The motto of the Order of the Garter, a component of the Royal Coat of Arms of the United Kingdom, seen by many, noticed by few, relevant to all in 2021. Roughly translated? “Shame on anyone who thinks evil of it.” Incidentally, the phrase also made its way into the master ignition source code for the Apollo11 lunar module.
How did a scrap of fabric, the garter, a rather humble undergarment, come to play such a pivotal role in heraldry? Some maintain that King Edward III used his garter to signal his troops the start of the Battle of Crécy in the year 1346, but I prefer a more noble origin for this chivalric proclamation.
After the aforementioned fracas, the king purportedly threw a party in the northern French port town of Calais and was dancing with his daughter-in-law, Joan of Kent. Perhaps due to their exuberant gyrations, the garter fell from her thigh, inducing a great deal of mirth from other merrymakers. His Royal Highness was incensed at such bad behavior and expostulated the immortal phrase embodied in the title above and an exhortation that those laughing today would soon be sorry, because to wear the garter would become a mark of great pride. However fanciful the story might be, it became so, a garter awarded to brave and loyal knights and a representative circle emblazoned on coats of arms. Although documented 166 years after the event, this tale encapsulates what chivalry has come to imply, and resonates with my message today.
Medical situations are often portrayed inaccurately in the media. For instance, forget Ernst Stavro Blofeld, head of SPECTRE and the archnemesis of 007; James Bond would actually face his maker as a cirrhotic, wheezing emphysematous wreck if the syphilis and other sexually transmitted diseases had not put paid to him. And gunshot injuries would not be portrayed as Bang! Fall over. Death. What we actually see is people screaming in pain, vomiting, leaking feces and urine and their faces portraying abject terror. You see, the problem is that although we have ever-present media in multiple formats, it is not accurate. I am not talking about fake news here – there has been so much said about that – I am talking about superficial news. News that glosses over the horror, blurs the details.
Although at the time you read this, likely over 400,000 Americans will have died from Covid, the method of their passing has not been explained graphically. But why do that? Well, maybe like Joan of Kent’s garter it might inspire a simple but very noble act. So that is what I am going to do here. And I am basing this on real examples, friends, colleagues, patients I have seen. Why? Because I want to upset my readers? Because I am a sick so-and-so? No, because of personal experiences I and colleagues have had with members of the public who seem to be offended by an article not dissimilar to a garter, a small slip of fabric: face masks.
So, what does Covid truly look like? If you will forgive the double negative, the fake news will have you believe that there is no pandemic, and even if there is, it only kills people unlike you and me – the old, infirm and so on. Tell that to the family who lost their fit 42-year-old husband and father to this non-existent disease. Alive and vibrant one day, dead the next. Or my friend, an eminent surgeon, whose 50-year-old brother, an otherwise healthy chap, had three days of feeling slightly unwell from Covid and then had a massive and fatal Covid-related stroke. Or my colleague and friend, who is my age, an eminent scientist doing important cancer research and is as fit as most men half his age. His dance with death started with a few days at home with low fevers, severe and constant headache and general malaise; a stumble on the way to the bathroom caused massive bruising due to Covid-induced clotting issues. Rushed to the hospital, he went into respiratory failure, requiring ventilation and dialysis as the blood contained in the bruises was slowly resorbed, blocking his kidneys.
The virus then played another trick and caused blood to clot in a vessel supplying his bowel, requiring emergency surgery to remove a few feet of dead colon. His bowel could not be joined back together, nor his abdomen sutured shut as he was too ill, so he was returned to ICU with his bowel emptying into plastic bags and another placed over the gaping wound with his intestines visible to all. Except that his family could not visit due to Covid restrictions. Then, the virus reverted to the first mischief, interfered with blood clotting again and caused massive bleeding that emanated from his intestines as melaena, a foul-smelling black tar. This was one of many days that we all thought we would lose him. But there were more assaults to come, including a stroke and heart attack again caused by defective blood clotting. And more surgery to rejoin his bowel and eventually close his belly wound.
This chap made it out of ICU, was eventually able to breathe, and when he first spoke it was apparent that his brilliant mind was thankfully unaffected. But it will be many months before he can walk, feed himself or do anything physical again. He has multiple symptoms that will also take months to resolve. These are people I know. And I have seen others I did not know die hideous deaths, their headache crippling, their hunger for oxygen unsatiated, their terror at impending death palpable.
And all of this potentially because some stranger refused to wear a mask? Really? You might as well have taken a gun and shot my friends, that is how criminal this behavior is. I totally support personal freedoms, but not when it endangers other people. Freedom to fly? Absolutely. Freedom to fly when impaired by alcohol? Absolutely not. It is that clear to me.
A few days after Christmas, traveling through a Florida commercial airport, I spotted several people at the gate not wearing masks, or wearing them improperly, despite repeated public announcements stating that masks were mandated by law. Noticing non-compliance, and with the background I have explained above, I dutifully, quietly and politely asked a rather obese lady to comply, pointing out that I was a doctor and that this would protect not only her and her equally overweight mother and children (obesity increases the risk of a bad outcome), but others, including me. She acquiesced, applied her mask and thanked me for explaining this to her. Duly emboldened, I approached a rather large gentleman whose mask was draped over his chin. He told me in no uncertain terms to mind my own business – I told him that I was – and that I should go forth and multiply. When I tried further to tell him that masks protected him and others from brutal death, he became abusive, threatening me with physical violence and accusing me of being a communist. I may not be the brightest bulb in the chandelier, but I struggle to understand how making a healthcare decision defines my politics – given that in decades of performing thousands of operations I have worn masks extensively; does this make me an honorary member of the Russian Politburo?
Healthcare workers the world over are being championed as “frontline workers” in this tragedy, but the truth is, we are not. You are. The word chivalry originates from ancient Latin, meaning a band of horsemen, and has come to mean an ethical code of honor, of decent and selfless behavior. Please, please be noble, and wear the humble mask; it is the modern garter.
On a final note, for those interested in learning more about the bleeding edge of medical science,
I am proud to host the weekly “EMG Health Podcast” that you can hear via the Apple podcast app or at: https://www.emg-health.com/omnipresent/podcasts/emg-health-podcast/. You can email me at: [email protected] or connect at https://www.linkedin.com/in/jonathansackier/