Killer Metaphors — Or How A Metaphor Can Kill You
In 2015, Sarah Kliff of VOX news conducted a stunning investigation into the different ways hospitals think of, prepare for and respond to medical outcomes. Specifically, they looked into preventable deaths in hospitals, of which number around 210,000 to 400,000 deaths per year in the United States.
They focused on central line infections — a condition where bacteria and/or germs enter the bloodstream and cause an infection — and the case of a 4-year-old girl who died in the care of practitioners at Stanford University Hospital after succumbing to four central line infections in a row. When pressed by the girl’s mother if her daughter’s death could have been prevented, Stanford responded in a letter, saying that “the placement of central lines is associated with risk of infection [and given that] there is a risk of infection, even in the best of circumstances, [the risk] can never be entirely eliminated.”
This metaphoric framing of inevitability — like a car crash — an unfortunate, but inevitable consequence in life, was contrasted with the framing at Sutter Roseville Medical Center, a hospital only 3 miles away, that had achieved a record of zero central line infections for seven years in a row. The difference? When research came out that showed that central line infections were preventable, Roseville’s team adopted a no-tolerance policy for the infections, and began to implement the research, stringently reviewing personnel, equipment, skill sets, procedures…everything that could have an impact on patient outcomes. And as they did this, framing “every infection as a defect,” according to Peter Pronovost at Johns Hopkins Medical Center, they pushed their rate of infections down to zero. Their framing, unlike that of Stanford’s, according to Kliff, was that of a plane crash — an unacceptable event that’s endlessly dissected post-crash as a system failure and then improved upon so that it never happens again.
The notion of metaphoric framing and outcomes recently came up for me when listening to Donald Trump speak about the current pandemic. When referencing COVID-19 and the resulting economic situation in the United States, he said, “We lose thousands and thousands of people a year to the flu. We don’t turn the country off — I mean, every year….we lose much more than that to automobile accidents. We didn’t call up the automobile companies and say, “Stop making cars. We don’t want any cars anymore.” While Donald Trump didn’t come out and say, ‘it’s inevitable that large swaths of people will die of COVID-19 and I’m complacent in that outcome,’ he may as well have. This use of car crash language is not isolated to Trump. Just a few weeks ago, Elon Musk was using the same framing, sharing with his employees that they “were far more likely to die from a car crash than COVID-19.” Speaking about the current pandemic in the same breath as a car crash reveals that leadership, both in our government and in our corporate community — has not taken this all that seriously — and this has a direct relationship to how our country prepared for COVID-19. According to Steven Taylor, a professor and clinical psychologist at the University of British Columbia, the language used around the pandemic is “hugely important. People pick up cues about how to behave or how to feel from their leaders.”
We see from the lack of pandemic preparedness on the federal level to the fact that people are still congregating in public and not practicing social distancing on the local level, that messaging from the top has had an effect, and a bad one at that. Contrast the current state of affairs in the United States States to that of South Korea, a country which reported their first case of coronavirus on the same day as the United States, but have handled the situation far differently with a vastly different outcome. Looking through the way that key figures in South Korea have spoken about and framed the pandemic, they consistently have used language describing themselves as detectives. According to the New York Times, Dr. Ki Ro-Man, epidemiologist and advisor to the South Korean government on the Coronavirus response, said “We did our epidemiological investigations like police detectives,” Lee Man-hee, head of the Shincheonji Church of Jesus, which is largely being held responsible for accelerating the spread of Coronavirus in South Korea was quoted as saying the epidemic was a “great calamity.” This framing of the pandemic in the language of a plane crash — a catastrophic event to be investigated — as opposed to a car crash — an everyday, inevitable event, reveals the difference that mindset can make.
Metaphors reveal mindsets and unconscious frames that people may be reluctant to express in public or even be consciously aware of. They are an expression of our deepest thoughts and feelings, and are clues into how people are really feeling about something and what they will do, as a result. As we examine the way our leaders speak, we can ascertain the seriousness with which they are taking on the pandemic, and consequently hold our leaders to account in taking COVID-19 seriously.
And so what do we do? Aside from staying home, washing our hands and avoiding touching our faces, we can also think carefully about the language we use when talking about COVID-19. The virus reaching the shores of our country might have been inevitable given our global community and the ubiquitousness of international travel, but mass death does not have to be inevitable. With attention primarily focused on what scientists are saying and following their recommendations, mass death is entirely preventable. Similar to Sutter Roseville Medical Center, the hospital that achieved a record of zero central line infections for seven years in a row, we can prevent the inevitable by refusing to accept the unacceptable. We can refuse to become a part of the problem and we can avoid passing along the virus to our fellow community members. We can refuse to treat this like the flu, and instead, meet COVID-19 with the energy and seriousness it deserves. We can refuse to stay silent when family members or friends disregard CDC recommendations and act like none of this matters. We all have a role to play in stopping the spread of COVID-19, and together, we can make a difference.