Referring to healthcare workers (HCW) as “heroes” has been popular since the beginning of the COVID-19 pandemic. An internet search reveals numerous hospital campuses newly adorned with large signs announcing “Heroes Work Here.” Indeed, HCW have been the recipients of synchronized communal applause and its cousin, communal pot banging, emanating from urban balconies around the world.1 We have received donations of lunch and lovingly hand-sewn face masks. At a deeper level, these gestures of honor may be motivated by the public’s need to communally celebrate at least one good thing during a time of dread.

But the designation “hero” is problematic even when it is “grass-roots” and more so when hospitals self-assign it. Heroism should be self-evident, not self-proclaimed. Furthermore, critics worry that designating HCW as heroes allows exploitation of their sense of duty. Public glorification of heroic qualities like stoicism and capacity for prodigious workloads contributes to burnout by closing the off ramp.2 Similarly, “heroes” are less free to complain about marginal compromises to safety. Psychological damage can result when HCW, labeled as heroes, nevertheless prioritize their own needs.3

It is widely accepted that HCW have an ethical “duty to care” often prioritizing patients’ needs beyond their own comfort or needs. The public’s expectations of physicians have evolved over time, but even the most expansive view of duty acknowledges that duty has limits with regard to compromising personal safety.4 In emergencies, expectations expand depending upon the type and severity of the emergency. An individual’s efforts to balance between personal concerns and professional duty becomes even more psychologically fraught when the health of the many is involved.4, 5

If the term “hero” is misapplied and carries baggage, what term serves better? I find answers in a superb plague narrative, Albert Camus’ 1947 La Peste (The Plague).6 The Plague depicts a fictional outbreak of Yersinia pestis, replete with dying rats and panicked populace in Oran, a placid, unsuspecting coastal town in 1940’s French Algeria. Oran’s ordinariness makes it a perfect vehicle for Camus’ “any town-any time” warning. The Plague is often described as an extended metaphor for non-medical plagues, e.g., the conjoined social plagues of fascism, racism, and nationalism. But it also reads well just as a story about human behaviors during actual plague which Camus learned by deep study of historical plagues. Camus’ take includes many of these behaviors, such as plague denial, victim blaming, self-interest, self-sacrifice, and, of paramount interest to today’s physicians, duty. Ultimately, The Plague reminds us that to know human nature, one has to know plague.

Twenty-first century pandemic physicians will be most keenly interested in the thoughts and actions of the main character and narrator Dr. Bernard Rieux. Rieux is an indefatigable physician who cajoles the city leaders into action, organizes a community sanitation corps, makes house calls, lances buboes, administers serum therapy, and palliates patients at the newly opened pestilence hospital, all the while suffering a separation from his ailing wife, confined to a sanitarium outside the quarantine. Dr. Rieux has probing (and talkative) companions so readers can listen as the characters contemplate the deeper meaning of plague and plague’s opponents. These dialogs have great significance to today’s physicians actively engaged in COVID-19 care.

Early in the epidemic, Tarrou, a visitor, trapped in Oran by the quarantine, queries Dr. Rieux on his views about the spiritual meaning of the fight against plague which a priest has insisted is an instrument of God, used both to chastise a sinning population and as an invitation for self-improvement.

My question is this, said Tarrou: Why do you yourself show such devotion [to treating the plague-stricken], considering you don’t believe in God?

…if he [Rieux] believed in an all-powerful God he would cease curing the sick and leave that to Him. But no one in the world believed in a God of that sort… Anyhow in this respect Rieux believed himself to be on the right road in fighting creation as he found it.

“Ah”, Tarrou remarked. “So that’s the idea you have of your profession?”

…Yes, you’re thinking it calls for pride to feel that way. But I assure you I’ve no more than the pride that’s needed to keep me going. I have no idea what’s awaiting me, or what will happen when all this ends. For the moment all I know is this; there are sick people and they need curing. Later on, perhaps they’ll think things over; and so shall I. But what is wanted now is to make them well. I defend them as best I can, that’s all. (pp. 126–127)

Rieux takes a narrow view of his role: defending his community against the many threats that exist in the natural world. He does not concern himself with any other “meaning” plague might convey. He is a healer, not theologian.

That Rieux maintains a personal professional code concerning duty is evident. When Tarrou describes his goal of achieving saintliness by joining the sanitation corp, Rieux responds,

…I feel more fellowship with the defeated than with saints. Heroism and sanctity don’t really appeal to me. What interests me is being a [good] man. (p. 255)

Heroism is not something that Rieux contemplates. His inspiration for working to exhaustion and assuming the risks of being a plague doctor lies elsewhere.

… there’s no question of heroism in all this. It’s a matter of common decency. That’s an idea which may make some people smile, but the only means of righting a plague is, common decency.

“What do you mean by ‘common decency’?” Rambert’s tone was grave.

I don’t know what it means for other people. But in my case I know that it consists in doing my job. (p. 163)

For Rieux, doing his duty in the job he has trained for (and is expected of him) is the heroic substitute.

In the penultimate paragraph, Camus describes why Rieux chose to compile a narrative of his plague year, “…he knew that the tale he had to tell could not be one of a final victory. It could be only the record of what had had to be done, and what assuredly would have to be done again in the never ending fight against terror and its relentless onslaughts, despite their personal afflictions, by all who, while unable to be saints, but refusing to bow down to pestilences, strive their utmost to be healers.” (p. 308)

This reveals Rieux’s concept of duty; doing what one was trained for despite “personal afflictions.” And by looking forward to the next “onslaught,” Camus links all plague physicians through the ages and into the future. I like to think of myself as part of that legion.

Back in my non-fiction world, I hear Rieux’s voice as I visit COVID patients for extended discussions of clinical trials through doubled face masks (mine) and over the noise of high-flow oxygen machines (theirs). It is a job I have trained for and needs doing.

I think too of Rieux when I observe other clinicians supplying COVID care. It is common decency delivered every day and every night.

I started this essay objecting to heroism self-proclaimed with large letters on the sides of buildings. But rather than discarding those giant letters, I suggest rearranging them to spell instead: “Duty and decency: we do our job.” No higher compliment is available.