The Child is Still Dead

I first posted this in January 2015, with the title “One Dead Child, Two Foolish Parents.” It went viral and was seen by over 5,000,000 people. Sadly, it remains relevant...

“A one year-old just died. Paramedics were called but he was gone by the time they got there,” the resident spoke softly, obviously affected by the news. “What happened?” I asked. She told me that the child had been seen in the ER two days earlier, was diagnosed with measles and sent home. My heart sank. I had sent home a one year-old child with measles two days earlier. Was this the same child? It was. He had looked so good two days earlier, responsive, alert and in no distress. The careful follow up instructions that were given were not followed and the child developed complications and arrested. I will never forget how I felt when he died.

He died, needlessly, because his mother and aunt did not believe in immunizations. He was one of 7 cases of measles in the family, 4 of whom were hospitalized. I was so angry at his parents and his aunt. I held them responsible for the child’s death. Their decision to believe false information from vaccine fear-mongers over the advice of their doctor was to blame for his death. Arrogance and ignorance ended his life.

The year was 1990, the peak of the last epidemic of measles in the United States. It was a year of frustration for doctors as we were forced to deal with a disease that was close to disappearing just a few years earlier. Prior to the development of the measles vaccine, measles was an incredibly contagious scourge. The numbers from the late 1950’s are staggering. It is estimated that there were nearly 4 million cases a year, only a fraction of which were reported to health officials. The yearly averages were frightening, 150,000 pneumonia like complications, 48,000 hospitalizations, 4000 devastating brain infections and 450 deaths. Measles was a disease as unavoidable as it was harmful. Over 90% of the population was believed to be exposed in their lifetimes.

In 1988 the story was different. Cases were rare with the majority of cases occurring in non-immunized immigrants. Measles cases were estimated to be fewer than 10,000 a year. There was talk that we might accomplish with measles what had been miraculously accomplished with smallpox, complete eradication of the disease. Then something happened. From 1989-1991 measles made a comeback. The boy I saw die was one of 55,000 cases and 123 deaths during that time.

What happened was that some parents decided not to immunize their children. As it is extremely contagious, measles does not need much of an opportunity to regain a foothold. That opportunity was provided by a false belief in some parents that immunization was unnecessary or even harmful. Parents who were too young to have experienced the disease became more fearful of the vaccine than the disease and their unvaccinated children became innocent victims.

In response to the epidemic in 1989-1991 the medical community mounted a counteroffensive. Doctors aggressively educated their patients about the safety of vaccines and the dangers of the disease. Measles faded from the scene, returning to its status as a rare disease seen mostly in textbooks and rarely in medical practices. Measles remained rare and hidden for 20 years, with only about 60 children becoming infected annually in the United States.

It’s back.

This generation has seen a large cohort of parents, skeptical of the medical profession and supremely confident in their own knowledge and judgment, repeat the mistakes of the past and refuse to immunize their children. Immunization rates are dropping.  The incidence of the disease increased 1000% from 2013 to 2014.

The recent outbreak traced to Disneyland illustrates the seriousness of the disease. At least 12 cases were traced back to visits to the theme park in mid December. 11 of the cases were in non-immunized individuals. Two of the children were too young to be immunized, the rest were unprotected due to a foolish parental decision. It is deeply troubling to consider how babies were put at risk by another person’s decision.

It is this Disneyland story that took me back the 25 years to the day I saw that child die. The feelings of anger and helplessness came rushing back. These feelings are intensified when I think of the increasing number of parents who are refusing to vaccinate their children. As someone who took an oath to help people I cannot comprehend the arrogance and foolishness that leads to these decisions.

As a doctor I have spent hours upon hours trying to convince such parents of the importance of protecting their children. The years have proven that such efforts by me are futile. As these are emotional and irrational decisions, rational arguments have no effect. I have reached a place where I don’t argue anymore. I tell parents that vaccines have been proven safe and that if they refuse to vaccinate their children that I will not provide care for their family. I will not stand by while they risk the health of their child and I do not want my other patients placed at risk. There is no negotiation. Their position need not be heard, tolerated or respected.

