Not much of a date movie. As we left the theater the military guys behind us were talking about where to get hand sanitizer.
Okay okay there’s more to life than trying to unwind from the work week. I wanted to see Contagion partly because it has Gwenyth Paltrow in it, and I now realize that she and the other stars (Matt Damon, Lawrence Fishburn, Kate Winslet, Sanjay Gupta) probably got signed on for the express purpose of luring their fans into the theater. It worked in my case. The movie was also recommended by Willie Marshall, a public health nursing faculty at UH.
Heroism is not always glamorous
Public health, the part that deals with epidemics, is heroic in it’s own quiet way, but not “sexy.” There is no glamor to be found, no countdown to a victory celebration at the end. Every schoolchild grows up hearing about polio, small pox, plague (“the Black Death”), Spanish Flu, Malaria, yellow fever and the like, but western society has insulated all of us from close contact with infectious diseases, and I greatly prefer to deal with illnesses that can be packaged and treated within the confines of a hospital building. I feel secure that way. We all do. Let’s keep the wild viruses in a zoo as if they were lions and tigers…..
The Dark Ages
For those of us in health care, there is a certain medieval quality to the idea that these things are out there and can kill you, that they have literally been a plague since the dawn of time. And that humanity is also a “herd” governed by the same rules that apply to the cattle business. Just because these diseases are old-fashioned does not mean they have gone out of style, and we get these jarring reminders now and again. And these threats have not gone away just because we now have pennicillin and DNA sequencing.
Memories of past adventures
Allow me to reminisce in an unsentimental way. Over my whole career, taken in it’s entirety, I have been in the presence of just about everything. AIDS was not named until 1981 or so, but I know that I took care of Intravenous narcotic abusers with broken-down immune systems at Boston City Hospital in 1977 in my very first RN job. (“Heroin does funny things to the immune system” we used to say in those days) At UCSF the neuro-ICU was the site of inpatient care for a study they were doing on infectious encephalitis while I was there, I remember calling for one particular specialist consult, then meeting UCSF’s Fellow in Infectious Diseases (I.D.). It was a small department in those days, with a shining history dating back to the days of Pasteur. The I.D. Fellow wore horn-rimmed glasses and was a bit tweedy. “Don’t run away. I may need you,the first rule is not to panic.” he said. This will be interesting, I thought. I.D. has always been a specialty for thoughtful nerdy doctors, with a sort of Clark Kent quality, and an air of the Mad Scientist about them. Whenever a doctor prefaces his remarks by saying “don’t run away,’ I have learned that something really really interesting is about to happen.
While at UCSF, the half-dozen or so Q fever victims of the now-infamous Q fever mini-epidemic were admitted to Neuro-ICU, my workplace. ( Infamous because it later became a poster child for the impetus to revise federal rules on use of laboratory animals in academic medical centers).
While President of ANA-Maine, part of the American Nurses Association (ANA), I was editor of their statewide quarterly newspaper mailed to every RN in Maine. In that role I got to know people from the public health infrastructure of Maine, and gained a new respect for the great care taken in efforts to present accurate public health info. Do you remember the anthrax threat after 9-11? Or that national debate about smallpox vaccination? I sure do. I remember coming back from an ANA national meeting in DC with a box of the first smallpox brochures, hot off the press, wondering how to best share the info with people in my home state. Maine State Public Health also sponsored an annual workshop on public health, a must-go-to event, and one year the featured speakers were the leaders of the Toronto SARS response. All the key players in Maine got a jaw-dropping inside look at the true story behind that the response to that event. Health workers died in Toronto. The speakers conveyed the gravity of the “oh shit” moments, times when the Toronto Public Health authorities realized it was getting away from them.
(First rule of public health – don’t alarm the public.)
And of course, Nepal. Read my book. :-)
Somewhere previous, http://joeniemczura.wordpress.com/2011/05/03/reprint-of-2008-meningococcal-meningitis-episode/ I described the single most gut-wrenching inadvertent exposure I ever was involved in, and it unfolded on a hot afternoon in Tansen in 2008 (I survived to tell the tale, just the smell of peach soap is enough to remind me of that day). Nepal remains a simmering stewpot of infectious diseases I hope we never see here in the USA – kala-azar, leprosy, tetanus, malaria, Japanese encephalitis, TB, brucellosis, hepatitis, meningococcal meningitis. A long list – what I am I forgetting????
Oh – add cholera, typhoid, plain ol’ infectious diarrhea, helminths of all types, snakebites, HIV, pneumonia and meningitis……
Worms and snakes *do* belong on that list.
I am happy to report that I have never caught anything major during that whole thirty two years. Oh, I got rotavirus (“cruise ship virus”) one time at a hospital, along with a dozen others, but I take comfort in the fact that I was the one who said “hey, something fishy here that we are all getting sick.” So, some good came of it.
The secret? I always wash my hands, always. That is still the number one rule at work. On the home front, I never got a tattoo, visited Haiti, drank unpasteurized milk, or had skanky sex. (TMI perhaps, but true).
Movie Review, here, finally
Back to the movie. The challenge for the moviemakers was to dramatize and personalize something that unfolds over time and which requires a bureaucratic response with hundreds of players. Also, quite frankly, to compete with fictional action-adventure movies. In a fictional outbreak, the disease can be exaggerated so that the audience is gripped by an immediate horror, satisfying the thrillseeking entertainment value of the genre, and allowing the pace to be faster. In real life, we are programmed so that an illness of this nature causes disgust and revulsion, not quite the kind of “thrill” that pulls people in to a movie theater. There is a slow-motion aspect caused by the incubation period, a seeming randomness to the victims that is maddening to uncover, and an element of quiet suffering, as the victims go down, one by one, laying quietly in a heap for awhile before they pass away.
These scenes were accurately depicted in Contagion. Whenever I see a movie in which a person dies, it’s ruined unless the details are plausible and realistic to the T.
Shakespeare in Love
(The autopsy scene was truthful but I prefer to remember Gwenyth as Viola De Lesseps, flowery incandescent youthful glory of her Oscar-winning role…..isn’t that how we all prefer to remember our loved ones?)
Death by Committee
To convey the drama of a worldwide pandemic, the movie was forced to include various committee meetings where the protagonists were educating elected officials or each other, a sneaky way to clue in the audience as to the relevant science. They tried to keep the lectures short, but it still had the feel of being lectured or taught about the action. The geography also played a role – switching from rural China to Atlanta, Minnesota, and San Francisco (and yes, I recognized all the San Francisco scenes since most were in the neighborhood of UCSF where I used to live, Parnassus Heights and on the UCSF campus. My alma mater).
Anyway, I think the movie did the best possible job to depict the phenomenon, given these constraints. At times it had the feel of a documentary, since there was an obvious educational component to it (here is what the Red Cross does, here is the National Guard. A very poignant moment in which a Roman Catholic nun appears. Go get ’em, Sister!) and of course, when we finally get the next pandemic I wonder if any body will be left around to tell the tale in a similar way. For those persons who have not been involved in this line of work, I can tell you it does mirror real life, people making decisions based on incomplete knowledge.
In summary – worth seeing, a thought-provoking effort to educate the general public about a little-known part of the medical establishment.