Inviting Back the Killers of Yesteryear

Texas has been in the news as the origin of the most recent rubeola measles outbreak, continuing to spread with over 124 cases recorded and one child’s death.  This morning, travelers are informed they were exposed to measles earlier this month at LAX after an international flight brought an infected person to the U.S. Later today, there was a Seattle area case announced.

The potential exponential climb of more rubeola cases is anticipated over the next weeks due to the growing percentage of unvaccinated children due to the “anti-vaccine” movement.

Mr. Kennedy, our new HHS secretary, has a great deal to do with that change in vaccination rates, but I’m not writing about the politics of his views which are popular among a strident minority of citizens.

He does not speak or act in concert with the world’s public health scientists and experts. They have worked tirelessly for decades to develop safe life-saving preventive medical care that has significantly dropped infant and child mortality rates, as well as all-age hospitalizations and deaths from infectious diseases.

It started with the small pox vaccine, routine in the U.S. 175 years ago. It’s now been almost seventy years since effective vaccinations became standard for childhood killers like polio, measles, mumps and whooping cough. People my age and older had no choice but to suffer through childhood infectious diseases, given how quickly they spread through a non-immune community. 

Yes, most of us survived, harboring life-long natural immunity. A significant number did not survive or have suffered life-long complications from the effects of those diseases.

People living in privileged first world countries have forgotten the harsh reality of morbidity and mortality statistics, and too many turn their backs on vaccinations, considering them “too risky” for themselves and their children as these diseases become less common in a mostly vaccinated society. In contrast, millions of people without easy and affordable access to vaccines in third world countries have not forgotten the devastation of these infections. They gladly walk miles to get their children vaccinated to give them a better chance at a long life.

As most measles cases in the U.S. originate from overseas travel, it’s especially critical that Americans be vaccinated when traveling outside the U.S., even to Europe. Those who serve in third world countries and mission fields are particularly vulnerable, and I’ve found it interesting that previously unvaccinated Christians are usually more than willing to accept immunizations when they know the risk of exposure is high where medical care may be minimal.

As a society, we simply don’t think about immunizations in the same way as we did in the 1940s and 50s. When I received my first DPT vaccination at the age of 4 months, my mother wrote in my baby book: “Up most of the night with fever 104.5 degrees,  considered a good ‘take’ for the vaccine.”  She truly was relieved that it had made me so sick, as it meant that I would be safe if exposed to those common killer diseases. Now a febrile reaction like that might be considered grounds for a law suit. Our vaccines have vastly improved with ongoing research to improve their effectiveness and reduce their side effects.

When measles or mumps or pertussis outbreaks reemerge within our borders,  we act surprised when it becomes a major media event — but we shouldn’t be. Diseases that were nearly nonexistent a few years ago are occurring with greater frequency again in modern societies due to misguided and misinformed anti-vaccination campaigns.

As a college health physician, I helped enforce vaccination requirements for a public university. A week didn’t go by without my having a discussion with a prospective student (or more likely the student’s parent) about the necessity for our requirement for proof of mumps, measles, rubella vaccination immunity. 

I am accused of being a pawn (or, absurdly, a financial beneficiary??) of the pharmaceutical industry because I believe in undeniable evidence of the efficacy of modern vaccines to help keep a community free of infectious disease outbreaks that can kill healthy people. 

I helped coordinate a public health response at our university in 1995 when we had a rubeola outbreak of eleven confirmed cases over a three week period, necessitating the mass vaccinations of over 8000 students and staff over three days so our institution could safely remain open.  

Having experienced first hand what the effort and resources it takes to respond to a potentially lethal contagious disease outbreak, I am so discouraged it is now happening again and again, due to a “MAHA – Make America Healthy Again” misinformation campaign swallowed whole without questions by thousands of concerned parents.

These families are banking that everyone else will be vaccinated, which puts their own child at lower risk. The problem is: guess again.  There are too many deciding that they are the ones who can remain vaccine-free.

I don’t think any one of these parents would deny the life-saving miracle of injectable insulin for their child diagnosed with diabetes, nor would they fail to strap their child into a car seat for the rare but real possibility of a life-threatening collision on even the shortest car ride.