It is time that society take a similarly firm stance. There is no duty to respect a foolish position.

-Bart

If you found this post valuable, please consider sharing it with others. Readers typically learn of the blog from their friends. The follow up to this post, "Autism, Measles, Vaccines and Truth. Protecting the Lives of Innocent Children" addresses the reasons parents refuse to immunize their children.  I blog on multiple topics including faith, family and culture with new posts every few days. You can search the archives for a listing of posts. Follow Doctor Barrett on Twitter @bartbarrettmd for blog updates. You can subscribe to the blog to have future posts delivered to your inbox. Dr. Barrett's book, Life Medicine, is available at Amazon.com.

Update- The Disneyland Data is evolving. The post reflects the data that was available at the time of writing. The post has been edited to clarify the reasons for parents not immunizing children in the late 1980s.

References-

http://jid.oxfordjournals.org/content/189/Supplement_1/S1.long

http://www.historyofvaccines.org/content/graph-us-measles-cases

http://www.latimes.com/business/hiltzik/la-fi-mh-antivaccination-update-the-measles-crisis-strikes-disneyland-20150108-column.html

Harsh Words for the Terminator

Her message was harsh. She called me pretentious, finger-pointing, judgmental and a liar, someone not worthy of the position I have in life. Even worse, my character is so terrible that she was able to reach this conclusion in less than three weeks. As mean and untrue as her words were, they were not unexpected. They were sent to me by an employee I had let go the day before.

Her response reminds me of why I hate firing people. I want to be known as a good person, a man of compassion and kindness. When it comes to terminating someone there doesn’t seem to be any good way to do it, merely degrees of bad. Human resource experts have told me to not worry about how the person feels and to say nothing more than “It’s not working out,” but I feel as if people should know why they are losing their job.

While this particular employee hadn’t worked for me very long, it had become clear to me that she was not going to succeed in her position. She tried hard it seemed, but she lacked the skills required for the job. I was ready to let her go a week earlier, but instead decided to give her a very frank performance review. I told her that if she was not able to rapidly and dramatically improve that she would not be able to stay. The warning didn’t help. She didn’t improve at all, leaving me with the difficult conversation. I thought long and hard about what to say when the time came and even prayed about it several times. I ultimately decided to take the Human Resources approach, figuring that the conversation of a week earlier should have been enough. I got to the office early so as not to embarrass her in front of others. I told her that things weren’t working out and then handed her final paycheck to her. It was awkward.

I received the angry text message the next day. I read it several times. I knew I was not the person she described, but I found myself wondering if I had done anything to validate her impression of me. In pains me to admit it but I can see how she arrived at her conclusions. As I reviewed some of the conversations with other employees I had in her presence I could see how a person lacking context, who did not have a history with me, might misconstrue some of the things I said. As a new employee she lacked such context and, choosing to trust her initial impressions, decided I was a bad man.

It was hard for me to judge her for her words. I can think of many times when I have acted in the same way. Too often I have confidently judged others based on first impressions and limited information. I shudder to think of how many people I have hurt in this way. I wish I had been less trusting of my opinions, kinder and more gracious in my interactions with others.

While I will not have the chance to prove to her that I am not the person she believes me to be there is still something I can do in response to her words. I can make sure I do not repeat the same mistake. Just as importantly, I can be more aware of how I am perceived by others who do not know me well. I can do my best to place my words in context, aware of the potential for misunderstanding.

Bart

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Christmas on a Supermarket Floor

It was a day of running errands. Lisa was in Christmas baking mode and my day was spent getting last minute gift cards, fetching lunch, and making runs to the store for more sugar, shortening and a few items for Christmas Eve dinner. It was the during last run to the market that I came across a sight that changed my perspective of the holiday.

