Street art on a wall in England (Photo: Oli Scarff/AFP via Getty Images)

Heroes and monsters of health

The Covid-19 pandemic has seen doctors and nurses cast as heroes battling a villainous virus. It may be well-intentioned, but it’s a narrative that serves no value, writes ICU doctor Alex Kazemi.

In a foyer in Southampton General Hospital in the UK hangs a one-metre-square artwork, donated by the street artist Banksy during the time of the first wave of Covid-19. The piece shows a boy holding aloft his new toy – a figure of a nurse, surgically masked, cape fluttering behind her, the only colour her Red Cross. Her arms are posed to suggest Superman in flight. In a waste basket next to the boy lie the discarded figures of Batman and Spiderman. The accompanying note began “Thanks for all you’re doing”.

It is deeply well-intentioned both in the underlying suggestion of how we should realign our concept of heroism for the pandemic, and as a gift to buoy broken spirits in the midst of the most extreme surge of patients the NHS has ever seen. For NHS workers, there is gratitude that the hidden and difficult work they do is now recognised. But, accepting that, it’s worth examining further whether the narrative of the hero itself remains of value to us in the world we now inhabit.

Our childhoods are often built on stories of heroes and monsters, stories created a long time ago to assuage our fears of an unpredictable world. From my own boyhood made far from here, one such story was of Theseus and the Labyrinth. The simple story is good. At the heart of the myth lies its twisted monster and into its containing maze is thrown the hero. In its most straight telling, Theseus confronts his own primal fear and, with the help of his erstwhile lover, Ariadne, dispatches the monster and escapes, using her gifts of sword and thread. The tricky part is that Theseus turns out to be as much a thankless misogynist as the next Greek hero, abandoning Ariadne to a solitary fate on an island on the voyage back to Athens.

Boyhood is long past, but if I’ve grown to see the damage the unchecked male psyche can do to the world, then I have also learned something of the damage the heroic narrative can do to our understanding of the multitude of quiet spaces of our daily existence, the necessary infrastructure of our progress. In this strangest of years, I have been privileged to learn that again at my own place of work, seeing how in crises, both actual and threatened, rapid adaptation arises from the wellspring of necessity, often from the most ordinary of places. We talk of essential workers but the word essential seems somehow insufficient to encompass all the ways the healthcare system depends on each worker, crucially interlinked, but largely unseen.

Photo: Getty Images

The first problem with the reductionist narrative of heroes and monsters, then, is how it ignores these unseen workers. The hero tramples on the ordinary and his story paralyses the notion of collective action, yet it is the collective multitudes of the ordinary that are the truth of how we make our way through the maze. There are no lone heroic moments, instead there is an undecorated and long wall of silent endeavour that is easy to walk right past. Our nightshifts are not made of watchmen and vigilantes, but myriad workers of all hues. In the need to produce a single, sensational story we ignore the patchwork quilt of all the stories that we should be stitching together, if we were to really understand how progress is made.

We could try and solve that by making every worker a hero. But for all the talk of frontlines this war is an artifice. In the case of Covid-19, we’ve made the virus the monster. That’s understandable – the speed and ferocity with which it has swept through some healthcare systems, trailing a wake of deaths, means that for those in the middle, it is an onslaught. Nature is capricious and the virus doesn’t care, but nor did it evolve to care or do anything other than replicate. As modern Yale historian Frank Snowden describes, plagues teach us much more about the societies they pass through. This virus isn’t a monster, it’s a mirror. We are fighting ourselves. And the way we’ve bent our world out of its natural shape. Widespread destruction of ecological habitats means increasing encroachment of animal vectors, such as bats, with new strains of pathogen, into our cities. Our drive to connect the world in a vast network of air travel means that no human is more than a few jumps from any other on the planet. And the creation of socio-economic systems that comprehensively oppress certain of our communities means that the virus rips through those same communities to devastating effect.

