Monthly Archives: October 2016

Many Cannot Breathe

It was almost 14 years ago. Our three sons had gone to bed and Doug and I were getting ready to go to bed ourselves.

We heard a strange noise coming from the boys’ room. We turned on the light in the hallway and looked into their room – Zachary, our eldest, who was six years old at the time, was sitting up, holding his hands over his chest and upper abdomen, and crying softly and desperately, his face contorted in pain.

“What’s wrong, Zachary? Sweet baby boy, tell us what’s wrong!” we yelled as we turned on the light and ran to him.

It took a minute before he could get any words out. “I can’t breathe, it hurts,” he sobbed.

My mind raced. Is he having a pulmonary embolism (a blood clot in his lungs)? Is it cardiac?

“What hurts, Baby?” I begged as I pulled him to me and put my ear to his chest, hearing air move in and out, hearing no wheezing, and feeling his thorax expand fully between sobs.

“Right here. My heart. My heart hurts,” he said, as he held his hands over the center of his chest.

Doug was ready to call 911. I was ready to let him.

And then I asked my son, “Why? Why does your heart hurt?”

I don’t know why I asked him that. But he answered.

“Because I’m so sad.”

We held off on the 911 call, and now our parental distress went in another direction. What could have happened? Who had hurt our child? What had he seen? What had he heard? What on Earth was going on?

“Sweet baby, please, please tell us. Tell us why you’re so sad. Tell us what’s wrong.”

We sat on his bed and waited for him to be able to speak. It took quite some time.

“We saw a movie at school today,” he started, and dissolved into sobs again.

Again, our minds swirled. What could they have shown a class of first graders?

We held him and waited again for him for him to speak.

“We saw a movie,” he repeated. “It had very bad things. It was so sad and so scary and just really, really bad.”

“Please tell us what you saw, sweet Zachary. What happened in the movie? What made you so sad and scared?”

“It was about a person named Martin. Martin Luther King. And people were so mean. Some kids couldn’t play with other kids. They couldn’t play with their friends. The people couldn’t be with their friends because of their skin color. The people were just being so mean – even parents and teachers and the principal and some kids. And then, and then…..” We waited again for him to regain composure. “And someone shot Martin Luther King. Someone killed him. Why? Why? And Mommy, Daddy,” he continued as he started sobbing again, “there was something else, even worse….”

It took a few more minutes for him to be able to speak again. “The policemen. The policemen. They were hurting people. They’re supposed to help people. They were hurting people. They shot water on them from a hose and they hit them with sticks. Why? Why, Mommy? Why, Daddy? Why weren’t they helping people? Why were they hurting people? I don’t understand. How could that happen?”

And so began our family’s first discussion of racism.

We spoke of people’s fear of differences. We spoke about how fear and ignorance could lead to hatred, meanness, and even to violence. Our son had known that people were capable of doing bad things, that people hurt one another and sometimes even killed people. It was less than a year-and-a-half after 9/11, so this was not his first exposure to evil in our world.

But this was different. He was stuck on the police officers in the movie. He could not grasp how our protectors could harm someone. He could tell that it meant something very different that it wasn’t a few bad people that were hurting others – Doug and I could see that a foundational aspect of his understanding of the world was crumbling. He was seeing that evil could be systemic, that injustice – even violent and deadly injustice – could be in the fabric of a society. This realization shook him to his core.

At the time, we told him that the events in the movie had happened a long time ago. We told him that things had changed. We talked about the ways that our country was better now for everyone. We talked about the good that people did, how lucky we were to have the friends we had, how lucky we were to be living where we were and when we were, and how grateful we were to the people before us who fought for what was right so that everyone could live in a better world. We talked about how great a man Dr. King had been, and how he helped make our society kinder and more just. We talked about what we could do to make sure people are always treated right – that we needed to speak up and stand up for what is right, always to treat others with kindness, even if – especially if – people around us were not treating others kindly.

This is what we could think of at the time. This is how we comforted our child. And as we comforted our child, we comforted ourselves: the world had moved forward.

I went to the school the following morning to find out more about the movie so Doug and I could know better what exactly we needed to address with our son. I learned that it was an animated film that they showed to the whole elementary school annually around Martin Luther King Day – it was rated “G,” and the school had never before heard from a parent that a child had been disturbed by it. The teacher said  that Zachary must have a very strong imagination to have been so upset – she said that it was a cartoon about elementary school-aged kids and time travel, that there were some very brief news clips that went over the young students’ heads, and that the students had always enjoyed watching it. The principal lent me a copy of the video, and Doug and I watched the hour-long production, “Our Friend Martin,” that evening.

