping patients and staff safe. Over one-third of the patients in the hospital were COVID-19 positive. 
The hospital was well staffed with providers and gear. The work force was totally engaged realizing the 
important task ahead of them. In 40 years, I have never seen such sick patients. Some ICU rooms had two 
patients per room – unthinkable in the past. The absence of family was stark, sad, and depressing. The 
words death and destruction are not an exaggeration. 
One such encounter will illustrate this situation. I met a 55-year-old patient, a construction worker who 
previously had been healthy. We highly suspected COVID-19. He had had a fever, muscle aches, cough, 
and shortness of breath for five days. He had no co-morbid conditions; he was not on medications, did not 
smoke and had never been hospitalized. I saw him for chest pains; his blood tests confirmed damage to 
his heart. His oxygen levels were still normal, and he appeared mildly ill – thus, I suspected that he would 
do well.  
I was wrong. He was intubated within 12 hours, on a kidney machine in 24 hours and died within 48 hours. 
No family, all alone. I have tended to hundreds of patients over the years who have died. Some I had met 
that very day; most I knew for many years. I could help them face their immanent death. I could assist their 
families cope with losing a loved one. I could not provide either for this patient. I felt a searing sense of 
failure. I think it will haunt me as much as any of the patients I have lost in the past. 
Now six months have passed since the beginning of this tragedy. We have made progress but my overall 
emotion is one of grave disappointment – in Americans who fail to take precautions to protect their fellow 
citizens, for our public health officials who are too beholding to the political system, and for our politicians 
who have made a health care issue a political issue. Nonetheless, I try to recall that the health care 
professionals I work with who are undeterred and focus on our mission – the patients and their families 
A quote from Dr. Rieux in Albert Camus’s novel The Plague says, “There is no question of heroism in all 
this. It’s a matter of common decency.” When asked by his colleague what that means, he replies, “I don’t 
know what it means for other people. But in my case, I know that it consists of doing my job.”  
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Live long enough and we all will face challenges in life. We must look into ourselves and decide what we 
want to accomplish. For me, the concept of “common decency” is my guide.■ 


Common decency

Presta, Christine

	
VOLUME	8	●	NUMBER	1	●	2021	●	24-26	
©	2021	Christine	Presta.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License		
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
	
IS	THIS	MY	LAST	DAY?	
Christine	Presta		
Registered	Respiratory	Therapist,	Chicago	Northwest	Suburbs,	Illinois,	USA		
christine.presta@hotmail.com	
	
