The Tragic Loss of Coronavirus Patients’ Final Words

It takes a special kind of inattention to human suffering to not notice how unfortunate it is that people have been left to face death alone

By Zeynep Tufekci

Of all the wrongdoings of this pandemic, the one that haunts me most is how people are left to die alone. Health-care workers have been heroic throughout all this, but they do not replace the loved ones whom the dying need to be with, and speak with, even if only one last time.

A hallmark of COVID-19 has been the speed with which some patients have crashed, going from feeling only a little sick to being unable to breathe, sometimes in the space of a few hours. Such a crash often necessitates intubation, a process that then renders one incapable of speaking. Many people on ventilators are also heavily sedated and unconscious, to keep them from pulling out the invasive tubes going down their throat. Thus, sometimes with little warning, all communication is lost, and more often than not, a patient is without family or loved ones when this happens.

Early in the pandemic, patients were left alone precisely because the crisis was so dire. Many hospitals outright banned visitors — often even to non-COVID-19 patients. They did not have enough protective gear for the health-care workers, let alone anyone else. Many COVID-19 patients were transported solo in ambulances, and family and friends were unable to join them at the hospital once they had arrived. Others were dropped off by loved ones who were then turned away. Patients sat in their rooms, waiting. If they experienced dyspnea, the acute shortness of breath known as “air hunger,” they crashed alone and terrified.

Sometimes, a nurse or doctor managed to connect the patient with their loved ones before the tube went in. But dyspnea is a medical emergency, after all, so in many cases there was simply no time for that last call, or anyone available to arrange it. As the disease progressed, families were left clustering around a phone as a hospital worker held up the device for a final goodbye on FaceTime. Often, the family could talk to their loved one, but not vice versa. That’s not enough. What the dying have to say must be heard.

The paramount importance of dying words has long been recognized across cultures. “When a bird is about to die, his song is sad,” Master Tseng, a Confucian leader, says in the more than two-millennia-old Analects of Confucius. “When a man is about to die, his words are true.” In Plato’s Phaedo, Socrates notes how swans sing most beautifully just as they are about to die. That concept of the swan song — one’s last, most beautiful expression — also comes up in Aesop’s fables and in Aeschylus’s Agamemnon, and was already a proverb by the third century b.c. In Shakespeare’s Richard II, a dying John of Gaunt, hoping the king will come to hear his last words, says:

O, but they say the tongues of dying men

Enforce attention like deep harmony.

Where words are scarce they are seldom spent in vain,

For they breathe truth that breathe their words in pain

Last words, or “dying declarations” as they are sometimes called, have long been recognized in jurisprudence as out of the ordinary, with known cases going back as early as 1202. That’s why statements uttered by people aware of their impending death can potentially be accepted in court without being subject to “hearsay” restrictions, which ordinarily exclude from evidence assertions made by those not in court to testify in person. In the Middle Ages, it was presumed that people alert to their immediate death would not dare lie, knowing they were about to meet their maker. Death was also seen as removing motives to lie: In a 1789 court case in England, which forms the basis of the modern hearsay exception, the court admitted a woman’s dying words — that her husband was her murderer — as evidence, noting that “when every hope of this world is gone: when every motive to falsehood is silenced,” then “the mind is induced by the most powerful considerations to speak the truth.”

The clarity that can come from those facing death is also integral to many modern traditions and philosophies, including the existentialist and psychotherapy schools of thought, which emphasize that death, meaning, loneliness, and freedom are core axes of our lives, and that making all these existential considerations explicit can be key to a good life. The Holocaust survivor Viktor Frankl talks about how these “primordial facts” of existence, including our mortality, help us realize and appreciate what truly brings meaning to our lives. The existential psychotherapist Irvin Yalom, who specializes in treating people with terminal illnesses, says that terminal cancer, as terrible as it is, gives patients clarity that they did not always have before: “What a pity I had to wait till now, till my body was riddled with cancer, to learn how to live,” a patient lamented to him. Yalom advocates listening to the dying and their wisdom even before we ourselves face our final stretch.

