Editor’s Note: There had been many COVID-19 patient narratives, some from health care providers and public health experts who have themselves contracted the illness. But there have been relatively few from philosophers working in bioethics. Here is one such narrative that highlights Simone de Beauvoir’s notion of the “serious” world.
On April 7th, I woke up in my Long Island apartment with a tickle in my nose. Having read several accounts of coronavirus patients whose illness began in just such a fashion, my immediate thought: I have it. I was right.
So began an illness experience that was not only physical but existential. An experience is existential when it is transformative of your interaction with self, other, and world. Being sick with covid was not just an average experience of being sick. Physically, I’d been sicker before. But the overall illness experience took place in the context of a global pandemic in a time of increased uncertainty and ambiguity.
Simone de Beauvoir described the “serious world” as the black and white world many occupy in childhood. In the serious world, right and wrong are clearly delineated, institutional rules and policies are the way they are for a good reason, and authority figures are there to protect you. Following the rules and doing the right thing results in being rewarded. Values are pregiven and inherent. Paths and possibilities are predictable and we can learn how to navigate them with ease. After adolescence most people realize the serious world is not as stable and certain as they once believed, leading to existential anxiety and angst.[1]
Beauvoir calls us to embrace the collapse of the serious world and choose our own values, but she knew the more common path was to find comfort in the ease and predictability of the spirit of seriousness. The serious person, as she called them, chooses to live in the serious world, either resorting to the values and beliefs of their childhood or substituting a new cause, purpose, or value that seems just as sure, and just as a safe. This is, of course, an illusion, but the serious person finds it preferable to the more difficult burden of accepting that it is human beings who bring value to the world.[2]
Certain social groups already have less faith in the spirit of seriousness than others. African Americans, for example, witness first hand that institutions are not designed to protect them and have less trust in aspects of the serious world, such as the medical institution. But for some people it takes a major breakdown of the system they believe in for the spirit of seriousness to show its true hand. In a crisis like the covid19 pandemic, the shortcomings of the serious world are laid bare.
I live and teach on the outskirts of NYC in Nassau County, an area that became the world epicenter of the covid19 pandemic. I’ll admit in the early days of March I wasn’t terribly alarmed, and I genuinely thought when my campus closed for two weeks that we would only be closing for two weeks. What delusions. In any case that belief was shattered pretty quickly as New Yorkers got a rude wake-up call that this virus was both very contagious and deadly. I adjusted. I washed my hands. I only left home when absolutely necessary. When I did I wore a mask. I cleaned and Lysoled and bleached my apartment. I washed my hands some more.
I contemplated getting out of Dodge. I’d heard rumors of colleagues heading to their Florida or Hamptons vacation homes. I have family in Iowa, a quiet rural state where the virus wouldn’t be able to spread as aggressively as it did in New York. But I share custody of my 12 year old daughter with my ex-husband, so my autonomy in the situation was limited.
All day on April 7th I sneezed constantly—often several times in a minute. I felt an existential dread in the pit of my stomach. Although I knew I was in a low risk category, news stories of local women in their 30s dying from it haunted me on social media. The following day I woke up and looked in the bathroom mirror. Large hives had formed above my eyes. My lips were swollen. I realized I also had hives on the bottom of my feet.
At this point I felt some relief. I did not have covid after all; I was having an allergic reaction to something. I popped some Benadryl and went about my day. That night before bed I realized I felt very weak. As I was brushing my teeth I leaned on the bathroom counter as it was difficult to stand. This allergic reaction was taking a lot out of me. I popped some more Benadryl and went to bed. As I lay in bed I realized I was shivering with chills.
I awakened feeling equally weak. My child was at her father’s so there was no need to get up. I spent the day in bed. Hives resembling mosquito bites now also covered my arms and legs. The existential dread in my stomach had returned. I feared this was no allergic reaction. I was scheduled for a covid19 test at the Queens drive through testing center in two days.
That night I needed to eat something so I got up to open a can of soup. I leaned over the bowl to inhale its aroma and realized I could not smell it. My sinuses were not clogged, there was nothing hindering my smell. But the sense had entirely disappeared. This prompted a sense of panic as I walked around the apartment finding things to smell. Hand soap, tropical lotion, Pinesol, nothing. Finally I cut up a piece of onion, the ultimate test. Nothing. In my head I tried to rationalize other reasons this could be happening but deep down I knew the truth: I was infected.
I continued to be ill for the next two days, in addition to my existing symptoms I began having painful digestive symptoms and diarrhea. The day of my test came. Although I was sure I had it I needed to know. I could barely stand, but I masked up and drove to Queens. When I approached the exit where my GPS told me to exit, I saw it was lined with cars. This couldn’t possibly be the line I thought, we’re still 1.5 miles from the testing spot. I saw everyone in the cars were wearing masks and many looked sick. This was the line.