 had a fantastic life right out of high school. I was a young, vibrant 18-year-old working for American 
Airlines. I lived carefree in my parent’s basement, rent free, traveling the world on complimentary airline 
tickets. What a life! I wandered throughout Europe and the Caribbean when the urge struck. Full of a 
lust for life, I had an insatiable thirst for adventure with ample friends to enjoy this expansive planet with all 
it had to offer. Backpack at the ready, I checked the departure boards at the airport to decide which 
destination I wanted to explore at that moment. I had a knack for learning languages and sincere interest 
in other cultures. I, like others in their prime, could not image anything going amiss.  
But it did when I was a gate agent with American Airlines during the attacks of September 11, 2001. A 
profound sense of loss, both economic and for my physical security darkened my bright outlook. The O’Hare 
airport where I had loved working for seven years felt ominous. Not knowing when a potential terrorist hiding 
a bomb might strike distressed me as I mingled among enormous Boeing 767 aircrafts. These very planes 
were used as missiles, reducing the twin towers to a pile of rubble, stealing over 2,600 lives in their wake. 
As I walked on the tarmac and looked up at them, I was overwhelmed with sadness.  
Because of the massive layoffs in the airline industry post 9/11, my full-time employee status was reduced 
to 20 hours a week. No longer feeling secure I wondered how I was going to survive financially. For that 
reason, I returned to school to study Respiratory Therapy. This choice seemed to promise safety. Who 
could have predicted that only a few years later I would be on the frontline of an invisible and highly 
contagious threat? 
I 
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Now, those years of fun and a carefree life I enjoyed are long gone. Sadness prevails as we cannot seem 
to find a way to end to this suffering. My knees shake as I drive to the hospital. Seven of my co-workers are 
COVID-19 positive, struggling to breathe. How ironic. A Respiratory Therapist who cannot breathe, go 
figure. I project that I will be next. Is this virus sneaking into my body at the hospital or grocery store? 
Currently, this is my personal war; it’s far different from the terrorist attack in America 19 years ago. The 
door swings open to my battlefield: a cold dark Intensive Care Unit. I am a type of soldier, but instead of a 
human enemy using airplanes as missiles, I confront an invisible and unpredictable pathogen. My body 
armor is PPE. Covered from head to toe to care for the most critically ill and dying people. Daily safety 
checks on my patients breathing through ventilators, I sense their sorrow and desperate need for attention. 
Today, I am caring for a rather large, lovely man from a nursing home with COVID-19. He has a 
tracheostomy and is ventilator dependent. His eyes follow our moves intently through the glass window of 
his room. Clearly, he craves human contact. Desperation and loneliness prevail as he fights off a fever.  
The nurse and I spend some time with him. We ask him questions about his life, but he is non-verbal and 
just gazes at us lovingly, appreciative of our brief companionship. The nurse talks to him about her children 
and shows him pictures saved on her cell phone, while I talk about Chico, my Chihuahua. I hold his hand 
and reassure him that we will not stop fighting for him. I will not let him die today, aware that I am also facing 
my grandmother's worsening health. We occupy his time as best we can, not knowing if viral droplets 
penetrate our masks. No family or visitors are admitted into his room. Vivid memories of my days at O’Hare 
dominate my mind.  
Despite understanding my patient’s hunger for contact, I moved on to the next patient. I exited his room 
and went about my tasks. From the corner of my eye, I glanced back on that lonely soul. Suddenly, he 
grabbed his ventilator tubing and tracheostomy and ripped them out. His ventilator was detached, spraying 
mucoid secretions around the room like an angry snake spewing its venom, potentially infecting everything 
in its path. His vitals were deteriorating rapidly. I struggled to put my PPE back on, yelled for help to save 
this confused and possibly suicidal man. At the same time, I was overcome with fear that I will become the 
next ICU patient. If that were the case, would I be as impatient for my end? With the desperate man’s vital 
signs quickly deteriorating, the team worked at a steadfast pace to stabilize him. Luckily two weeks later, 
he returned to the nursing home where he resides but others who were not as fortunate. The eighteen-
wheel refrigerated semi-tractor trailer parked at the loading dock buries their stories.  
This is the life I have chosen; it is a vocation devoted to those who cannot care for themselves. It is my 
duty. Once home, I remain on high alert because my grandmother is dying from leukemia. I spend my days 
at the hospital caring for patients and my nights and weekends caring for her. Driving her to and from 
chemotherapy treatments and helping to feed and toilet her is my overtime occupation. She is a strong 
Italian immigrant who came to America with my grandfather while pregnant with my mother. She arrived in 
New York after a twelve-day voyage across the Atlantic traveling in the most barren of accommodations in 
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the bowels of the ship while the vacationers enjoyed a more luxurious travel experience. They had fourteen 
dollars in their pockets and a vision for a better life. But she is no longer full of vigor as she slowly fads 
away. Being the only healthcare worker in the family, other than a cousin doing a medical residency in 
another state, I am the one who took responsibility for both my elderly grandparents’ medical care.  
I am the eldest of my two siblings, with many years in between us. When I lost my grandfather, it was 
overwhelming. He was such a significant part of my life. In my youth we spent time traveling and visiting 
relatives in New Jersey, New York, California, and Italy. Just the three of us. My fondest memory was a 
month in Italy with them, visiting his childhood home and his brother on the family farm. We picked 
vegetables together, fed the pigs and chickens, and made pizza in the brick oven. In Rome, we marveled 
at the ceilings of St. Peter's Basilica and threw pennies in the Trevi fountain. I had all their attention and 
was by far the favorite grandchild. Yet, loss has entered my life with a vengeance over the past three years; 
my grandfather, my first dog, and now my grandmother.  
I feel like my world is closing in on me. I eat my meals thinking it may be one of my last, so I make sure it 
is a good one. I called the cemetery and picked out and paid for my plot, as if I were buying real estate. I 
wanted to ensure it would be close to my grandparents’ graves. I cleaned out all my extra clothes and old 
toiletries because I do not want anyone else to be burdened with my belongings, should this be my last 
day. I have not spent time with any friends or family because I worry about infecting them. I recently visited 
my parents by standing under my childhood home window and waiving to them.  
I see the sorrow in my father’s eyes while my mother just cries. I would not dare walk into their home or get 
too close because my mother is a breast cancer survivor. I am worried that if I unknowingly infect her, that 
it may cause her demise, I could never forgive myself if that happened. Presently, my only comfort is my 
loving companion, Chico, who I rescued two years ago from a shelter. I drive home every day feeling an 
isolation like no other, alone with my thoughts and no one to share them with, ruminating about my last day 
here on Earth. 
 