I was in a hurry and after grabbing my shopping cart I quickly headed to the back of the store, moving down the leftmost isle and turning right. To my surprise, there in front of me an elderly woman lay flat on her back, surrounded by two women, each of whom were trying to find her pulse. I left my cart and rushed forward. “I am  Family Doctor, what’s going on?”

“She collapsed, I think it was a seizure!” said the younger of the women, her fingers on the woman’s neck over the area of the right carotid artery, “I think I feel a pulse.”

I looked down at the woman. She was clearly unconscious. She was breathing in a labored fashion, gurgling with each breath. “She’s breathing, so she has a pulse,” I replied, “Has 911 been called?” A man nearby siad that he had just seen the paramedics pull up outside the store. As she was breathing and the paramedics were on the scene I realized there was nothing I could do for her as a physician. I stood back as the paramedics took over her care.

As I watched them attend to her the thought went through my mind, “Merry Christmas…” Whatever her plans were for Christmas, they had certainly changed. I wondered about her family, and if she was going to be in the hospital over the holiday. My heart ached for her. I found myself saying a prayer for the woman as they loaded her onto a stretcher and wheeled her away.

I have thought of her often today, for her story reminds me of the fragility of life and the futility of human plans. Regardless of the intensity of our efforts or the thoroughness of our preparations, stuff happens. Everything we desire and hope for can evaporate in a moment. Christmas is not a time of year we like to think about such things but for people like the woman in the market, these thoughts can be thrust upon us.

In such moments the true message of Christmas is profoundly relevant. Christmas is not about gifts, music, cookies, or even getting together with family. Christmas is about the birth of the Christ child, the One who came to die for the sins of the world, the One who came to save us from our sins. It is He who gives us hope, He who promises peace, He who we celebrate.

It is because of the Savior that we can be hopeful in any and all circumstances, the reason we we have hope in the darkest moments. Whether we find ourselves on the floor of a supermarket, or in a bed in a hospital, it is the true story of Christmas that keeps despair at bay.

We have hope and peace, “For unto us was born that day in the city of David a Savior, who is Christ the Lord.”

Merry Christmas

Bart

Getting our Faces Eaten

It is amazing what comes into my mind during Bible study. This week it was a quote from Jonah Goldberg, one of my favorite writers, “Bears want to eat your face.” The quote was from a column he wrote about our culture’s tendency to think wild animals are cute and cuddly, even though when given the opportunity most would eat us.

The verse that triggered this mental wandering was Matthew 10:16 “Behold, I am sending you out as sheep in the midst of wolves, so be wise as serpents and innocent as doves.”

Jesus was talking to the 12 apostles as they were preparing to go out into Israel proclaiming the good news of the kingdom of heaven. He taught them that while the news was good, the response of the Jews might be hostile. They would be like sheep, the world would be like wolves.

Sheep were to be wise, careful and shrewd. They were to be as nice and as polite as possible to wolves, do everything they could to appease them. Regardless of their efforts, when all was said and done, the wolves would still want to eat their faces.

So it is with Christians in the midst of a hostile world. We can be kind, humble, gentle and nice, as accommodating as possible, and people will still hate us.

Jesus told his disciples that in spite of their shrewdness and innocence they would still be charged with crimes, publicly flogged, and called to give account before governors and kings. Families would turn against one another, and they would be widely hated by others. All of this for “his name’s sake.”

This called to mind the recent story of Peter Vlaming, a Christian school teacher in Virginia. A girl student in one of his 2017 classes returned in 2018 claiming to be a boy. Peter wanted to be respectful but did not want to support or encourage something he thought was wrong. His solution was to address the student by her new chosen name but to not use male pronouns. He thought it was a reasonable compromise. As shrewd and as innocent as he was trying to be, it was not good enough. The wolves ate his face.

