Saturday, February 12, 2022

Scarlet Letters and Healthcare

When I was in high school in the 1970s, one of our reading assignments was The Scarlet Letter by Nathaniel Hawthorne. Though subtitled “A Romance”, I doubt any high school boy was interested in love per se; rather, we were consumed with the forbidden thrill of sex outside of marriage and the subsequent public humiliation of the offenders – at least the young Hester Prynne in the story, who was both imprisoned and forced to parade in public, forever wearing an embroidered scarlet “A” (for adulterer) over her breast. Nothing like the threat of guilt (or disease!) to keep a young boy “pure,” or so we were raised to believe.

Then there was Mary Mallon, an Irish immigrant and domestic worker and cook in New York City in the early 1900s. She was also an asymptomatic carrier of Salmonella typhi, bacteria that infect the gastrointestinal tract and blood. Seven of the eight families she worked for contracted typhoid fever, which at the time had a 10% fatality rate. She refused to believe she was the source of disease – she wasn’t sick herself, and the concepts of germs and hygiene disease were in their infancy at best – and she continued to work and evade authorities for quite some time. She ultimately was forced to live in quarantine for decades and died alone. She will forever be known as Typhoid Mary.

There have been times in history when labels like “Typhoid Mary” or Hester Prynne’s scarlet “A” have carried an even more sinister meaning. As part of the Nazi extermination program during World War II, Jews were forced to wear a yellow Star of David on their outer clothing with the local language word for “Jew” inscribed in the star. According to the United States Holocaust Memorial Museum, “[The Nazis] used the badge not only to stigmatize and humiliate Jews but also to segregate them, to watch and control their movements, and to prepare for deportation.” For six million Jews and millions of others, including homosexuals and the disabled, that meant death. January 27 was International Holocaust Remembrance Day. I was reminded that day by an old friend of her parents, who were some of the few survivors of Auschwitz. They bore the forearm prisoner identification tattoos they received in the concentration camp as teenagers for the rest of their lives.

Being reared in a conservative and deeply religious community, my formative sense of morals in high school was very black and white. An ethic where actions are only right or wrong leads to equally black and white decisions to punish or not (and, obviously, wrongdoing should never go unpunished!) – in other words, not unlike the Puritan ethic in The Scarlet Letter. There was little room for nuance or grace. 

Healthcare shaming is not unique to Typhoid Mary. Think of the AIDS crisis, when just being gay was considered a disease. Now the COVID-19 pandemic – especially with the ubiquity of social media – has taken public shaming into a new and different realm. To die from COVID-19 now that vaccines are available is practically to have a scarlet “C” affixed to your name and legacy, forcing some families to keep COVID-19 deaths a secret in order to protect them from shame and social stigmatization. Some are separating victims into the vaccinated – worthy of our sorrow – and the unvaccinated – deserving only of disgrace. Websites have sprung up shaming victims with great vitriol. As The Atlantic noted, “With the arrival of vaccines, compassion for COVID-19 deaths began to dry up, sometimes replaced by scorn.” Facebook and Instagram accounts of the deceased and their relatives can be flooded with mocking comments. It is public COVID-19 shaming as blood sport. One family, while acknowledging their loved one who died from COVID-19 was not vaccinated, nonetheless pointed out that vaccination decisions have been quite difficult for some. “We think he was a victim of misinformation,” the deceased’s daughter lamented. She was pleading for understanding and grace.

Unfortunately, we have more of a Puritan mindset all around than we care to admit. Legalism and judgmentalism are increasing on both sides of the political spectrum, with some on the right fighting to have government enforce their preferred religious beliefs and some on the left want to cancel those who they deem to be bigoted. Neither extreme allows dissent or disagreement. Despite our talk of tolerance, we only tolerate that with which we agree. Black and white. Judgment only. No grace. Depeche Mode sang about it in their 1984 hit: People are people / So why should it be / You and I should get along so awfully / So we're different colours / And we're different creeds / And different people have different needs / It's obvious you hate me / Though I've done nothing wrong / I've never even met you so what could I have done. 

We cannot minimize the incredible number of deaths in this pandemic – nearly one million so far – or deny that choices (both societal and individual) have consequences. As I started this column, a good friend’s unvaccinated 20-something niece was on a ventilator with respiratory and liver failure due to COVID-19. She, too, is a victim of misinformation as well as COVID-19, in her case pervasive and false information about vaccine effects on fertility. No amount of gentle urging on the part of relatives could convince her once that doubt was seeded. She was one of the fortunate ones who came off the ventilator and was discharged home, but she still has a lengthy recovery ahead. This family needs prayer and grace, not a scarlet “C.”

Though we are understandably tired of the pandemic – tired of masks, tired of vaccines and boosters – we cannot allow ourselves to tire of compassion, even as we fight to educate and persuade. The Puritans in The Scarlet Letter were so busy judging that they could not feel empathy. Compassion for others forbids us from placing a scarlet letter on anyone’s chest. We don’t know – and don’t need to know – the back story of the injured traveler in the Parable of the Good Samaritan. What was he doing on that road at that time of day? Shouldn’t he have known better? We are simply commanded to have mercy, loving our neighbor as ourselves.