Is this my last day?

Courteau, Catherine

	
VOLUME	8	●	NUMBER	1	●	2021	●	27-29	
©	2021	Catherine	Courteau.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License		
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	
	 	
TWO	PALLIATIVE	CARE	STORIES	
Catherine	Courteau	
Physician,	Palliative	Medicine,	Vancouver,	British	Columbia,	Canada	
catherine.courteau@mail.mcgill.ca	
	
“SHIT”	
	
“	
                  hit. It’s all shit. The hospital. The hospital food, dry, tasteless. The fucking cancer. The fact that  
                 nobody knows what the fuck is going on with me and everything is delayed because of COVID- 
                whatever. The plastic tubes stuck up my nose making it bleed.”  
 
That’s what you get for asking a forty-two-year-old with a new diagnosis of cancer how she is doing today. 
I bite my tongue. I expect shame and guilt to rush in but surprisingly her words soothe me. “This IS shit” I 
think to myself. Aliyah purposefully spreads her loud words across the hospital ward for all other health 
care workers to hear. This would normally provoke a general malaise, but somehow today it lands 
differently. She speaks, no, she SCREAMS, for all of us silently carrying on, heavier with every step.  
 
I ask her to tell me more. No pause, no hesitation. She points at her four-year-old daughter’s drawing 
brightening the faded gray wall: “I haven’t seen Nia in five days because of the stupid pandemic restrictions. 
She asks me every day when I am coming home.” I ask for more. I feel my eyes getting wet and would 
normally look away, but I cannot break our eye contact. With our mouths covered by masks and our hands 
six feet away, we are only eyes.  
S
Two	Palliative	Care	stories		
Catherine	Courteau	
	
28	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
Next to the purple and yellow butterfly-like shapes pinned to the wall, a poem by Maya Angelou: “Just like 
moons and like suns, with the certainty of tides, just like hopes springing high, still I'll rise. […] Leaving 
behind nights of terror and fear, I rise. Into a daybreak that’s wondrously clear, I rise.” 
 
Aliyah is trapped in a wheelchair. She is stranded by nasal prongs attached to a noisy portable oxygen 
tank. Still, she is strong and fierce. Aliyah owns the room, holding her head high and looking straight at me, 
honest and unapologetic. She makes me want to sob and applaud at the same time. I want to join her, yell 
across the hospital corridors. I want to throw down my mask, my sterile gloves and my professional code 
of conduct. My stethoscope’s is suffocating around my neck. I stay very still. I envy her life-affirming fury. 
Today. Right now.  
 
 
THE	RINGS	
 
er fingers had doubled in size, swallowing her golden rings. Her arms and legs were full of fluid. 
Simply checking her pulse left an imprint on her wrist for several minutes. Ruma asked us 
repeatedly to remove the trapped loops strangling her digits. Given the pandemic-related hospital 
visitors restrictions, her family members came one by one, each with a new strategy to battle the stubborn 
rings. Ruma’s sister slathered cream on her hands, massaging them endlessly hoping the rings would slip 
off. Her son would pull gently and then progressively increase the force applied. Then Ruma would start 
moaning and the operation was immediately aborted. Her mother brought butter from home, a “secret trick”, 
but no luck. I would see the family members come and go, giving reports at the room’s entrance as one 
entered, hopeful, and one exited, pessimistic. As the week advanced, Ruma’s skin turned pale yellow and 
she drifted into a deeper sleep. She could no longer speak, but every once in while she would make 
uncoordinated gestures that seemed to point towards the jewels ornamenting her hands.   
 
Ruma’s family members became obsessed with the rings. Whenever a new nurse came on shift, they 
desperately asked for innovative tactics. Ruma’s gastric cancer, diagnosed only a few months ago, had 
aggressively migrated from her stomach to her liver and travelled to the inner lining of her abdomen, filling 
it with liquid. As Ruma approached end-of-life, her whole family was exceptionally allowed at her bedside. 
In fact, they now lived at her bedside. When I visited, I would find them silently sobbing or plotting the next 
“ring removal mission.”  
 