Vaccines are miracles and instruments of prevention too, but the rub is that we have to give them to healthy youngsters in order to keep them healthy.

I’m an old enough physician to have seen deaths from these diseases as well as the ravages of post-polio paralysis and post-polio syndrome, the sterility from mumps, and deafness from congenital rubella. My father nearly died from the mumps that I brought home from school when I was eight and he was in his early forties. My sister-in-law almost didn’t pull through when she was an infant and contracted pertussis. I’ve seen healthy people develop encephalitis and pneumonia from chicken pox. 

I’ve seen an otherwise healthy college student die of influenza within a week of getting ill despite everything modern medicine could offer him.

If only there were a shot for irrational fears and conspiratorial distrust.  When I’ve written about my stance on vaccinations over the years, I’m astonished at the vehemence of the angry responses coming from individuals who have no trust whatsoever in the advances of modern medicine to prevent the killers that have devastated mankind for centuries, but will spend resources on unproven prevention strategies.

Sure, I wish vaccines were perfect with no side effects and conferring 100% immunity — but as yet they aren’t.

I wish medications that are developed for treatment of a few of these illnesses were perfect but we can’t depend on a 100% guarantee of cure once sickened.

I wish our immune systems were perfectly able to respond to infectious diseases, but they too fail and people do die.

There will always be a new plague on the horizon – history has demonstrated that over and over with the appearance of COVID, HIV, SARS, Ebola or multidrug resistant tuberculosis, and now new strains of Avian flu are in our farmyards. There will be plenty to keep our immune systems at the ready because we don’t yet or may never have effective vaccines widely available for all diseases.

But there is simply no good reason to invite the old plagues back into our homes, our schools,  our blood streams, and onto our death certificates. They deserve to be merely a chapter in the history books as the killers of yesteryear, now wholly overcome by modern medicine.

It takes a united front against these killers to prevent them from leaping from the pages of history to once again wreak devastation upon us all.

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Learning the Hard Way

There are three kinds of men.
The ones that learn by reading.
The few who learn by observation. 
The rest of them have to pee on the electric fence for themselves.
~Will Rogers

We living creatures learn from the moment we take our first breath. We continue to learn until our last breath. With that lifetime of learning, one would think eventually we should find some semblance of wisdom.

But we don’t. We tend to learn the hard way especially when it comes to matters having to do with our (or others’) health and well-being.

Within a community, we want autonomy to do as we like, no matter what the science says. You’d think we’d know better, but as fallible human beings, we may impulsively make decisions about health issues. Is it evidence-based or simply an anecdotal story about what “worked” or “didn’t work” for someone else?

We’re facing at least four years of a new administration encouraging us all to “pee on the electric fence” and learn for ourselves rather than trust science. Careful research, years of observed experience, and plain common sense isn’t enough to trust public health and infectious disease experts to make wise recommendations about community and individual risk and prevention strategies.

The cows and horses on our farm need to touch an electric fence only once when reaching for greener grass on the other side. That moment provides a potent learning curve for them to make important future decisions. They won’t try testing it again no matter how alluring thngs appear on the other side. Humans should learn as quickly as animals but unfortunately don’t.

I know all too well what a shock feels like and I want to avoid repeating that experience.  Even so, in unguarded careless moments of feeling invulnerable (it can’t happen to me!) or annoyed at being told what I can and can’t do, or simply indulging in magical thinking, I find myself reaching for the greener grass. 

I suspect I’m not alone in my surprise when I’m jolted back to reality.

Many great minds have worked out various theories of effective learning, but, great mind or not, Will Rogers confirms a common sense suspicion: an adverse experience, like a “bolt out of the blue,” can be a powerful teacher. 

So we call peeing on an electric fence it “a teachable moment.”

Sadly, when we learn the hard way, it often ends up hurting everyone.

AI image created for this post

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Reflecting Back…

The Pacific Medical Center (2012) Photo by Joe Mabel
http://www.pactower.org

Some years ago, while sitting with my husband and young family high in the upper reaches of Seattle’s (then) Safeco Field watching the Mariners lose to the Cleveland (then) Indians, my attention diverted from the baseball game to the expansive view of the surrounding city.

