Every night at 7 p.m., residents of Manhattan, where I live, fling open their windows. For about five minutes they cheer, shout, whistle, and bang spoons on pots in acknowledgment of all who put their lives on the line to care for those suffering from coronavirus.
The phenomenon is rumored to have begun in Italy—where lockdown has dragged on the longest. But it has since spread to Spain, France, and even to India. In the United Kingdom, it’s called the “Clap for our Carers” tribute—an expression of appreciation. Even the royal family participates.
My children love it. They run to the window, push up the glass, and add their voices to the din. They clap for their Uncle Mike, who is a medic and fireman, and for me, a physician.
As we return to the dinner table and the last shouts fade away, I find myself at once heartened and perplexed by the display of gratitude. Do we deserve it? Wouldn’t others with our training do the same? Would they clap if they knew that—hypothetically—if we all fell sick, those of us on the front lines might receive a ventilator, and they might not?
Hospital ethics committees around the country have been debating how to approach the looming shortage of mechanical ventilators. First come, first served? A lottery system? Or an assessment based on likelihood of recovery? Should age or terminal disease affect this assessment?
One point of contention that has particularly intrigued me is whether health care workers should be prioritized. Many feel that they should. Medical professionals are a scarce resource, the logic goes, akin to N95 face masks. We must do everything we can to conserve them. Others argue based on morale. Fighting a pandemic with limited resources is hard enough—doctors and nurses may mutiny if their well-being isn’t considered paramount. And then there is the issue of competing obligations. Sure, health care workers are responsible for caring for the sick, but they also have commitments to their own families and neighbors.
Less often, over the last few weeks, have I heard my fellow physicians voice a willingness to “go down with the ship.” Maritime tradition holds that in an emergency, captains either save their passengers and crew, or they die trying. Medical ethics emphasizes that physicians have a duty to care for patients, even in crisis. Should we doctors be willing to serve, no matter the cost, and to put ourselves last? For my own part, I’m inclined to say yes, even if the personal protective gear proves inadequate. But I’m on the favorable side of fifty, in good health, and not afraid to die. For me, it doesn’t seem too much to ask. But this isn’t the case for everyone.
After the 2003 SARS epidemic, a survey of health care workers in New York City hospitals found that just under half would be willing to serve in another SARS outbreak. They counted the cost and determined it wasn’t worth it. They worried about their families and about their own health.
There’s no way of knowing for sure, but my hunch is that far more than half of New York’s health care workers are serving in this present crisis. The same will probably be true as disease acuity shifts to other locales. Health care workers are rising to the occasion. But it’s not just doctors and nurses.
Massive teams are involved in caring for patients—not least, those who provide meals, security, and environmental services. Consider this last group. The hospital would completely fall apart if the cleaning crew went on strike—especially now, with our unprecedented guidelines for deep sanitization of public spaces. Janitorial staff are as critical to the care of patients as doctors. Would my physician colleagues agree that they also should receive priority for ventilators?
All of us in health care depend on an even wider circle of essential workers in grocery stores, pharmacies, delivery services, public safety, and transportation. As with frontline health care workers, large numbers of people in all of these groups are falling sick. In times of crisis, it’s natural to view those working in risky roles as victims of an unjust system rather than as unsung heroes.
The truth is that there is an ordinary sort of heroism—that of doing one’s work well and resisting fear. Every day at the hospital, I encounter ordinary heroes. My priest helped to construct a pop-up hospital in Central Park and then phoned to ask what else he could do. “I’d even come take the trash out of the hospital, if they’d let me,” he said. In the midst of this crisis, we need to call one another to ordinary heroism.
Perhaps we can start at 7:00 this evening, when the windows fling open and the whistling begins. Instead of clapping for our carers, we might holler for our heroes—which has the potential, of course, to include every one of us.
L. S. Dugdale is a physician and medical ethicist at Columbia University and author of the forthcoming The Lost Art of Dying.