It’s also not just that the dying deserve to be heard or that their wisdom is valuable, but that the living need to have the chance to hear them — to let go on their own, mutual terms. That was something I learned the hard way, when my mother died unexpectedly in her 50s. There is no good way to lose a mother, but my loss was compounded by how complicated our relationship had been as she spiraled into alcoholism later in life. Her drunk version was mean, terrifying, and vicious, although when she was sober, she remained the loving, funny, if quirky, parent I knew as a child. When I moved to the United States, most of our conversations took place over the phone, and I became a human Breathalyzer via voice — a sad talent, I suspect, that I share with other children of alcoholics. Before she even finished saying “Hello,” I knew exactly how drunk she was, and if it was Jekyll-time, I just hung up without fanfare. It never went well if I didn’t.

Then my phone rang early one morning. I jumped out of bed to learn that she had died, without apparent reason — just dropped dead. My mind raced with only one thought: What was our last conversation? Had I hung up on her?

Losing an alcoholic parent can be marked by the same grief anyone feels after losing a parent, especially under tragic circumstances. But it’s also full of regret and guilt in its own ways. The regret is obvious: There is no longer a chance for a final, redemptive chapter. The guilt is layered: Was there anything else one could have done? One more intervention, despite the futility of all the others? And what to do with the feeling of relief from avoiding other, even more feared futures that tangles up with the loss?

In this knot of confusing feelings, though, it was that last conversation that my mind kept circling around for the next many months. The last time my mother called me, she was not only sober; she was in a reflective mood — something that did not happen a lot. She apologized, sort of, for all her drinking and said she was very proud of me. We had a pleasant, lengthy conversation, a rarity that year. She wanted to talk about the latest books she was thinking of translating. She rambled about all the good times, and came back to how happy she was that I was her daughter. It was as close to closure as one could hope for. Intellectually, I knew that it didn’t matter much and that even if I had hung up on her the last time — as I had so many times before — I could have tried to focus on some other good conversation or experience we had shared. I knew it was a stroke of luck that this just happened to be our final conversation. It’s not logical, but that’s how grief works; in the thick of it, the last conversation feels like the truest word.

It’s been six months since the world began battling COVID-19. Coronavirus cases are now surging across the Sun Belt, and hospitals are filling up again. Immediately, some reacted by restricting visitorsMany places had never lifted their restrictions in the first place. Those facing the worst moment of their life still aren’t being treated as a priority.

That dying alone has been normalized, as if it were a small matter, is frightening and inhuman. The panic of the early days of the crisis could be seen as a temporary, terrible compromise. Since then, though, airlines have been bailed out to the tune of many billions of dollars, while there has been no rush to build more negative-pressure rooms, designed to circulate air out, at hospitals, which would allow for much safer visits. We still haven’t developed the infection-control protocols for visitors and built up supplies of personal protective equipment in ways that would avoid the need to completely isolate patients in the days and months ahead.

Even without all the wisdom of the ages, it takes a special kind of inattention to human suffering to not notice how unfortunate this is, that people have been left to face death alone. Some have come to fear dying alone more than the coronavirus itself.

In the years after my mother’s death, I managed to move my focus away from the last conversation and take stock of the good and the bad. I regained perspective, and now I would be at peace with whatever had transpired the last time we spoke, even if I had indeed hung up on her. After a bit of time, I am able to broaden out and consider everything, not just that one last conversation. But that certainly wasn’t always the case. The adage is true: Time has its own healing powers. But that’s not what the people who have lost loved ones to this pandemic should be left with, that time will help with the injustice of having been separated from them at the very end. If society seems to have lost perspective about both compassion and death, all that may be left for us is to reclaim what perspective we can, as best we can.

