Plain-spoken words about the “7 stages of severe COVID death” go viral

In late August, the Los Angeles Times published an unvarnished description of illness and death from COVID-19, written by a respiratory therapist who has worked on the front lines of the pandemic: “Here’s what the seven stages of severe COVID-19 look like.” The tone is plain-spoken — almost matter-of-fact — but does not qualify its message:

Get vaccinated,” wrote Karen Gallardo. “If you choose not to, here’s what to expect if you are hospitalized for a serious case of COVID-19.”

From there, the op-ed counts down what happens as COVID cosumes the body’s processes, stage by stage, until death is imminent. Written in a second person point-of-view, it inserts readers into that journey, as if they are the ones in the ICU, listening to calm-but-dire prognoses.

The power, and likely the clarity, of Gallardo’s piece made it a popular social media share as readers passed it along, hoping it might convince the vaccine hesitant. There’s no way to track that, but the origins and writing offer lessons worth note:

• Word Choice: Gallardo explained what happens when breathing fails in concise, no-frills language that is dramatic for its simplicity. She cites important scientific information in a way that lets it stand out amid the tidal wave of COVID-19 misinformation. Writing scholar and coach Roy Peter Clark of Poynter Institute held up an article on the delta variant by Dr. J. Stacey Klutts, a scientist and physician from Iowa, as an example of effective “public writing.” Clark explains the use of word choice in making the scientific accessible while maintaining a strong, steadfast voice that builds in quiet frustration and is seems to quietly build with frustration, grounded in personal experience. It, like Gallardo’s piece, is a call to get vaccinated. It, like Gallardo’s piece, went viral on social media.
• Access and authority: Gallardo’s descriptions take readers inside the hospital. We are the patient in the bed. We feeling the pain as our breath is sucked from our chest. She has the credibility — the eyes, ears and expertise — to take us where only medical professionals are allowed.
• Form: Using the number “seven” as a narrative hook pulls the reader through as they wonder what happens next, and next, and next. What’s the fifth stage? Now, what’s the sixth? The fowarrd progression echoes other easy-to-remember writing structures, such as Elizabeth Kubler Ross’ foundational “Five Stages of Grief.”
• Voice and point-of-view: Then there is the power of Gallardo’s imagery in the unadorned details, the accumulation weight of those details, and consistent use of the second-person “you.” You, the reader, can find your lungs feeling heavy by the end as you inch every closer to death. It is reminiscent of the accumulated weight of war from “The Things They Carried” by Tim O’Brien, or the description of freezing in the Outside essay, “Frozen Alive,” by Peter Stark. Our human instinct is to want to know what it might be like on the brink, our senses going to those limits, comforted by the reality that we are only imagining it.

Gallardo has worked for seven years as a respiratory therapist, and now staffs the night shift at Community Memorial Hospital in Venture, California. We spoke to her about why and how she came to write this piece, and what previous writing experience, if any, she has. Our conversation has been edited for length and clarity.

Why did you write this piece?
I lost my adoptive mom to COVID early on in the pandemic. My mom lived with her daughter and her family and I think she caught it at a funeral, back in March 2020. She passed away March 26. She was 92 and fought a good fight. I started journaling more after that and talking with a grief counselor. I found that so many times during the pandemic, since I turn off the machine that makes someone breathe, I feel like I owe it to that that patient, to remember him so I would include them in my journal.

There are so many times when the family decides to terminate care and we get the order and have to take out the tube and shut off the ventilator. We are the only ones in the room because the families are not allowed. By proxy I hold their hands. I spend the last few minutes with them so they are not alone. The faces are with me.

Do you have a background in writing?
I don’t have any training or background in writing. I’ve been a lifelong journal writer, but moreso since December of last year. This started as a journal entry. I showed it to my boyfriend and he said, “This should be read by a lot of people.” He urged me to submit it to the Los Angeles Times.

I had written the whole thing on my phone. It was originally over 1,000 words — very long. When I looked up the requirements to submit an op-ed to the Times, it was 700 words, so I had to trim a lot of it.

I am surprised that it resonated with people. Maybe because we do this everyday it is so ordinary, so routine. Someone forwarded it to me and I saw that it was shared 400,000 times and that is when I knew it went viral. 

You use short sentences that move the action forward. They are filled with succinct descriptions that drive the point home. This passage comes to mind:

If your blood pressure drops critically, we will administer vasopressors to bring it up, but your heart may stop anyway. After several rounds of CPR, we’ll get your pulse and circulation back. But soon, your family will need to make a difficult decision.

Was the clear, straightforward style intentional?
The idea of writing this in stages came from Susan Brenneman (deputy op-ed editor of the LA Times). I told her that respiratory therapists are ugly step-sisters of health care and not a lot of people know what we do. But when people can’t breathe, they call us. By the time they are admitted to critical care and beyond, we see patients at each progression of the disease. We see them on every floor and every unit of the hospital. So I rewrote it in what we see and give them at each stage.

It is almost matter-of-fact in the way it explains how the virus takes over a patient’s body, and the medical procedures needed along the way. Was this difficult to do?
My original submission was more technical. Susan wanted it to be layman’s terms. She would say, “Let’s not use the word ‘thorax,’ Let’s just use the description.” A lot of comments have said that the simplicity is why it is effective. I credit Susan with that.

As a writer I am interested in the choice to write it in second-person. Was this a conscious decision?
Again, it started as a journal entry. I had a patient who was very young; he was unvaccinated nad dying. He was on my mind and it just came about that I was talking to him in the entry. The end of my original submission was, “If only you had gotten vaccinated.” But editors suggested putting that in front.

English is not my first language. I immigrated from the Philippines in 2005. Until now, I still have trouble using the proper pronouns — he/she when referring to a third person — because we don’t have that in my language, Tagalog. Maybe subconsciously this is why I used the second person?

I get the sense from your writing that there might be anger bubbling underneath the words?
I’ve found that I write better when I have extreme emotion — when super happy or sad. But I wasn’t angry when I wrote this. It’s more frustration. I convinced one of my co-workers to get the vaccine a week before I wrote this. And I thought that is one person, how can I convince more? I keep thinking it is a no-brainer and why are they resisting?

Maybe I have some anger I don’t realize. But, frustration? Absolutely.

What were you hoping your essay would achieve?
I had no expectations but I did have two hopes. One, I was just tired of unvaccinated people coming into the ER. We had a lot more unvaccinated cases, which are the worst cases. And, two, I have friends who are still on the fence about vaccination. They were also in my thoughts when writing this. I wanted them to see what I am seeing. I want people like them to read it. That is my way of trying to convince them. I’ve seen the comments saying, “That’s scare tactics” and maybe that was intentional. I was thinking of one particular person I was wanting to scare.

 In this age of misinformation with people circulating false and even anti-scientific/medical sentiments, despite health-care workers continuing on, and medical writers and other public-health officials continually trying to spread accurate information, where do we go from here?
I tell my co-workers that it’s almost like religion. You can’t convince someone. I think in most cases it’s hubris: “I’m not going to let the government …” It was a mistake to incentivize people to get the vaccine because this sows doubt.

In terms of communication I feel like there’s nothing else to be done. My goal in writing this was that when it was published if I can get to five people to change their minds and get vaccinated. Then I’m happy with that.

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Traci Angel is a writer, editor, author and teacher in Kansas City. She has a background in environmental and health reporting.