Spring 2022 (Volume 32, Number 1)
A Century of Progress?
By Philip A. Baer, MDCM, FRCPC, FACR
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“History doesn't repeat itself, but it often rhymes.”
– Quote attributed to Samuel Clemens (Mark Twain)
The pandemic we are all tired of continues to fatigue
us physically and mentally. Numbers spew out hourly
from the information firehose: cases, hospitalizations,
intensive care unit (ICU) admissions, deaths, percent
vaccinated, testing backlog, and more. Each number
comes with many flavours: municipal, public-health unit
level, provincial, national, and international. Even within
the span of reasonable debate, one can find incredibly
diverse and conflicting sets of views covering essentially
all possibilities: we are doing too much or too little; we
are acting too late or prematurely; we should or should not
follow the example of some other place “X”.
So, what can one do? Minimize exposure to conventional
media, such as television, radio, and newspapers, to
start. Of course, social media is flooded with memes, GIFs,
and posts, so turn that off as well. Good luck trying to stop
family, friends, and colleagues from discussing the number
one concern of the day.
Perhaps a more promising escape is to history and to
fiction. Pandemics are richly represented in movies and
books. Modern takes such as “Contagion,” “28 Days Later,”
“Outbreak,” “I am Legend,” “The Hot Zone,” and the Canadian
film “Pontypool” may be too closely linked to current
events to provide relief. A classic like “The Plague” might
be better.
I found what I was looking for in “The Pull of the Stars”
by Emma Donoghue, who now lives in London, Ontario. In
2018, she decided to write a book centred on the events
of the “Spanish flu” pandemic of 1918, and its particular
impact on pregnant women and those caring for them at a
hospital in Dublin. My wife volunteered us to moderate a
discussion on the book at our local book club, populated
by many retired English teachers and professors, so we had
to parse the manuscript much more carefully than those
reading casually.
In doing so, striking parallels emerge with our current
situation. Progress in technology and in science has been
dramatic in the last century, but human behaviour and
our reaction to crisis is not that different. Viruses were
unknown in 1918, so theories abounded as to the cause
of the pandemic, including World War One and various
toxins. Spain was open in its reporting of the pandemic,
hence the “Spanish flu” name, though it apparently originated
in the U.S. This time around, we had initial names
like “Wuhan flu” and equally speculative origin stories involving
lab experiments gone wrong, wet markets, human
incursions into the wilderness, and others. Blaming South
Africa for Omicron rather than lauding scientists there for
identifying this variant is another example.
Crisis as opportunity is another theme common to both
eras. In the book, doctors are in short supply, giving nurses
and midwives more agency than they would normally have
been allowed to exercise. Similarly, we currently have leveraged
the expertise of pharmacists to deliver vaccines far
more than they usually do, and we have created teams to
extend the reach of our small cadre of ICU and infectious
disease physicians to deliver care to all who require it.
Other similarities abound: “Health care heroes” is a
familiar label currently, often applied by our leaders to
those who pre-pandemic were toiling away in difficult
and precarious jobs for low pay, but whose value has
belatedly been realized. Similarly, the novel highlights the
efforts of those toiling with little recognition in the pandemic
trenches: volunteers, junior nurses, midwives, and
orderlies.
Equity issues have been highlighted in our current pandemic,
with marginalized and racialized workers who must
work in congregate settings at the highest risk of infection.
A century ago, food insecurity and poverty were rampant,
and outcomes were equally skewed.
“Patient first, hospital next, self last” is a quotation from
the novel which resonated with me. That is definitely a recipe
for burnout, and unsustainable beyond the initial response
to a pandemic or any other crisis.
Gender bias in 1918 was not surprising. The book features
male orderlies lording it over better trained female
nurses, and male doctors of any specialty exercising clinical
authority over trained midwives. Today, we still have an
embedded gender pay gap in medicine in Canada, and a
recent profile on the fate of the first female head of cardiac
surgery at McMaster shows we have not come as far as we
thought.1
Masking controversies and unconventional remedies
(onions and garlic vs. ivermectin) are well-represented as
well in both eras.
Finally, my research for this article revealed that
Edvard Munch was a survivor of the Spanish flu and
painted a self-portrait at the time. No, it was not “The
Scream,” which was painted in 1893, but rather “Self Portrait
with the Spanish Flu,” painted in 1919, and viewable
at the link referenced below.2 If that intrigues you, you can
learn more about using art to manage the stress of medical
practice in the final reference below, featuring a program
pioneered at Harvard and now offered in Canada by the
Art Gallery of Ontario.3
Do whatever works for you and stay safe.
Philip A. Baer, MDCM, FRCPC, FACR
Editor-in-chief, CRAJ
Scarborough, Ontario
References:
1. Frangou, Christina. “The Only Woman in the Room.” Toronto Life. December 30, 2021. Available
at torontolife.com/city/irene-cybulsky-surgeon-fired-for-being-female-hamilton-general-hospital/.
Accessed March 8, 2022.
2. “Self Portrait with the Spanish Flu.” Metmuseum.org. Available at www.metmuseum.org/art/collection/
search/668328. Accessed March 8, 2022.
3. Francine Kopun “For physicians stressed out from COVID-19, a brush with fine art might be just
what the doctor ordered?” Toronto Star. December 28, 2021. Available at www.thestar.com/news/gta/2021/12/28/for-physicians-stressed-out-from-covid-19-a-brush-with-fine-art-might-be-just-what-the-doctor-ordered.html. Accessed March 8, 2022.
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