Learning from Taiwan about responding to Covid-19 — and using electronic health records

outlier — and not in a good way — with more than 2.5 million cases and 125,000 deaths, or about 36 deaths per 100,000 people. One of the strongest performers is Taiwan, with 446 confirmed cases and just seven deaths for nearly 24 million citizens, or 0.03 deaths per 100,000. On a per capita basis, the U.S. has 1,200 times as many Covid-19 deaths as Taiwan.

Lost in the fractious and frankly broken conversation about reopening the economy is a simple truism: containing the virus is the best fiscal stimulus. The U.S. Congressional Budget Office is projecting double-digit contractions in the gross domestic product for 2020 and unemployment rates going up to 16% this year — the highest they have been since the Great Depression. By comparison, Taiwan’s central bank expects growth to slow to about 1.5% for the year, and unemployment has “surged” to 4.1%.

To get the economy moving again, we need a functioning health care system.

A lot can be learned about handling a pandemic — and its aftermath — by looking at the health care systems in other countries. Over the past few years, we have been studying 11 countries to write a book titled, “Which Country has the World’s Best Health Care?” Taiwan was one of the countries we studied, and its successful response to Covid-19 was not a matter of luck. It was the result of careful planning and digital innovation, which the U.S. must learn from.

Taiwan could easily have had a Covid-19 disaster. It is situated less than 100 miles from China, and more than 1 million Taiwanese work in China. There is frequent travel between the two countries. As a result, Taiwan is at high risk of exposure to any novel infection that arises in China. So why didn’t it get slammed by SARS-Cov-2?

Some of the success is due to accidents of history, including the outbreak of severe acute respiratory syndrome (SARS) that began in February 2003. It generated a culture of taking infections from China seriously — unlike what happened in the U.S. The island also has a strong “face mask” culture, which the U.S. should be emulating, but isn’t.

Perhaps the most important element is Taiwan’s deliberate, systematic use of its digital health infrastructure.

The key to avoiding massive, economically ruinous lockdowns is effective testing, isolation, and contact tracing to control viral spread. Taiwan’s innovative electronic health records system made possible the country’s swift, targeted response to Covid-19. Although the system was not designed to stop a pandemic, it was nimble enough to be reoriented toward one.

Every person in Taiwan has a health card with a unique ID that all doctors and hospitals use to access online medical records. Providers use the card to document care episodes for reimbursement from the Ministry of Health. As a result, the card gives the ministry regular, nearly real-time data on physician and hospital visits and use of specific services.

With that data, the ministry can modify payments to reflect utilization. If physicians collectively have more office visits than anticipated or are ordering more MRI scans than budgeted, payments per service are reduced quarterly to reflect the overuse. This payment-adjustment mechanism allows the country to adhere to its annual health care budget and return information to physicians on aggregate and individual resource utilization.

When Covid-19 hit, the health card and electronic health records system were repurposed to fight the spread of the virus.

The government merged the health card database with information from immigration and customs to send physicians alerts about patients at higher risk for having Covid-19 based on their travel history. Utilization data was also employed to identify candidates for Covid-19 testing when supplies were limited. As researchers reported in the Journal of the American Medical Association, “Taiwan enhanced Covid-19 case finding by proactively seeking out patients with severe respiratory symptoms (based on information from the National Health Insurance [NHI] database) who had tested negative for influenza and retested them for Covid-19.” The availability of almost immediate data on patient visits allowed the country to efficiently identify, test, trace, and isolate cases. This has dramatically reduced Covid-19 spread without the need for extensive lockdowns.

No other country we studied had a comparably effective real-time electronic health record system, including the U.S. The U.S. has come a long with its use of electronic records, thanks in part to the financial incentives built into the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The percentage of office-based physicians who use these systems has grown from 48% in 2009 to 86% today. They are nearly universal in hospitals as well, with utilization now at 96%.

