The Circus Is Coming to Town

After a crazy shift in the E.R., I sat on the couch with my wife, Leslie, watching the news. As Tucker Carlson was talking about the coronavirus like every other TV reporter, my wife turned to me and asked, “Are you all right?”

I gave her my standard reply, “Yeah, babe, why?”

She looked at me and said, “You look empty.”

At that moment I realized I was doing a piss-poor job of masking what was going on inside my head.

I have spent the majority of my adult life preparing for what our nation is currently facing. I started my career in medicine as a Fleet Marine Force Corpsman with 2nd Battalion, 8th Marines. I served 20-plus years as a civilian EMT/Paramedic, completed a fellowship in bioterrorism and emerging infectious diseases for the National Institute of Health, and worked 12 years as a disaster and infectious disease epidemiologist. Now 22 days into my emergency medicine fellowship as a newly minted physician assistant, I’m witnessing a public health nightmare emerge firsthand. I would be remiss if I didn’t admit that the emptiness I’m feeling is associated with a fear of the future.

Airmen, coast guardsmen, Marines, sailors, and soldiers spend their careers preparing for war.

“Kill!”

“What makes the grass green?”

“Blood!”

“What makes the grass grow?”

“Guts!”

I’m sure these battle cries—echoed on any drill field, on any given morning at Camp Lejeune—haven’t changed since I was there, only the names and faces. But the current battle cry echoing across our country is different, and what scares me is that my neighbors, family, and friends are not taking the threat seriously. A few days ago, someone asked me if I had a current advanced directive on file and a will. At that moment, it became clear that we weren’t dealing with some conspiracy theory or media-driven hoax but the real deal. The last time I filled out or updated my will, I was 25 years old, preparing to deploy to the Mediterranean with the 24th Marine Expeditionary Unit, weeks after we lost 14 of our brothers in a midair helicopter collision.

Cpl. Scott Glascow, Gilpen, Cpl. Robert Harvey, 2nd Battalion, 8th Marines, 24th MEU-SOC, on the USS Saipan, 1996. Photo courtesy of Johnnie Gilpen

As an emergency room healthcare provider and based on the experiences in countries like China and Italy, I will be exposed to the coronavirus and will more than likely get sick at some point. Unlike the other ER physician assistant fellows, who are young and as far as I know healthy, I am a 48-year-old disabled veteran who developed occupational asthma as a result of toxic exposures during my service. I could probably tell my leadership about my lungs, and my increased risk for an adverse outcome should I get sick, resulting in being sidelined to a position that decreases my risk of exposure. My wife and I have had serious discussions about the increased risk, however, at this conjuncture the recommendations for healthcare providers with underlying conditions is to use proper protection equipment (PPE) any time we are at work and to isolate when we are not working. I don’t want people to think that I am not taking the threat seriously myself; quite the opposite. But it’s in my nature to help. Several years ago, I had a turkey buzzard fly into me while I was riding my motorcycle. After I slowly picked myself up from the ground, I did a five-point self-body check: head, arms, legs, back and … then, standing in the road in the middle of nowhere, Oklahoma, I looked up at the sky and yelled, “OK, God, you have my attention. What do you want from me?” Five months later I was accepted into a program to become a physician assistant. Call it fate or some divine plan, I know that I’m supposed to be where I am at this specific point in time and my background has prepared me for it.

Growing up, I learned to work on vehicles and farm equipment. With a welder and torch, I could build you almost anything you needed. Hell, with the help of friends and family, I literally built our house, but it was as a corpsman that I found my true calling—medicine. Like the many who came before me, when the word “corpsman” was screamed, I found I was able to suppress the fear and self-preservation at the forefront of my thoughts, and do more than asked, because that’s what was needed. That ability to function in what my friend and fellow emergency medicine PA Jeff Evans described as a “VUCA” environment—volatile, uncertain, complex, and ambiguous—is what makes me who I am. And the crisis at hand is definitely volatile, uncertain, complex, and very ambiguous. The Navy not only provided training in prehospital and tactical emergency care, I learned about tropical diseases, like malaria, Lassa fever, Ebola, and Loa loa, commonly known as the African eye worm. After I left the Navy, several of my professors at the University of Oklahoma indulged my aspirations for a more defined career in medicine. Infectious diseases and epidemiology was a logical path.

Johnnie Gilpen

During my undergraduate and graduate studies, I got my first true taste of outbreak investigations and infectious disease epidemiology conducting West Nile virus surveillance in mosquitoes, birds, horses, and humans in the early 2000s. Since 2007, I have crisscrossed the globe teaching first responders, health care workers, emergency managers, and business leaders about pandemic preparedness. I spent the majority of 2009 working the H1N1 pandemic as an epidemiologist for the Department of Homeland Security’s Center for Domestic Preparedness. For my training, it was emphasized that pandemics were the equivalent to lots of really sick people, not necessarily dead people, and that the larger issue was having supplies “just in time.” But I’ve seen the lessons learned during that time sadly lost due to politics and business, causing inattentiveness, personnel turnover, and ultimately a lack of education. We are having to find our own masks, while hospitals ask local seamstresses to make homemade ones. The emptiness my wife saw on my face the other night is the same expression I’ve seen on so many others. Although there are no wounded Marines on the battlefield yelling, “Corpsman!” the uncertainty, chaos, and fear felt in society right now are the same.

I have been off for the last couple of days, but I will go back to work tomorrow. When I left the other night, a huge blue-and-white circus tent had been erected in the ER parking lot. My colleagues and I joked that we were finally going to get our chance to be circus performers. I am neither a fortune teller nor an alarmist, but the battle ahead of all of us is real. It is not about if you will get sick, but when and how sick you will become. For most, this will be no different than the flu, but for our parents, grandparents, and friends who have predisposing health issues like asthma, cancer, COPD, HIV, etc., the gravity is dire. The public health professionals have been attempting to “flatten the curve” or, as I like to analogize, “kick the can down the street,” to get us past the ongoing flu season and ramp up production here at home to replenish our dwindling medical supplies.

Circus tent in the parking lot of St. Anthony Hospital in Oklahoma City, 2020. Photo courtesy of Johnnie Gilpen

As we go forward, I hope people take the recommendations seriously and practice social distancing but not social disengagement. I hope we take advantage of the time to reconnect and strengthen our family foundations, putting aside old hatred and racism, and healing broken personal relationships and communities. When I was a kid, I remember reading the children’s folk story “Stone Soup.” It told the story of a man who came to a village where people were very poor and starving. He goes to the communal fire in the center of the village and starts boiling water and stones. People, being curious, asked what he was doing.

“Making stone soup,” he replied. Soon, each member of the village slowly and somewhat reluctantly began adding something: potatoes, carrots, and other vegetables to the soup, and before long they had something that they all could share and eat. Never in my lifetime has that story been more appropriate than now. I hope people get out and grow gardens, growing more than anyone can eat, and sharing it with neighbors, while maintaining social distancing, of course. We must remember, we are all in this together.

Veterans like to sit around and talk about how we wished we could saddle up and ride again. Well, now we can. This time the battle is on our doorsteps. Our families, friends, neighbors, and people who we just can’t stand to be around will need our help. Most of them have never had to operate in a VUCA environment, but we have. We can help, set an example, and lead. That’s what I plan to do, and I took an oath once upon a time to do so. And to fellow vets, so did you.