Tuesday, December 18, 2018

Sonoma Medicine

The magazine of the Sonoma County Medical Association

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Keep Moving Forward, No Matter What

Mark Sloan, MD

Dr. Aaron was my attending on the first general pediatrics hospital rotation of my internship. He was very old, or at least he looked that way to the 20-something residents and students who trailed him on rounds. Gnomishly short, with a hunched back, a hearing aid and arthritic hands, he navigated the hospital corridors with a rubber-tipped cane. His eyes, though, are what stand out in my memory. As he moved from bed to bed, reading charts and examining children, they fairly danced.


Dr. Aaron was an incurable medical optimist. Polio, diphtheria and smallpox had vanished in the course of his long career. Measles, mumps and congenital rubella were on the run. During my residency he watched along with us as Reye’s Syndrome suddenly appeared, killed or damaged dozens of children, and then, once linked to aspirin ingestion, left the scene nearly as quickly as it arrived. His favorite aphorism—Amazing, don’t you think?—became a catch phrase among the house staff.

Looking to the future, he believed that no disease could long survive the march of pediatric progress. Ours was to be the generation of doctors who would finally put an end to serious childhood infectious diseases, among other primeval scourges. “Come here and see this, young people,” he once called from the bedside of a scrawny baby in the midst of a classic whooping-cough paroxysm. “By the time you’re my age, this will be ancient history.”

If Dr. Aaron were here today, what would he think of these past 30 years? He’d no doubt marvel at the progress made against diseases that filled the wards back in my internship. Hib, pneumococcus, rotavirus, varicella and meningococcal vaccines have greatly reduced the burden of illness on today’s children compared with those of the recent past. Advances in cancer, diabetes and asthma care have dramatically improved survival rates and the quality of afflicted children’s lives. Inhaled steroids? Insulin pumps? Bone marrow transplants? I can almost hear his deep, froggy voice: Amazing, don’t you think?

But he would also see disturbing trends: the as-yet inexplicable rise of autistic spectrum disorders; an epidemic of obesity and its accompanying increase in hypertension and “adult” diabetes; and, most shockingly, the resurgence of vaccine-preventable infections. I can see him cocking his head in disbelief: American children are still dying from pertussis? What in the world went wrong?

These are interesting times for physicians who care for children. We pediatricians and family doctors are simultaneously planning for the future while looking over our shoulders to the past. We are helping to secure insurance coverage for all children, and to redesign our communities for healthier living. At the same time, we’re still fighting yesterday’s battles, trying to convince young parents that the dangers of “old” infectious diseases—those whose devastations have disappeared from collective memory—are still very real, while the vaccine-autism link they read about on the Internet is not. Here in Sonoma County, where anti-vaccine sentiment runs particularly high in some areas, that’s a battle we’re far from winning.

Today I teach young doctors from the Santa Rosa Family Medicine Residency, medical students from UC San Francisco, and college and high school students considering a career in medicine. Though I would love to be as confident in the future as Dr. Aaron was, to point out to them a host of rare and disappearing diseases, my own optimism is tempered by a hard look at the realities of 21st century America. We have the skill and will to tackle the daunting list of health problems facing today’s children. But as the economy implodes, and more and more families lose jobs and health insurance, can we keep our children’s health from declining? Forced to make do in a time of diminishing resources, will physicians be up to the challenge?

Those questions bring to mind one more Dr. Aaron-ism, dispensed with an arm around the shoulder of this shell-shocked intern the morning after I’d first seen a child die. “Look at all the children who still need you,” he said, sweeping his cane around the ward. “Keep moving forward, no matter what.”

I looked into the eyes of a man who had seen epidemics come and go—who had once been an acknowledged whiz at troubleshooting iron lungs, no less—and whose own body was now failing him. He was smiling. I got up and went back to work.

E-mail: mark.sloan@kp.org

Dr. Sloan, a pediatrician at Kaiser Santa Rosa, serves on the SCMA Editorial Board.


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