on consent & pandemics

The individualist culture that white supremacist capitalism/ableism propagates is nonconsensually exposing vulnerable people to deadly diseases. You are either actively fighting against that culture, or propagating it.

a drawing of leaves on an off-white background. the text "on consent and pandemics" is in italicized, sans serif font.
a drawing of leaves on an off-white background. the text "on consent and pandemics" is in the middle, in italicized, sans serif font.

It’s a hot and humid day. I am running late. Finding parking was an issue. I will have to pay 20 bucks realizing that I will surely not remember to get this reimbursed, thank you ADHD. I make it in time for clinic.

Mr. Robinson (name changed) is sitting there already, waiting to see the doctor. He is dressed in a gray suit and tie.

We greet each other, and I say I will be ready in 5 minutes.

“Take your time, doc,” says the older gentleman in a low voice, sounding tired.

Over the years as a doctor you learn the value of being a keen observer. At least that’s what I was taught. I promise you such teachings are no longer valuable or even possible.

Anyways, I get my shit ready and ask him to step into the tiny crowded room/office in the basement of a homeless shelter. “So what’s been going on? How can I help you?” I parrot, as I have learned to speak like a businessman in these years in usameriKKKa.

“I dunno, doc. I’m tired all the time. I just don’t know what’s going on.”

His words are hard to hear as he speaks in a very low volume. We both have our face masks on. I try looking at him when he is speaking but I have to go through his chart, old labs, etc. I see he had COVID 6 weeks ago.

I ask him to keep talking.

As he explains slowly, I already know what might be going on. He is in his sixties and like most Unhoused people in usameriKKKa, he has a job but can’t afford a place to rent. This is the story for millions of Black elderly people in this country.

My ADHD brain sidetracks and I start wondering what his life might have been like. I redirect myself and start asking questions.

Long story short, he says he has been progressively getting weaker, he can’t sleep well, he is tired while doing basic tasks. He has been struggling at his job. He works in construction and has to do some manual labor. We obviously don’t have time to talk about what exactly he does, etc. I have a thousand questions, but none of that matters in this healthcare system. I have already spent more than 10 minutes just listening to him and asking questions. I know I am running behind schedule. Patients are lining up, my schedule is packing up. Typically, doctors order some basic labs for fatigue, easy wheezy breezy. Appointment is 5 minutes tops.

But I knew from the first 2 minutes that he is probably suffering from Long COVID.

1 in 5 COVID patients get it.

It’s a completely different disease than COVID and he has all the signs and symptoms, in fact he meets the CDC criteria for ME (Myalgic Encephalomyelitis). I spend more time because he is speaking slowly.

It becomes clear he has cognitive brain damage (aka "brain fog") from COVID, he is forgetful, etc. I explain to him what might be going on. He has shortness of breath, too. I order a chest x-ray and an echo for his heart, and a bunch of blood tests.

He then asks, “Doc, so when will this go away?”

And this is when my heart sinks.

I pause for a few seconds.

I am lost looking at his face.

I can see his eyes and the lines on his face.

I see, no, I feel his fatigue.

I am transported to when I was in eight grade and had just lost my grandfather. An event which changed my life forever and made me want to become a doctor. Two weeks after his death, I started having vivid dreams about him. And then two weeks later, he came to me in my dreams to say a last goodbye. He looked at me and I remember him looking tired and saying that he needed to go away. I remember crying, howling. I had not shed a tear in the two weeks prior and my parents had been worried. They had come rushing to hug me as I screamed and cried. He was out on his morning walk and was hit by a drunk driver and we were lied to that he had a heart attack. We drove around town trying to find a doctor. But it was too late. He had passed. And I couldn’t do anything about it. No one could.

He had not wanted this.

He did NOT consent to an early departure.

He did not get to say goodbye to any of us.

I come back to reality and see this older gentleman, a buzurg (Urdu for "elder"), waiting for me to answer.

“I don’t know,” I whimper.

“Is there a treatment?” he asks.

“Not yet."

He sinks in his seat and says “wow”.

We talk a bit more. He has a job, but he won’t be able to keep up with it much longer if he doesn’t get better. He doesn’t say anything else. He looks away and my heart just sinks. I can’t imagine what despair he might be feeling.

This is what white supremacist capitalism has done to impoverished Black people.

He has a meeting with his boss and that’s why he is in a suit. He’s got enough problems in life. This is NOT what he needs. I don’t even know with what face I am supposed to explain that what he needs most right now is Rest.

This is a mitochondrial disease, and exertion literally kills you.

How is he supposed to rest? He is Unhoused despite having a job. He sits there quietly for a minute, letting the reality sink in.

I try to reassure him that we need to take it one step at a time. Let’s get the tests done and maybe we find something reversible. And that hopefully he will slowly recover.

But that’s not what he came in for. He didn't even know what the fuck Long COVID was.

He had taken all his shots, he wore KN95 masks.

He did his part.

He did NOT consent to getting Long COVID.

He is Unhoused, Black, elderly, and needs to be cared for.

He needs rest and fucking reparations.

This is the story of so many of the people I meet. Older, Disabled, sick, immunocompromised people who are also essential employees, aka disposable, getting fucked over now by a deadly disabling illness called Long COVID that ableism and eugenics keeps trying to brush under the carpet.

Meanwhile, there are all these ableist so-called "leftists" going to brunch, flying around, partying, holding indoor unmasked events. Like literally not giving two fucks about COVID.

The individualist culture that white supremacist capitalism/ableism propagates is nonconsensually exposing vulnerable people to deadly diseases.

You are either actively fighting against that culture, or propagating it.

Consent is not simply an agreement between two people. It is also a communal agreement.

And as many of us go about violating consent and helping spread a deadly airborne virus, which leads to increased viral burden and increased community transmission, guess who gets fucked over the most.

Impoverished Black and Brown folks, like Mr. Robinson.

Khoyadoc (pronouns: he/him/his) is an oppressor caste South Asian, western-medicine-trained physician, currently living on stolen Piscataway Lands. He is working to fight against COVID-19 imperialism.

originally written in september 2022.

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