Removing Ruma’s rings seemed the one thing everyone invested hope in. 
 
H 
Two	Palliative	Care	stories		
Catherine	Courteau	
	
29	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
As I gently pressed my hands on his wife’s swollen stomach, Pankaj delivered the story of the last months 
in fragmented pieces. “She wanted to go to India” he blurted out. The pandemic had interfered with the 
couple’s plan to visit Jaipur, Ruma’s hometown. Many of her loved ones had not been able to travel to 
Vancouver to say their good-byes. As I moved on to auscultate her lungs, I heard Pankaj muttering under 
his breath “unfair, unfair, unfair.” The rings seemed to bite into her skin with more determination than ever. 
 
Lindsay is today’s nurse. She suggests taping the fingers tightly to allow the rings to slip off. Ruma’s aunt, 
mother, children and husband’s faces all light up. A new approach to this lasting issue! Lindsay meticulously 
wraps Ruma’s index finger, middle finger, ring finger and pinky. Then she moves on to Ruma’s second 
hand. Slowly, Lindsay pulls jewels over tape. The bedside audience gazes in attentive wonder. When the 
last ring comes off, Ruma’s son and daughter jump up from their seat. Shy screams of joy surround us. 
Caught up in the week-long quest, I am smiling from ear to ear and participate in the family cheer. Until I 
see Pankaj. Ruma’s husband stares quietly at the rings nested in the palm of his hand. The wedding band 
stands out by its simplicity among the emeralds and the topazes. 
 
 
 


Two Palliative Care stories

Beaulieu, Marie-Claude

	
VOLUME	8	●	NUMBER	1	●	2021	●	51-53	
©	2021	Marie-Claude	Beaulieu.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License	
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
THE	COVID-19	PANDEMIC:	ONE	
PERSON,	VARIOUS	PERSPECTIVES	
Marie-Claude	Beaulieu		
Physician,	Family	Medicine,	Sherbrooke,	Quebec,	Canada		
marie-claude.beaulieu@usherbrooke.ca	
	
	
t 62 years-old I am experiencing the COVID-19 pandemic from various perspectives: as a wife, 
mother, grandmother, family doctor, teacher, manager, and patient. I was diagnosed with 
rheumatoid arthritis (RA) five years ago. Initially, control of the disease was complicated but 
eventually it was achieved through a combination of medications (hydroxychloroquine, methotrexate 
injection, and tofacitinib, all at maximum doses). This renders me immunosuppressed but works quite well 
especially since I am adherent to the treatment regimen. However, I am more susceptible to infections. If I 
stop taking the medications, symptoms and synovitis would recur. I have been a family physician since 
1983, but three years ago stopped working in the clinic due to my susceptibility to infections that circulate 
there. I truly enjoyed interactions with patients, so this was one of many losses due to RA. Now I concentrate 
my professional energies towards management, teaching and research full time at the Faculty of Medicine. 
My spouse is a rheumatologist and we have been working together on research projects since 2007, prior 
to my diagnosis. Moreover, I am the mother of three grown daughters as well as the grandmother of 6 
adorable grandchildren aged one to six years old. What a joy! Yet, being immunosuppressed has impacted 
my role as a grandmother because children in daycare are often sick and I sometimes am forced to cancel 
planned activities with them - such as outings or babysitting.  
In February 2020 we spent a few days at Disney with one of our daughters, her husband and their two 
children. This had been planned for a year prior to any indication of COVID-19 in America. After our 
vacation, we took the plane to Victoria, British Columbia, to attend a Canadian rheumatology congress 
where we both presented. This too had been planned for several months. We passed through Seattle 
without any knowledge of COVID-19 in those areas. The congress went well with participants from across 
A 
The	COVID-19	pandemic:	one	person,	various	perspectives	
Marie-Claude	Beaulieu	
	
