The cost

Having been married to a really amazing person who was diagnosed with stage 4 lung cancer at the age of 34 and tragically succumbed to the disease at the age of 36 has, I think, given me a perspective on the COVID-19 pandemic that most people my age don't have.

For a related example, during my early adult years, I didn't bother getting an annual flu shot. I'll be fine even if I do get the flu, so what's the point? I thought. I know this is a very common attitude.

After Cara became ill with lung cancer, she passionately advocated for everyone to get their flu shots. Obviously, I did get mine, and I've continued to ever since, because now I understand - the reason it's important for young, healthy people to get their flu shots isn't to protect those young, healthy people from the flu; it's to decrease the chances that someone like Cara, who had compromised lung function and at certain points during her various treatments a compromised immune system, would get the flu. Getting a flu shot is such an easy thing to do but something with such enormous benefits if everyone does it. (Yes, flu shots aren't perfect and sometimes there are outbreaks of a strain that the shot didn't cover - that doesn't mean that flu season wouldn't have been much worse without the flu shots.) But before it was made personal, the importance of getting those shots never got through to me. So now I try to remind all the people out there who are lucky enough to not yet have had it made personal.

Now we're facing a historic outbreak of a viral respiratory infection that is far more deadly than the flu, and there's no shot we can get to protect ourselves and our vulnerable loved ones. So we have to do other things to protect all the vulnerable people out there - be diligent about washing our hands, don't touch our faces (these are things that would help against flu outbreaks too, and hopefully that's a lesson that society will learn going forward), and most important right now, social distancing.

It's simple math and biology. When an infectious disease is spreading in a population and we don't know who all has it, the more contacts there are between people, the more likely it is that the disease will spread. And with this particular disease, unless strong containment measures are taken, exponential, uncontrollable growth is inevitable, and it will result in our health care system being overwhelmed. There's a tendency for people to think "it can't happen here" but it can and it will. Look at places like Italy and Spain where the body counts are piling up and doctors are having to triage patients like during wartime. People who have severe symptoms and are too old are simply not given life-saving treatment because the resources just don't exist. It's already starting to be like that in New York City, and without serious intervention it will eventually be like that Everywhere. In. The. Country.

I've been thinking a lot about that twenty month period of time between Cara's diagnosis with lung cancer and her death, and what that time would have been like if it had happened against the backdrop of the raging COVID-19 pandemic.

Three months after Cara's initial hospitalization, her first treatment failed, her condition dramatically worsened, and we spent Thanksgiving in the ICU leading up to a surgery to create a window in Cara's pericardium and drain the fluid that was accumulating in the space around her heart. Imagine if that had happened while ICUs were overwhelmed with COVID-19 patients and there were no available beds. Stage 4 lung cancer is incurable; although some people now live a long time with the disease thanks to new treatments, the expected prognosis is still, ultimately, death. Someone with a terminal illness would not and could not be a top priority for an ICU bed in such a situation. Chances are Cara would have been dead. It would all have been over just three months after her diagnosis. Those additional seventeen months that have so many memories that I cherish so much (because that Thanksgiving in the ICU my honest assessment of the situation was that she likely did not have a whole lot more time left) would never have happened. And that's what will happen to so many people if the pandemic spreads unchecked. So many people will die premature deaths of COVID-19 and of so many other things, deaths that could have been prevented if the health care system wasn't so overwhelmed.

After the Thanksgiving in the ICU, Cara started a new treatment and her condition improved greatly. She never again returned to the ICU until the week before her death. But imagine also how different those seventeen precious extra months would have been if COVID-19 had cropped up during them. Cara would have had to live in constant fear of contracting the illness. She couldn't have continued working. She wouldn't have been able to hang out with her friends. The two of us couldn't have done so many great things that we did together. We couldn't have gone out and done pretty much anything other than go for walks. And walks are wonderful and I'm sure a lot of us are gaining newfound appreciation for them right now, but there are so many other things, so many wonderful social activities - for humans are social creatures, after all - that we and especially Cara would have had to miss. She would have been essentially trapped in our home for most of every day to reduce her risk of getting the infection and knowing Cara, I know how awful that would have been for her. And if I happened to find myself in any situation where there was a fear I might have contracted the virus, I'd have had to physically separate myself from Cara, and it's hard to imagine how hard that would have been for both of us, the whole time knowing that she had a life-threatening disease and every moment we had together was precious.

The spring after Cara's diagnosis, I successfully defended my dissertation after many long years of graduate school. Cara was so proud of me and so excited that she got to walk across the stage with me as I received my diploma.

Imagine if that had happened against the backdrop of COVID-19. The dissertation defense would have been virtual. There'd have been no going out to celebrate with family. The graduation ceremony wouldn't have happened. Cara wouldn't have gotten to walk across the stage with me. So many happy memories would never have been created.

In early March of 2015, Cara and I took a trip to Miami Beach together.

Obviously, that trip would not have happened during a COVID-19 pandemic. It was really great that we got to take that trip because it had been a very cold winter and that was really hard for Cara. We had no idea at the time she only had a month and a half to live. Because of that the memories are extra special to me.

When Cara did go, in a room on the Cleveland Clinic's palliative care floor, her mother and I were with her, and one or the other or both of us had spent a great deal of the time with her during those last few days. Right now at the Clinic there are no visitors to hospital patients with certain very limited exceptions. So for most of that time, at least until it became clear that the end was imminent, Cara would have been scared and alone in her hospital room. Or if the hospital system had become overwhelmed, maybe she wouldn't have even been able to receive proper end of life care.

And of course after Cara died, there was a funeral. When someone we love dies, it's such an important part of the grieving process to be able to get together with others who loved that person and to share memories and hugs and tears. Right now, that couldn't happen. There would probably be a video chat memorial service. There are probably going to be a whole lot of those in the weeks and months to come. And we would be thankful for having the technology to allow us to do that, but we would also be missing out on an essential part of the human experience by not being able to get together in person to say our goodbyes, to grieve, and to celebrate the lives of our lost loved ones.

Because being physically together with people we care about is such an important part of the human experience, it's hard right now to remove so much of that contact from our lives. But understand - the hypothetical scenarios I envisioned in this post, of what Cara's life with and death from cancer might have been like under the specter of COVID-19, those are reality right now for so many people. That's part of the cost of all this. And although we cannot control the fact that this virus exists and has spread to our country, we, collectively, have a great deal of power to control how bad it gets. If we let it get really bad, if a large percentage of the population ignores social distancing, the scenarios I imagined in this post multiplied by millions could be the ultimate cost. That is a really horrible thing to imagine. But it's not imaginary. It's already real in places like Italy. It's already starting to become real here.

Every time someone ignores social distancing, they potentially add to that cost. Every time someone decides to get together with a group of friends because they think this can't hurt them. Every time people go and play basketball at the park (playing basketball is something I really miss right now, but I understand why I can't do it!). Every time a business owner decides their business is essential when it isn't really essential and keeps their employees coming into contact with each other and with other people. Most especially every time someone in a position of government authority makes a decision to not enact strict social distancing measures when all the evidence and all the experts say it's imperative we do that right now. Every time someone does one of those things, it's potentially adding another name to what will be a very long list of people who had to suffer alone in a hospital without their loved ones visiting them, to die not because there was nothing that could be done to save them but because there weren't enough resources to do it, and then to not have a funeral to give their loved ones some comfort at such a horrible time.

That's the cost. Please do everything you can to minimize that cost. Please. I know most of my friends are already taking this seriously, but if you aren't, please, please do. And if you know other people who aren't taking it seriously, please, please pass along this message to them. It could be one of the most important things you'll ever do in your life.