nANIMOv

Working in healthcare, especially with everything going on with the new CDC vaccine recommendations, is a little scary and frustrating. A few things have come up for me as I listen to the things anti-vaxxers say and how some people in the medical community respond. One that has been on my mind is whether it is worthwhile to debate conspiracy theorists and some of these staunch anti-vaxxers. The common argument is that it’s not worth it. You are not going to change their minds, and you are giving a platform to baseless and completely meritless ideas. The cynical part of me agrees with this and thinks there are more valuable ways to spend time and attention.

That said, I’ve always wanted to believe in the better nature of other people, and I do believe that at each person’s core is someone who wants to do good based on the information (and intellectual capacity) they have at a given moment. And that anyone can be convinced of anything with enough information (one way or another). The idea that someone’s perspective is beyond reproach or without merit is, I think, arrogant and contributes to a harmful culture of discourse, something that I think significantly plagues progressive movements. Progressive ideas are heralded (by progressives) as these absolute moral high grounds, and if you don’t agree with them, you are a “shit person,” which is usually not the case.

Some of the words of Dr. Paul Offit, vaccine champion and legend over at CHOP, helped sway me back towards the idea that it is worthwhile to debate the “undebatable.” He argues that these are not opportunities to convince the “undebatable” person, but rather to educate those who witness the debate.

There is a Jubilee series (which is somewhat controversial) called Surrounded, where 1 person from one POV takes turns debating 20(?) people from the opposing (often at the far extreme) POV, or vice versa. People make the argument that I mentioned about giving a platform to meritless ideas. I was watching clips from one of the recent episodes with Dr. Mike vs. MAGA/RFK Jr. people. At least from the clips I saw (I still need to watch the whole thing), Dr. Mike does a good job of addressing the concerns of the people without being judgmental or condescending. He finds common ground and areas of agreement and then builds his arguments from there. He acknowledges the validity of people’s concerns and fears, which is key—if not for the 20 people in the room, then for the millions of people who are watching at home. I imagine the Jubilee viewership is predominantly left-leaning, but based on the comments, there are some viewers from the extreme other side that likely will not be convinced. This indicates to me there are more moderate people in between that may be swayed if Dr. Mike did a good job, because, at the end of the day, I do believe that facts and consistent reasoning win out in the hearts and minds of most people.

When I am in clinic talking to patients and parents about vaccination (either childhood vaccines or adult vaccines), there is no audience watching that I am trying to convince; there is only the patient (or parent) in front of me. I will say a huge number of them are not open to discussion when they decline vaccines. They don’t have questions; they don’t want information; they just say no. While that is within their right, I can’t help but think about if there is anything I can do to create a more open environment in which they would be comfortable enough to share their fears or help me understand their point of view. A lot of that comes from trust that is built over a long time, which is hard to do as a resident, but I will keep trying.

There is so much going on in the news right now, in particular with respect to the federal government, and idiotic things that are happening that feel so backward and that seem to defy all rationality and logic, making it feel like we are living in the darkest timeline.

For someone like me who has lived a relatively privileged life (through the work and strife of my parents and their parents before them), the impacts of some of these actions and threats are minimal. And as has always been the case throughout human history, this makes myself and people with similar privilege susceptible to an attitude apathy towards terrible things happening around the world.

One of things that makes us human though is our ability to not only empathize (which itself is not a uniquely human trait), but to empathize and have compassion for people and things beyond our direct human experience, to anticipate needs and suffering, and to abstract the experiences of others.

However to do any of that we need to open ourselves up to the lived experiences of others. That is why it’s so important for people with privilege and people with power to be cognizant of what is happening in the world and to engage in community outside of their usual spheres.

I have patients who are dependent on SNAP. I have patients who are afraid to come to their clinic appointments because of ICE. I have patients who refuse to get vaccinated because they were told it would make them sick or parents who refuse to vaccinate their children because they were told it would give their child autism. I have patients who are going to lose coverage for life saving medications. I have patients who have uncontrolled chronic illness because they have the competing priority of just trying to stay alive on the streets.

These stories from the clinic and from the hospital and the stories I hear with street medicine and when I’m out in the community are reminders of how much work we have to do.

Being a resident training in both internal medicine and pediatrics, I often feel like I am behind my categorical colleagues. Throughout my first year-and-change as a doctor I have had about half the amount of direct clinical time spent with adults as the internal medicine residents, and the same can be said on the pediatrics side. And it certainly does not help that I spend the majority of my time working along side categorical residents who are all so brilliant and quick, making void that I perceive to exist between us even greater.

I recently watched a TedEd video based on a Ted Talk about how most people become “good” at something. The speaker David Epstein argues that there are multiple paths to mastery and in many cases it can involve a meandering journey and a breadth of seemingly unrelated/ indirectly related experiences. He brings up this concept of frogs, who spend their time down in the mud seeing things in great details and birds, who may not see all the minute details but integrate a wider point-of-view into a cohesive picture.