52	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
Canada mingling during breaks, presenting and sharing, as is common during such events. On Thursday 
evening, we learned about the first case of COVID-19 in Quebec; it was a traveller returning from Iran. This 
news was like a quiet alarm bell that rang as we set out to go home. I was anxious about returning while at 
the same time, I could not wait. We had to transit through Vancouver, so I took care to wash my hands 
often and distance myself as far as possible from the others while we waited and boarded the large cross-
continent airline. I was especially vigilant during the 6-hour flight from Vancouver to Montreal (in the 
washrooms, during meals and when people coughed around me).  
Once back in Sherbrooke, a small university town in Quebec, I learned that there had been several cases 
in Seattle and Vancouver. I decided not to hold face-to-face meetings at the faculty, favouring virtual 
meetings, and cancelled a concert scheduled before the official announcement of province-wide 
confinement. The next day, the government announced several closures: schools, universities, rallies, ski 
resorts and imposed a lockdown. Like everyone else, I followed to the news regularly on television and on 
the Internet. I received instructions right away from my department regarding the impact on residents' 
internships. As Program Director, I received daily updates and resident placement instructions as things 
changed quickly and frequently. As a member of a crisis cell, we had regular virtual meetings, received 
daily emails and reorganization notices. The spirit of collaboration and support in the team has helped me 
considerably. Nonetheless, I spent many hours per day online and experienced fatigue, accordingly. 
The recommendations of the Ministry of Health were/are clear: immunosuppressed patients must remain 
at home and take extra precautions to stay safe. My family, colleagues and friends worry about me and 
encourage me to follow the recommendations. Because my spouse must go to the hospital to treat patients, 
there is added stress for us. Is he able to prevent contamination at home? The Faculty of Medicine and the 
University Hospital Centre quickly organized virtual platforms for telehealth and teleconsultations from 
home. My spouse has become the shopper for groceries and medication since I must stay home. Like many 
patients, I feel like I am losing my autonomy and I wonder for how long... not knowing is difficult for me. In 
addition, the government has announced a shortage of hydroxychloroquine in Quebec. I hope I do not have 
too many problems. Because I am a family doctor, I receive numerous questions from my family about 
COVID-19 as they seek advice for themselves and their children. I respond as best I can but so much 
remains unknown. Nonetheless, I forward interesting articles and offer recommendations.  
As a patient-partner, I am asked to be involved in fund-raising requests for urgent research projects 
“COVID-19 and inflammatory diseases.”  I find it satisfying to be in the action and able to collaborate in my 
own way. However, I feel guilty that I cannot help my clinical colleagues on the frontline. Being a doctor and 
not being able to help because I am also a vulnerable patient is a hard pill to swallow. My three daughters 
(an internist in Montreal, a neurologist, and physiotherapist in a geriatric unit in Sherbrooke) all work in the 
health care system in essential services; they are on call, remain exposed and I worry about them. I also 
feel culpable because I am less available than the other grandparents. I cannot assist my children with their 
The	COVID-19	pandemic:	one	person,	various	perspectives	
Marie-Claude	Beaulieu	
	
53	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
children as I must avoid associated risks. I deeply miss social contact with them all. We meet via facetime 
regularly, and once allowed, began to visit outside two meters apart, but hugs are forbidden. 
A chronic illness for five years with losses, bereavements, reorganizations at work and in life, limitations, 
constraints, adjustments after relapses and infections, has been manageable. I have been able to accept 
all of this because I am resilient. But, when COVID-19 and confinement were added to the equation, I lost 
my bearings and regressed into the familiar processes of loss and grief experienced when first diagnosed. 
My morale took a hit, sometimes showing up as discouragement, other times resulted in tears. Despite 
relatively good arthritis control, I feel sicker and more fragile than before. I harbour many questions; I even 
considered stopping the biological medications. Yes, I would be less immunosuppressed and more "normal” 
yet I know that this is not a solution. My partner and my rheumatologist concur.  
How can I cope and adapt to all this? I continue to walk outside every day, bike, engage in telehealth, eat 
well and practice mindfulness meditation. Yet, my sleep has worsened with me waking up earlier and more 
often. I have limited my exposure to the news, especially in the evening. I talk with my loved ones (family, 
friends, and colleagues) and express my worries when I feel down. I also find it helpful to chat with other 
patients. Since 2018, I have been part of a group of patient-partners in Quebec (PIRA: Patients Interested 
in Arthritis Research). We meet virtually four times a year. The May 2020 meeting was appreciated by all, 
both to share our experiences of confinement and progressive deconfinement. We published a collective 
article that appeared in a journal, the Arthritis Research Canada. 
Despite my efforts, in the midst of messages conveyed in the media about vulnerable and 
immunosuppressed patients, certain contradictions and questions about the severity of the disease versus 
a certain protection against severe inflammatory respiratory syndrome, long-term confinement and 
restrictions, I have become ambivalent. Is it better to contract COVID-19, which may not be that bad, or 
wait for future treatments and vaccines? I mull over questions about serologies, responses to the upcoming 
vaccine, and long-term immunity. It is reassuring to know that other patients have similar vexing issues. I 
must stand firm and remind myself that there are people for whom all this is much worse. I remain hopeful 
while gradually engaging in permitted activities. I wear a face mask and wash my hands often. I continue 
to be involved in work, collaborate on COVID-19 research projects, and I enjoy my family from two meters 
distance! My various roles are in balance, at least for now. 


