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If the global crisis of childhood adversity were a book, we would be in the second chapter. In a lot of ways, this book is the story of that first chapter—the discovery of the biological mechanisms.
One big problem with the miasma theory was that if something didn’t smell particularly bad, folks figured that it couldn’t be the source of disease.
Things like washing your hands between patients or changing your operating gown did nothing but take up more time, so the most dedicated surgeons would go from patient to patient as quickly as possible, covered in blood and viscera. To ward off infection, they instructed the nurses to open up the windows of the surgical room to air things out.
Dr. Joseph Lister was a surgeon who had read the work of chemist
Louis Pasteur on how wine was soured by microbes.
insisted that his surgical team employ antiseptic techniques such as hand-washing, cleaning their instruments, and cleaning the patient’s skin and wounds. In the three years after Lister instituted his antiseptic practices, the death rate from ...
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making it possible for someone to roll out of an operating room with a good chance of survival.
it took a very long time to get from the discovery of germ theory to the institution of universal hand-washing, the use of sterile surgical equipment, and the development of antibiotics, and it took even longer to get to our current tools of fourth-generation antibiotics and surgical equipment that’s sterilized by radiation. What happened between then and now?
The public-health response was all the ways this information changed things outside of hospitals and clinics, including the creation of practices like municipal sanitation and the pasteurization of milk.
These combined efforts were all based on a simple frame shift—that exposure to germs, not foul air, causes disease and death.
But just as important as any individual intervention was the recognition that both approaches were necessary to achieve transformative change.
The cause of harm—whether that’s microbes or childhood adversity—does not need to be totally eradicated. The revolution is in the creative application of knowledge to mitigate harm wherever it pops up.
“It’s Sarah. Evan had a stroke.”
I knew what that meant clinically; the thing I couldn’t wrap my mind around was the fact that it was happening to my
I could periodically hear the doctors and the nurses in the ICU relaying information about his case: “Forty-three-year-old male with acute stroke, nonsmoker, no risk factors.”
The last part echoed and rattled around in my brain. No risk factors.
That wasn’...
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When my brothers and I were growing up, our mother suffered from paranoid schizophrenia, a severe form of mental illness that, unfortu...
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The problem was that we never knew which mother we were going to get.
His unique combination of nature and nurture led to his own schizophrenia; he was diagnosed in 1992, when he was just seventeen years old. Two years later, he got out of my mom’s car at a stoplight and walked away. We never saw him again. He’s been on the national missing-persons registry ever since. Louis is what brought me to Bayview Hunters Point. I see his face, his potential, his fundamental worth in the faces of my patients.