We saw that it was not Zachary’s imagination that had caused him such anguish.

At six years old, the time travel concepts had gone over his head, but not the interpersonal interactions nor the news clips. He saw and felt the inhumanity.

He was saddened and confused by friends’ turning on one another, by parental unkindness and school-sanctioned exclusion, by rules that made no sense, by the killing of a man who was helping others. And what caused the worst of his agony was what he saw in just a few seconds of film footage of the police yelling, turning fire hoses on people, and raising their sticks. He saw the hatred in their eyes and felt the cruelty in their actions, and he could not comprehend how that could exist in the people whose job was protecting others. He understood that this was extremely significant.

What a child of six registered was analogous to what a doctor sees when looking at blood cells that have gone awry.

He saw that parents, friends, and teachers, society’s red blood cells that are supposed to deliver oxygen, were not providing the love that normally sustains us. And he saw that the police officers, our society’s white blood cells that are supposed to protect us from infection, were attacking society’s own cells. A hematologic and immunologic nightmare. And while it is possible, in an acute setting, to provide a transfusion of red blood cells when needed (although it does not work well as a long-term solution), it can be a bit trickier to deal with an immune system that has turned on its own body – since autoimmune conditions and allergies arise from erroneously triggered overactivity, rather than from deficiencies that can be replenished, they can be difficult to stop. When a white cell sees a threat in something not dangerous, the body can be in true peril – we know all too well that allergic and autoimmune reactions can kill.

A body, like a society, is indescribably complex. There are countless more questions than answers, and rarely are there easy, universally effective fixes. But we study, we experiment, and we learn. Sometimes slowly, sometimes in amazing spurts of advancement, we evolve and improve our understanding and ability to heal what is ailing.

Medicine has come remarkably far in its ability to treat and prevent illness and injury because the field has focused on finding and fixing the root causes of ailments. Yes, we have developed treatments for symptoms of disease and injury, but our greatest advances have been in addressing the processes rather than bandaging or putting a salve on the results. And this is because we look to see what lies beneath the symptoms. We look at the patients. We look at x-rays, CT scans, and MRIs. We look at blood and tissues under a microscope. We do autopsies. We search for the causes so that we may find the cures.

Medicine has come remarkably far, but we have a long way to go. Although our life expectancies have increased dramatically, people still die far too young, and far too frequently, not only from accidents or from intentional violence, but also from natural causes.

Our society, in terms of civil rights, has come remarkably far. Even 14 years ago, the concept of children not being allowed to play together or go to school together because of their skin color, of this injustice being enshrined in school policy and enforced with violence by the police, was unfathomable to a six-year-old. We have come a long way from the times of separate lunch counters and separate drinking fountains.

But we have a long way to go.

We have, with laws, with education, with evolving social norms, fixed some of the most egregious symptoms of systemic racism. We have not eliminated the racism. We are far from having even mitigated many of its effects. And its effects are still sometimes fatal.

We have to see it. We have to see it in order to fix it.

When we try to excuse the tragedy, by pointing to reports that he had used marijuana, of a child murdered for walking through a neighborhood with a bag of candy, when we justify, by pointing out that he had been selling loose cigarettes, the murder of a man who repeatedly told officers he couldn’t breathe as they compressed his airway and held him down, when someone in a helicopter, watching an unarmed man hundreds of feet below, says, “that looks like a bad dude,” as another officer shortly thereafter shoots the unarmed man, when we don’t hear universal outrage at how long these people lie dying before anyone tries to help them, we aren’t seeing it.

We aren’t looking. We need to not only open our eyes to see the videos right in front of us, but we need to use x-rays, CT scans, MRIs, and microscopes. We need to perform autopsies – not on the bodies of the unarmed victims, but on the underlying process. While it may appear that some of the white blood cells are malfunctioning, white cells do not function in a vacuum – they are getting signals, in so many cases, to attack when there is no danger, to turn on their own pancreatic cells like occurs in Type 1 Diabetes, to respond to a peanut with an anaphylactic reaction.

It seems that right now, our society has, in effect, a low-to-moderate level inflammatory malignancy which triggers these and other reactions. The raging cancer of systemic racism that was so obvious just a few decades ago has been treated, resulting in a partial and variable remission. The chemotherapy of judicial and legislative action has knocked out some of the largest areas of disease burden – the police are no longer tasked with and ordered to remove people from eating at the wrong lunch counter. The targeted radiation therapy of education has enabled individuals to work on surgically excising incidences of racism when they are recognized.

