One Dead Child. Two Foolish Parents.

I first shared this post 6 years ago in the midst of the Disneyland measles outbreak. 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

 

 

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Falling from Grace

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He was one of my heroes. He was a gifted writer and speaker; I purchased his books and listened to his sermons. He was gentle in his demeanor and delivery, but powerful in his arguments. His defenses of the Christian faith were eloquent, articulate, and persuasive. I wished I could be like him, that I could make a lasting impact with my life and words.

I was not alone in my admiration. He was incredibly respected in the Christian community, a much sought after speaker and teacher. He traveled around the world, lecturing and debating at the most prestigious universities. He consistently held his own against the most brilliant secular minds and as a result inspired many to follow Christ.   When he died earlier this year I felt like the Christian faith had lost a great mind and a great warrior, one who would be very difficult to replace.

Then the accusations came.

They seemed ludicrous at first, descriptions of grossly immoral behavior that seemed out of character and clearly beneath the man. I was surprised to learn that he was a part owner in a health spa that offered massage services and shocked to read of the multiple female employees who accused him of sexually abusive behavior. Some of them went on the record,  claiming that he had repeatedly revealed himself to them during massage sessions, had touched them inappropriately and gone so far as to regularly masturbate in their presence. According to the women, the reason he gave for his egregious behavior was that he “needed to release stress.”

I read the words of the women with a mixture of shock, disgust and anger. I wanted to dismiss the accusations, to write them off as false and malicious, but I couldn’t. The women were not seeking any damages and their stories corroborated one another. They seemed true. Sadly, they were. The organization he founded hired a private investigative firm to research the claims and this week they released the preliminary findings of the investigation- all of the initial accusations were confirmed as true, and many more episodes of abuse were uncovered. He was a fraud.

In the wake of his death his family must now grieve more than his passing. His daughter, the chairman of the board of the ministry organization that bears his name, is left to mourn not just the loss of her father but also the loss of his reputation. Instead of celebrating his life she must now give answers to donors and supporters about his behavior. I cannot begin to imagine the pain his widow must feel as she deals with the reality that he frequently sought sexual pleasure outside of their marriage

How could this happen? How could he betray his message, his ministry and his marriage in such a way?

As I reflect on his story, one thought repeatedly comes to my mind. He was not content with the life and the blessings that God had given him. Consumed with pride, he thought he deserved more.

He was not content with his $500,000 a year salary. He was not content with the love of his wife and children. He was not content with the admiration and praise he got for his ministry. He thought he was special, that he deserved more.

His was not a sin that blossomed overnight. He did not wake up one morning and say, "today is the day I am going to reveal myself to the massage therapist." His symptoms began in his mind, with the thoughts that he needed and deserved more. Even in his 70s, he felt he needed and deserved the touch of younger women, to touch younger women, to be sexually desired by women other than his wife.

More tragically, he quit believing that God was enough. The hope for eternal life, the belief that wonderful blessing awaits those who are faithful, had somehow dimmed in his mind. He turned away from that eternal focus and instead focused on momentary pleasure. This desire so consumed him that he irrationally convinced himself that it was acceptable and appropriate to pleasure himself in the presence of women who were his employees, women who feared for their jobs, and that they would not be believed if they spoke up.

It is easy to shake our heads at such a story, to say that we would never do such a thing. I am not so sure. I have seen too many similar stories in my lifetime, stories of men, Christian leaders, who used their positions of authority to feed their desires. I have seen pastors consumed and addicted to admiration, who have sought praise and attention from women other than their wife. I have cared for pastors who felt there gifts entitled them to material wealth. I have seen other Christian leaders verbally abuse and demean those are served under them.

The Bible is filled with details of leaders who abused their power. The most famous examples are king David, whose lust so consumed him that he murdered a faithful friend so he could bed his wife, and David’s son Solomon who had 700 wives and 300 concubines. As king Solomon built the first temple in Jerusalem and was blessed beyond measure. Sadly, he eventually abandoned his faith to worship the false Gods of his pagan wives.

