altruism – Go Retire Psychiatrist

When I think about all the mandates and bans against mandates for the COVID-19 vaccines and masks, I wonder about my own motive for getting the vaccine and wearing a mask.

In one sense, I’m doing it for myself. I’m a retired consultation-liaison psychiatrist and I got called to the intensive care units a lot. Almost always, the patient was delirious. And almost always, the patient was delirious in the setting of being on the ventilator or in the process of being liberated from the ventilator.

The critical care physician and the nurses were always looking for one specific thing from me. I was supposed to stop the patient from being agitated, to calm the wildly thrashing, terrified person fighting the restraints and struggling with hallucinations and fragmented paranoid delusions that every caregiver in the unit was trying to kill him. Often there were many medical problems, including multiple organ failure often from lack of oxygen, resulting in brain injury as well. Nowadays, COVID-19 is a frequent cause of delirium for the same reasons.

Years ago, the only tool I had was an antipsychotic called haloperidol, because it could be given intravenously. It would calm some patients, but it could and did cause side effects including akathisia (extreme restlessness), dystonia (severe muscle spasms), and neuroleptic malignant syndrome NMS, a rare, complex, life-threatening neurologic emergency attributable to antipsychotics. Over the past several years, the ICU pharmacies acquired newer drugs like dexmedetomidine, which is not a psychiatric drug. That didn’t stop the ICU from calling me.

I’ve seen all of that. I got the vaccine and wear the mask mostly because I don’t want to be in that boat. But I think those measures help protect others, too. I think many people have that motive. Those who think they’re getting it just for themselves can go on thinking that.

We’re taking a risk when we get the vaccine. It’s not completely harmless. There are very rare side effects which can be life-threatening and they have killed people. There is some level of altruism involved. Those who get the vaccine are playing a role, however small, in reducing the chance the virus will mutate into something that will kill even more people.

Wearing masks is a nuisance and doesn’t really feel heroic. But this act combined with other measures (the usual suspects: hand-washing, social distancing, avoiding large crowds) spreads love instead of infection.

We don’t have to agree. We don’t have to love each other. I just hope we can respect each other.

Like everyone else, I groaned aloud about the revised CDC mask guidelines yesterday. I still trust the CDC guidance, and I’m sure many might disagree with me. I think some headlines overstate the CDC mask change. I don’t believe it’s a “reversal” per se. I think it’s common sense to wear a mask if you’re inside somewhere with a lot of people whose vaccination status you know nothing about.

I think it’s worthwhile to actually read the CDC web site’s mask guidance in the section entitled “When You’ve Been Fully Vaccinated.” What it says is:

“To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoor in public if you are in an area of substantial transmission.”

It’s a good idea to check your geographical area (COVID-19 Integrated County View) to see what the transmission situation is. It’s moderate where we live in Iowa. That’s enough for me to go back to wearing a mask in tight quarters with people I don’t know.

I was dismayed to read an opinion piece entitled “Stop listening to the CDC,” in which the author said that “the vaccinated are not responsible for the unvaccinated, and vice versa.”

That made me remember my former pastor, Reverend Glen Bandel, who is now in his 90s. When my mother was very sick, he spent a long night sitting up with her. My brother and I were too little to manage the crisis by ourselves. She was unable to keep any food or fluid down and he made many trips from her room to the bathroom, to empty her bucket of vomit in the toilet. You could have made a case for hospitalizing her, but we somehow got by without it.

If we all believed that we are not responsible for each other, we would have been extinct long ago, let alone getting through this pandemic in the last 18 months. Not all of us who got the COVID-19 vaccine did it just for ourselves. I think a great many also did it for those they loved and for whom they felt responsible. This is called altruism and I think humans are still capable of it, despite what you read in the news.