"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Friday, September 12, 2014

Hypochondria And Ebola – When To Be Really Scared

Hypochondria comes early and stays late.  Billy Ratchett, a classmate of mine from country day school always covered his nose and mouth – albeit it as discreetly as possible – when anyone spoke to him.  He opened doorknobs with his elbows, avoided shaking hands whenever possible, and washed his hands incessantly.  He also irrigated his nose three times a day with a diluted chlorine solution to kill whatever bacteria had made their way up and in to his interior passages. His nasal septum was redder and more raw and nasty looking than that of any cokehead today.

He always sat by the window in class.  Fortunately our school had been built many years before and was as porous as a sieve, so he could breathe in the clean but nasty drafts that the rest of us avoided.  He was on a hair trigger and jumped a mile when someone coughed or sneezed.  He wrapped his face in the scarf which he always wore and looked like a soldier in Rommel’s Afrika Korps. 

To deflect the chides and snickers from his classmates, he wore a silk scarf in the warmer months, and affected a debonair, RAF rakishness; but before the echo of a cough had disappeared, he was wrapped up like silkworm in a cocoon.

Billy’s parents were understandably worried about him and wondered how he would make his way in society if he avoided proximity, contact, and intimacy.  God knows how he would react to a wet, slimy kiss.  They tried everything.  His father talked sternly to him, telling him to man up and face the world.  His mother calmed and soothed him when he was anxious and told him that she loved him no matter what horrible disease he got. Nothing worked.  In fact Billy looked more and more like a jumpy marionette, pulling his hands out of reach when anyone approached, jamming them into his pockets, jerking his face into his collar, and hopping out of the way of greasy litter and dog shit on the sidewalk.

His parents tried another tack and felt that if they created a safe haven for him – an antiseptic home – they could gradually wean him out of his irrational fears of germs and disease.  The house smelled like an indoor swimming pool, so completely and thoroughly did his mother scrub down the walls and the floors.  If the homemaker ethos of the Fifties wasn’t enough, the hospital scrub-downs, lint-picking, and antiseptic spraying made her normal routine almost unbearable.

Her husband thought up ingenious work-saving devices to both clean, sanitize, and save time. He jerry-rigged a fire extinguisher and made it into a power-sprayer that Billy’s mother used to blast germs from the corners of the kitchen.  Appearances were everything to Billy, and as every hypochondriac knows, logic means nothing.  The smell of chlorine and the sight of his mother power-spraying the kitchen were very comforting.  The law of unintended consequences kicked in, however, and Billy became reluctant to leave the house. Rather than become a refuge from a world of pathogens, the Ratchett house became a redoubt, a safe haven, and the only possible place for Billy to live.

Eventually the Ratchetts sought medical advice, and Billy had to be hospitalized for a while.  Those were the days before sophisticated anti-psychotic drugs had been developed, so he got big doses of chlorpromazine and some ‘mild’ electro-shock therapy.

“I can’t remember too much about those days”, he told me recently, “but I’m better now. I’m glad my parents locked me up.”  Better is a relative term, and Billy still suffers from mild mysophobia - the term recently devised by the medical community to express the increasingly common ‘morbid fear of germs’. He still swabs his silverware with pre-moistened Purell wipes, eats meticulously so that he does not have to use a napkin and wipe his mouth, and only frequents the one or two restaurants in DC which have agreed – for a stiff surcharge - to steam-wash and blow-dry his plates before serving.  He has disciplined himself to walk more or less in a straight line, no more hopping over gum, snot, and gobs of food like he used to.  He has been married for years to the same woman, also a recovering mysophobiac, and although I have never been to his house, I hear that it smells pretty much like his childhood home – a cross between a hospital and a swimming pool.

Billy at least has company.  The fear of germs has morphed into a national neurosis. Antiseptic wipes, cleansers, dispensers, and clothes are a multi-billion dollar market.  New kitchen counters have been developed with ‘anti-microbial action’ – impregnation with potent germ-killing chemicals.  Even more remarkably a new anti-microbial coating for fruits and vegetables has been developed.

A colleague of mine installed an ‘anti-microbial vaporizer’ which was set on a timer to go off periodically in the bathrooms while he was at work. He also put in a new anti-microbial shower head which had the dual purpose of washing his body clean of external microbes and giving the shower stall a good dousing at the same time.  Another colleague hermetically sealed her house, built airlocks for the front and back door entrances, and deployed air purifiers in every room.

New research has shown that exposure to relatively benign pathogens and allergens are important for the development of immature immune systems.  A healthy dose of dog can ward off asthma.  The ‘five-second rule’ should be jettisoned (it never had any scientific basis in the first place) and replaced by ‘drop, wipe, suck’ – a quick swipe across the apron to get rid of the big bits before giving the baby back her pacifier.

