[Sent – 22 March 2020 to the 170+ surgeons et al of our Surgical Ethics (Education) Consortium]
Greetings from St. Louis and WashU. I am sending this communication a bit early because so much has changed so radically and rapidly for each of us in the last few weeks. As the construct below delineates, the coronavirus pandemic is creating an escalating surge in need/demand that is threatening to overwhelm our capacity to respond and is confronting us with ethically disturbing choices/actions
Be safe. And please do not hesitate to call or write if having an exchange – private and confidential – might reinforce your integrity and refresh your courage.
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[selection from Literature and Medicine essay re Albert Camus’ novel The Plague]
Let me explain why I quickly came to appreciate the broad-shouldered Dr. Bernard Rieux, an unassuming 35-year-old physician in Oran given to absentmindedness whose loyalty to his poorer and most at-risk patients demonstrates his intent to be humane and to exercise a social conscience. Soon after the morning he steps on something soft – a dead rat – Dr. Rieux, “torn between conflicting fears and confidence”, is the first among his colleagues to utter the word ‘plague’. It takes the Oran city officials several meetings to be convinced to act. But Dr. Rieux knows that the patients have to be evacuated. Families resist, realizing they will likely not see the victim again – “Have some pity, Doctor!” Dr. Rieux has “nothing to look forward to but a long sequence of such scenes renewed again and again”. His perspective on pity is cause for pause. As Camus has him argue – “One grows out of pity when it’s useless”. Dr. Rieux admits – “For the moment, I know this – there are sick people and they need curing. What’s wanted now is to make them well. I defend them as best I can. Against whom? I haven’t a notion. When I entered this profession, I did it because it was particularly difficult for a workman’s son like myself. And then I had to see people die. I saw that I could never get hardened to it.” He sometimes hears well-meaning radio broadcasters call out fervently to the quarantined city, “Oran, Oran, we’re with you!” His assessment -- “They are too remote”. A frightened woman tells Dr. Rieux – “You haven’t a heart!” His exhausted reaction – “A man can’t cure and know at the same time. So let’s cure as quickly as we can. That’s the more urgent job”.
And then there is Jean Tarrou, the good-humored but estranged son of a successful prosecuting attorney. He is a young traveler of private means and new to Oran who “seemed an addict of all normal pleasures without being their slave”. A faithful diarist, he “had a habit of observing events and people through the wrong end of a telescope. He sets himself to recording the history of what the normal historian passes over . . . seemingly trivial details which yet have their importance”. He accompanies Dr. Rieux on home visits and gives him a safe conversation partner. Sitting across from Dr. Rieux at his office desk, Tarrou notes, “In a fortnight, or a month at most, you’ll serve no purpose here. Things will have got out of hand”. He continues as Dr. Rieux nods, “The sanitary department is inefficient – understaffed, for one thing – and you’re worked off your feet. . . . Why not call for voluntary help? . . . I’ve drawn up a plan for voluntary groups of helpers. Get me empowered to try out my plan. . . . I have friends in many walks of life; they’ll form a nucleus to start from. And, of course, I’ll take part in it myself”. Dr. Rieux replies, “I need hardly tell you that I accept your suggestion most gladly. But I take it you know that work of this kind may prove fatal to the worker”. Later in this evening conversation, they sit together on a terrace where Dr. Rieux has earlier remarked -- “you’d think that plague had never found its way up here”. Tarrou reflects -- “I only know that one must do what one can to cease being plague stricken, and that’s the only way in which we can hope for some peace or, failing that, a decent death”. What then does it mean to live life well? Tarrou’s answer – to minimize “lapses of attention” that result in harming others, in turning others into victims. Tarrou’s resolve -- “All I maintain is that there are pestilences and there are victims, and it’s up to us, so far as possible, not to join forces with the pestilences”. It is indeed “a wearying business” to resist slipping into or even purposefully making shortsighted, self-centered, damaging choices – “a vigilance that must never falter”.
Two days after an official communiqué feeds optimism in Oran that the plague is finally ending, Tarrou closes his last diary entry with shaky handwriting – “Feeling very tired tonight”. Ganglia swell under his burning skin. There is a rumbling in his chest. Dr. Rieux can “only watch his friend’s struggle”. Tarrou has “lost the match”, as Dr. Rieux puts it. But Tarrou endures the experience without flinching and lucid. Who notices? Who understands what his life and his death were about? Perhaps only his friend Dr. Rieux who himself has received word that morning of his own wife’s death, a tuberculosis victim who died alone in a sanitarium miles from the quarantined city.
As the survivors in Oran celebrate the plague’s receding after killing thousands, Dr. Rieux chooses instead to draft a chronicle so that he will not be among those who remain silent. He chooses to bear witness for the plague-stricken victims – “The mothers, husbands, wives, and lovers who had lost all joy now that the loved one lay under a layer of quicklime in a death-pit or was a mere handful of indistinctive ashes in a gray mound – who gave a thought to these lonely mourners?”
