I received my COVID vaccine on December 21st before starting an ER shift; sitting in the cold, plastic chair in a hallway-turned-vaccine-clinic, I tipped my head back to blink tears into submission as I reflected on making it this far in the pandemic without contracting COVID.  Four days later, after three twelve-hour shifts, I tested positive for COVID.

The COVID vaccine did not cause my positive result; getting exposed to — and infected with — COVID did.

I work part-time in rural settings as a locum tenens physician.  I love the variety it brings and the people whose paths I cross while I’m doing it.  For the last six weeks, in light of critical workforce shortages and with my partners’ support at my clinic, I’ve stepped back from my daily direct primary care duties and stepped into whatever rural site needs support across Colorado, Kansas, and Missouri.

In both getting the COVID vaccine and coming down with COVID, though, I became another statistic.  I became a mark on the ticker counting up the number of health care workers getting the vaccine.  My infection also checked the box for yet another physician who couldn’t work because the virus had pulled me out of the workforce. I quarantined at home for 10 days as I moved through a (thankfully) very mild course: headaches, body aches, congestion, and a scratchy throat.  I slept a lot, read a lot, and enjoyed both Christmas and New Years’ with my family via Zoom.

At the end of my CDC-recommended 10-day quarantine and with symptoms resolving, I was immediately pulled back onto the road to a new rural location.

Walking from an exam room to my newest temporary desk in southwest Kansas, I offhandedly tossed my stethoscope around my neck as I finished up a clinic visit; the relatively young nurse helping me kept accidentally wrapping her O2 tubing around her neck. Frustrated, she let me know how much she hates using oxygen.  She followed by offering that her prolonged recovery and lingering hypoxia a COVID infection months ago wouldn’t stop her from coming back to work.

As I swiveled in my chair to face her, I shared my COVID story and asked, “Are you going to get the vaccine?”

She quickly and sweetly replied: “I don’t trust the government.”

I paused.  On my locums assignments, I often let bygones be bygones and let opinions, thoughts, and beliefs different from mine flow through me without reacting.  But I was stunned.  I didn’t know her, but here she was: on oxygen, injured from a now-preventible virus, and still wary of a vaccine.

I couldn’t help myself and replied: “The government didn’t make this first vaccine; it was developed without direct government support by a corporation.”

She paused thoughtfully, I swiveled back in my chair, and we returned to work in silence.

A few seconds later, she offered the back of my head this thought: “You know, though, that the same people who invented the vaccine were the ones who released the virus in China.”

I turned, not quite knowing how to respond, but chose my words carefully, sidestepping the accusation of a nefarious, intentional release of the virus. “You’re right that there are Chinese researchers that contributed to the science behind the vaccine; however, a good amount of the basic science was done domestically.”

Again, she paused, and we returned to work, again, silent but for the staccato of our keyboards.

Sighing, a few seconds later, she added: “It’s just too new for me to trust.  We don’t know the long-term effects.”

Of all the concerns raised, this is the one that is the most understandable to me.  Hesitation based on erroneous facts and falsehoods is frustratingly baffling; however, the basic human reaction to the fear of the unknown is predictable and understandable.

I empathized, turning to face her, “That makes sense, but there are more things that you put into and onto your body on a daily basis that are far less studied than this vaccine.  That Coke you’re drinking in a disposable plastic cup, for example.  The lotion you use every morning. The air we breathe and the industrial contaminants may only show themselves harmful after a lifetime of exposure. Life is full of things that we don’t know much about.”

I then went on to explain that the mRNA vaccine works, ending with, “I get how hard this is.  It’s hard to be in a place where we feel like there are so many unknowns.  Feels on theme for this whole pandemic.”

This we could agree on.

I’ve had the same conversation about concerns with the newness of the vaccine with nurses at every location at which I’ve worked since the vaccine came out.  They’re wary.  Even some doctors espouse incorrect information about the vaccine, further fueling hesitancy and conspiracies in and among these hospitals’ staff.

In contrast, every member of my small clinic back home accepted their appointments with the local health department to get vaccinated against COVID.  In fact, they were clamoring for it and were counting down the days to their vaccinations.

How can two clinical settings, staffed by people with equivalent degrees, have such dramatically different attitudes towards the vaccine?

In one short word: culture.

When I hire physicians, I emphasize that my only expectation is that they provide excellent, evidence-based care. As a clinic, we keep our patients in the loop on the latest science with frequent website updates and blog updates.  When it comes to COVID, we follow breaking news and read through the published literature it cites.  We review trusted resources to help our patients separate fact from fiction. We admit when we don’t know the right answer. It’s part of our core mission.

I can’t comment on the culture of these rural sites at which I serve, but as I sat working at the nurse’s station at a different assignment in rural Missouri, I overheard a lab tech laughingly say to her colleague, “This here is Trump Country.  We do things differently here.”

My conversation with the nurse in southwest Kansas happened on Monday, January 4th. On Thursday, January 7th as I drove the three hours directly from one assignment to another, I cried.  I cried as I listened to the news reports of the insurrection the day prior at the Capitol.  I cried because I heard the fear in the voices of the people reporting from within the Capitol.  I cried at the thought of a Confederate flag marching through the Capitol’s hallways.  I cried at the systemic racism that protected these protestors but leaves Black people dead at the hands of law enforcement far too often.

But I also cried because I understood the protestors.

I see them in the ERs in which I work. I work with them. I treat them. I know them. I understand that in their perspective, this is Trump country.

Given the events of the last few weeks, I’ve seen things differently when it comes to dialogue and working through uncertain things: words matter. Culture matters.  As physicians, we must keep repeating the truth so that the truth is heard as loudly as the falsehoods.  We must admit when we don’t know the right answer and hold our patients’ and colleagues’ hands as we walk with them through the unpredictable process we lovingly call science.  And we have to speak up when conspiracy theories are repeated — especially when our peers repeat them in health care.

In doing so, we do not need to be angry.  We can communicate with empathy.  We can seek to understand our peers’ concerns and work through them.  We can build bridges and create more trust.  We can have a conversation, and we can connect.  It’s a matter of listening; actually listening for understanding.

I received my second vaccine in mid-January.  The day following, as I slogged through work, I felt the effects it was having on my immune system.  The chills, headache, body aches, and a temperature elevation to 100.3 hit me hard. I shared with the medical staff that I was experiencing these, and that these side effects were to be expected.  I wanted them to know that this is expected and is part of the vaccine’s process.  I invited them to share why they were wary of the vaccine, to ask questions, and we worked through their concerns about efficacy, long-term effects, vaccine stabilizers and additives, and all sorts of other thoughts they had about vaccines spanning microchips and long-term fertility.  (Note: the vaccine does not include microchips, nor does it have a direct effect one way or another on long-term fertility.)

And even though I don’t work with these people daily and we don’t know one another well, we still had a conversation.  I listened, and we found reliable sources to address concerns and answer questions.

Perhaps trust is something that fuels conversation.  Or perhaps it is with conversation that a sense of trust can develop between people.  Regardless, we can build trust with empathetic conversation and listening to understand one another. We can — slowly — change the culture, one conversation at a time.

And we can — slowly — inoculate ourselves against division in the future.

Allison Edwards is a family physician and founder, Kansas City Direct Primary Care. She can be reached on Twitter @KansasCityDPC. 

Image credit: Shutterstock.com