Few mothers have bought into this, however, and still rigorously adhere to the scrub-and-sanitize approach to housecleaning.  A few colds, sneezes, and sore throats are better than some horrible disease brought in on the plumber’s shoes.

Which brings us to Ebola, a truly scary disease.  We would like to think that we are more organized, disciplined, and educated than the poor Liberians and Sierra Leoneans; and as importantly that we have a certain national aplomb, a social coherence, and a mutual respect which will assure us of a measured but effective response to an epidemic.

I am not so sure. A few years ago when there was concern that a particularly virulent strain of influenza had jumped from pigs to humans in Asia, and that there were only a few bits of DNA missing for it to become airborne, the healthiest and wealthiest among us made a run on Tamiflu, a drug said to give some protection against the disease.  Fuck young people, the elderly, the infirm.  “I’m getting mine” was the rule.  Of course this was understandable.  Family first, community second; and although one would have hoped for a more rational assessment of risk and a more considerate if not ethical regard for the more vulnerable, self-interest has always ruled the roost throughout human history.

A few years before that (the virus stayed pretty much put in chickens, and despite a few worrisome jumps to Chinese chicken vendors, an epidemic never materialized) SARS was an even greater concern.  The Chinese and Japanese where the virus first surfaced took it very seriously and screened international airline passengers upon entry.  If they had an elevated body temperature, they were quarantined.  Although SARS was many thousands of miles away, people here still were worried. 

Offices on K Street – even the wood-paneled, mahogany, polished brass and old leather executive suites of influential lobbyists – installed human sheep dips.  Shoe soles had to be wiped on an antiseptic-impregnated doormats, hands swabbed with chlorine, and anti-microbial dispensers installed throughout.  After a few weeks, such community consciousness flagged, and busy executives stepped around the doormats, ignored the dispensers, and never gave SARS a second thought.

So what happens when the going really gets rough, and a virus like Ebola actually hits American shores?  Our combination of “It can’t happen here” exceptionalism, belief in American technology, rallying ‘round the flag; universal mysophobia; and an ingrained individualism and self-interestedness is a volatile, contradictory mix. We either will calmly mobilize to meet the threat, or completely lose it and pillage every CVS for Purell, chlorine, and baby-wipes; bribe CDC sentinels to let us out of town; and clean and oil our guns to protect our families.

If Ebola takes half the population it infects, we will be no different from Africans.  We will panic. As our hospitals and dispensaries fill up we will take desperate measures. Armed private militias will cordon off neighborhoods to keep out the infected.  Sysco trucks will be hijacked and schools taken over as food warehouses.  Guerrilla raids will be mobilized by ISIS-style militants.  AU Park and Spring Valley will raid Chevy Chase and Bethesda, ransacking stores from Whole Foods to cooperative organic markets.  Polar Springs will hire armed guards and travel in convoys to supply military installations and hospitals; but militia snipers with high-powered rifles will lay in ambush along MacArthur Boulevard and Massachusetts Avenue.

Political leaders will call for calm.  Religious leaders, finally vindicated because the Armageddon they have predicted for so long has finally arrived, will fill their churches to overflowing. Conspiracy theorists equally vindicated will have a field day, saying “I told you so”.  Gays, Jews, Feminists, and Communists have succeeded in bringing down America.

The military will be deployed and a draconian medical occupation will be instituted – a take-no-prisoners quarantine which will begin with polite orders but will end up with a shoot-on-sight policy for anyone who tries to escape.  The virus will peter out, leaving at least half of Americans alive but disillusioned and despairing.  God and Nation let everyone down.  It will be a crisis of conscience and faith from which it will be hard to recover.

Or not. Optimists may be proven right, and faith in God and Nation will coalesce rich and poor, black and white, gay and straight; and a militant rainbow coalition will rally against the unseen enemy and ultimately prevail.

I laid out my doomsday scenario to Billy Ratchett who was unmoved.  “It’s all the same to me”, he said.  I have been worried about dying from some insidious disease for fifty years.”  He left our lunch with a spring in his step.

As for me, the coming of Ebola will test my que sera sera nihilism, force me out of Dostoyevsky, Nietzsche, and the head-of-a-pin philosophizing of Augustine and Aquinas.  I will take to the streets like everyone else. I will not let myself be trampled by the mob, and will take to the barricades like everyone else.  Or not.  Maybe Ebola – if it does not kill me – will force an epiphany of faith in God, goodness, and generosity.  Let’s hope I don’t have to decide.

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