The Max MacKay Rule: Decision-Making in the Time of COVID-19

These last days have come at us hard and fast. As we continue to respond and adapt, all of us at Opal School hope that we can continue to serve as a resource to your efforts to grow and thrive.

Yesterday, I received this from our friend Ben Mardell. While it’s not the kind of post you typically find on this website, it felt important to publish. Our community needs to be one not solely defined by how we work with children, but by how we strive to live in the world.

from Ben:

An obvious disclaimer: I have no special expertise to bring to bear on understanding the current global pandemic. I am neither an M.D., a public health professional, nor a biologist. And like my fellow non-experts, I am making daily decisions that, on an individual level seem insignificant, but on an aggregate level are extraordinarily consequential. While there is no clear guidance for making these decisions, I have adopted the Max MacKay rule to guide my behavior.

Here is the rule: make all my decisions–be that to hold an important meeting online or in person, or have dinner with friends—as if the life of someone who is dear to me depends on it. Prioritize minimizing contact, “flattening the curve,” and avoid contributing to the inadvertent spread of disease. Keep Max MacKay—who here represents millions and millions of at-risk people—in mind.

Max MacKay is the 19-year-old son of Susan MacKay. I actually have never met Max, but know his mother Susan, the Pedagogical Director of Portland Children’s Museum and Opal School in Portland, Oregon, who is one of the most gifted educators I know. Last summer, just before Max was supposed to start university, he was diagnosed with cancer. Treatment put him in remission and he was able to start his studies and even resume playing lacrosse. Then, in November, it was discovered the cancer had reappeared and spread. He is in the middle of an aggressive treatment regime.

On Saturday, Susan sent out the following message about Max:

Max should have started high-dose chemo yesterday and had his first stem cell transplant next Tuesday. But on Wednesday afternoon we learned that, because of Covid-19, it is too dangerous to proceed. We had to grind the recovery train we had been riding for weeks to a halt. The good good good absolutely wonderful news is that the CT scan he had this week showed that the treatment he’s had so far is working. His lungs are clear of perceptible cancer and the tumor in his belly has shrunk to about the size it was when we started in May. That buys us a little time. But given how aggressively this cancer grows it isn’t much time. A couple of weeks.

Plan B is to head to Los Angeles to have the RPLND surgery done at USC. The doctor said, “yes” on Wednesday to our doctor here — and that’s all we know. So when we read things like there are soon to be 75,000 cases of Covid-19 in Oregon, or that the doctors in Seattle only have 4 days’ worth of gloves left, or that within 10 days our hospital systems will be overwhelmed, and we don’t get a call back from LA for two days, I wonder whether the treatment will move forward. I wonder whether people think we have plenty of time, or that they know we don’t have any at all.

And then what?

I don’t think anyone knows. But the cancer doesn’t care. 

The Max MacKay rule is a planning tool, not an evaluative one. Some of us have spacious, second homes we can retreat to while waiting out the current situation; some of us live in cramped one-bedroom apartments. Some of us are empty nesters; some of us have young children at home. Some of us have great health insurance and guaranteed income; some of us don’t have access to clean water in order to wash hands. And of course, some have essential jobs. And all of us need to make decisions and change our behavior.

I am keeping Max in mind when I make my decisions.

I’m lucky because I have a good friend who does have expertise, which he shares generously. Dan Kass worked for the New York City Health Department and now is part of the leadership team at Vital Strategies, a global public health NGO. In explaining the current situation to me he said, “We just don’t know enough about the course this disease will take. We all have to take this very seriously, for our own health and for the health of others.” For me, this means adopting the Max MacKay rule.