Photo: Getty Images

To date, the reality of most successfully dealing with the pandemic has not been that of massed frontlines of hospital workers or a heroic breakthrough, but rather the simple acts of community and public health that prevent the virus from spreading in the first place. Acts that crucially depend on the recognition that by protecting the most vulnerable amongst us, we are, in fact, protecting all of us. That is humanity, not heroism.

The second problem is the murkiness of the politics. Trenches can be dug and filled with heroic soldiers to serve propaganda. While our colleagues in the NHS have done tremendous work to deal with an incomprehensible surge, I felt nothing but grave unease watching the television pictures of the weekly ritual clapping for the NHS. From here it is difficult not to draw the conclusion that the UK government was slow to deal with the pandemic and made some fundamental mistakes of inaction. It then doesn’t seem much of a stretch to suggest that the exaggeration of gratitude shown now is an attempt to marginalise any anger at the reality of one the highest excess mortality rates in Europe.

Tied into that is the history of slow erosion of the NHS, to the point where each winter brings near collapse. It’s worth noting that New Zealand isn’t immune from this, but particularly in the NHS, tales of dehumanising treatment of staff, pay freezes, overcrowded emergency departments and unattainable managerial targets are common. One might see the erosion as an attempt at privatisation or, more probably, the failure of successive governments to grasp the complexities of dealing with health policy at that scale, particularly when economic policy may be at odds with it. But it is erosion all the same. Handclaps and chocolates are unlikely to fix disillusionment with empty words. One might wonder if the super-nurse figure might be as easily be discarded into the waste basket too when this is all passed and the clapping has served its purpose.

Prime minister Jacinda Ardern and director general of health Ashley Bloomfield (Photo: Hagen Hopkins/Getty Images)

If our heroes are transitory, we also fashion them with feet of clay. The trouble with elevating individuals such as Jacinda Ardern and Ashley Bloomfield as heroes of the pandemic is that the pedestal is all too easily removed when the inevitable errors creep in. The truth is that the mistakes spring from the many as much as the success. The unprecedented reality of shutting international borders suddenly and keeping them watertight was always likely to be difficult and iterative, and many countries richer than New Zealand have struggled with the problems of ongoing containment. Baying for sacrificial blood when mistakes are made serves no end other than a political one. From a healthcare viewpoint, asking for improvement is one thing but political point-scoring just feels tiresome and counter-productive, in what may become a long haul.

In the end, perhaps the only Greek hero whose story touched on any of these complexities was Odysseus. Tired of the senseless violence of Troy, which he played a part in creating, he sought only to return to his family. I suppose that, imperfectly, captures where we are. Healthcare workers seek to do their best with the resources we are given and within the constraints of an often unyielding system. But we still wish to be valued as humans, not temporary heroes. And be listened to. When we are done with the grief, we seek simply to return to the sunlit spaces of our own families. We may at times be exhausted, at times frustrated, at times both. But it’s tricky, this act of balancing, the high wire we walk, where we can simultaneously feel heartfelt gratitude at kind words and recognition, yet still smile ruefully at what we know is a system that is broken in many places. The Banksy artwork in Southampton General will hang there until the northern autumn and then be auctioned to raise money for the NHS. If we do not take care, the damage done by then to the psyche of healthcare workers may be immeasurable, and the loss of trust in some of their governments irreparable.

One way or another, we are all navigating the labyrinth, either personally or collectively. But there is no monster in the middle, just us and our fear of the dark with all its uncertainties. The threads we use to find our way out will be tangled together into a difficult tapestry showing all our overlapping stories. But whether the complex problem we face is burgeoning healthcare needs, or sudden climate anomalies like that which now blossoms like a bloodstain over Siberia, or the precarious nature of our democracies, we are better to admit that the heroic narratives that served us in simpler times do not serve us so well now. Humans and our future are a turbulent sea but best navigated as a plural, not a singular. And once we have finished reading them to our children, the heroes and monsters should remain shut in the storybooks, for another time.



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