In particular, I couldn’t help but place myself back inside the old Art Deco building that sits up on Beacon Hill (now known as the Pac Tower.) I had spent a hundreds of hours of my life in that building in the late 1970s; it was easy imagine my younger self in those hallways and rooms.

The 90 year old building had a number of different purposes since originally being constructed to provide hospital care for the region’s Merchant seamen. By 1999, it had become the home of a five year old business that had outgrown Jeff Bezos’ garage — Amazon.com. 

I trained inside the walls of that Public Health Hospital, back in the days when it was the hospital in the region for not only Merchant Marines, but many of the indigenous people of the Pacific northwest and Alaska, in addition to local folks who needed affordable (as in free) health care. I had opportunity to work several clinical rotations in this building as a University of Washington medical student, and to think of it being Amazon’s first (but not last) major headquarters for Amazon made my brain do twists. 

I remembered so much life and death happening inside those walls over the years. 

I first walked into this building as a very green 24 year old med student beginning a surgical rotation in fall 1976, knowing only which end of the stethoscope to put in my ears and which end rests on the patient. On the first day I was shown how to put on a surgical gown, masks and sterile gloves without contaminating myself and the people around me. I never have forgotten that sequence of moves, even though my opportunity to go into an operating room (other than as a patient) became rare after my training days. My chief surgical resident was an exceptionally talented young man who worked himself and everyone working with him around the clock caring for his patients. This brilliant surgeon could only operate on patients while listening and singing to the music of Elvis Presley. I can’t hear any Elvis Presley songs to this day without smelling the odors of surgery–cauterized blood vessels and pus. 

He was soon to become a leading trauma surgeon in a city known for its fine surgeons. The pressure was too much for him. He experienced a personal crisis for which he sought treatment. When he returned to medicine, he abandoned his incredible surgical skills to train as a psychiatrist and still remains an authority on helping impaired physicians, assisting other care providers to acknowledge and deal with addiction and mental health burnout before they harm a patient. 

Those endless clinical rotation days and nights meant witnessing the misery of the most vulnerable of humanity in desperate need of healing, and sometimes we succeeded, but often we did not.  I still have a recurring dream of running up and down the staircases of the Public Health Hospital, bringing pint after pint of blood to the OR from the lab as our team operated on an Alaskan indigenous patient bleeding from dilated esophageal varices, developed as a result of a damaged liver from chronic alcohol dependency. We did not save her, nor have I saved her even once in my dreams over the decades, though I keep trying to run faster. My response to her death was to spend 20 years of my clinical career working with patients in an alcohol and drug treatment program, hoping to prevent her fate in others.

Nor did we save a classmate of mine, on a rotation on a different service, the daughter of a beloved radiologist in this very hospital, who for reasons unknown, had a cardiac arrest while napping briefly during her 32 hour shift.  Another medical student sleeping in the same room heard her odd breathing, found her unresponsive and all medical interventions were employed, to no avail. Even when all the right people, and the right equipment, and the right medicine is seconds away, death can still come, even to healthy people in their 20s.  This was a shock to us all, and an extraordinarily humbling lesson to the pompous and overconfident among us. We might die, in our sleep, whenever it is our time. Years later, I still remember that in my evening prayers.

There was also the young surgical resident who was hospitalized there with jaundice and subsequently died of Hepatitis B, contracted from a blood exposure during his training. No vaccination was available in those days, but was in development. And it was in this and other hospitals in the city, we began to see unusual cases of gay men with severe wasting, rare skin cancers and difficult to treat pneumonias. Initially called GRID (gay-related immune deficiency), it was renamed AIDS as it began appearing in the general population as well, and for too long was a death sentence for anyone infected.

One on-call night in particular is memorable. It was Christmas Eve, and a heavy snowstorm had brought the city to a standstill.  We had very little to do that night in the hospital as the elective surgeries were all postponed until after the holiday and no ambulance could easily make it up the steep drive to the ER, so they were being diverted to other hospitals. As a result, our patient load was light. I was in my tiny sleeping room, on the 14th floor of the tower, facing out north to the city of Seattle, able to enjoy the view of the city, everything blanketed under snow, so peaceful and very quiet.  The freeway, ordinarily so busy day and night, was practically abandoned, and the lights of the city were brighter from the snowfall. It was an enchanting vision of a city forced to slow itself and be still, so anticipatory on a sacred and holy night.