These stories are a warning to us all. We need to remember who we are and what God has given us. We need to remember that we are wretched sinners, saved by Grace and entitled to nothing. We need to continually remind ourselves that our spouses are gifts to be treasured, honored, and adored. We need to focus on the truth that nothing this life has to offer compares to the blessings that await us in heaven. We need to be content and happy with the lives that God has given us.

Perhaps most importantly, churches need to cast away the culture of celebrity that has invaded our congregations. We need to quit looking for charisma and start emphasizing character. We need to hold our leaders accountable, and set up structures where accountability can happen. If we don’t, we should not be surprised when we see our leaders fail.

 Bart 

PS: I wrote this post 7 months ago. I decided to share it after listening to the story about the disgrace of another man of faith. Christianity Today has a podcast about the fall of another Christian leader, “The rise and fall of Mars Hill”. It is a sobering cautionary tale of what can happen when churches elevate talent over character. It should be required listening for all church leaders.

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Am I a Racist?

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I have been accused of racism or racist acts three times. Each accusation hurt, and I remember each interaction vividly.

The first time was in my final year of my Family Medicine residency. A few days before, at a meeting of all the doctors in training, we had been encouraged to have patients get their care from a single doctor. Continuity of care is the backbone of family medicine, and the program director wanted us to get that experience. Staff were instructed to schedule patients accordingly.

With that fresh in my mind one morning, I walked into the room of a patient I had never seen before. Looking at his chart before I entered the room, I saw that he had been assigned to one of my colleagues, Dr. Nahin. I made a mental note to address this during the visit and walked in to greet the patient.

The patient, a young man in his twenties who happened to be black, was slouched in a chair waiting for me. I greeted him, sat down, and asked him why he was there. He told me he needed some forms filled out for the state. As I looked over the paperwork, I asked him, “Is there a reason you are seeing me instead of Dr. Nahin?”

“Why you ask?” He replied.

“We are trying to encourage patients to see the same doctor every time they come to the clinic, and I was wondering how you ended up seeing me today,” I replied.

A sneer came across his face as he answered me, “Oh. I get it. It’s a Rodney King thing.”

“Excuse me?” I was incredulous. Race had not for a moment entered my mind.

“It’s because I’m black.” Stunned, my mind raced, searching for the appropriate response. I was angry and offended. It was an insult like no other I had experienced. I did not know what to say, but I did know what I wanted to do. I had to get out of that room before I lost my cool. I asked him if he had any emergent needs, anything that had to be taken care of that day. When he said “No”, I told him to leave the office.

“Nobody calls me a racist!” I replied with a shaky voice as I opened the door and walked out, leaving him stunned in his chair. (Looking back, I don’t think my response was the best one, but it was the best I could come up with at the time. I felt that he needed to know that he shouldn’t casually accuse people of something so terrible.)

The second accusation came 5 years later. I had just joined two other doctors in a private practice in Huntington Beach. They were great guys and excellent doctors, but terrible businessmen. It took only a few months for them to ask me to take over the management of the practice. I immediately learned that we had problems with our office manager. The two doctors had almost $200,000 in uncollected payments!

I began to investigate and soon found the problem. The office manager did not know what she was doing. She was nice, and sweet, and wonderful with people, but she was terrible at her job. Patients were not being charged at the time of service, nor were they asked about past due balances when they came in for follow up. If she did not know how to bill for a service, she simply didn’t. I found dozens of bills in her desk that had never been submitted to insurance.

It was clear she had to go, but there were obstacles. She was black, she was pregnant, and she had been given excellent reviews in the past. I was afraid to fire her, fearful that if I did I would be accused of racial bias. I couldn’t fire her, but I had to get her out of the manager position. I was told that she was an excellent employee before being promoted to manager, so I devised a plan.

While she was out on maternity leave, I hired a new office manager to replace her. When she returned to work, I told her that as the practice was growing, we wanted someone with more experience running the office. We moved her to the front desk, telling her that out of respect we would keep her at the same pay. As I genuinely liked her, I hoped the problem had been solved.

She did not take it well. In a passive-aggressive way, she made her dissatisfaction known by deliberately moving as slowly as possible. Phone calls that took other employees 30 seconds somehow took her 5 minutes. Other employees picked up calls on the first ring, she would wait until someone else took the call and then say, “Oh, I was going to get that!”