But sharing the data — so-called interoperability between different electronic health record vendors — has lagged. Only now are we beginning to see real-time data monitoring to permit proactive interventions to improve quality of care, not only in a pandemic but also in routine care. Only recently has the data been used to give physicians timely feedback on their quality of care and resource use. It will be years before these features become integral to routine health system operations across the entire country. As Taiwan shows, however, this is a challenge of policy, not technology.

Even in the midst of the ongoing pandemic, we can learn from Taiwan. Americans share every movement and sentiment with Facebook and Google, yet we seem reluctant to allow the Department of Health and Human Services to monitor patient encounters, as Taiwan does, to track disease and determine what medical tests and treatments to order.

Medicare and Medicaid could adopt something similar to the Taiwanese health card and allow an independent third party to monitor the data. The third party could proactively identify infectious outbreaks, deficiencies in the quality of care, and other important health issues. The contract would have to strictly forbid sharing the underlying data or commercializing them in any way.

Insurers already get data based on hospital and physician claims, but only weeks or months after encounters, making the information less useful for tracking infectious outbreaks. They could use Taiwan as a model to upgrade their data systems and share the insights with public health authorities.

Such an upgrade is tremendously expensive, prohibitively so without inducement. Fortunately, the HITECH Act showed that the federal government can spur investment in electronic health records. Nearly a decade since HITECH, we have the benefit of hindsight for what went well and what went wrong. Another round of investment in electronic health record upgrades — specifically targeted to generating interoperable data that can be shared in real time with public health officials — should be part of any new stimulus bill.

Taiwan’s amazing success in responding to Covid-19 highlights ways the U.S. can improve its pandemic response. By now it is evident that we need a faster, more serious response to public health emergencies, and Taiwan’s health card offers a basis for executing such a response.

Shoring up the U.S.’s digital health infrastructure will help improve routine care in the long run while empowering us to better respond to future infectious disease outbreaks.

Ezekiel J. Emanuel is a physician, vice provost of global initiatives, professor of medical ethics and health policy at the University of Pennsylvania. He is also the author of “Which Country Has the World’s Best Health Care?” (Public Affairs, June 2020), co-host of the “Making the Call” podcast, and a member of the Biden for President public health advisory committee. Cathy Zhang is a senior research fellow at the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Aaron Glickman is a project manager in the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

About the Authors:

Ezekiel J. Emanuel

[email protected]

Cathy Zhang

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Aaron Glickman

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I’m Training as a New Doctor in the Shadow of a Pandemic

My generation of physicians is entering the field at a historic moment. Covid will likely follow us through our careers.

The transition from medical student to physician, even in normal times, is a profound one; Covid-19 projects a whole new improbability to this moment. I graduated from medical school early to briefly join the ranks of New York City frontline workers in April, as the pandemic reached its peak. I had dreamed of being a doctor for more than half my life, and as a college student volunteering in a hospital, I conjured up gallant stories of my first weeks as a physician. Instead, Covid-19 ruthlessly dashed my expectations.

The gravity of this moment is now starting to sink in as the majority of medical residents start their training on July 1. I’m among a class of more than 35,000 other newly minted physicians who are entering hospitals across the country this summer amidst the worst global pandemic in over a hundred years. It’s not lost on us that we sit on the precipice of a major change in our lives during a critical moment in history.

Though it may seem unflattering to admit, I take some delight in joining the medical profession in this historic moment.

Like everyone else, we are afraid. We are scared of getting sick or passing Covid-19 to a loved one; scared for our psychological health; scared for our educational trajectory. I fear my early residency training will prepare me more for a career in palliative care than in my desired specialty of cardiology. But of course, we are also motivated, energized, and eager to help.

There is no “normal” way to become a doctor. Nor is there a “right” time to make the transition from a naive student to a physician who is confronted by life or death decisions for their patients daily. Humility takes on a heightened significance for new physicians in hospitals. Our radical advances in medical technologies over the last century have provided little solace or tangible benefit in our fight against Covid-19. In fact, we have resorted to medieval plague eradication techniques, like social isolation and quarantine, to successfully combat this scourge.

