Fear is the mind-killer

Covid-19 is the greatest challenge the healthcare system has faced in more than a generation. If we are to win the battle against the virus, it is vital we overcome fear.

We are waging a battle on two fronts: Victory requires that we win on both of them.

The most obvious battlefront is with the coronavirus. This is undoubtedly the greatest challenge our healthcare system has faced in a generation or more. Make no mistake, this has the potential to cause medical and financial devastation on a scale we can scarcely imagine.

However, to ensure we are best positioned to face this first challenge, we must battle as arduously on a second crucial front; that of fear.

The fear of what will happen tomorrow, or next week, or next year.

The fear that those close to us may suffer and die.

The fear that we will be called upon to make decisions of major consequence with little information to guide us.

The fear that we will be tasked with operating at the very limits and beyond of our medical training.

We must win the battle against the coronavirus and to do so, we must conquer fear.

Fear is the mind-killer.

In the movie No Country for Old Men, the protagonist puts a gun to people’s heads and asks them to call a coin toss.

Heads, you live. Tails, you die.

Understandably, all of them say they do not wish to play this sadistic game. The irony is, just as in life, when such dilemmas are thrust upon us, we do not get to choose whether we play or not. We only get to make a choice on how to act next, with no assurance that our choice will be correct.

We do not get to choose whether or not we confront the circumstances that the coronavirus has presented us with. We only get to steady ourselves, stand together and act as rationally as we can. Our best option is to make decisions with the clearest possible minds and understand that even with such clarity, we may choose incorrectly.

But we must choose. Opting out is not a choice.

Failing to choose is not an option.

Fear is the mind-killer.

There was a saying amongst soldiers during the Vietnam war that “calm is contagious”. When others may be losing their clarity of thought, it is up to us to navigate the fear that will permeate our society. The fears of our families, our patients, our colleagues and of our own doubts. Fear has the ability to shut down our higher and rational capacities and now, more than ever we need those valuable skills.

It is not that as clinicians we are immune to fear. Far from it. But we must learn to hold that fear in tension and still act with calm and clear minds.

You’ve already done this. There is no reason you cannot do it again.

Remember your first night on-call?

Remember your first cardiac arrest?

Remember your first patient that ‘nearly died on you’?

We have all survived these trials of fire. We were terrified then, but we survived.

We might be terrified now. But we will endure.

To feel fear is normal. To paraphrase Nelson Mandela, bravery is not being afraid, but in acting even when one is fearful.

Fear is the mind-killer.

I have little doubt that with sharp minds we will overcome the enormous challenge that we face. More than ever we will need to rely on each other just a little more than we are used to. We will all be responsible for playing our part in the complex orchestra that will be our response.

When this time has passed, the collective effort of what we have done will be acknowledged, but it is unlikely that each of us individually will receive recognition for what we will have done. But never before have we asked for recognition and in the future, it will be no different. However, each of us will know that we played our part, that we stood together with our colleagues at a time of great need and did what was required of us. That is the only recognition we will need.

I have no doubt that difficult times lie ahead, but with clear minds, we will prevail.

I must not fear. Fear is the mind-killer. Fear is the little death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past, I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain.

Frank Herbert. Litany Against Fear, Dune.