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Marie Myung-Ok Lee: How Should a Doctor Act?

New York City: an infection story.
Image via Flickr

By Marie Myung-Ok Lee

A New York story: guy comes home from working abroad, reunited with his girlfriend and friends. Glad to be back home in the city, he goes jogging, strolls on the High Line in Chelsea, he eats in restaurants, hopping on and off the subway. He travels all the way from his apartment up in Harlem to Brooklyn to go bowling, he takes an Uber cab back.

The next day, running a fever, he checks into Bellevue and is whisked into an isolation unit as the City’s first Ebola case. Officials from the CDC arrive in a hot mess.

We New Yorkers learned that Patient Zero is Craig Spencer, a young Columbia University-affiliated doctor who’d just returned from West Africa where he’d been treating Ebola patients with Doctors Without Borders. We also learned that he’d started not feeling well a few days prior to checking himself into Bellevue. Under the influence of Ebola-induced fatigue, he’d spent a few days traversing the length of Manhattan, all the way to Brooklyn and back.

Every New Yorker knows not to enter a completely empty subway car for various reasons, including the likelihood of encountering excrement and/or vomit.

This news set off a wave of consternation amongst my New York friends. We live in a city where people are packed cheek-by-jowl; where getting sneezed, vomited or bled on is much more likely in ways that people who live in places where transport is via hermetically sealed vehicles, where there are separate houses, fenced yards, a garage that’s built into your home, probably can’t understand. In Wyoming, you could be simultaneously bleeding and vomiting, but the range of your effluvia would likely be fairly contained.

In New York, unless you are helicopter-and-chauffeur-wealthy, you commute via packed sidewalks, subways, buses, elevators—including interminable journey-to-the-center-of-the-earth elevators in the subway stations. All of us have encountered mystery liquid on a subway seat, and everyone knows not to enter a completely empty subway car for various reasons, including the likelihood of encountering excrement and/or vomit.

New Yorkers also have a leavening gallows humor about the absurdities of life here (I like to think of it as a grumpy optimism), as well as unsung pride at our high level of tolerance dealing every day with the unpredictabilities of interacting with a wide range of people. Our teenaged son has autism, and while a screaming tantrum in the parking lot of Whole Foods in Providence led immediately to the police being called, a similar tantrum when he couldn’t get his bike up a steep hill in NYC, led a passerby to pull him up the embankment (anything to stop the screaming), and wordlessly walk on: no hello, no goodbye, no expression—the epitome of the jaded New Yorker.

The New York Times tried to assuage concerns by quickly running the article, Can You Get Ebola From a Bowling Ball?

I’ve noticed that in the media, the New York public’s concerned, if not outraged, reaction to the news that this doctor practically left no corner of Manhattan untouched whilst in the incubatory phase of his Ebola infection has been portrayed as neurotic New Yorkers, Woody Allenish germophobes, self-involved narcissists who peevishly fret about a remote, possibly infinitesimal risk to themselves while scores of people are dying in West Africa.

On the temperature-check that is social media, it quickly broke down into New Yorkers versus non-New Yorkers. My Facebook post about the infected doctor brunching and bowling was greeted with incredulity and outrage. The New York Times tried to assuage concerns by quickly running “Can You Get Ebola From a Bowling Ball?“, concluding it was “unlikely,” although last week, subway commuters barely missed being gored by a giant drill bit that accidentally drilled into a packed L train car–also, in general, unlikely.

On Facebook there were plenty of “Don’t be so paranoid/hysterical!” exhortations by non-New Yorkers. This, in turn, was followed by a vigorous back and forthing about who had more medical creds, who was being illogical, each side accused the other of not knowing how Ebola is transmitted, of not understanding the risks; a few doctor friends joined the spirited debate, however on different sides.

The next day’s news that the New York/New Jersey metropolitan area was officially moving from “self-monitoring” for returning Ebola healthcare workers to a mandatory 21-day quarantine set off another wave of people glad an official protocol is in place, while others equally vociferously declaimed that politicians are merely pandering to paranoid, selfish New Yorkers at the expense of selfless healthcare workers (although, n.b., let’s also not forget Dr. Nancy Snyderman—a paid network personality doing her own grim reporting from Liberia—sneaking out of her Ebola quarantine to go to a restaurant, a move unanimously decried).

I don’t deny the taxi driver’s humanity, but I also don’t deny that the pedestrian would have been just as dead from his most human of mistakes.

It’s possible that everyone’s a little bit right: that Dr. Spencer is a hero, that he followed best-practices protocol (as we presume he did in West Africa, yet he still was infected), but was still irresponsible—as a New Yorker.

The collective bargain we make to live here is that certain unsaid, unwritten, but cardinal rules have to be followed: when the full-to-the-gills subway stops at the station, you neatly queue up on each side and let the riders out first before you board. It’s always amusing to see tourists trying to ram their way in against the flow (and delaying the train).

Also, you jump in and help when necessary. My husband broke his own bike when he dashed into traffic to pull out another cyclist—an elderly lady—who fell in the street after her tire got stuck in a pothole. In turn, I skidded on some wet leaves and fell headlong into that same embankment that bedeviled my son, and a passerby (“Jesus, lady!”) helped me up and brushed me off, and even helped me back on the bike. Then, as I rode away, I happened to turn around and saw that he had not yet melted back into the faceless crowd but had stopped up at the top of the hill to watch, obviously intent on making sure I really was okay. Anyone who’s ever seen a human chain at work at a busy intersection in order to rescue a baby bird will understand that we are jaded, maybe, but we also highly prize our interconnectedness. It’s not a kumbaya, we are all friends (although in certain, bright, rare moments it can feel that way), it’s more an almost biological exigency: if we’re going to coexist in this crowded hive, there has to be unselfish collective behavior and a high level of tolerance, i.e., if you only like to smell the piped-in white-tea scent of the mall and can’t handle a little urine or rotting garbage, this place is not for you.

I am not an infectious disease specialist, so I can’t comment on the scientific reasoning or validity behind the new (and ever-changing) quarantine rules or the theoretical risk Dr. Spencer posed to the public. However, Dr. Spencer (and Dr. Snyderman) are not infectious disease specialists either, and it’s interesting to learn that many doctors and hospitals themselves don’t trust the official experts, i.e., the CDC, and have instead been backchanneling Doctors Without Borders for their Ebola protection policies—protocols which, ironically, were largely cribbed from the CDC in the first place. As a layperson, I have no idea where that leaves official Ebola science, but this article by Dr. Jerome Groopman for The New Yorker suggests that the science on the virus’ transmission isn’t exact, either.

Last night, I was in a taxi that almost hit a woman in the crosswalk. As she stood screaming at the driver, “Didn’t you see me?” he shouted back at her “Look, I am human!” As he drove on, he turned back to us grumbling and pointing out that there was a blind spot on his windshield. “I am human!” he repeated. “People think we are not human.” I don’t deny his humanity, but I also don’t deny that the pedestrian would have been just as dead from his most human of mistakes.

It’s not that we New Yorkers unreasonably fear Ebola, we are against the virus I’m calling “Ebowla”: we would and should still be unhappy with Dr. Spencer if he, a doctor, went dining and bowling all around the city, feverish and dangerous with the flu.

Marie Myung-Ok Lee’s next novel is about the future of medicine. She teaches fiction at Columbia and also writes for The Atlantic, The Guardian, Slate, Salon, The New York Times, and The Nation. Find her on Twitter and on Facebook.

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