Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes
“We desperately want to be part of it. For most of us, this pandemic has tapped at a foundational, altruistic urge to do our part. Our friends and loved ones are on the frontlines, their faces creased by masks worn all day, their eyes bloodshot, their foreheads grooved by too-tight goggles. Our friends and loved ones risk their lives while we … don’t.
If you’re anything like me, social isolation has felt like the opposite of heroism. It’s felt like a jarring mix of survivor guilt, uselessness, and boredom.”
Mark G. Shrime is an otolaryngologist.
He shares his story, global health perspective, and discusses his KevinMD article, “Let’s not let our pride get in the way of heroism.”
Did you enjoy today’s episode?
Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!
Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.
Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Mark Shrime. He’s an otolaryngologist based in Boston, and he wrote the KevinMD article “Let’s not let our pride get in the way of heroism.” Mark, welcome to the show.
Mark G. Shrime: Thanks for having me, Kevin.
Kevin Pho: So we’ll get into your article in a bit, but first, tell me your story and your journey to where you are today.
Mark G. Shrime: Yeah, the story is fairly convoluted. So as you said, I’m an ENT by training. I did an ENT residency, did a couple of fellowships in microvascular surgery and surgical oncology, and practiced for a couple of years full time as an academic ENT here in Boston. Back in 2009, I kind of started to switch my career. I went back to school and got an MPH, went back to school again in 2011 to get a PhD, and have really kind of moved out of full-time clinical work. I primarily, at this point, work in the field of global surgery, which is the provision of surgery in resource-constrained settings. Most of my time now is spent either clinically in West Africa or here in education, training, and research around this issue.
Real physician voices, twice a week
Free, and one click to unsubscribe.
Kevin Pho: So over the past few months, how has the pandemic affected you and your practice?
Mark G. Shrime: That’s a great question. So at the start of the pandemic, Africa, the continent of Africa, didn’t have a lot of cases, and I was actually physically in Senegal, which is in West Africa, when the pandemic started. There was kind of a thought that, well, maybe you should just sort of stay where you are, because Europe and the U.S. were exploding, and Senegal hadn’t been at that point. We now know that that was simply a delay, and not necessarily that there was anything different. It’s just now hitting Latin America and Africa.
As somebody who works in global health, right, I mean, most of my time is spent on airplanes, and obviously I haven’t set foot in an airport since I came back from Senegal. That hasn’t been the worst thing, though. There’s a lot to be said for in-person interactions, especially if you’re working cross-culturally, but a lot, obviously, as we’ve learned over the last few months, can continue to happen virtually, like this.
Kevin Pho: All right. So you wrote the KevinMD article back in April, “Let’s not let our pride get in the way of heroism,” and I want to start by reading the excerpt. You write, “We desperately want to be a part of it. For most of us, this pandemic has tapped at a foundational, altruistic urge to do our part. Our friends and loved ones are on the front lines, their faces creased by masks worn all day, their eyes bloodshot, their foreheads grooved by too-tight goggles. Our friends and loved ones risk their lives while we don’t.” So I was wondering if you could share the story behind that article and why you decided to write it.
Mark G. Shrime: So this was written about a month, less than a month, into my return back to the U.S. at the beginning of this pandemic. And I am, sadly, a hyper-specialized surgeon who spends most of his time working in West Africa. There was precious little need for any skills that I had, and appropriately so. The last time I managed a vent by myself was in residency. But I’d be sitting there at home, basically with the hardest decision that I had to make being which couch cushion to be sitting on, while people that I knew and loved were out there literally risking their health and their lives. And it was eating at me.
I had had a conversation with a friend of mine about the fact that when things go south in the hospital and we have to code a patient, there is this innate desire to go and help, to do something. However, often, for most of us, the best thing that we can do in the middle of a code is to step back and to let the code team run it, and not to kind of get in the way, because it feels like we’re doing something to get in the way. And that image had been bouncing around in my head, that this was exactly the same thing, except this time the code was a global pandemic. Sometimes the best thing for me to do, and I think it still continues today, the best thing for us to do, really was to lock down, really was to get out of the way, really was to minimize the risk to our friends who are out there of overwhelming them, and get out of the way so they can do the things that they know how to do.
Kevin Pho: So I think what you described is common for a lot of physicians. I’m in internal medicine, primary care, and a lot of the things I did were virtual and telemedicine, and I certainly wasn’t on the front lines. So are there any tips that you could share from your experience that you could give to these clinicians who may not be on the front lines dealing with the pandemic?
