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One morning on hospital rounds I stood in the hallway outside of a negative airflow room with the other members of my team. We were preparing to see a patient on airborne and contact precautions, so we were all putting on gowns, gloves, and face masks. As he was about to put on his mask, the attending physician looked sideways at me and the corner of his mouth turned up slightly. He said, “Has your PPD turned positive yet?” We all stared at him with muted alarm. The PPD (purified protein derivative) test is used as a screening test for tuberculosis, an infection I hope I never get. “I remember when mine went positive,” he continued. “It was during my fellowship. I had to take isoniazid for 9 months.”
I placed my face mask on very carefully that day, and have ever since. Coming to understand the real purpose for something forever changes your attitude about it.
Every occupation has hazards, and safety equipment to minimize those hazards. Gowns, masks, goggles, rubber gloves, and other such equipment used in healthcare settings are known as personal protective equipment (PPE), and are essential tools in keeping the healthcare worker safe from infections, and in preventing the spread of germs from patient to patient.
The Whole Armour of God
Soldiers throughout time have used various types of shields, body armor, helmets, and other protective gear to minimize the obvious safety risks of combat. The Apostle Paul used this armor as an analogy for the personal spiritual defenses which help us resist the evil forces in the world. “For we wrestle not against flesh and blood,” he wrote to the Ephesians, “but against principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places. Wherefore take unto you the whole armour of God, that ye may be able to withstand in the evil day, and having done all, to stand” (Ephesians 6:12-13). He then compares the individual elements of the armor to specific religious principles and ideals, such as the shield of faith, the helmet of salvation, the breastplate of righteousness, and the sword of the Spirit. (Ephesians 6:11-17, compare to Doctrine and Covenants 27:15-18)
I have pondered this passage many times, and I think it is rich with symbolic meaning. Military combat analogies are effective, and are pervasive in human culture because war is pervasive in human history.
The Whole PPE of God
A few weeks ago I thought about the Whole Armour of God as I put on my PPE to see a patient in the hospital who was on contact precautions. I thought, “If Paul had written this analogy about personal protective equipment instead of armor, what would the various articles represent?” Here are my suggestions:
Goggles of Judgment
Body fluids under pressure have a way of squirting out in the direction of healthcare workers, who often have their eyes focused on the source of the fluid when this happens. The best protection from this occupational hazard is wearing a pair of goggles or a face shield. Being able to see what you are doing is critical, especially when you are holding a sharp object near a human being.
In a world full of temptation and deception, we need to see clearly to judge between good and evil. Final judgment belongs to the Lord, so we should never presume to make final judgments on the souls of other people, but we make smaller decisions every day about which activities we will participate in, what music we will listen to, shows we will watch, books we will read, and websites we will visit. These decisions require us to exercise righteous judgment.
“Wherefore, I show unto you the way to judge; for every thing which inviteth to do good, and to persuade to believe in Christ, is sent forth by the power and gift of Christ; wherefore ye may know with a perfect knowledge it is of God. But whatsoever thing persuadeth men to do evil, and believe not in Christ, and deny him, and serve not God, then ye may know with a perfect knowledge it is of the devil” (Moroni 7:16-17).
If we look to Christ as our standard, we will be able to see clearly as we judge between good and evil.
Gloves of Humility
Gloves are a critical barrier against germs for healthcare workers, who sometimes have to touch the most disgusting things you can imagine. When I am wearing a latex or nitrile glove I have confidence to touch whatever I need to touch, knowing that the barrier will prevent it from reaching my skin. Also, when I am working in a sterile environment I know that my gloves will protect the patient from any germs I may have on my hands, reducing the chance that my procedure will cause an infection.
Our hands are the major elements of action in our bodies, representing our ability to accomplish work of all types. Rubber gloves protect that ability, and prevent our work from causing inadvertent harm to others. Our humility serves a similar function, protecting us from some of the unseen dangers of our actions. The more capable we are, the more we are tempted to hold ourselves in high esteem, but pride can blind us to our own errors and to the needs of others. Humility is our antidote to pride, helping us to rely upon God for our strength and reminding us to focus our efforts on accomplishing his work and bringing glory to his name, not ours. When we are humble it is easier to work with others and to see things from their perspectives.