My first venture into the hospital was a crash course in medical humility. I was confronted again and again by critically ill patients, and each time I had to wrestle with the basic truth that there was almost nothing to be done. Senior physicians and older residents reminded me of this as so many of my early patients died, but in the moment, their guidance offered little comfort.

Many doctors adapt to this enormous responsibility by developing a steely exterior, or worse, a god complex. My own experiences as a patient gave me early exposure to this open secret within the medical world. I imagine doctors believe such confidence and poise project well for their patients, but it’s often to a fault. My hope is that a silver lining will emerge from the pandemic: It’s harder for this culture of narcissism to persist when young physicians are being trained around such high death rates, or having to constantly confront medicine’s limitations. Perhaps this generation of physicians will usher in a new age of medical humility and leave the paternalistic patient-doctor relationship in the past once and for all.

But medical humility is not the only trait young physicians need. It is equally crucial that young doctors have the chance to bolster their competence and confidence by being able to help their patients. However, confidence comes out of experiencing medicine’s astounding capacity, not its constraints. Covid-19 has and likely will continue to rob us of this crucial confidence boost for some time to come.

The intensity of training during a global pandemic is undoubtedly a double-edged sword for young physicians.

After the SARS outbreak in Toronto in the early 2000s, one study showed health care workers had significantly higher levels of burnout, PTSD, and psychological distress, which lasted more than two years after the outbreak was contained. Similarly, residents who trained during the AIDS epidemic in the 1980s and ’90s reported not only high levels of lasting psychological distress, but also decreased autonomy, breadth of training, and trust in medical technologies. No studies from that era capture whether these early challenges influenced their practice patterns, or for how long. Based on conversations with physicians who trained during that time, my sense is the AIDS epidemic has been profoundly impactful on their careers.

One of my mentors often reflects on his medical training during the AIDS epidemic by citing Shakespeare’s St. Crispin’s Day speech: “We few, we happy few, we band of brothers.” For most of medical school, I had a tinge of envy and awe when I heard about the intensity of his training. Now, I’m experiencing it myself.

Though it may seem unflattering to admit, I take some delight in joining the medical profession in this historic moment. I am not alone among my peers and colleagues. In my stint as a junior physician during the height of Covid-19 cases in New York City, older physicians repeatedly said I would look back at this time as a highlight of my medical career. I believe they are correct, however, I don’t want to reminisce about my training with rose-tinted nostalgia as many older physicians do. Our Covid-19 response has been filled with misery and suffering, along with occasional moments of profound joy. I am proud to have played some small role in helping and humanizing my patients thus far, but I’m most excited to arrive at a place where our medical interventions become more nuanced and effective.

There is an interpersonal joy in becoming a doctor at this time as well. It seems there is an endless appetite for medical knowledge and expertise right now. I have been overwhelmed by the number of questions about Covid and epidemiology I have received in the last three months. I’ve also been surprised by the new weight my words carry. In seeing my friends and family take my theories about the prospects of a second wave and the speed of vaccine development as medical fact, I’ve realized I need to be prudent about how I discuss medical information. In the midst of a pandemic, communicating clearly has the power to change public behavior, health policy, and thereby save lives.

The intensity of training during a global pandemic is undoubtedly a double-edged sword for young physicians. On the one hand, I worry Covid-19 will rob us of the important early experience of witnessing the powerful capacity of medicine to do good. On the other, in training through this pandemic, a generation of young doctors might reject paternalism, embrace humility, and understand medicine does not just take place in the interaction between a doctor and a patient, but also in the development of a trusting communication between health care workers and the community-at-large. I remain hopeful that by training during Covid-19, my generation of young doctors will be expert communicators and public health advocates. This is our chance to be vocal in the face of injustice and uncompromising in advocating for the health of the population, particularly those most vulnerable.