The COVID-19 pandemic: one person, various perspectives

Laneuville, Laurence

	
VOLUME	8	●	NUMBER	1	●	2021	●	30-32	
©	2021	Laurence	Laneuville.	This	article	is	distributed	under	the	terms	of	the	Creative	Commons	License		
CC	BY.	
International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)																																																																																																																																																																													
	 	
SUPERMAN	DOES	LAUNDRY	TOO	
Laurence	Laneuville	
Medical	Resident,	Department	of	Psychiatry,	Faculty	of	Medicine	and	Health	Sciences,	McGill	University,	
Montreal,	Quebec,	Canada	
laurence.laneuville@mail.mcgill.ca	
	
 
raise for health care heroes appears on factories near highways, covers billboards across the city, 
and rings at the sound of police siren concerts in the evening. The existence of doctors, nurses, 
orderlies, and other allied health care professionals is raised on a pedestal. Suddenly what they 
were doing yesterday merits attention and a wave of recognition flows toward them. I am surprised by my 
own role in this global saga. I am unexpectedly aware of my ordinary daily gestures; my regular hospital 
commute transformed into an epic parade. I am reminded of an old childhood photograph where I stand 
proudly, draped in a fairy dress, shoulder to shoulder with my brother. Halloween, a time of the year when 
we delight in imagining scary characters and evil creatures. Today the threat is real, and our costumes are 
far from amusing. I instantly realize I am a doctor through the eyes of thousands of strangers. I examine 
my hands. Whose are these? What will they accomplish today? 
 
Sitting at home I avidly scroll through the newsfeed: a tsunami of information composed of new daily threats 
and absurd realities flood my mind. Every e-mail notification rings a bell in the silence of my empty 
apartment, threatening like an anvil of doom hovering above our heads. Something from the life we knew 
before has slipped away and cannot be found anymore. The March sky is grey, and the streets are soulless. 
As the harshness of winter recedes, nature enters its yearly revival revealing sidewalks littered with 
shameful garbage and morose plants. It is spring and everything is ugly.  
 
All known aspects of our day-to-day lives are turned upside down. Yet, within my immediate surroundings 
not a single detail has changed. Netflix continues to be a cascade of shows fulfilling our curiosity, neatly 
contained in a square box, while life seems far removed from the one depicted on TV. I wake up every 
P 
Superman	does	laundry	too		
Laurence	Laneuville	
	
31	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
morning, glance at my bedroom window and I remember within the first few seconds that a pandemic is 
taking the world hostage. There is a great conflict between reality and a lack thereof, between the felt 
urgency and the intangibility of what there is to grasp. The morning light shines on my hands. The pandemic 
remains a reality. My shoulders weigh me down as I carry on throughout the day.  
 
The moment arrives when I must cross the threshold of the COVID-19 wards. After many weeks of 
anticipation, I am unspeakably afraid, yet relieved to finally face the scary characters and evil creatures. 
We are at war and I am called to serve; the health care heroes are its soldiers while the enemy is an invisible 
virus. How do we win a global pandemic? How does this all end? There is inherent aggression in this battle 
metaphor, one I cannot quite wrap my head around. My mind is cluttered with diverse images: of families 
losing their loved ones, those who lost their lives, and those left behind. While I recognize our need to 
dominate and conquer this enemy, I can not help but think of the drawback from fighting, which becomes 
inevitable exhaustion. Where do soldiers and casualties in war zones rest? Warriors combat and kill 
whereas doctors provide care and cure. I learn to float somewhere in between the former and the latter: the 
talon and the hand. In this war, I crave the human touch that binds us all together across life, death, and 
everything in between. Fortunate to be young and healthy as I begin my career, I carry an intact reserve of 
soft compassion for the patients I serve. I cultivate a space for these attributes someplace hidden in my 
heart along with my use of modern technical medicine tools. I am a young sailor boarding a ship traversing 
rough seas towards novel, dangerous territories with a picture of a fiancé tucked inside my coat pocket.  
 