But something remains and we are not seeing enough. We are not recognizing. Our detection capabilities are not where they need to be. We are not seeing our misplaced fears, our faulty immune reactions which are fueling a cycle of anger and deadly violence. We are not detecting the inflammation or the tumors. And one of our biggest blocks in this area is that we are not willing to do self-exams.

What are the self-exams we have been advised by our doctors to do? Breast exams and testicular exams. They are at first awkward and uncomfortable. They’re done on parts of our bodies that we tend to cover in public. We are shy about these areas, and these areas are physically sensitive. We tend not to seriously discuss these parts of ourselves or their exams with people of the opposite gender – women may discuss breasts or breast exams with other women, men may discuss testicles or testicular exams with other men, but we don’t tend to discuss these at the family dinner table. And because we are reticent even to discuss self-exams, we are frequently reticent to do them. We hold on to the awkwardness and we miss finding information that could save our lives.

When we don’t talk openly, we miss out on learning information that could save not only our own lives, but the lives of others as well. We need to talk about the lumps we find on ourselves. We need to describe exactly how they feel, how they move, how deep they are. We need to talk about whether we found them by chance or by concerted effort to look for them, or if someone else noticed something that caused us to look. When women hear men’s stories and men hear women’s stories, they learn about symptoms or feelings that could be a warning sign to their opposite-gendered friends or relatives, or even analogous to things going on in their own bodies.

We need to look. We need to feel. We need to talk. It doesn’t matter if it feels awkward. It needs to be done. We need to find the lumps. We need to evaluate them further with ultrasounds, and sometimes with CT scans or MRIs, and sometimes we need to biopsy them and prepare the biopsy samples with different stains and fixative agents and look under microscopes. And we need to figure out which of the lumps are benign and which are harmful, and if they are harmful how best and most safely to remove them. And also when they are harmful, we need to look for metastases and try to clear those as well.

A properly functioning immune system will recognize and destroy the majority of pathogens – bacteria, viruses, parasites – and it should recognize and destroy an occasional malignant cell. It should recognize and not harm its body’s own cells. It should recognize as harmless a particle of pollen or a walnut and should not release poisons to attack which put its own body in mortal danger.

We are complex. We don’t always function properly. So we need to be ever vigilant. We cannot remain silent. We cannot be reserved. We cannot stop speaking out loudly when we hear something dangerous.

We must keep looking – checking ourselves from head to toe, noticing suspicious moles on our loved ones’ skin. And when we see an obvious problem – a tumor, a misdirected immune response, an inflamed area – in ourselves or in our society, we need to address it. We cannot let racist/sexist/xenophobic/homophobic/prejudiced statements nor exhortations stand without refutation or repudiation, for all of these are truly, in effect, misanthropy, and feed on one another to harm us all.

Sometimes we will overreact. Sometimes we will do an invasive biopsy and find out that the lump is benign. Sometimes we will do a cardiac catheterization and find that there are no blockages. But not to look when there exists the presence of such ominous symptoms in our society is gross malpractice.

We need to quell our society’s low-level, simmering inflammation.

Yes, our country has moved and continues to move forward from the inhumanity and injustice that so shook my child when he first learned of it while watching a cartoon in his first grade classroom. But we have a long way to go. I hope we get far enough that when our three sons have children, our grandchildren will react with similar shock and disbelief to the hatred, fear, and violence that was still present in 2016.

Ready to Speak Out About Race

My heart is heavy and I am afraid, yet I am not the one who must fear for the life of her husband and sons because of the color of their skin.

I am sad and I am angry, yet people who look like me are not the ones who are still experiencing the lethal effects of systemic racism.

My sons, ages 20, 18 and 15, are outraged and devastated, incredulous and indignant, questioning and searching, while they understand fully that they are in positions of privilege due to our societal advantage of having lower dermal melanin levels than others.

My husband is distressed and discouraged, though he knows that he and I and our sons could not have anywhere near the level of distress of those with darker skin.

We are not currently the targets here, but this is our fight. It is our fight because we are human. Because this is our country. Because we all need to be better than this. Because people are dying.

Because I am a doctor, this is specifically my fight. I chose to go into medicine because I want to help people. I want to help keep them from getting sick or injured, to help heal them when they do become sick or injured, and to help ease their pain and suffering whether or not they can be healed.

People are being hurt and I need to help.

The best way I know how to help here is to speak and to write. I have listened and read, and now I am ready to talk. In my next post, I have a story to tell.