Fragility and Hope: Practicing Medicine in a Pandemic

The May 6 Theology Town Hall featured Dr. Brian Volck and Dr. Matthew Loftus, who have practiced medicine in a variety of settings (including Baltimore city, the Navajo Reservation, South Sudan, and Kenya, among others). They reflected on practicing medicine in the time of a pandemic. Dr. Volck’s remarks are included below, or you can view the full town hall. Prior writings by Drs. Loftus and Volck on the coronavirus pandemic include the following:

Practicing Mercy 
Dr Brian Volck
One evening not long before the statewide order to shelter in place took effect, I and my wife, Jill, were climbing into bed when she asked, “Is someone knocking at our front door?” I thought I’d heard a soft voice from the sidewalk below a few minutes earlier, but now I, too, could hear a faint tapping. Upon opening the door, we found a boy about two years old dressed in pajamas and shivering in the cold night air. A slump-shouldered woman sat on the front steps. She looked up at us with heavy-lidded eyes and said, in the muffled undertone of someone who’s had far too much to drink, “We need help.” There was no one else nearby – no car, no clue why she had chosen our house. I was wary, uncertain what to do. To be honest, I was a little scared this was a setup, a ploy to get into our house for who knows what mischief. Jill, however, took one look at the child and said, “Come on in and get warm.”

We helped the mother to her feet, picked up the boy, and brought them both inside. She was clearly intoxicated. Her clothes were neither torn nor dirty, just disheveled. She was missing a shoe. There were no signs of physical trauma. The boy looked scared, staring silently at his mother, his eyes wide, his nose runny – whether from tears or a cold it was hard to tell – and the diaper under his pajamas was twisted to the side as if he’d been dressed in a hurry. In time, he stopped shaking as we talked to his mother. She said she was trying to get to the baby daddy’s house but had lost her way. She lived with her mother in another neighborhood where she said she felt safe. For some reason, though, she didn’t want to return there tonight. She had no cell phone or ID and couldn’t remember anyone’s number.

It was clear they needed what’s traditionally been called a corporal work of mercy. What wasn’t clear was how to help them. Jill and I are both physicians, but we hadn’t trained for this. We brought them something to drink, some cookies for the boy to eat, then Jill quietly stepped away to call our pastor in search of advice. He encouraged her to call the police, which she did. By the time the officer arrived, the boy was in my lap, talking to me while rubbing his snotty nose in my shirt. We were not a good example of social distancing. The police officer was annoyed at us for letting strangers in the house. Didn’t we know how dangerous Baltimore gets at night? In the end, however, he managed to trace down the mother’s mother, who quickly drove to our house to take her daughter and grandson home, thanking us profusely. The officer called Jill fifteen minutes later to say that the boy’s grandmother was grateful to have the two of them back rather than with the baby daddy, whom she described as an abusive alcoholic. “Mercy,” I said. Mercy, indeed.  

I share this story because it can help us think theologically about health care during the COVID-19 pandemic without getting lost in a thicket of biomedical details. When Jill welcomed two strangers in our living room that evening, we were making it up as we went along. Few of us like to think of our personal physician doing that with us, but many cases don’t fit the textbook descriptions. This was one such outlier. Yet we’d been practicing for these moments since our medical school days, when we formed habits essential to our profession, habits like as prudence, courage, and truthfulness. No one in our rigorously secular medical school or residencies called them virtues. No one quoted Aquinas, Alasdair MacIntyre, or Stanley Hauerwas.  Some of our mentors admonished us to leave questions of God to the hospital chaplain and refer any moral dilemmas to the ethics committee. But, in retrospect, I see all that training now through theological eyes, further refracted by my more recent formation as a lay oblate in the Benedictine monastic tradition.

I have time to name just two such habits. The first is hospitality, something that seems conspicuously absent in hospitals today. Yet, “hospitality” and “hospital” derive from the single Latin word, hospes, which can mean both “guest” and “host.” What’s more, these words share a root with the English word “hostile.” Linguists trace these surprising connections back to a Proto-Indoeuropean root *ghos-ti- , which can mean “guest,” “host,” “stranger,” and “foreigner.” This jumble of contradictory meanings also appears in the ancient Greek word xenos, from which the fourth century Byzantine xenodochia – the first true hospitals – took their name. Etymologically, then, xenophobia may be less about fearing the stranger than fearing what we, as the host, might be asked to do for her.

In most traditional cultures, hospitality is understood as a duty and a danger at the same time. Host and guest enter a relationship of mutual obligation: the host offers protection and inquires after the guest’s needs, doing her best to meet them. The guest does not abuse the host’s generosity, and sincerely pledges to reciprocate. But a guest’s inability to repay the favor should make no difference to the host. Chapter 53 of the Rule of St. Benedict says, “All guests who present themselves are to be welcomed as Christ.” That sets a pretty high bar – especially now, when it might literally make you sick –  but the practice of hospitality requires the virtue of courage, which doesn’t mean you’re not afraid, but that you are afraid and you do it anyway.

A hospitable hospital will welcome all patients, not at unnecessary risk to its healthcare workers, but through a series of calculated risks inherent to the profession, addressing present need before taking into account ability to pay, documentation status, cognitive ability, or productive potential. That’s well worth remembering in a time of contagion and social distancing, whether we’re staffing hospitals, debating public policy, thinking about shut-in neighbors, or opening the door to strangers. Hospitality is risky business, but from Abraham’s day to ours, when has it been otherwise?

The second habit is stewardship, a word whose long, strange history I wish we had time to discuss. Faithful stewardship requires an awareness of place, need, and limits. Chapter thirty-one of St. Benedict’s Rule lists duties of the monastery cellarer, the monk who manages the material goods of the community:

He must show every care and concern for the sick, children, guests and the poor, knowing for certain that he will be held accountable for all of them on the day of judgment. He will regard all utensils and goods of the monastery as sacred vessels of the altar, aware that nothing is to be neglected. He should not be prone to greed, nor be wasteful and extravagant with the goods of the monastery but should do everything with moderation and according to the abbot’s orders. Above all, let him be humble. If goods are not available to meet a request, he will offer a kind word in reply, for it is written: “A kind word is better than the best gift.”

What would it be like to conduct our debates about COVID-19 testing, medical resource allocation, and regional or local mitigation practices with this understanding of good stewardship? How would our lives be forced to change if we looked seriously at our city or neighborhood, “aware that nothing is to be neglected?” What might happen if we accepted the limits of our technological fixes for individual problems and used what’s at hand for the community’s good – especially our presence, our embodied witness in this time of grief and isolation?

I seriously doubt thick accounts of practices like hospitality and stewardship will dominate the fractious COVID-19 response chatter anytime soon. The U.S. medical-industrial complex is too technology-driven, too commodified, and too individualistic to consider them in any but the most superficial fashion. But people of faith must, I believe, ground themselves in such habits before engaging the disembodied abstractions of secular bioethics or the acrimonious partisan harangues that now pass for public debate. In a world of suffering, habits of mercy make strong medicine. The eighteenth century Hasidic master, Rabbi Zusya of Hanipol, once said, “All God does is mercy. Only that the world cannot bear the naked fill of his mercy, and so he has sheathed it in garments.” I’m pretty sure that we are some of those garments – not just healthcare workers, but all of us. And even in this strange time when we’re overtaxed, anxious, and more than a little afraid of who might infect us or what nonsense our supposed leaders are fomenting, God still calls us to be garments of mercy.