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Spectator, 18 April 2020
Dr. Matt Strauss Matt Strauss is the former medical director of the critical care unit at Guelph General Hospital, Canada. He is now an assistant professor of medicine at Queen’s University.
As Boris Johnson was being treated in intensive care, Dominic Raab expressed his confidence that the Prime Minister would defeat Covid-19 and return to work because 'he is a fighter.' The press howled in opposition to these hopeful words. Things culminated in BBC Newsnight’s Emily Maitlis, disdainfully telling viewers: 'You do not survive the illness through fortitude or strength of character, whatever the Prime Minister's colleagues will tell us'. The video clip achieved its intended virality, and was picked up by cable networks around the world. But we need to set the record straight.
She’s wrong. Medically wrong. Dangerously wrong. As a critical care physician, I can say from both clinical experience and from scientific literature, courage in illness matters. It matters for survival.
In 'Man’s Search for Meaning' the Austrian psychiatrist and holocaust survivor, Viktor Frankl, describes a crystallised behaviour pattern among concentration camp inmates who lost the will to live:
'Something typical occurred: they took out a cigarette from deep down in a pocket where they had hidden it and started smoking. At that moment we knew for the next forty-eight hours or so we would watch them dying.'
No one blames such people for giving up hope, of course. And obviously, many people who never gave up hope perished all the same. Even so, Frankl observes the converse clearly: every single person who gave up hope died.
I see the same of patients in the throes of life-threatening illnesses. Sadly, no amount of optimism and pluck will cure terminal conditions like stage IV pancreatic cancer. But with infectious disease, there is some proportion of cases that could go one way or the other. In my experience, if the patient decides to let go of life, they really only go one way and never the other.
In the year before his death, Coleridge remarked, 'he is the best physician who is the most ingenious inspirer of hope.' I sometimes feel like a woolly-eyed mystic healer, telling my patients that spirituality matters. But I don’t mean spirituality in the sense of incense or chanting. Instead it's about the sense of keeping one’s spirits up. The mind-body connection definitely exists, it’s called the spinal cord (as well as the hormones secreted by the hypothalamus.) One need not resort to unscientific claims about energy meridians to make the case for the salutary effects of high spirits in illness.
Statistical evidence for the relationship between hope, purpose, and survival abounds. Depressed heart attack patients are four times more likely to die than their non-depressed counterparts. Men who lose their wives are 17 per cent more likely to die in the following five years than men who have not (somewhat awkwardly, the corresponding number was only six per cent for women who lost their husbands.) Homebound elders who report feeling 'rarely' hopeful are 50 per cent more likely to die than those who feel 'often' hopeful.
I do not need to know how these relationships work in practise to observe them empirically. Perhaps the patient who will fight for their life is more likely to alert the care team to an important change in their symptoms, or to engage more vigorously with physiotherapy, to eat better, to breath deeper. It could be any of those things, or all of them, or yet some others I haven’t thought of.
For an illness like Covid-19, where the only real treatment is supplemental oxygen and time, hope and courage are all the more critical. Which brings us to Boris. Can anyone question that the leader of a great nation, in a time of global catastrophe, with a young pregnant partner at home, is going to be anything less than cataclysmically motivated to keep breathing? I do not think the producers of BBC Newsnight can find one critical care physician or nurse who will say that such things don't matter.
On my morning run yesterday, I was passed by a man and his teenage son on a tandem bicycle that had been ingeniously modified to accommodate the boy’s significant physical disability. They both pedalled like mad. My heart leapt. Everyone can fight. In my leaping heart of hearts, I don’t believe this plague will take either of them.
Even if you have not contracted Covid-19 yet, you can start fighting now. Start jogging. If you can’t jog, start walking. Feel the sun on your face. Breathe the wind. Tell your family you love them; they’ll probably tell you the same. You’ll remember their words when tribulation comes.