Future Tense

To Whom Do Health Care Workers Owe Their Ultimate Loyalty in a Pandemic?

Paul Theroux’s short story “The Vastation” demonstrates how crisis forces health care workers to grapple with dual responsibilities.

Boy looking out the side of a passenger side car window at barbed wire.
Natalie Matthews-Ramo

A physician responds to Paul Theroux’s “The Vastation.”

“The Vastation” is a tension-filled story about a father-son journey to collect the remains of the boy’s mother, a physician who died caring for people suffering from a deadly infectious disease. Although the story is set in the future, the similarities between that society and today’s COVID-era world are eerie—as are the parallels between the choices the doctors in the story must make and those faced today by physicians and other health care workers.

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Today—as in this story—we fight a deadly contagious disease that has hit some communities much harder than others, and through which xenophobia and racism have been allowed to fester. In Theroux’s story, people are segregated into camps by nationality, into “island[s] of ethnicity, renewed country-of-origin pride and defiance in the enormous sea of rural America.” Perhaps these stemmed from viewing people who are different from oneself as the enemy, and then working to avoid them—something that is already increasingly prevalent in our society, in part thanks to social media.

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Father views the lives of people who die as expendable—a means to a greater end—which disturbingly echoes the belief some people today hold about those lost to the COVID-19 pandemic. He reminisces about how smallpox decimated the Aztec civilization many years ago. “When things are catastrophic … maybe that’s a kind of beginning—a leveling, which can be a purification,” he tells Son. Indeed, ageism, ableism, and racism—as well as callous disregard for others—are the foundation of the calls to allow today’s pandemic to run its course, unchecked, rather than facing the inconvenience of wearing a piece of cloth over one’s face and avoiding crowded spaces.

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As I’m a doctor and mother of a son in the midst of the COVID epidemic, this story hit home for me in an uncomfortable and unpleasant way. My skin crawled as I read about how the mother in the story ventured to a virus-ridden community to try to help others, abandoning her family and ultimately dying from the infection. Too many health care workers have faced a similar predicament, grappling with whether to isolate themselves from family in the hopes of not infecting their loved ones, and whether they should venture to far-flung cities where there are too few front-line workers to care for the people sick with the virus. Yet to whom do health care workers owe their ultimate loyalty—to family, for whom they are irreplaceable, or to the patients they have pledged to serve? Mother and Father hold two different beliefs as to the answer to this question, it seems.

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Yet that question doesn’t quite capture the complex decisions health care workers face every day during a pandemic. How far does the obligation to help others extend? Are we expected to sacrifice our lives in the effort to save others? “The Vastation” doesn’t delve into the efforts the people in these futuristic villages might be taking to prevent the spread of disease within each town, although it’s clear the settlements constructed barriers to separate themselves from others. Today, too, nations restrict travel from certain parts of the world to prevent the spread of an infection—yet as always, it remains unclear whether front-line workers are permitted to have any boundaries at all, constantly balancing their own health and safety with the duty to serve others, even as leaders and some members of the public actively work to spread disease.

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Indeed, during today’s pandemic, it’s impossible to ignore the stark contrast between what is being asked of health care workers and the unwillingness of many Americans to make even the smallest sacrifice to protect others. Seeing the difficulty with which many of our neighbors summon even a modicum of respect for others’ lives is discouraging to say the least, and at times makes caring for patients on the front lines feel futile. While reading the story, I wondered whether Mother ever doubted that her decision to leave her family to care for others was the right one. We don’t know much about Mother and Father’s relationship, or whether his resentment of her had taken root before she left, but one also wonders whether she was running from something, rather than simply toward the virus.

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In Theroux’s story, as in our society, physicians simultaneously carry a unique responsibility to others and immense privilege. The acceptable ratio of helpfulness to others to taking advantage of one’s privilege varies between people, of course. Mother lost her life fulfilling an obligation to others; in contrast, Father was a doctor in title only. He carried none of the responsibility to others but profited off of the prestige, benefiting from being a physician both in his career as a businessman and from the doors the title opened. It was because he was a doctor, after all, that he was able to travel between villages in a secure convoy and enter settlements closed to others, a gesture that seemed loving and dedicated until Son learned that Mother’s body had been collected only to be deposited along the journey home. She was more “useful” at the hospital lab, Father said. (It’s not clear whether this is what Mother wanted for her remains, although it seems possible it was, given her desire to serve others.)

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I came away from the story wondering whether it was an allegory providing commentary on today’s world or a prediction of what our civilization might look like a hundred years in the future. After all, the dusty, barren landscape through which Father and Son travel might be what’s in store for our planet as the result of climate change—so perhaps it is both. The COVID pandemic isn’t the first time doctors have faced impossible questions about personal and vocational responsibilities, and it is illusory to think that it will be the last. As Father says, “That’s why we pessimists are prophets.”

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.

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