I waited in the line for three hours. Military personnel directed traffic. They held signs that said to keep car windows closed. We showed them our licenses through the window. They took down our information and placed it on the windshield. As the line progressed I eventually saw two large white medical tents in the distance. For the first time it truly felt like a scene from a movie. It was a grey, rainy day as masked military personnel directed traffic and doctors were covered from head to toe in protective gear. This was not the bustling NYC I had fallen in love with, the city with constant social interaction. Streets were empty. People were fearful. Had life really been normal only one month ago?
My turn to be tested finally came. The only time we were allowed to roll down the window is when the doctor was ready to administer the test. Through his protective gear he had kind eyes. “It will be uncomfortable” he said. He inserted it into my nose and my immediate reaction was that it was not that bad. Unfortunately that was just the beginning and it had to go several more inches up my nose. With watering eyes, I got through it.
Three days later I accessed the results online. Positive for 2019 Coronavirus. At least now I could move from speculation to speaking with knowledge. “I tested positive” holds significantly more weight in every respect when speaking to others than “I think I have it.” I told my roommate first, as she shared my immediate living quarters. I told my daughter next. The looks on both their faces was identical and quite striking: wide eyes and a mixture of bewilderment and fear.
My biggest concern, once I tested positive, was my immunocompromised neighbor living downstairs. In NY it is difficult to get space from others, and while we had separate entrances to our building, I was terrified that I would infect a common space. I put on my homemade Hazmat gear and cleaned with Pinesol and Lysol and bleach everything there was even the slightest chance he could come into contact with. I then locked myself and in my apartment and vowed not to leave until I was completely certain I was no longer contagious.
I continued to be sick but life went on. Many of my students reported their family members were ill. Some lost grandparents, others lost parents. We were advised to keep our classes as normal as possible—completely impossible. Once neighbors heard that I had it some were kind enough to stop over and leave groceries in our building entryway for me.
As I continued to recover I did not seem to be developing the most dangerous symptoms in the lungs. But what I learned is that this virus tricks you into thinking it’s done with you, all the while it’s still lurking. Lying on the couch scrolling Facebook, a very sudden and aggressive tightness gripped my chest. So severe that I genuinely believed I was at risk of death. I called my doctor for advice. She asked if I could speak a full sentence. I could. She said not to go to the ER unless I could no longer speak a full sentence. Otherwise, stay in the apartment. I stayed. The pain and tightness in my chest persisted. At this point the virus was personified; it lived in my body as a character that wanted to kill me. It had attacked every part of my body- my nose, my head, my skin from head to toe, my digestive track, and it had finally come for my lungs.
Far worse was when my daughter fell ill.
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Then it came for her lungs. Worse than it had come for mine. She woke me up in the middle of the night, said she felt like someone was stepping on her chest. We used an albuterol inhaler. We inhaled Vicks. Nothing budged. The next day I wanted to take her to our local urgent care, the one we always use. I went to the website to schedule her an appointment; I saw a notice: we are not seeing COVID19 patients on site–call your primary care provider or schedule via telehealth.
Okay, I really wanted a physician to check her over just in case, but telehealth it would be. It was a strange change from the “we don’t diagnose over the phone” and “bring her in as a precaution” that I was used to. But telehealth was ultimately more convenient and we didn’t have to risk exposing others by leaving the apartment. I described her symptoms to the urgent care doc via video, who was wearing his Hazmat gear even as he spoke to me through telehealth.
I told him all about her chest tightness, chest pain, how concerned I was, how nothing seemed to help that would normally help, how I wanted to bring her in as a precaution. He repeatedly emphasized that we should not leave the apartment. “But when do I take her?”
“If she seems to just be getting worse and worse.”
“What does that mean?”
“I am looking at her, she is sitting up, she’s been able to talk to me. If she’s unable to do things like that. If her lips are blue, or fingers are blue. If she’s in obvious respiratory distress. Otherwise stay in your apartment.”
He emphasized that morbidity rates for children were extremely low and that the most important thing was to avoid the spread. “We want the chain to end with you” he repeated. Multiple communications with physicians confirmed the same thing and I finally got the point: we should only leave the apartment if we thought we were going to die.
In spite of the fear of the unknown short and long term effects of this virus, as well as the breakdown of usual ways for dealing with and treating illness, both she and I could have developed more serious infections. Neither of us were hospitalized. And while it took several weeks of symptoms coming and going, showing up somewhat randomly and aggressively and then disappearing again, we both did eventually get better.
