An unusual letter after an unusual week: Liliana De Lima alone writes to readers about a polar vortex. Dr. Lukas Radbruch is this month’s author of the Featured Story; his topic is assisted suicide.
A couple of weeks ago, Texas went through one the most severe winter storms in its history, thanks to a polar vortex. A polar vortex is basically a large low-pressure system—a wide area of swirling cold air—that is parked over the polar regions, according to the United States National Atmospheric and Oceanic Administration. The term "vortex" refers to the counterclockwise flow of air that helps keep the colder air near the poles, but when it strays south, it can cause brutal weather conditions, including sub-zero temperatures.
Since we knew it was coming, we brought the potted plants in from outside, and hunkered down for a storm we thought it would last three days. I have been living here for over 25 years and I never experienced the cold we endured. It was something bizarre and out of this world. Unfortunately, this vortex decided to stay and linger over this southern part of the US, and many people, animals, wildlife, and plants suffered, and sadly some lost their lives. Millions of Texans were left without power and no water. I live with my husband in a small town in the hill country in Texas and we were fortunate to have power for a few hours every day. That allowed our house to warm up a little, and for us to charge our phones and boil water. But millions could not, including several IAHPC staff members. Many of us were wondering how could this have happened when Texas is one of the largest energy producers in the US? So, what did happen?
Texas produces more natural gas, oil, refined petroleum, and related products as well as propane, methane, and many other energy fuel sources, including sustainable sources, than any two US states (excluding California) combined. The state transmission grid, new sustainable energy sources, as well as the oldest and most reliable were all impacted. Stockpiles of coal were frozen solid and could not be easily moved or broken up to fire coal-burning plants, which generate steam to power turbines that generate electricity. Natural gas, the state’s primary fuel source, was frozen in its liquid form in pipelines, which were also frozen solid with moisture inside and out and could not be sufficiently warmed and converted back into gas. Once brownouts become blackouts, rebooting, and restarting these systems during extreme weather conditions is also quite challenging, with everything from frozen transmission lines and transformers, to overtaxed substations shorting out due to excess demand. Frozen wind turbines had to be de-iced, but that “weatherization” requires ongoing maintenance done routinely on the front end, which apparently did not happen. With the decrease in supply and the increase in demand, the grid was unable to meet the need.
You are probably wondering what does this have to do with palliative care? During the storm, I thought how this situation mirrors some in palliative care. Lives are deeply affected and disrupted while the illness runs its course, similar to the way nature does. We realize how vulnerable we and things are. And since health care systems are designed mostly for curative approaches, many times palliative care workers and caregivers are forced to “think outside of the box” and take decisions that include repurposing resources and changing treatment goals. In our case, when we were wondering what we could eat, I looked outside the window and saw our barbeque grill – which we use frequently during the warm months - sitting in the cold and covered in snow. I decided that I would dare the extreme cold weather and, given that there was no electricity, use it to prepare our food. Similar things happen in palliative care—physicians and caregivers have to innovate and decide how to make the best of what is available, to ensure the best quality of life possible to relieve suffering. And when palliative care is available and accessible to patients and families in need, it is a blessing. The circumstances surrounding palliative care are not easy, and demand coping, adaptation, and acceptance—but it certainly improves the quality of life of those involved, even with the limitations of the field and the challenges in the system.
Things are back to normal now, and we are enjoying the regular, seasonal weather that happens during these dates in Texas. It was a weird, strange week in which our comfort and daily lives were affected and made us reflect. And this, too, may also be applicable to palliative care. Patients may go through periods of excruciating pain or serious health-related suffering that require intense palliative care interventions. And afterwards, the patient may improve, continue treatment as before, and may even live many more years. We had a taste of “palliative care for serious weather-related suffering” and it proved to be a lesson in humility and gratitude.
Liliana De Lima, MHA