Gown of Righteousness
The gown is an indispensable part of the PPE when you are visiting a patient on contact precautions. You don’t want their germs to get on your clothes, so that you spread them to other patients or take them home to your family. Also, a gown is critical to the success of maintaining a sterile field for procedures, especially in the operating room.
The scriptures refer several times to the “robe of righteousness” (see examples here). These passages associate righteousness with purity, glory, joy, and confidence in the presence of God. In addition, and pertinent to a discussion about PPE, righteousness is associated with protection against evil, as in this verse from 2 Nephi: “O Lord, wilt thou encircle me around in the robe of thy righteousness! O Lord, wilt thou make a way for mine escape before mine enemies!” (2 Nephi 4:33) Righteousness — a conscious decision to follow the Lord because of love for him — is a powerful shield.
Bouffant Cap of Virtue
The purpose of a head covering for food service workers is obvious to anyone who has found someone else’s hair in their meal. Bouffant caps and other head coverings serve a similar function in health care, particularly for people who work in operating rooms. Long hair can also inadvertently touch contaminated areas, and then serve as a vehicle for transmitting infections to other patients.
The head is the seat of consciousness and rational thought, so the head covering can metaphorically represent what we think about. Section 121 of the Doctrine and Covenants counsels us, “let virtue garnish thy thoughts unceasingly.” Virtue refers not only to chastity, but to any excellent or righteous moral quality, and to the power which results from the possession of that quality. The cognitive behavior of garnishing our thoughts with virtue is connected to a host of great blessings:
“Then shall thy confidence wax strong in the presence of God; and the doctrine of the priesthood shall distil upon thy soul as the dews from heaven. The Holy Ghost shall be thy constant companion, and thy scepter an unchanging scepter of righteousness and truth; and thy dominion shall be an everlasting dominion, and without compulsory means it shall flow unto thee forever and ever” (Doctrine and Covenants 121:45-46).
There is no more virtuous being than Jesus Christ, and no better place to rest our thoughts than on his teachings. He promised, “And if ye do always remember me ye shall have my Spirit to be with you” (3 Nephi 18:7,11).
Face Mask of Praise
Face masks come in two varieties. The most common type is simply a cover to filter out the airborne germ-containing droplets produced by coughs and sneezes. I wear a mask like this on days when I have a cold, and while doing sterile procedures. The second type of mask is called an N-95, and is a much more powerful filter for catching smaller particles. This is the preferred mask for seeing patients with pulmonary tuberculosis.
The essential role of a mask is to filter what comes in and out of our mouths, and the scriptures provide some guidance on that theme. “Let every thing that hath breath praise the Lord,” proclaims the Psalmist, and I think that is a good meaning for our metaphorical face mask. James described the problem of hypocrisy in our speech:
“Therewith bless we God, even the Father; and therewith curse we men, which are made after the similitude of God. Out of the same mouth proceedeth blessing and cursing. My brethren, these things ought not so to be” (James 3:9-10).
Praising the Lord with the same mouth we use to curse and swear at our fellowmen is a bit like paying tithing with stolen money. The face mask of praise can act as a reminder to hold back those criticisms and unkind words.
In my clinic I often perform a diagnostic medical procedure called electromyography (EMG). This involves using electricity to study nerves and muscles, and during part of the procedure I use a small needle electrode to listen to electrical discharges from inside of the patient’s muscles. I always wear rubber gloves while performing the needle electrode examination so that I don’t come in contact with the patient’s blood. Those gloves remind me of the awesome responsibility I have as a medical doctor, and of the immense trust that patients place in me. And they also remind me to be humble, because I have weaknesses and limitations, and because I am wrong sometimes. The last thing I want to do is harm my patients.
Judgment, humility, righteousness, virtue, praise — I will think about all of these things when I put on my PPE. The next time you are in a hospital or clinic, maybe you will too.
Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.