Dodging the bullet

We roll out of bed, groggily trudge down the stairs, open the front door, and pick up the newspaper – oblivious to the risks inherent in that short journey. But COVID19 has heightened our awareness of risk, making a trip to the grocery store an exercise in sanitization and personal protection – something previously so unfamiliar to us. How we approach, react to, and deal with this new reality significantly affects not just our physical health but our mental health and happiness as well.

There are three critical components to successfully navigating the challenges of our current pandemic:

1) developing the ability to adjust and accommodate to the new and changing conditions imposed by COVID19;

2) finding meaning and peace in the myriad aspects of our lives – in other words, changing our focus from danger and alarm to safety and calm, and;

3) making decisions about COVID19 based on a risk-benefit analysis.

These three components also encourage our practice of resilience.

Psychologists define resilience as the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress. As much as resilience involves “bouncing back” from these difficult experiences, it can also involve profound personal growth. Becoming more resilient not only helps you get through difficult circumstances, it also empowers you to grow and even improve your life along the way. (https://www.apa.org/topics/resilience)

I’ve been thinking a lot about resilience lately, as I’ve emerged from the social isolation of the past 2-3 months and, more recently, traveled from Israel to Toronto. The bubble of social isolation, although challenging at many levels, was just that: a safe bubble. Once I began to socialize again, I had to constantly re-think my risk practice – to carefully consider who I spent time with, how close we got physically, and whether I wore a mask or not. Context was everything: meetings outdoors were safer than indoors; friends who had maintained strict isolation were safer than those who hadn’t. It was soon clear that unless I was resigned to living in a self-imposed prison cell, there would always be some, hopefully minimal, risk of infection during this pandemic.

The first component of successful coping with COVID19, stated above, involves adjustment to changing conditions and this requires making educated, reasoned decisions. To that end, we need to be strategic – to have all of the available facts at hand – something not always so easy in these days of fake news, misinformation, and hurried or sub-standard medical studies. As a physician, I am diligent about staying professionally up to date on COVID19. Friends and family often call on me to interpret news headlines so that they can better understand potential but disproven cures like hydroxychloroquine, or preventive home remedies such as hot water gargles.

However, being informed about a situation does not necessarily lead to safe choices. How many unwanted or unexpected pregnancies occur despite the availability of simple, effective methods of contraception, for example? Fear, denial, and even inconvenience impair our ability to move decisively. We can address fear in many ways, including practicing meditation, mindfulness, distraction (with physical or cognitive exercises including hobbies such as knitting, art, and writing), faith, and utilizing social resources (family and friends) for support. These approaches help define the second component mentioned above – finding meaning, peace, and safe solutions in a world of danger, chaos, or aggravation. The goal is to maintain some semblance of normalcy without suffering PTSD or other long-term effects of stress. As the description of resilience infers, this challenge can be empowering and change the direction of your life in powerful, positive ways – if you work at it.

The third aspect of coping with challenge, in what I like to think of as “getting past and beyond COVID19”, is our use of risk-benefit analysis. We’ve been doing this consciously, if not sub-consciously, since our slow emergence from strict isolation. I spent my past three months in Israel, where the COVID19 battle has been well fought – with low numbers of infection per capita and a minimal mortality rate. Of course those numbers are now increasing as the economy has reopened. In May, Israel started to ease tight restrictions and I began to see friends, outdoors mostly, and even hosted small numbers on our patio. Two weeks ago I started teaching again – this time as a mentor for five medical students in the ER at Rambam Hospital in Haifa. Immediately, I was thrown into a potentially higher risk environment than I’d been in since the beginning of COVID19. Then, at the completion of the teaching rotation, I flew from Tel Aviv to Toronto – another potentially high-risk activity that has become prohibitive or at least intimidating for many people.