Coronavirus Has Made Me a Better Physician

you only have five minutes with a patient, what questions do you ask and what physical exam maneuvers do you perform? If you can only order one laboratory test, what should it be? If the MRI or CT scanner is unavailable, are you still confident in your diagnosis?

These are questions that we resident physicians ask ourselves daily as part of a critical thinking exercise. They help us stay grounded and able to practice medicine without relying on the luxuries of expensive or advanced testing.

Theory becomes reality

When Covid-19 engulfed our state and hospital, this critical thinking exercise took on new meaning by becoming a daily reality. I found myself increasingly working in a resource-limited environment, in which every patient encounter and test was scrutinized for necessity. It wasn’t easy to completely upend my usual practice — yet I suspect that facing constant limitations may have made me a better physician.

Coronavirus has prompted me to relearn the fundamentals of medicine, triage appropriately, and adapt to a virtual visit model — all of which may mean I’m providing increased care.

Because covid precautions demand limited patient encounters, I am forced to think carefully through the minimum necessary steps, exam findings, and testing to clinch the diagnosis.

I recently saw a 23-year-old woman in the emergency department for a severe headache. She was in significant pain and could not provide much of a history, which meant we were unable to rule her out for Covid-19. She also had a low-grade fever, flagging concern about meningitis, a deadly brain infection.

I abbreviated my exam to look for two things: neck stiffness and trouble with eye movements. She had both, indicating a likely deadly infection, with early signs of increased intracranial pressure. The patient needed prompt antibiotics, urgent head imaging, and a spinal puncture. This type of “emergency neurology” workup is normally frowned upon, as there may be subtle things that are missed in a rapid encounter. However, because Covid precautions demand limited patient encounters, I am forced to think carefully through the minimum necessary steps, exam findings, and testing to clinch the diagnosis.

Tests become risks

In today’s climate, the stakes are higher for any scan I might order. A brain MRI, for instance, will potentially expose the patient’s nurseemergency room physician, transport team, radiology technologist, radiologist, environmental services team, and administrative staff to the virus — if the patient has it. Likewise, the patient will also be exposed to all of these individuals who might be carrying it.

With this in mind, I am frequently forced to reconsider my recommendations. Obtaining unnecessary imaging is a dangerous practice. Incidentalomas, unexpected incidental findings, occur in as much as 10% of patients. These findings can lead to increased worry, stress, and unnecessary interventions. This is in addition to the harmful radiation or intravenous contrast, which may cause anaphylaxis or kidney damage, that a scan might entail.

We now have to be absolutely sure about every test we order.

Because of this particular patient’s abnormal eye movements and neck stiffness, she needed imaging despite the risks of exposure.While at times it has been daunting to practice medicine without the guaranteed safety net of advanced testing, it has been refreshing to place new emphasis on our clinical skills and knowledge.

Caring for patients at home

This type of risk-averse thinking and triage has impacted our outpatient management as well. We now ask ourselves on a regular basis: Does this patient need to be in the hospital? We have started to triage small strokes for expedited follow-up, completing the work-up over a few days in an outpatient setting. Likewise, we have been doing our best to keep our immunocompromised patients, including those with brain tumors on chemotherapy or with multiple sclerosis on immunosuppression, out of the hospital. We have done this by increasing our number of virtual visits.

Initially, I was hesitant to move toward telemedicine. My training has always prioritized physically seeing patients and testing all parts of their nervous system — including strength, sensation, and coordination. However, while virtual visits are not perfect substitutes for in-person interactions, they offer tremendous value when it comes to increasing access to care.

Many neurologists are clustered in certain regions of the country. This has led to disparate access, particularly in rural and urban areas. Someone in rural Alaska or Maine may live hundreds of miles away from the nearest medical facility. Even living in a city with an abundance of medical specialists does not guarantee access to care. Transportation costs may be prohibitive and time consuming, ultimately contributing to health care disparities.

