When the 1960s came around, the “Greatest Generation” – those men and women who served during World War II were still largely and stoically silent about their wartime experiences – but the television networks began television shows about the war. Series such as “Combat,” “12 O’Clock High,” and “Men at War” became staples of prime time viewing. Knowing things about WWII became part and parcel of determining one’s status within the pack (and here I am referring to Cub Scouts). Sure, you might be able to identify the German Messerschmidt 109 fighter aircraft from a flash card, but the real test was could you identify the difference between 109-C and the 109-G series (except the 109-G6 which was soooo… obvious). Clearly such things were critical to national defense among the Cub Scouts. Or so it seemed at the time.

There has been a lot of time passed by since the close of WWII, and sadly there have been other wars: Korea, Vietnam, the Cold War, a variety of “police actions”, Kuwait, Iraq, Afghanistan, and all the special operations in between. And there are always letters from the front line. As I have recently written, we friars support interment services for military veterans and their families at Quantico National Cemetery. Every burial service is to enter into a world of stories about service and life on the front lines. And so, I spent part of the day reading letters from the front lines and essays from veterans about their reasons for serving, their experiences, and their coming home. Every story is different, but there were common threads: all were proud to serve, mourned their loss, and were grateful to come home. And all were silently worried about us, as a people, where fewer families and political leaders have a direct familial connection to service in the armed forces. One writer said that he gratefully accepted “Thank you for your service,” but wondered what the answers would be if he asked in reply, “what are you grateful for?” Perhaps that is how all veterans are best honored – by a people who are informed, reflective and concretely appreciative of the sacrifice others have made on our behalf.

With that in mind, I ran across another letter from the front lines. It shared so much of the passion and frustration of letters from combat soldiers – akin to “Do people at home understand how horrible and difficult this is? Do they care as they go on with their lives. Do they know the sacrifices and loss?” Almost 20 years ago I talked about this dynamic: a select few who serve and sacrifice while most citizens do neither. When I shared the “sense of the front line” the replies centered on “they shouldn’t be there… they should quite and come home.” Not one person responded in compassion or empathy to the ones of the front line. Their responses were framed by their particular political position on the current conflict. “Do people at home understand how horrible and difficult this is? Do they care as they go on with their lives. Do they know the sacrifices and loss?”

I will let the letter that follows speak for itself. I wonder how many people will respond with the lenses of their held political views. I wonder how many will  respond in empathy and compassion for the writer serving on the front line. I wonder how many will be grateful and the next time we meet these folks from the front line will say, “Thank you for your service.” We face the same question: “what are we grateful for” and will our response be informed, reflective and concretely appreciative of the sacrifices made on our behalf.

From the front lines of a hospital ICU

“We can’t let COVID win.” This was my colleague’s mantra when the pandemic started last year. And for the almost 18 months since, health care workers have rallied to the battlefields, even at times when we had no weapons to brandish.

We took care of the infected and the critically ill when no one else would. We reused N95 masks, carefully placing them in labeled brown paper bags in between shifts. We witnessed lonely deaths and held up iPads for families to say their heartbreaking goodbyes. We created elaborate backup schedules and neglected our personal lives. We stepped up during surges and when our colleagues fell ill. Camaraderie in the ICU had never been stronger because we recognized that this was a team effort and all of humanity was battling against a common enemy.

But as health care workers, we also were painfully aware of our own vulnerabilities. We can run out of ICU resources for our patients. We can run out of personal protective equipment for ourselves. We can be exposed on the job and get sick. And we can die — many of us did, more than 3,600 from COVID-19 in the first year.

Many of us quarantined away from our families to protect the ones we love. We counted the risk factors of our children, our elderly parents, our spouses, and came up with our own formulas to decide whether to come home at the end of the shift or hole up in a hotel room. One of our ICU directors wrote and rewrote our COVID-19 clinical guidelines to keep up with the evolving literature and somehow she carved out the time to write her own will.

I worked daily to adapt our end-of-life program to the changing needs and restrictions of the pandemic and signed up for a vaccine clinical trial as soon as one became available. I also updated my own advance directive and printed it out for my husband, just in case.

Then, effective vaccines became widely available in the U.S. — I briefly saw light at the end of the tunnel. The number of patients with COVID-19 in ICUs across the country plummeted. It looked like our sacrifices and commitment as health care workers had paid off. We believed herd immunity could become a reality and we could return to some sense of normalcy.

But the relief was short-lived, the hope was fleeting, and we are amid another surge. A surge that is fueled by a highly transmissible variant and those unvaccinated. My experiences in the ICU these past weeks have left me surprised, disheartened, but most of all, angry.

I am angry that the tragic scenes of prior surges are being played out yet again, but now with ICUs primarily filled with patients who have chosen not to be vaccinated. I am angry that it takes me over an hour to explain to an anti-vaxxer full of misinformation that intubation isn’t what “kills patients” and that their wish for chest compressions without intubation in the event of a respiratory arrest makes no sense. I am angry at those who refuse to wear “muzzles” when grocery shopping for half an hour a week, as I have been so-called “muzzled” for much of the past 18 months.

I cannot understand the simultaneous decision to not get vaccinated and the demand to end the restrictions imposed by a pandemic. I cannot help but recoil as if I’ve been slapped in the face when my ICU patient tells me they didn’t get vaccinated because they “just didn’t get around to it.” Although such individuals do not consider themselves anti-vaxxers, their inaction itself is a decision — a decision to not protect themselves or their families, to fill a precious ICU bed, to let new variants flourish, and to endanger the health care workers and immunosuppressed people around them. Their inaction is a decision to let this pandemic continue to rage.

I am at a loss to understand how anyone can look at these past months of the pandemic — more than 600,000 lives lost in the U.S. and more than 4 million worldwide — and not believe it’s real or take it seriously.

And meanwhile, immunocompromised people, for whom vaccines don’t generate much immunity, are desperately waiting for herd immunity. I have no way to comfort my rightfully outraged transplant patients who contracted COVID-19 after isolating for over a year and getting fully vaccinated as soon as they could. With angry tears, these patients tell me it’s not fair that there are people who are choosing to endanger both themselves and the vulnerable people around them. They feel betrayed by their fellow citizens and they are bitter and angry. I cannot blame them.

I am at a loss to understand how anyone can look at these past months of the pandemic — more than 600,000 lives lost in the U.S. and more than 4 million worldwide — and not believe it’s real or take it seriously. But the unhappy truth is that there are people who do not. They did not in the beginning and many are doubling down now.

I thought when this pandemic began that we were all in this fight together, engaged in a war against a common enemy. Now, I painfully realize: Perhaps we were never on the same side and we never had a common enemy. Perhaps the war has been among ourselves all along. We have won many battles but unvaccinated America is choosing to let COVID win the war.

Thanh Neville, M.D., M.S.H.S.
Huffington Post – August 1, 2021

I think every combat veteran would read that letter and understand the frustration of life on the front lines. “Do people at home understand how horrible and difficult this is? Do they care as they go on with their lives. Do they know the sacrifices and loss?”