A short while ago I cared for a patient who was admitted to the hospital with breathlessness. He’d developed heart failure, a condition with a cruel name which describes a state where the heart muscle ceases to pump efficiently enough to deliver blood and oxygen to the cells that need them, often leading to a build-up of fluid in the lungs. He’d been unlucky: in spite of losing weight, cleaning up his diet and quitting smoking a while back, the damage had continued. I saw him after a turbulent year of decline, exacerbated by a Covid-19 infection. He needed oxygen all the time, and was going downhill fast. And I was the one tasked with relaying this to him and his daughter.
It should have been obvious; all the signs were there. He was becoming dependent on his wife for help with washing and dressing. He could barely walk round the house without struggling for breath. “I just want to make it to December and my 65th birthday, so I can start claiming some of my pension back from the bastards I’ve worked all my life for,” said my patient. “He needs to make it to next spring, to walk me down the aisle” said his daughter, seeing something in my face that betrayed doubts that either of these were realistic.
“When I’m feeling better, I’ve always dreamed of visiting Lake Maggiore,” said the man. “Book your tickets” was the only conciliation I could muster.“Pay whatever your travel insurer is quoting and go”.
The family had known for some time that things were getting bad but had been holding out hope, despite the bleak prospects painted by the specialists, that he might get a heart transplant and they could all put this nightmare behind them. A heart transplant is by no means a panacea, and my patient’s window for even getting through the pre-transplant assessments was shrinking fast. But his family weren’t ready to absorb this reality, so we agreed to put them in touch with the palliative care team in the meantime, “just in case” things didn’t play out as they’d hoped.
But this patient’s decline surprised even me. The following day I returned to the ward just after 5pm to a commotion outside the patient’s room. The cardiac arrest team had been called when he became suddenly unresponsive while talking with his wife. She had been ushered outside while the team tried to work out what was wrong, tried to fix it. Seconds later a colleague opened the door and informed us that he’d died.
This news hit me hard, as it did everyone else. Here was a man who had shared with me his fears, his aspirations, and his unrealised dreams. He wasn’t just a man whose heart had stopped working. He was a person who never got to claim his pension, and would be absent from his daughter’s wedding. A man who would never get to look out across Lake Maggiore.
Denial is a powerful thing. It stops us from confronting the truths that should smack us in the face. It makes us irrational; we cling to a vision of the future that can only ever represent the past. It’s also rarely helpful to tell a dying patient, or a grieving relative, that they are in a state of denial. We must confront our self-deceptions in our own time, with support from our family and friends.
Six months prior to this encounter, I gave up practising medicine for a while. The climate and ecological emergency was overwhelming me, and ploughing all my mental energy into the exhausting cut-and-thrust of a full-time hospital job did not align with my need to do something – ANYTHING – to raise the alarm that the planet is burning. I believed that being a doctor and an environmental activist were diametrically opposed.
But what I learned during that period is that the climate and ecological crisis is a health crisis. I’m used to dealing with those all the time. But the climate emergency will harm more people than I could ever hope to heal in a lifetime of trying.
Let’s imagine that my patient’s heart got worse because of heat stress from a record-breaking heatwave, which is scientifically plausible. It was a very hot week. Or that he was killed by a lung condition caused by air pollution, a stroke, dehydration, an infectious disease such as malaria, flooding of his home, war, food insecurity or any other health or social condition that is and will be exacerbated by global warming. And let’s replace the heart transplant with some other glimmer of hope that experts tell us is vanishingly unlikely to save us, such as artificial carbon capture or colonising another planet. And just like that, we’re all the breathless patient in the hospital bed, dependent on the oxygen that trickles up his nose, or the tearful daughter who dreamed of being walked down the aisle by her dad. As a human race we’re stuck in a state of unreadiness for the reality that’s smacking us in the face. Finally, let’s replace the sudden decline of my patient with an ecological tipping point that we can’t resuscitate our planet back from.
If we all developed a relationship with the Earth systems that sustain us that is as deep and complex as those we have with our partner, our parents, our siblings, our children or friends, how could we apply what we know about loss and denial, and avert the worst possible outcome?
In short: if you have suffered the loss of someone you loved before you were ready to let them go, what would you have done differently if you knew how short time really was?
Some patient details have been changed to protect anonymity.
CALL TO ACTION:
If you are a health professional: The climate and ecological crisis is a health crisis. Think of all the unnecessary harm we could prevent if our corporations and governments acted in a way consistent with their stated goals to limit global warming to 1.5°C. The General Medical Council’s Duties of a Doctor tells medics to “Protect and promote the health of patients and the public” and “Take prompt action if you think that patient safety, dignity or comfort is being compromised”. Doctors for Extinction Rebellion welcomes all health professionals to fulfil our moral duty to the wider public by educating the public and putting pressure on the UK Government and corporations to cease activities that contravene our climate commitments.
If you are a member of the public: Have the difficult conversations with those close to you. Are you and your loved ones doing what you can to limit climate change? Many of the solutions to the climate and ecological emergency have co-benefits for physical and mental health, such as driving less and walking, cycling, or taking public transport more, reducing the meat and dairy content in your diet, and encouraging nature in your gardens and green spaces. We can’t individually turn the tide of climate change but our actions can have a profound influence on those around us, and the ways you invest your time and money impact on what governments and businesses prioritise.
Katie Percival is a junior doctor working in Dumfries & Galloway. She is a member of Writers Rebel and Doctors for Extinction Rebellion.