In nursing school they teach us how to counsel people about risks, benefits, alternative treatments and the importance of shared decision making.
These concepts are core tenants to how I practice as a midwife. But I have felt incredibly shaken in my ability to calmly and dispassionately counsel people about the COVID vaccine the last few months. I have felt cracks in my deep compassion and understanding of people who will make choices different than the ones I would. I have been thinking about writing down my feelings about this since the December/January omicron surge, but honestly was too exhausted, too pained, too angry to put my feelings into words.
Each visit starts the same. “Have you had the COVID vaccine?”
A quick no comes from behind a mask, often dangling under a nose or slipping off altogether.
“Are you open to getting the COVID vaccine?”
“Can you tell me more about the reasons that you don’t want the vaccine?”
This is where the answers typically veer in different directions. For some, immediately the answer becomes “I don’t want to be experimented on. I’ve done my own research. I got COVID already so I have natural immunity.” I can feel the distrust and bristling defensiveness hanging in the air.
Sometimes I am met with genuine concern. “I just don’t want something that’s not safe in pregnancy. Is it actually safe?” These are two vastly different conversations, but I am bound by my duty as a member of the midwifery community to provide information that is true, that is accurate, and only then, if the patient declines are they doing so with informed consent. Would it be far easier to end the conversation after the patient says they are not interested in getting the vaccine? Absolutely. Would I be doing my job ethically and fully if I did? Nope.
That’s honestly usually what I tell people, in my kindest, sweetest, most Ted Lasso-iest demeanor.
“Say something horrible did happen to you and, god forbid, you do get super super sick from COVID, or you or the baby has complications from COVID and I come to visit you in the hospital and you say to me, ‘Why didn’t you tell me a vaccine could have prevented this? Why didn’t you tell me that I wouldn’t get as sick, or that it could keep me from having a premature birth? or a stillbirth?’ and I wouldn’t have a leg to stand on if I hadn’t. So I have to tell you. You always get to choose what goes in your body, but my job isn’t done unless you have the information and THEN you decline.”
On my best days, this is the counseling I give.
I used to have endless patience and could counsel people for half a visit about the importance of the flu vaccine, the TDap vaccine, and not loose sleep over my patients that chose not to get them. I wouldn’t feel any of the resentment, bafflement, or, frankly, the rage that I feel now.
The COVID vaccine brings to the forefront the ethical issues of personal choice in the midst of a deadly global pandemic that threatens to wage on indefinitely. In all likelihood we have now surpassed over a million deaths in the US from this virus. Yet there are those who, for whatever reason, political, personal, or those who are skeptical of the dozens and dozens of changes made by our fumbling public health institutions, who will probably never be vaccinated. It honestly feels like fighting a losing battle.
Now I can feel my frustration and anger seeping into the counseling I give. I try to keep from rolling my eyes when I hear the most nonsensical, idiotic things about vaccines and public health parroted back to me. I legitimately almost asked a patient which lab she worked in when she told me she had “done her own research.”
What I wish I could tell people is what haunts me most nights as I try to fall asleep in our small, windowless call room. The terror on the face of a patient as I ran into triage to assess her shortness of breath. She was satting in the mid 70s, her eyes wide, gasping like she was trying to breathe under water. She had had two vaccines even, but hadn’t had the booster.
I think about the NICU board full of preemies born to parents so sick that they didn’t meet their mothers for weeks or even months.
I think about sitting in report each morning, listening to the OBs and MFM docs decide how much sicker they will let people get before delivering their babies by emergent c-section. Deciding the careful balance between how unpredictably sick COVID patients can get while balancing their babies getting a little bit bigger, letting their lungs a little bit stronger.
I think about board rounds with the whole nursing and OB leadership team. Hearing week after week of the patients intubated on the medical floors, either still pregnant or immediately postpartum. Not knowing if they will ever see their babies grow up.
I wrote about midwifing in a pandemic now almost two years ago when everything felt fresh and terrifying for completely different reasons than they do now. Now, your midwives, we are still here, but our compassion is worn thin. We are trying to find joys in the small joys of our jobs. Helping new parents catch their own babies. Learning how to smile so wide with only eyes above our n95s that parents can see how proud we are of them crossing into the unknown and back.
But deep down we are broken. Our trauma still held just below the surface so we can continue to function in this pandemic, which contrary to public opinion, continues to rage. Some day our dams will all break open and our stories will threaten to drown the world.