I talked to her repeatedly and was repeatedly met with excuses. She told me that I did not know what I was talking about. I was forced to write her up again and again. Only the fear of retribution kept her from being fired. Finally, I moved her again, this time into the back office. I told her, “Dr. Besley says you were a wonderful nurse, so we thought we would move you back here.” Again, we did so without cutting her pay.

She quit a few days later. Not long after that I received notice from the Department of Fair Housing and Employment that she had filed a discrimination complaint against me. I could not believe it. If there had been any bias, it had been in her favor! If she had been white, I would have let her go weeks earlier. It was because I did not want to be thought a racist that I had worked so hard to keep her on.

Fortunately for us, the person from the Department saw things our way. After reviewing her file, she asked me, “Why didn’t you just fire her!”

“Because I did not want to end up talking to you!” was my reply.

A few years after that we had two medical assistants working in our office through a temp agency. We had one employee out on leave as well as one permanent opening in the office. Both temp nurses seemed excellent, and as the time approached for the person on leave to return the office manager and I realized we had a decision to make. While both of the temps were worthy of a full-time job, we could only choose one. One of them happened to be black and the other was white.

One day at lunch I sat in the manager’s office so we could review their performance. Neither of us could point to anything that separated the two. “So, let’s offer the job to the one who has been here longer!” I declared. The difference was only a few days, but it was all we could come up with. The black nurse had started working us first, so I decided to offer her the job when she returned from lunch.

She didn’t come back. When we called and asked her where she was, she told the office person, “I don’t want to work for such a racist office!” Needless to say, I was puzzled!

Over the last several months, multiple stories of alleged racism have proliferated. It seems that any interaction between a person of color and someone white is stained with accusations of bias. In addition, we are now told that we live in a racist nation, that our entire justice system discriminates against minorities.

While I do not doubt for a moment that there are racists in this country, both in government and in private institutions, I struggle with these widespread allegations. I struggle because racism is an attitude of the heart, and I cannot know the hearts of others.

I understand for example, that each person who accused me of being a racist truly believed I was one. Previous experiences had put them on guard. Having experienced racism, or having heard stories of racism, they knew that I was acting in a racist way.

Except I wasn’t. I may have been awkward, or mean, or just a jerk. I may have acted rudely, or insensitively, or smugly. I do not know how my actions came across, but I do know that my heart was in the right place. In none of the interactions did the color of a person’s skin have a negative impact on my responses.

The problem is that I was never given a chance to share my heart. I was either not asked for my reasons, or had my reasons dismissed out of hand. The others did not care to know what was in my heart. They lumped me in with others they knew or had heard about, and in that context passed judgments on me.

It does not have to be this way. A few months ago, one of my black patients showed my how he avoided living in a racist world. A very dark-skinned man from West Africa, he has lived in Huntington Beach for a few years. At the time of his visit, a story of possible racism was everywhere in the news, so I decided to broach the subject with him.

I asked his permission to ask him a personal question, in so doing giving him permission to not answer me, and asked, “Huntington Beach is one of the whitest towns there is. Do you ever feel you are a victim of racism?”

“Never,” he replied, “Everybody is nice.”

“Really?”, I replied, “You don’t feel, for example, that you have been pulled over for the color of your skin?”

“Oh, I been pulled over a few times, but I just figure they are doing their jobs. I just do what they say, and I never have a problem.”

His approach surprised me. In my mind, the odds favored  that on at least one of the occasions he had been pulled over, some form of racial profiling must have occured. From what I had heard in the news, how could it not have been?

But he didn’t see it that way. He didn’t see it that way because he chose not to. He chose to believe the best in others, and to never assign bad motives to anyone. If he does not know what’s in someone’s heart, he refuses to judge them or condemn them.

What a lesson for all of us. He is living out a verse from the book of James that has always been a challenge to me. “Everyone should be quick to listen, slow to speak and slow to be angry, because human anger does not produce the righteousness that God desires.”

May we all be people who listen, people who are slow to anger. May we assume the best in others whenever possible.

May we also assume the best in our nation and in its laws, in our leaders and in our police. If we don’t, we may end up living in a very angry world.

Bart

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