One Monday morning I feel nervous because I have been redeployed to an unfamiliar environment 
necessitating untried tasks. I slip a visor over my head, as I seek ease in the ritual of gearing up with 
personal protective equipment. I don different layers, each concealing an unfinished, raw piece of me that 
is not feeling ready yet. Fortunately, the familiarity of medical ward routines reminds me of the unremarkable 
nature of our day-to-day work. Pandemic aside, the electronic medical records annoy me. The nurses chat 
amongst themselves, complaining over their tedious schoolwork and examinations. One staff member 
babbles about her grandson learning to walk for the first time. Endless quiet nights are spent mindlessly 
watching football replays. Loneliness haunts me. Patients are secluded in their rooms; they become a 
diagnosis with documented problems. Their names become familiar; their characteristics are committed to 
memory. Who are they outside this enclosed setting? I am a bystander witnessing a long wait for their lungs 
to recover thanks to a constant flow of oxygen hissing in their room.  
 
One night I admit a lady from the intensive care unit who just recovered consciousness after a protracted 
week of intubation. She frowns and tells me that she would not wish this disease on her worst enemy. She 
reminds me of my mother. She is a kind, tiny, Vietnamese woman with short black hair. She tells me about 
the Asian marketplace I used to go during my childhood anticipating eating delicious banh mi. She 
Superman	does	laundry	too		
Laurence	Laneuville	
	
32	International	Journal	of	Whole	Person	Care	
Vol	8,	No	1	(2021)	
	
embodies the furiousness of a fearless mother and the fragility of a woman who has been worn down by 
countless hardships. She has two adolescent children who work outside the house, one in a grocery store 
– he may have brought the virus home. She had been careful, diligently following all the public health 
recommendations. Now, her entire family is infected, and she ended up attached to a ventilator, a few 
breaths away from death.  
 
I stand two meters apart from her dressed in scrubs and a blue cape, masked, hidden. I look like an 
awkward bird. She cries and declares God saved her. I look at her with my eyes, the only part of my body 
that remains visible. I simultaneously wonder about God, the virus, and the parameters on the cardiac 
monitor. I feel small, albeit immensely privileged. Before I make my way out of the room, worrying I might 
have spent too much time in there, she asks me to write a thank-you message on the board to all her 
caregivers during the critical part of her illness.  
 
I realize something astonishing happened. Her story is probably very common. I am just another health 
care professional. But somehow, we all became wonders amongst many others – like a wave in the ocean, 
a flower in a field, a simple star in the night. It is a quiet insurrection, a successful claim for life in an ordinary 
hospital room. I am struck by the humble, undemanding beauty of this process.  
 
At 5 a.m. the sun rises and shines into the on-call room. It illuminates the sky, promising a bright new day. 
It is magnificent and celebratory. I am grateful that all the patients in my care made it through the night and 
my worries vanish instantly with the dark. While groggy and stale from a nearly sleepless night, I feel 
energized from the excitement of the end of my shift. Ça a bien été. [Everything went OK]. From the 19th 
floor window, I watch hospital staff line up and enter the doors from the parking lot clutching coffee mugs. 
The contrast between the ghosts at night and the mundane workers of the day is quite amusing. No one 
would believe that the hospital houses a parallel fantastical world, where anything can happen, during the 
briefness of a night. We do not believe in fairy tales. The hospital is a serious place. I wonder if the staff I 
sign over to in the morning can smell a subtle jungle whiff on my scrubs. 
 
When I return home fatigue rushes over me, even though the sun gently suggests that I continue with my 
day. I stand by my doorstep and question what a health care hero is. What makes the ordinary 
extraordinary? If a hero defines itself by its distinguishable virtuosity, what does an army of heroes make 
of the concept hero itself? I hear my partner stirring in the kitchen. I carefully remove all my clothes and 
toss my shoes away to avoid contamination. I sit and stare at my backpack. I wonder how many virus 
particles crawl on its surface. My backpack stays silent and seems to pretend life is normal. I toss a long 
overdue laundry load into the washer.  


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