But perhaps most striking about this illness experience was the sense of isolation and loneliness. It went beyond an “I am lonely because I cannot see and interact with my family and friends.” It was a loneliness of experience. A loneliness of wallowing in the collective unknown. I am a member of several online parents’ groups where you can often go for valuable hivemind advice. While these groups were still supportive, we were all collectively wading through a sea of uncertainty. There were simply no definitive answers for a single parent with covid trying to decide whether or not to take her child with covid to a NYC emergency room. I followed the physicians’ advice and stayed in, each night apprehensive of what the virus would bring the next day.
The covid19 pandemic has shown the collapse of the serious world in many respects. What is definitive regarding an existential experience from the perspective of both Sartre and Beauvoir is what meaning we give it, what values we choose in the aftermath. We can retreat back more aggressively into the spirit of seriousness, or we can embrace the existential ambiguity that comes with acknowledging the failure of our trusted systems.
Covid19 has been disproportionately killing minorities, especially blacks and Native Americans, due to deeply embedded disparities originating with colonialism, genocide, slavery and segregation and persisting in contemporary structural racism. The crisis has further aggravated the divide between the professional and working class. Most professional positions can be continued from home, while many working class workers are furloughed or laid off, or forced to put themselves and vulnerable family members at risk to work. The coronavirus crisis did not create new disparities, it has aggravated and intensified inequalities that already existed: disparities in income, safety, health, and overall quality of life. And it has made more evident than ever the failure of a health care system that is motivated by profit and tied to employment rather than a public service guaranteed to all as a right.
Additionally it has shed light on the disproportionate labor completed by women in the home, aggravated in a time of crisis, as well as an increased feeling of powerlessness and intensified abuse for women living with abusive spouses or partners. Moreover shelter in place protocols are disproportionately difficult for single parents, especially those working and raising children in cramped living quarters. Women are now expected to take on the task of educating their children while still having to work and run the home.
And the nonchalant ways that some have expressed life should continue as usual because covid19 primarily kills old people reflect just how little we collectively value the lives of the elderly. Again, this is not a new phenomenon: the elderly are neglected and devalued in a myriad of ways in public life, disproportionately suffering from depression, loneliness, boredom and loss of self-worth. What is new is having those values stated so explicitly in public discourse, coming from citizens, politicians, and our media, some who have even said the elderly should be willing to die for the economy. An economic system should serve the needs of human beings; human beings should not be sacrificed to prop up an economic system as if that system is an end in itself. And examples of citizens refusing or protesting shelter in place orders are unfortunately a natural result of a cultural ethos in which self-interest is the primary value: people are uncooperative and unwilling to accept restrictions on liberty for the sake of the common good.
A personal existential rupture results in a radical rethinking of self: of one’s values, beliefs, and orientation in the world. It is a radical, new projection of one’s ends and a novel ongoing choice of self in the world. It is almost always the result of an experience or event so radical that you are unable to fully return to your previous ways of thinking and doing. I am of the mind that we can have existential ruptures at the social level as well. This would entail a collective rethinking of our cultural and social values, norms, and social structures. A rejection of the spirit of seriousness in favor of acknowledging the inequities in our society are not anonymous inevitabilities, but the direct product of the values, behavior and choices of human beings.
A crisis shatters our collective illusions. These problems are not new, they just show themselves more clearly when a crisis hits. If an economic policy, a health care system, and a social order cannot withstand a public health crisis, it is time to let them die and rebuild, not cling to them out of the comfort that the spirit of seriousness brings.
I interact in the world now as someone who got covid and got better. Many got sick and did not get better. Life does have to go on. I don’t know what the future brings. I hope it is not a return to normalcy, because what this crisis has helped make apparent is just how deeply inadequate normalcy is. As a bare minimum we should embrace collective protective measures to contain and manage this disease. This includes wearing masks, social distancing, and understanding that we have a social responsibility to other people and an obligation to help protect public health, until hopefully a treatment or vaccine is available.
But I hope we can go beyond the bare minimum and recognize that the vulnerabilities and disparities that covid has thrust into the spotlight should not be an accepted part of everyday life. Further I hope the collapse of the serious world helps us collectively realize that our social structures and our institutions are not inherent and did not fall down from the heavens. The serious world is comforting because everything seems to have its place. But this is illusory and exists only on surfaces. Upon acceptance of its collapse we get to choose where things go, how we rebuild, what it will look like—what kind of values we want to choose.
[1] Simone de Beauvoir, Ethics of Ambiguity, trans. by Bernard Frechtman (Secaucus, N.J.: Citadel Press, 1980), 35-36.
[2] Ibid., 47-49.