I remember thinking about how young and inexperienced I was, and how very little I knew. My chief resident thought I’d make a good surgeon – I was a diligent worker and technically very good with my hands. My heart told me that I’d be better as a generalist/family doctor. The city held many attractions and excitement, but I longed to return to a farm and a someday family. It was a wistful bittersweet night and I slept very little, perched on that little bed overlooking the sleeping snowy city. I wondered where life might take me, as I reflected on who I was becoming and where I was meant to be.

Forty five years later, I still am reminded every day at how little I know,  but I do realize this:
for however long we’re on this earth, each day we have a distinct purpose and reason for being.

That day, my purpose was to be snowbound on that Christmas day at the old Public Health Hospital, unable to go home from my shift because my car was stuck in the parking lot. Instead, I covered for others who couldn’t make it in to work, singing Christmas carols for all the patients who had to stay put in their hospital beds.

Soon, my purpose was to meet the man I was to marry, eventually living with three beloved children on a little farm 100 miles to the north while practicing medicine in a variety of primary care roles for over forty years. 

And perhaps, my purpose now in retirement is to share a few stories while reflecting on a life still in progress.

Only the Lord knows why He places us where He does.

view from the “sleeping room” at the top of the tower
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Absorbing the Shock

There are three kinds of men.
The ones that learn by reading.
The few who learn by observation. 
The rest of them have to pee on the electric fence for themselves.
~Will Rogers

Learning is a universal human experience from the moment we take our first breath.  It is never finished until the last breath is given up.  With a lifetime of learning, one would think eventually we should get it right.

But we don’t.  We tend to learn the hard way especially when it comes to matters having to do with our (or others’) health.

As physicians in training, we “see one, do one, teach one.”   That kind of approach doesn’t always go so well for the patient.   As patients, we like to eat, drink, and live how we wish, demanding what interventions we want only when we want them – this also doesn’t go so well for the patient.  You’d think we’d know better, but as fallible human beings, we may impulsively make decisions about our health without actually using our heads (is it evidence-based or simply an anecdotal story about what “worked” for someone else?).

The cows and horses on our farm need to touch an electric fence only once when reaching for greener grass on the other side.  That moment provides a sufficient learning curve for them to make an important decision.  They won’t try testing it again no matter how alluring the world appears on the other side.   Humans are smarter sentient beings who should learn as quickly as animals but unfortunately don’t.  I know all too well what a shock feels like and I want to avoid repeating that experience.  Even so, in unguarded careless moments of feeling invulnerable (it can’t happen to me!), and yearning to have what I don’t necessarily need,  I may find myself reaching for the greener grass (or another cookie) even though I know better.   I suspect I’m not alone in my surprise when I’m jolted back to reality when I continually indulge myself and climb on the scale to see the results.

Many great minds have worked out various theories of effective learning, but, great mind or not, Will Rogers confirms a common sense suspicion: an adverse experience, like a “bolt out of the blue,” can be a powerful teacher.  As clinicians, we call it “a teachable moment.”  None of us want to experience a teachable moment — none of us, and we resent it when someone points it out to us.

When physicians and patients learn the hard way, we need to come along aside one another rather than work at cross-purposes.

It just might help absorb the shock.

Because You Matter to Me…

If I can stop one heart from breaking,
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.
~Emily Dickinson

So if there is any encouragement in Christ,
any comfort from love,

any participation in the Spirit,
any affection and sympathy,
complete my joy by being of the same mind,
having the same love,
being in full accord and of one mind.
…. in humility count others more significant than yourselves.
Let each of you look not only to his own interests,
but also to the interests of others.
~Philippians 2: 1-4

Walk in a manner worthy of the calling
to which you have been called,
with all humility and gentleness,
with patience,
bearing with one another in love,
eager to maintain the unity of the Spirit in the bond of peace.
Ephesians 4: 1-3

By wearing a mask…

If I can stop one person from infection,
I shall not live in vain;
If I can ease another’s worry,
Though masking goes against the grain,
Or help a divided country be
Restored to health again,
I shall not live in vain.

I wear a mask because you matter to me…