From April-May 2021, I committed 94 volunteer hours to vaccinating the general public of Indianapolis against COVID-19 at IU Methodist Hospital, the IUPUI Student Campus Center, and the Indiana Motor Speedway. I’ve given at least several hundred vaccines, likely exceeding a thousand (as of this writing, 3,005,438 Indianans, or 44%, have received at least one COVID dose).
I am obviously a proponent of the COVID vaccines. The majority of the (vocal) people I vaccinate are of a similar, if not more neutral, mindset (it is, after all, the subset of Indianapolis that willingly seats itself beneath my waiting syringe). With the institution of mandatory vaccination for IUPUI students and IU Health faculty, though, the population at my stations has subtly changed, now hosting a larger proportion of the hesitant or undecided. I make a point to ask about my patients’ attitudes, and, though I had anticipated many of these arguments (the side effects, fear of needles, time constraints, autonomy…), others surprised me, both in content and fixedness.
A case: There was the man who feared the possible aftereffects of the injection; he complained to me about his sister, who had “three weeks” of malaise following vaccination, along with a mysterious tendency to drink “gallons of water.” Other patients claimed to have witnessed odd or unrelated side effects, including hair loss, unremitting gas, and an increased frequency of hiccups… in addition to the advertised (and better-documented) fevers, chills, aches, pains, and fatigue. My approach: I affirmed to this patient that the effects of the vaccine can be palpable, but they are usually not so… well, weird. My argument that was not heeded. It did little to quell this patient’s firsthand experience of puzzling, alarming, seemingly linked symptoms. In the end: I’ve been taught that logic and data don’t easily change minds. I was resigned to admit that some patients clearly did not or would not believe my evidence-based medical advice. The same goes for much of the data about the vaccines, immunology, and epidemiology. I was simply thankful the patient accepted the shot.
A case: Another patient had a strong history of anaphylaxis and was extremely anxious. He showed me his collection of epi-pens and his allergist on speed dial. Begrudgingly, he was vaccinated, and, to my knowledge, suffered no severe physiological reactions. My approach: I stood aside from this patient’s reasoning. He had considered the chance of a life-threatening reaction to a vaccine against a decreased chance of catching COVID-19 and had chosen the latter. I’m not sure if I would have made the same choice. In the end: for some, though a decision may not be literally ‘life and death,’ it bears similar significance. And, if I can’t argue with the anaphylactic patient’s personal cost-benefit analysis, then I probably shouldn’t try to argue with other patient’s analyses if their understanding of the situation is intact and they perceive grave consequences to any facet of a medical decision.
A case: A teenaged patient spoke to me about the threat of judgment from her family, who remain staunchly against vaccination, almost to the point of altogether disbelief in COVID. She told me her mother would most assuredly not let her visit over the summer if they knew she’d gotten the shot. She imagined her mother saying, “That’s not how we raised you.” She looked tearful at the imagined condemnation from her parents, but still submitted to vaccination because she though it was right. But it took her weeks of what seemed to me obviously heated internal discussion and turmoil. My approach: I told this patient I was glad she decided to get the shot, and that her secret was safe with me. In the end: some consequences are unfathomable by outsiders, and, though considered nonsensical or arbitrary by some, still have real sequelae.
A case: One spectator at the Speedway asked me, “Where are all those sick people? I haven’t seen anyone headed to the hospital.” He had been watching us vaccinate for several hours. My approach: I told this man about my parents-in-law, who both contracted difficult cases of COVID-19, but who luckily survived with only minor (though long-lasting) aftermath. I told him about the dozens of patients I’d seen in the ICU during rotations and shadowing palliative care unresponsive, hooked up to ventilators. In the end: This spectator refused vaccination but thanked me for speaking so intimately. Though shared vulnerability may occasionally work to convince people of a truth hard to swallow, they can also come off (unpalatably) as scare tactics.
A final case: I met a woman with countless self-harm scars covering her upper arms, down to her wrists. She said she didn’t want to get vaccinated because someone would see her arms. My approach: I took her behind a privacy curtain, and she wept as the rolled up her sleeves. In the end: I thought for hours about how brave this woman was. I wish I could say more.
Vaccinating Indianapolis has been a pleasure, and a monumental opportunity for personal and professional growth. Medical school offers plenty of didactic instruction in speaking to patients, managing fear, and tempering expectations, but the skills go unpracticed and unanalyzed when unapplied to real encounters. We are primed to recognize the reasons why patients may feel a particular way towards a particular intervention, but we are not taught how to understand and process those reasons. We are not taught when those reasons are better left untouched. Vaccination is a personal choice, and I’ve offered a biased cross-section of those who accepted it with varying degrees of hesitation. Throughout my experience, I learned to argue patient’s hesitancies less and listen to them more.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Aubrey Kenefick is a third-year medical student at IU School of Medicine and a Graduate Assistant for the IU Center for Bioethics. She is currently taking a gap year in her medical education to pursue a Master’s Degree in Philosophy with a concentration in Bioethics at IUPUI.