The student was participating in a class room exercise in which she wore virtual reality goggles, and therefore could not see where she was going. Seeing her about to walk into a wall, the teacher called out to warn the newly “male” student saying, “Stop her before she walks into the wall!” In his haste and concern he moenmtarily forgot to use the patients name and instead used the pronoun that the student had rejected.

All hell broke loose.

The student and her parents were incensed and complained to the school board. The school board voted to fire Peter, rejecting his offer to use the student’s name in place of the a pronoun. Just weeks before Christmas, the father of four was out of a job.

It would be easy for him to wonder what was happening, or where God was. Easy if he had not read Matthew 10. If he had, he would remember that Jesus had told his disciples that things like this would happen. He would see that he had been a lamb amidst wolves, and that he had been called before a court, for his name’s sake. When his story went national, millions of people learned that about a man whose faith in Christ was more important than his job. A man whose faith was real to him.

His story is sobering reality for all who bear the name of Christ. The world does not share our values. Standing up for what we believe may come at great cost. Our faces may get eaten. We will suffer, but we cannot say we haven’t been warned!

Bart

This is my midweek Bible post, shared a little late this week as I was out of town. For those not interested in religious posts, I post on other topics every weekend. If anyone wants to receive my posts in their email, just click the subscribe link on the page

Calling Out a Friend

I received a Christmas gift this week, inexpensive but meaningful. It came from a patient who is becoming a friend, a man who attends my men’s support group on Wednesday mornings. His gift of a T-shirt touched my heart.

In October Lisa and I took a trip to the Smoky Mountains and I have shared many stories of the trip, of the people and the beauty and how much we wanted to return there. His gift of a “Great Smoky Mountains” T-shirt was personal, a gift that made me smile.

What made the gift even more meaningful is the back story behind our friendship. Joe (not his real name) has been a patient of mine for several years. He is an alcoholic, for a while drinking enough for his blood tests to reveal liver damage. For years our visits were characterized by him making empty promises to do better, half-hearted commitments to decrease his intake but never to quit. He almost never followed up as requested and sometimes over a year elapsed between visits.

This changed a little over a year ago. During that visit, when he said, “I know I need to do better,” I interrupted him.

“You know what your problem is?” I said matter-of-factly, “Your problem is that you’re are a filthy, rotten, drunk.”

He looked as if I had slapped him in the face. I explained that I felt comfortable saying this because I was also a filthy, rotten sinner. My struggles were not with alcohol, but being a good man is still a struggle. I went on to explain that the key to a successful life was not the absence of dysfunction, but the willingness to recognize one’s dysfunction and deal with it. I told him he needed to get serious about his alcoholism.

He did. He has been sober for months now. A few months ago he started coming to the Wednesday men’s group. (The purpose of the group is for men to encourage one other to be better men, a perfect environment for him.) He has been a fixture ever since, openly discussing his problems and sharing his life with the other men.

His gift was not only kind, it was the perfect illustration for our conversation that morning. We discussed the proverb, “Faithful are the wounds of a friend”. The truth that there are times in life where we go off course and need some sense knocked into us, times when the truth we need to hear is painful. Faithful friends, true friends, will love us enough to hurt us when this happens.

He shared about how my words about his drinking had hurt him yet had also helped him turn his life around. It was a powerful moment. His story inspired us as the group talked about being the type of men who could both speak such words in love and who could also receive such words when spoken to us.

We went on to review the second half of the proverb, “Profuse are the kisses of an enemy”, about the tendency to surround ourselves with people who only tell us what we want to hear, who only praise us and never correct us, and how this is unhealthy and harmful. (We also talked about how a certain orange tinged politician could benefit from this lesson!)

We live in a world that is afraid to confront, afraid to correct, out of fear we will lose friends or be called judgmental. The words of my friend and the gift he gave are proof that this is not always the case. We have a relationship based on truth and a shared desire to be better men. For me, this is true friendship.

Bart