clinic · fellowship

Zero to Ten

Overheard in clinic:

MA: Do you have any pain?

Patient: Oh pain! Do I got pain? So much pain!


Can Scientists (Not) Be Activists?

I just went to a talk titled this, given by a leading climate change scientist and activist. I was hoping for some practical advice from his 20+ years advocating for alternative energy sources and reducing dependence on fossil fuels (which is not only bad for the environment, but also bad for human health).

Unfortunately, what I got was a rambling lecture on how young people need to rise up and do something. Didn’t say what. Didn’t say how. But something. Then he showed more pics of himself age 4 on the family farm in Iowa.

I don’t know if I even count as a “young person” any more (it’s all relative, right? but seriously, when did they start admitting children into medical school?), but I can tell you that my generation, or at least my bubble of my generation, has the passion. We have the science. What we lack is the generational knowledge of the folks who pushed for the Clean Air Act of 1970 and the Clean Water Act of 1972. Unfortunately, it appears that generation is committed to blaming us for perceived apathy, while withholding the practical knowledge they acquired in pushing forward the most important pieces of environmental legislation since the creation of the National Park System.

So anyway, can scientists not be activists? I don’t know, because to me, being one is being both. See you all at the March for Science next week!



One of the first patients I met in medical school was a 10-year-old boy with SSPE, a not-so-rare and always-fatal complication of measles infection. He was blind, deaf, severely encephalopathic, and spastic. It was a peds GI clinic, so I guess he had some GI issues too, but the thing I remember most about him was his father lifting him out of his wheelchair and carrying him across the room to the exam table. His head flopped as Dad laid him down; he had scissoring clonus at both legs.


He was the first neurologically devastated person I’d met, and it was shocking. I was pretty naive, I guess — I was a first-year medical student, 22 years old, still wet behind the ears. In the decade since, I’ve taken care of a lot of people in various stages of coma, but that kid stands out to me. That kid, more than anything else — more than the science, even — convinced me that vaccines were essential.


So when I heard that SSPE is on the rise (previously thought to be 1:10k cases, but with vaccination rates falling, appears to be more like 1:600) and that Europe is facing a massive measles outbreak that’s left 17 children dead in Romania alone, I’m struggling a bit with the appropriate response. Yes, sympathy for the families of those kids — no parent should ever, ever have to bury their child. But I can’t quite silence the little part of me that wants to say, “What did you think was going to happen? You withhold a lifesaving preventative measure from your child; therefore they die. Do you make sure your kid wears their seatbelt? Brush their teeth? So why don’t you vaccinate?”

I’m a big believer in the patient’s right to bodily autonomy, but I think we’ve lost sight of the fact that the patient here is the child. I can’t think of anything that strips your bodily autonomy faster than complications of a vaccine-preventable disease.

[Please, no anti-vax arguments in the comments. I’ve heard them. They are wrong. And if there is a God, there will be a special circle of Hell for Andrew bloody Wakefield, who is directly and personally responsible for this current iteration of the anti-vaxxers. Preferably involving torture by the souls of the children he has killed.]