Rounds

Originally published September 11, 2020

I walk to work. I do this every day now.

I have twenty minutes before my morning rounds start. Duty and caffeine propel me. It’s still summer, but there is a subtle coolness in the air. The trees look weary, the leaves ready to cast themselves off to a cold ground.

I think of my dream last night. I can’t remember much other than it involved not being able to breathe. This has been a recurring dream of mine for the last few months. It’s happened so often that it no longer terrifies me. Like my morning walk, I have become accustomed to it. Last night, a translucent hand covered my mouth. Was this God’s asphyxiating hand? In the dream, my skin was darker than my usual light-brown farmer tan.

My forty-ninth birthday is in less than two months. How have I used the years? I try to think back to what I dreamed of being when I was a child. Not a doctor. I don’t remember much. I do remember that I wanted to write books. My grandfather bought me a typewriter when I was nine, and I wrote my first non-fiction book. It was about fish. I just copied a passage from one of my animal books. I do remember that. I typed out what seemed to be a rather hefty manuscript. It was probably only 10 pages but I felt as if I had completed a mammoth undertaking.

It took me a while to figure out how to type all the words, since the letters were scrambled on the keyboard. After I wrote, I traced out a shark on a sheet of paper and put my title and name underneath. I cannot remember how I bound the pages together. I vaguely remember punching holes and tying the pages together with a red string. There was a sense of completion.

I am not nostalgic for the past. If I am nostalgic for anything, it is for the greater simplicity of my earlier adult existence. Teleological living is exhausting. Mapping out life as a series of tentative equations linked to one another, and too many of the numbers are so light as to be indecipherable.

Robert Sapolsky, the Stanford University professor who has made a career of studying human behavior, wrote that ambiguity is what distinguishes the time of Covid. Ambiguity is quite different from risk. Some people thrive on risk, but people, all people, consistently hate ambiguity.

Sapolsky notes that we are accustomed to evaluating risk. We figure the odds. We utilize our executive functioning. If it works, we feel rewarded. Smart. This is especially true of physicians.

"In contrast, when we wrestle with ambiguity, we activate brain regions central to anxiety and revulsion, and if there's a good outcome, we mostly feel less dread,” Sapolsky writes.

Normally, we can reason our way to a logical response when it comes to health issues, at least in the developed world. We don’t necessarily make good decisions—we tend to rationalize our impulsive behavior—but we know the terrain.

By contrast, "our brains unravel and run amok in the empty moonscape of ambiguity. And that's what our pandemic world is now."

There are questions, none of which come with answers.

Can airborne coronavirus infect you, even if you are appropriately socially distanced?

Still not clear.

When will there be a vaccine?

Too early to say.

How long do you make antibodies after surviving Covid-19?

Researchers are only in the preliminary stages of understanding that.

Will a second wave of sickness this winter dwarf the first wave (as with the 1918 flu pandemic)?

Why does Covid-19 ever kill a perfectly healthy young person?

In response to the unpredictability, some people ignore the whole thing and ride their Harley to Sturgis while others refuse to leave their house, for anything, under any circumstances.

"A time like this can make us gyrate between paralysis and impetuousness; blind us as to whose well-being matters; drive us to a frantic search for attribution that leads us to scapegoating. We must guard against how ambiguity can bring out the worst in us,” Sapolsky writes.

I treat women with breast cancer: a known phenomenon. But I realize that, in a deep way, all disease carries that sliding terror. I comfort my patients with my knowledge of risk: for some this means estimating the probability of a cure with current treatments, for others estimating their chances of living another six to twelve months.

Just as I did as a child, I type, organizing the letters of the alphabet. Carefully, I trace the picture of the shark. I name sea creatures, copying words from one book to another. When it's all done, I tie the pages together with red string.

Only now the uncertainty of where to go next, of not knowing whether to turn left or right, swims beneath my words. At certain times, it is paralyzing. As a doctor, I’m no different from anyone else.

I pass beautiful small blue flowers. I don’t know their name, but their color and delicate architecture strike me as stunning. I stop and snap a picture. Under the elevated tracks, a train barrels off eastward. I am near the hospital now and the sound of the train becomes fainter.

Alberto Montero is clinical director of the Breast Cancer Medical Oncology Program at University Hospitals Seidman Cancer Center in Cleveland, Ohio. He is an associate professor of medicine at Case Western Reserve University School of Medicine.

That Uncertain Feeling ::: The Everly Brothers

My Lord Is Writing All The Time ::: The Heavenly Gospel Singers

Train In The Distance ::: Paul Simon

The Abyss ::: Kim Taylor

Nothing ::: The Fugs