How did I overcome my unease with these scenarios and how will I plan to cope in the upcoming weeks, once my mandatory Canadian quarantine is finished and I start to work again as an ER physician here in Toronto? Firstly, my three-pronged approach, as described above, has served me well thus far. In addition, in assessing risk, I’m wary to avoid the trap of availability biases, a concept discussed in detail in the international bestseller by Daniel Kahneman, “Thinking, Fast and Slow”. Citing research by Paul Slovic, he describes how people make judgments and decisions by consulting their emotions. Kahneman states:

The affect heuristic is an instance of substitution, in which the answer to an easy question (How do I feel about it?) serves as an answer to a much harder question (What do I think about it?). An inability to be guided by a healthy fear of bad consequences is a disastrous flaw.

I would add that an unhealthy or excessive fear can have equally disastrous outcomes, including anxiety, depression, and prolonged social isolation. Risk assessment is not for the faint of heart and objectivity must be its guide.

Fear may not be the leading emotion that leads us astray – other factors can also derail or bias us. These include malaise or an attitude of “laissez-faire”, such as pandemic fatigue – an unwillingness to adhere to enforced restrictions and a minimization of risk. It’s a predictable consequence of prolonged enforcement of tight or new restrictions, yet imagine an employee in a high-risk environment such as a virology lab, radiation facility, or any quality control position who decides to “let down his guard” for any reason. We’re now in the situation where government and policy makers must address the public health repercussions of a growing population that refuses to wear masks or shirks the practice of “safe distancing”.

And finally, we can’t ignore the “fun” factor of risk-taking  – like the thrill experienced by a teenage girl who slips out her bedroom window for a prohibited date or a secret kiss. We’ve all likely done something of the sort – and felt that adrenaline surge and release of dopamine – the “feel-good” hormone. It is claimed that those who are perpetual high-risk takers are “adrenaline junkies” of sorts. How many stories and Hollywood movies reward bravado and defiance? Playing Russian roulette with COVID19 might just be the kind of high jinx that teens and young people are into, yet not all high-risk escapades are bad; they can also take on epic and heroic proportions.

High risk on the high seas is impressively portrayed in a Hollywood blockbuster I recently watched on my flight to Toronto. “Midway” highlights the incredible bravery of thousands of men, some of whom turned the tide of major battles. One of these heroes was Richard Halsey Best – a bomber pilot who not only survived Midway, but who personally helped sink two Japanese aircraft carriers. Ironically, it was not bullets, bombs, or dumping at sea, that took Best out of action, but a heated oxygen tank that released toxic fumes while on his last sortie, resulting in a reactivation of his latent tuberculosis. Here was a man who chose to take huge risks and who survived, against tremendous odds, only to suffer from a crippling lung disease because of a trivial oversight. One might think of him as a tragic figure but his resilience shines through both after the war and in his dogged determination during the war. The latter is perfectly exemplified in the movie when Best dives his F-4 Wildcat at an impossible angle towards the target on the Akagi warship – a huge painted, red “circle of the sun” – with such complete intention and fearlessness that it’s breathtaking. That moment captures the purely unselfish, purely unadulterated risk that heroes take to save the lives of others.

We’re not asked to be heroes like Richard Best, and I can’t imagine that kind of bravery, but they teach us an important lesson. Risk is not categorically bad – there are nuances to it and consequences, good and bad. In addition, there are no guarantees in life. You can die with COVID19, not from it, or you can die from a thousand other causes. So don’t let this pandemic get in the way of your life.  Live with purpose and meaning, notwithstanding the risks. As another heroic navy figure and a fellow Canadian physician, Dr. Bonnie Henry, stated during this pandemic, “Be calm, be kind, be safe.” My neighbour, Judy, wisely advised me: “Just keep a watch on it (COVID19) and HaShem will take care of the rest.” My humble motto is: keep dodging the bullet and be the best you can be!

PHOTO CREDITS:

1. Geran de Klerk; 2. Karim Manjra; 3. Michal Parzuchowski; 4. Amelie and Niklas Ohlrogge; 5. Sammie Vasquez; 6. Olli Karola; 7. Aziz Acharki