By Kevin Patterson
This piece was originally published in The Globe & Mail.
The Forever War draws to a close just as a struggle far more lethal and existential begins to unfold. Now might be the right time to reflect on the distorting effect that two decades of militarism have had on the idea of courage – and what a more useful version of it might look like.
Heroism once meant courageous self-sacrifice; for a long time now, it has been code for homicidal. I served as a civilian physician at Kandahar Airfield in 2007 and when the nights were long, we watched the drones, the tactical bombers and the helicopters take off to deal death at great distances. Coming in to land on that same airstrip, though, were the medical assistants and the navy corpsmen, rushing their wounded – sometimes the enemy wounded – to the Role 3 hospital, having extracted them from the battlefield, not having killing top-of-mind, but rather rescue. The medics died, too, by the hundreds, making up almost 10 per cent of the fatalities sustained by military personnel in Afghanistan and Iraq.
But it was rarely the medics who were discussed. The popular imagination instead was captured by the idea of lethality – and something about the ability to kill from a distance, immune to danger oneself, appealed to people.
American Sniper made half a billion dollars in 2015, making it the most successful war movie ever based on box-office earnings. It earned an Academy Award Best Picture nomination and featured Bradley Cooper, executing brown men of fighting age at great distances and presaging Navy Seal Chief Petty Officer Edward Gallagher, who was recently pardoned by U.S. President Donald Trump after being convicted for war crimes. Mr. Gallagher’s targets were not confined to men, nor to fighting age, nor to anything except human beings, wanting, in his eyes, killing. Although there is no reason to be confident that house pets and songbirds entirely escaped his attentions, either.
That sniping became a kind of fetish subject during the height of the Afghanistan/Iraq wars is repugnant and counterhistorical: the original response of traditional infanteers was that, in the safety and secrecy they enjoyed while killing, snipers were anathema to one idea of soldiering, not so much fighting as assassinating. In the Franco-Prussian and the First World War, snipers were often summarily executed.
The medics, and health-care workers more generally, present a different idea of heroism. A few years before I was in Kandahar, in Toronto in 2003, during the SARS outbreak, nurses cared for hundreds of infected patients and many became infected themselves – representing 43 per cent of the 438 who fell ill. During this time, the risk of an ICU nurse being infected was calculated to be 6 per cent for each shift worked. Three died.
In 2009, in the ICU where I work as a critical care physician on Vancouver Island, we were hit hard, as ICUs around the world were, by H1N1 influenza. Although the overall mortality that year from influenza was low, that virus was capricious, hitting some patients extraordinarily hard. Our ICU was over capacity for months, beginning in January, until well into April. The nurses worked preposterous amounts of overtime and, by the time the crisis eased nearly four months later, were just spent. You could see it in their posture, in the way people stopped bantering. Around their eyes. But they all kept coming to work. And would have, I believe, for as long as they were able and needed.
And now, in Wuhan, there are 3,300 health-care workers, almost all nurses, who have developed COVID-19. Thousands of nurses have travelled to Hubei province from parts of China less seriously affected by the outbreak, not knowing precisely what they were coming to, but surely knowing that this was contagion, and dangerous, and that the hospitals were strained and short of resources. Which is the sort of circumstance that leads to nurses falling ill, which is the sort of circumstance that has made for a 5-per-cent mortality rate in Wuhan, among the confirmed cases. Presently, 14.8 per cent of health-care workers – mostly nurses – in Wuhan have been infected.
Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, has emphasized, since Feb. 6, that nurses face a global shortage of personal protective equipment. Factories that manufacture this equipment are now back-ordered by six months. In a recent report in JAMA, in one hospital in Hubei almost 30 per cent of their COVID-19 patients were health-care workers who had themselves become infected. It seems reasonable to anticipate a Toronto experience enacted on a scale many orders of magnitude larger.
And still, they rush into battle. Under-armoured and unarmed, in Italy and Iran and China, mostly women, mostly poorly paid, not respected nearly enough. In full knowledge of the risk they run.
When this is over, there had better be a parade.
Kevin Patterson is a physician and writer, and a Global Reporting Centre collaborator. He practices general internal and critical care medicine.