The Occasional Random Consideration - 4/19/19

Weighing In On The Anti-Vaccine War – Activism is one thing.  Terrorism is another.  It’s time for doctors and all of our allied health colleagues to rally together for the purposes of stepping forward in the name of science and public health to demand an accounting.  Some of our colleagues have been dubbed “pharma vaccine whores”.  If they want to throw that charge at me – let them try.  I’m clean as a whistle.  And, I find the tactics and information used by the anti-vaxers to be demonstrably hollow.  As a young resident, I had the challenge of caring for a young man who we admitted to our city hospital with subacute sclerosing panencephalitis.  It’s a debilitating disease caused by the measles virus and, more importantly, it’s totally preventable by administering the measles vaccine.  It occurs in 1 of 10,000 cases but 1 in 100,000 or 1 in a million is too many.  And, the same goes for the mumps, rubella, polio and all the other interventions we implemented over the last century that precipitated a plummet in the death rate of children.  Now we are seeing a resurgence of diseases that should never be seen.  The situation is getting so dire that the World Health Organization (WHO) recently named “vaccine hesitancy” as one of the top 10 global health threats. And, there are other efforts as well.  Chad Hermann, the Communications Director and Todd Wolynn, MD, a pediatrician at Kids Plus Pediatrics in Pittsburgh, PA have taken up the mantle by speaking out at conferences and creating a pro-bono project – “Shots Heard Round the World” – a site for providers that provides tips on how to ban commenters, disable Facebook ratings and mobilize supporters who will support providers with pro-vaccine web information. It’s a laudable effort.  Now, we need to mobilize the professional societies and the rest of health care to support their effort.  The time has come to stand up and be counted.  Facts are facts.  It’s what drives good medicine and good practice. 

Remembering Mrs. Cary – I live a long distance from my Mom who has end stage Alzheimer’s disease.  Although I try to schedule regular visits, it’s quite difficult given the breadth of the country that separates us from one another. In the last couple of weeks there have been several hospitalizations for a variety of reasons but all related to the down turn in her daily existence.  In fact, her life has become an existence or, as my brother noted this past week, “She’s alive but not living.”  It’s sad to consider.  It’s painful to see.

But, all of this has brought to mind Mrs. Cary.  Working with her as a young lad was one of the seminal experiences in my early years as a health care provider.  My career in health care started on a very hot day in August at one of our local nursing homes in Bismarck, North Dakota where I worked as the “lawn boy”. One afternoon, the Chief Nurse walked out into the glazing sun and out of the blue offered me a job as an orderly.  She told me the job was an “inside the home” job where it was air conditioned.  She told me I’d have to wear a clean white smock. But, the cincher was when she offered me a pay raise of about $1 per hour – which back in the early 60’s was a tremendous amount.  My job was to help lift the patients into their wheelchairs, take the guests down to the dining hall for meals, assist with showers and personal hygiene, support the men patients, in particular; and, be the helper to all of the other aides for any and all manner of assistance. 

So, back to Mrs. Cary. She was a very slender, rather tall, distinguished looking lady with a patrician presence.  She wore her hair in a tight bun on the back of her head – just like her daughter had explained to the nurse’s aides.  She had an air of authority. In fact, she gave lectures nearly every day to the other guests in the nursing home as she sat in her wheelchair often before an audience of blank stares.  The lectures were about the proper use of English, spelling and papers that had obviously been written a long time ago.  She frequently quieted the room with rather loud statements like, “People, people – now, listen to me.  I have something to say!”  Then, she would clear her voice and begin a soliloquy.  And, her conversations or presentations were simply thrown out to the crowd of residents like a confetti of words that seemingly landed everywhere and nowhere.

We were told that Mrs. Cary was one of the very first woman graduates from the university in North Dakota where I grew up.  She had been a teacher of repute.  But, she suffered from dementia – most likely Alzheimer’s. I had a front row seat in her gradual decline with its weakened voice, increasingly incoherent “word salad” and physical descent.  It got to the point where she became a shadow of her former self.  She was “alive but not living.”  It was very sad to watch. For some reason, she always called me “Steven” – which was the name of her son that she had lost (I believe) in World War II – until the very end of her life.  I embraced her recognition and gave her all the care I could muster. 

I thought of Mrs. Cary because my family – like the 5.6 million other families in the USA who have a family member with Alzheimer’s – are often aghast at the services provided.  I often wonder if there is a young orderly at my Mom’s nursing home who provides the supportive care she needs.  My experience is that it is irregular and plus/minus.  And, an admission to the hospital is even more dreadful.  The focus is on scans, blood work, x-rays, lab tests and any manner of technical work that is far from the needs of the family and often done based on protocol rather than rationale.  Because of the overlaid demands we place on our health care workers from doctors through orderlies – the time available for holding a hand, listening to a family member, giving a hug and simply sitting with someone is simply shunted aside.  Too frequently our “care process” is broken and disjointed.  It seems to me that we – as health care providers – must as a first order of things provide support to not only the people who are “alive but not living” but also more holistically for their families as well. In fact, the Hippocratic Oath that many of us took in the mid-1960s said:

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”

In the age of technology – of which I am an ardent advocate and supporter – we need to remember our entire role as health care practitioners.  Holding hands and simply listening are just as important as all the other accoutrements we offer are part of our armamentarium.