Regenerating life amid the Covid-19 pandemic

On the walls of Cedars-Sinai Medical Center, where I work, there is a print by artist Raymond Pettibon. It shows a swath of blue paint above the words, “Yes, but alas, the blue sky has been repainted. By restoration, there is no telling how much you have lost.”

I usually visit Pettibon’s work after teaching rounds with the medical teams in the Intensive Care Unit. Alone after raw encounters with broken bodies and disrupted lives, I often seek out the reminder: restoration may not be enough.

Pettibon’s work asks us not to accept the illusion of restoration to what was before. It calls on us not to lose lessons that emerge through adversity. It reminds us that sometimes, in the seemingly unimaginable, we find an invitation to imagine our way forward.

I have visited Pettibon’s “Yes, but alas” at least once a week since the pandemic began. When I do, a thought revisits me: Maybe none of us can take on all the moral challenges raised by this pandemic. But perhaps we can take on some of the concerns that we may not have recognised before.

As a clinical ethics consultant, educator and public scholar, I engage questions about complex moral experiences in healthcare settings. I work with patients, families, nurses, physicians, social workers, chaplains, lawyers and administrators. When someone calls for a clinical ethics consultation, it is because they seek support in a crisis: there’s confusion or miscommunication to think through, an impasse to overcome, the aftermath of a disease or accident with which they must now learn to live.

Navigating the unwelcome uncertainties of giving and receiving care means brushing against structural factors that shape interpersonal encounters. Communal and institutional politics; local, state and federal law; theoretical frameworks; and public health policies intersect actual people’s lives. In such moments of crisis, suddenly we see our taken-for-granted ways of being in the world, and often-unspoken values, come into sharp focus, especially when they collide with those carried by other people.

I’ve learned that those collisions can be hard. In moments of uncertainty — medical and moral — it can be daunting to see beyond oneself. We have to choose deliberate understanding: what social psychologist Pierre Bourdieu describes as a focused attention to different people that lets us see them as whole persons, not just caricatures or types.

Covid-19 hasn’t changed the character of clinical ethics work, but I have seen new parallels between conversations in the hospital and conversations in our communities.

The pandemic has exposed our interdependence in ways that deeply challenge the American mythos of rugged individualism. It has exposed the raw injustice we all suffer as what philosopher Herbert Spiegelberg calls “fellows in the fate of existence”: those persistent, deeply ingrained inequities that are taken for granted simply because some are born to more resources, safety and health than others.

All anyone has to do is look around the neighbourhood to find someone experiencing a very different pandemic than themselves. If some aspect of “this pandemic life” is difficult for me, that gives me an opportunity to consider how it might be for a neighbour, in different circumstances. Those connections can introduce us to resources, coping mechanisms and networks of support we haven’t yet considered. We haven’t yet had to, until now.

Inviting these connections is a kind of moral engagement: a listening and telling, an affiliation, as the philosopher and ethicist Richard M Zaner has written. I help make space for these conversations in my clinical ethics work. They can be an avenue for understanding within and beyond our communities, even — or especially — in a global pandemic.

This kind of deliberate moral engagement feels strange for many of us — especially amid a pandemic, when everyday challenges make it seem flatly impossible to focus on how others feel. Can we open to real curiosity, seeing near and far neighbours as they are, rather than as we have imagined? Can others’ perspectives help us see ourselves in new ways?

If we are able to “see with new eyes,” as Marcel Proust invites us, perhaps we can connect our individual, interpersonal experiences and needs to our communal, collective challenges and actions.

This comes across vividly when we consider the Covid-19 vaccine rollout. Vaccines are closely connected to hopes of returning to normal, to what we have always known and done. Yet in the difficult processes of allocation, distribution and acceptance, we can see why a return to before is not possible — why restoration cannot be enough.

We should not continue, or consider returning to, a society where unequal access to vaccines takes egregious health disparities and widens them to the point where they are obscene. We should take a hard look at the efforts of the wellresourced and privileged to move ahead in vaccine allocation lines.

We should direct resources to communities struggling with diseases of poverty and limited access to primary care. We should learn from evidence of generational trauma that impacts community health and a healthcare system that systematically disenfranchises people of colour.

We should engage with concerns around vaccine hesitance. We should alleviate the burdens on tech-limited Americans that have made it so difficult for them to navigate online sign-up systems. We should start paying attention to distribution difficulties, material logistics, and systemic inefficiencies that few have had to know or worry about before.

Even as thumbnail sketches, our current vaccine challenges highlight pre-existing conditions that we can no longer ignore.

One year into this overwhelming pandemic, I recognise that accepting responsibility for seeing with others and thinking differently feels heavy. But pandemic experiences also create possibilities for new ways forward. We have had to practice in our own lives: seeing anew the way things were, revamping our activities and routines, and making things work in the new normal. We have adapted, even as our surge capacity has been depleted and we’ve despaired that we can’t go on.

Instead of following breadcrumbs of our deep yearning for pre-pandemic life and how things used to be, we continue into the unknown. We have learned by ourselves, from others around us, and from sheer necessity that we can learn to see differently, that we can make a deliberate choice to listen and tell, to understand, to go forward. Not back to before.

In clinical ethics encounters and community moral engagements, we can learn from each other in this unavoidable pause. We can carry on, together, into recuperation, rejuvenation, renovation, regeneration.

After all, as Pettibon reminds me every time I take a moment to stand in front of his beautiful, provocative print: We’re not going back. Too much has been learned — often hard-gained. Too much work lays ahead, for individuals and communities. Too many beloved people have been lost to be forgotten.

My hope is that none of us will paint over these months, grabbing at the blue sky we think we remember.

‘‘ We should look at the efforts of the well-resourced and privileged to move ahead in jab allocation lines.

Virginia L Bartlett is assistant director of the Center for Healthcare Ethics and assistant professor of Biomedical Sciences at Cedars-Sinai Medical Center in Los Angeles. She is currently finishing a book on her experience of becoming a clinical ethics consultant.