As someone who has always had a wide variety of interests (and sometimes a short attention span), this resonated with me, especially as the world feels like it is becoming increasingly focused on specialization, with medicine being far from an exception to this.

I went into Med+Peds because I love to learn. I wanted to continue learning the art and practice of medicine for both kids and adults. Because I like tying together disparate ideas and experiences together and to think of problems from various perspectives. So on days like this when I’m feeling particularly inept, it just a good reminder that my journey is my own.

I really wasn’t sure what to expect when traveling to Singapore or Malaysia. This whole trip was kinda very loosely planned with minimal expectations.

One of the most interesting things from this trip was learning about the pre-colonial, colonial, and wartime histories of these countries and their respective paths to independence and current trajectories.

Part of that history is preserved in the buildings of these cities. You have ultramodern skyscrapers right next to old shophouses with architecture from multiple different cultures. I particularly loved wandering around Georgetown in Malaysia. In many ways it felt like a city frozen in time, as if my experiences walking those streets wasn’t too far off from the experience of people 50+ years ago (of course minus the all the cars and other modern technologies). But then when I entered the various shophouses lining the streets I never knew what to expect. Some embraced the rustic charm with distress walls (some with more intentionality than other) and handmade furniture. Others were portals back to the 21st century with minimalist, concrete interior design and chrome fixtures. There was so much creative use of these old spaces that were now being reclaimed for use in the modern era.

Just because something has been around long time, does not mean that it needs to stay the way it was from when it was created. The worlds changes, people adapt, ideas evolve. That said, the past is full of opportunities to learn and grow, and in that way can never be fully be rejected, but instead can be reclaimed.

This is my last week on pediatric pulmonology. Something a lot of people say when you are applying to a pediatrics residency is, “Wow how can you do that, it must be so sad.” And it’s true, we see heartbreaking stories and children with severe, debilitating, sometimes terminal diseases all the time. But we also get to be participants in stories of intense joy and hope.

During this rotation I’ve had a chance to work with a lot of patients with cystic fibrosis (CF). These patients often can get very sick. There was one patient who I had a chance to see a few times in clinic and peripherally once in the emergency department. He is only about 6 months old around the time I’m writing this, but in his first few visits after he was born he just wasn’t gaining weight the way we would expect. He got admitted a couple times because of this, but his poor weight gain kept being attributed to poor feeding at home. Eventually he did get a work-up and diagnosis of CF, but it took way too long and something that I will continue to reflect on and think about throughout my career. I serendipitously had a change to see him in CF clinic while on this rotation and see him now getting proper treatment and growing well and looking healthy fills my heart so much.

We have another kid on the inpatient side who came in very sick and just has severe pulmonary disease due to his CF. He is only 3 years old. When I first saw him and he was still early in the course of his acute illness, he was just not a happy camper, understandably. Over time I’ve gotten to see him perk up and be more playful and interactive. Today he wanted to borrow my stethoscope and wanted to listen himself and then listen to me. He’s been smiling and happy, saying hi to us and bye to us enthusiastically these past few days and I just melt.

It’s these stories that keep me going. Especially for these kids who spend so much time in the medical system, in and out of clinic appointments and hospital stays, we as medical providers have an opportunity and privilege to try be a part of their reality, and hopefully bring some joy into situations that others may see as tragedy.

This may be obvious, but it just occurred to me today that the real reason 80% of Disney productions in the last 10+ years have been sequels, spin-offs, and live-action remakes (I actually calculated it and its closer to 53%, but still) is that they are afraid of failure. I always knew it was about money which makes sense given that they are business and they would rather invest in something that has a track record of success, but just never connected that to them being so afraid of a flop that they forgo creativity. It’s just a bit ironic coming from a company that is supposed to represent magic and imagination, that’s all.

A family member of 2 of my patients (twins) told me about an unfortunate experience they had during their admission. A staff member of the hospital, threatened not to perform their duty because the family member and one of the nurses were speaking to each other in Spanish. This was pretty shocking and upsetting for me to hear, and I can only imagine how it must have affected this family member. Our hospital serves a diverse community, but with a large majority of that population being Spanish-speaking, so the fact that someone in who works here can carry that kind of attitude in their heart made my heart sink.

I just sat for a while and listened to what this woman had to say, as she was understandably angry and shaken. What surprised me though was the good things she had to say about this hospital besides this isolated event. That, at least prior to this incident, she felt this hospital genuinely cared about the community and the patients that came through our doors. And how she trusted this hospital to see her and her family members as people, not just as patients. It was affirming to hear that many of the reason I wanted to stay here for residency, are ways the people in the community view this hospital. It was a good reminder to always do right by our community in the face of emboldening bigotry, and actively fight against it.