Mark G. Shrime: Yes. I would say right now, in the U.S., as we’re sort of on the downslope of the pandemic, things are going to start getting back to normal. Most of us in public health very much expect that there will be a second, and maybe a third and fourth, wave of this pandemic, and whether or not they’ll be bigger or smaller, more or less lethal, we don’t really know yet. But as we prepare for the next wave, as we prepare for the fact that we’re going to have to lock down again, we’re probably going to have to stop elective surgeries and stop in-person visits. I think now’s the time for us to consider the way we felt and acted the first time around and kind of learn how to do it better, learn how to respond better for our friends that are on the front lines, for what happens next.
Kevin Pho: So I want to ask about your global perspective. Can you give a prediction of the next three months of the pandemic? I know that it’s hitting Latin America particularly hard. It’s hitting India. So from your experience, what do you see the next few months to be from a global perspective?
Mark G. Shrime: So if you look globally at the numbers of daily cases, for the last six or seven days now, the world has registered 100,000 cases per day or more. Our curve shot up, then kind of plateaued a little bit, and now it’s shooting back up again. Now, for sure, some of that is increased testing, some of that is sort of increased availability of testing. But if you then start looking at a country level, as you said, we’re seeing these rises in Latin America, in India, in sub-Saharan Africa, and sadly in places like Iran and Uzbekistan, who already had their first wave, already came back down, and are starting to come back up again. We are starting to see it here in certain states as well. Some states never plateaued; some states plateaued and are starting to come back up again.
It’s hard to say. Here’s what I keep saying about this pandemic: We know how the virus behaves. Viruses behave the way viruses behave. It’s not the first time the world has faced a pandemic. What’s hard to predict is how governments are going to respond to it and how people within the governments are going to respond to the government’s response. My sense is that worldwide, we’re not done. We’re not even done with the first wave yet, and it’s going to go back up again.
And my fear in a lot of the countries in which I work is that both treatment and testing are limited. In other words, we may never really know the full extent of this pandemic in certain countries in sub-Saharan Africa, because there’s simply no way to test for it, and also it’s very difficult for patients to access whatever tests are available. So we may end up finding sort of massive increases in mortality that are not necessarily attributed to anything but are likely to be attributed to COVID-19.
Kevin Pho: Now, what should countries do? So we have two ends of a spectrum here, right? You have a more draconian approach that some of the Asian countries did, and you have a more laissez-faire approach like Sweden, and to a lesser extent, what’s happening here in the United States. So from a public health standpoint, what should countries do going forward?
Mark G. Shrime: The examples you gave are perfect, Kevin, because we also know the results of those approaches. We know that the, quote unquote, draconian approaches, like Taiwan did, like South Korea, like New Zealand, have been immensely successful. And then we know that the more laissez-faire approaches, like Sweden and the U.S., have not been. We know, for example, Sweden is a great example. The chief epidemiologist in Sweden just last week came out to say, “I made a mistake. We should have locked down.”
And one of the things that’s interesting about Sweden is that the whole argument against locking down is, “It’ll impact our economy. We need to make sure that we keep our economy moving.” Sweden’s economy was impacted just as much as its neighbors’, which locked down. So it had worse numbers in terms of deaths and not really much better numbers in terms of the economy.
The public health person in me says we’ve done this before. We’ve been here before. We’ve faced pandemics before. We know the response. The response is to distance, is to test, is to trace, is to mask, is to do all the things that we’ve been saying. It’s just convincing people that it’s more important to do that, that it’s more important to take care of your community than it is necessarily for you to immediately be out there, back in your jobs.
Kevin Pho: Well, thank you so much, Mark, for sharing your insight. I do have one final question for you. What’s your take-home message for the KevinMD audience?
Mark G. Shrime: These are complicated times. We haven’t even addressed some of the things that are happening in the U.S. right now around structural inequity as well. These are very complicated times, and I think, especially as medical practitioners and medical students and people in training, it’s important for us to continually put a lens of health around the things that we say. We take oaths to improve the health of populations and of our patients. What are the best ways that we can respond with that lens of health in mind?
Kevin Pho: Well, thanks again for your time. Today on the show, we have Mark Shrime. He’s an otolaryngologist. He wrote the KevinMD article “Let’s not let our pride get in the way of heroism.” Mark, thank you for joining me on the show.
Mark G. Shrime: Kevin, thanks for having me.
Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes
