It means looking not at a virus for answers — but to ourselves. Environmental and agricultural reforms to protect us from a virus that moves from one species to the next, looming over us the possibility of a pandemic, mean asking why, as people, we desire the things we do, and what a world from which we take so much from will eventually return to us.

Pinpointing how someone becomes sick involves a careful examination of their life’s circumstances. Overcrowded environments, poor living conditions, economic insecurity, malnutrition, and limited health care infrastructure all, in some form or other, contribute to the spread of TB and other diseases. That much we know. While I had simply accepted many of these elements as hard realities of a life lived on the margins, I now find myself considering how they are intensified by a factor I had always thought outside of my grasp: warfare.

I often think about what gives meaning to the help we offer patients, how that might be shaped by the precision and calculations of a looming revolution from a novel technology, or by greater investments into the social safety nets that undergird them. But, in the end, I come to the same the conclusion: that neither is of any use without the uniquely personal connections that sustain us.

Nevertheless, many of my TB patients do live hardscrabble lives, making it harder for them to get diagnosed and access treatment. They might live in overcrowded shelters or have been incarcerated at some point. Nearly all of them are society’s marginalized, and that is where the disease finds them — at the margins.

The health needs of the unhoused cannot be fixed with a pill. They need a more comprehensive type of healing. For doctors, whose emotional stores are still drained from the maelstrom of the last few pandemic years, this means opening our hearts and minds to our patients’ experiences. When we do that, we not only fight against the stigma attached to our patients but directly improve their health.

A connection to a rural identity could be bought with incentives, or it could be learned. Or, I realized, just as importantly, it could be lived through simple and heartfelt things: a teary “thank you,” a firm handshake, or the question, over and again, from patients of your plans to stay.

Over the years, however, my outlook shifted. As the neighborhood grew, and as each autumn wrestled the canopy of gold and crimson to the ground, exposing a sinewy understory, that humble patch of trees stayed. It held a certain magic: of permanence. I imagine when most people think of forests they summon a similar sense of everlastingness — the ability to endure a world in flux.

What made our interaction possible, I later thought, was a remarkable program called PEPFAR. In the early 2000s, therapies for HIV were widely available in Western countries but scarce in the developing world — in places like Botswana, one-third of the adult population was infected. Millions of people were dying from AIDS.

Solving the problem of antimicrobial resistance faces the same challenge presented by most points of public health. Finding individual solutions — even remarkable ones — is not enough. Rather, the key lies in finding solutions that function in unison.

I don’t have many memories of my father from when I was a boy. But one particular day almost 25 years ago persists with the pesky stubbornness of a garden weed. Around this stretch of the calendar, it pushes forth.

Fungi are everywhere and very much part of human life. Scientists believe that we have long been protected against invasive fungal diseases by our warm core temperature, which few fungal species could tolerate. But innate to any living organism is the ability to adapt.

When I comfort a family after a patients’ death, I often say that they are never truly lost. People remain embodied in things: like their wedding band that slides over the next generation’s finger, or their woolen quilt that drapes the end of another bed. But for me, my grandfather, who died in 2020, remains vividly alive through language. His memory is conjured when I hear Punjabi – a language I myself could never speak.

The ecological networks that bind us with our natural surroundings are clearer than ever. It’s a relationship we must honor. Failure to do so would escalate biological collisions we cannot possibly win.

A few days after I met D., his test came back positive for the monkeypox virus. It was the result he’d feared and, he told us, the reason he’d delayed seeking treatment sooner and hadn’t been vaccinated for the virus when he’d had the opportunity.

My limbs grow heavy and my body sinks into the floor. Releasing the tension sets something free. It occurs to me that I have spent so much time over the course of the pandemic disoriented — in my thoughts, my worries, my contemplations, my ruminations. For a moment, it seems as if I’ve forced these all away.

When I play the recording for their loved ones, I witness how these little parts of my patient remain alive with them. How in speaking to those they've left, they wrap themselves around them. Stabilize them. Grieve with them. This precious bit of preservation comes to a head with a question I must ask. And one that nearly breaks me.

So when I read that my patient refused to be intubated and instead requested a glass of Scotch, I was surprised. It allowed for a deeper realization to set in. And it cut so deeply through the hardened shell I had surrounded myself with that it split open the seed of my buried, neglected humanity.

Is that the effect of a pandemic? Maybe you had done these sorts of things all along, and I’d taken little notice of them. We live now in a different world: one where each act of kindness is made kinder when it is a hand that comes to offer it.

I try to describe the feeling. The one, when my tinnitus reaches a crescendo, as if the walls of my skull have lost what gives them structure, are caving in, while my brain throws sparks and short-circuits.

Still, on certain sleepless nights, I found myself thinking long and hard about my doctor’s offer. The image of the prescription pad and his pen in hand glowed large in the theatre of my tired mind.