This pandemic has provided us with the unique opportunity to improve our telehealth system. Previously, these systems were clunky and outdated — requiring expensive technology or complex interfaces. Now, most virtual visits can be conducted using a cell phone. Even though these systems are still in their infancy, there is untold potential in increasing access to care, particularly to our most vulnerable populations. While telemedicine is not perfect and cannot fully substitute for a face-to-face visit, possibilities abound when it comes to providing medical care via telemedicine to traditionally underserved communities.

Covid-19 has undoubtedly changed the practice of medicine. And not all of these changes are negative. When this pandemic is finally over, we should not be so quick to revert back to the status quo, but rather try to integrate these changes to continue to improve health care for all.

How we can overcome the coronavirus

Positive attitude and belief in the healing power of the mind can help defeat pathogens

Viruses and other germs are all around us. But why do some people catch a virus while others don’t? Why do patients respond differently to drugs, and some don’t even respond at all? What is exactly responsible for the difference? Is it the immune system, or conscious beliefs, or both?

Science tells us that skin cells can entirely regenerate themselves in two weeks, while the intestine cells need only five days. The plain truth is that whereas every single organ of our body can repair itself within a certain frame of time, we do not know enough of our mental and physical structure.

Our beliefs and emotions have links to poor health as the Quran says, “And Who, when I fall ill, heals me” (26:80). The Bible says, “A joyful heart is good medicine, but a crushed spirit dries up the bones” (17:22). In these messages, the physical symptoms are attributed to the human psyche holding human at fault for his sickness and impacting health. In fact, the mind can defeat mental disorders and physical illnesses caused by negative thinking.

To change patients’ attitudes, California Simonton Cancer Centre introduced guided imagery and visualisation exercises. Imagery is the ability of the mind to visualise images as reality and sense every single bit of it, leading to self-healing. To explain, a laryngeal cancer 60-year patient slowed down the progress of the malignant tumour and improved his health thanks to the imagery sessions where he visualised radiation as bullets targeting and chasing the cancerous cells out of the body through liver and kidneys.

The success was astonishing! The cancer was defeated. Doctors attributed it to the daily imagery and visualisation exercises. The perceived images can lead to changes in the body — unfortunately, the vast majority of patients associate recovery with clinical treatment. So medical professionals have prescribed placebo, an inert sugar drug, to stimulate the innate healing powers in the patient.

The state of mind can alter the course of illness while superstitions, fear, stress and anxiety weaken our immunity and digestive systems.

– Dr Noura S. Al Mazrouei, UAE writer

The drug proved effective but the effect was ascribed to two factors. First: the patient’s faith in the drug relieved his symptoms as if he was given a real medical treatment. Mind-body connection supersedes reality. Second: the behaviour of the doctor influences one’s psychology. It is established that the unshakeable beliefs of the patient cure or ruin him.

A case in point is an American businessman who was diagnosed with lymph node cancer in Simonton Cancer Centre. The tumour spread throughout his body. He, however, was so convinced a press-advertised anti-cancer drug called Krebiozen would cure him that he substituted it for radiation therapy. The tumours had shrunk due to the patient’s belief in the efficacy of the drug not to the efficacy per se. Having recovered, he was discharged to lead a normal life as he used to.

A while later, he suffered from severe depression after reading reports questioning the efficacy of Krebiozen. He was left totally devastated and died shortly after the cancer relapsed.

The state of mind can alter the course of illness while superstitions, fear, stress and anxiety weaken our immunity and digestive systems. According to Ed Diener , professor emeritus of psychology at the University of Illinois, summarised in his studies, “feeling positive about your life, not stressed out, not depressed — contributes to both longevity and better health among healthy populations”.

The lesson we learn that helps us face the coronavirus pandemic is that our positive attitudes and belief in the healing power of the mind can defeat all pathogens as well as tumours.

— Dr Noura S. Al Mazrouei is a writer, academic and artist.