It’s a box in the top right hand side of the emergency chart, just beside the patient’s weight. I fill it in routinely, every time I’m seeing a patient in the pediatric emergency department. I systematically check the vital signs typed in at the triage desk, ask “Any allergies to medications?” and then “Are immunizations up to date?” I abbreviate it “ImmU2D” to save time. And each time I ask, my heart rate jumps for just a second, a guttural butterfly-in-stomach wave shoots through me, and I hold my breath while I await a response. “Yes, of course” most parents say, and I exhale, moving on to the next question.
Most parents. Not all. There’s a few, and I emphasize a few, who launch into a confident and slick diatribe when “Oh, we choose not to immunize” would do. It’s often dramatic, confrontational, and seems to have been practiced in the mirror over and over and over again. Of all the people I judge, I judge them the most: he who doth protest too much. I try not to show it, the actor in me rising to Oscar-worthy performances that say “I don’t hate you, but I don’t in the least agree with you, but I’m trying to hit my quota of 16 kids this shift, so let’s just assume you’ve already been made aware of how stupid you are and have elected to be stupid regardless.” I move on.
And that was it, I thought, until last night.
Now this isn’t a post about why vaccines are good. For the sake of completeness, the save lives, they don’t cause autism, and their utility in stamping out disease is based entirely on the concept of “herd immunity” – the idea that if two cows out of a hundred are susceptible to a disease, they can’t catch it from the 98 who are immune (since immune people don’t get the disease). It’s worth noting that some people – like babies and immunocompromised people – aren’t able to be immunized and thus depend on herd immunity for survival. If you like, Penn and Teller explain it better than I.
All of you have surely heard of the tragic death of Ezekiel Stephan, a 19-month old who died of bacterial meningitis after his parents, who are against vaccines, spent weeks caring for him with hot peppers, garlic, horseradish, and positive vibes, none of which kill Neisseria meningitidis.
This week, his parents were found guilty of “failing to provide the necessities of life,” a cop-out used by a Crown painfully aware that no jury would find well-intentioned (though stupid) parents guilty of murder. The maximum jail time is 5 years. This verdict, while better than an acquittal, angered me and, I suppose, made me extra-sensitive last night, 15 hours into my work day and still 3 hours from the end of my shift when I grabbed the next chart in the to-be-seen rack.
NOT IMMUNIZED, I wrote in large letters, circling it twice (out of anger, not emphasis) along the entire top of the chart. I started taking a history, and immediately felt my eyes rolling as the parent recalled a years-long-battle with an “assumed” diagnosis of a rare, transient disease. I could feel the sarcasm broadcasting from my body. I performed a cursory exam, and reported to the consulting pediatrician that this patient could be discharged and follow up with their unfortunate immunologist. I could not hide my contempt, and my boss went in to discharge the patient. She came out with a signed consent to administer blood products. To save you the medical jargon, I had missed something serious that required immediate (and significant) treatment.
Eight hours earlier I sat in a lecture about being compassionate. I made a comment about trying to be compassionate towards people I dislike. And yet, primed by the tragedy in Alberta and tired of the vindication antivaxxers wear on their smug faces, I let my own judgments of a parent affect the care of my patient – a child – who was an innocent bystander in this massacre of my clinical integrity.
I’ll spare you the root-cause-analysis and discussion of cognitive biases. Suffice to say, I could have performed better. I let my “negative countertransference” towards her affect my ability to care for her child.
I’m no where near being able to throw compassion towards antivaxxers. But I’m more aware of my own reactions to these idiots, and (I hope) more capable of helping their extra-vulnerable children, lest a kid like Ezekiel be fortunate enough to end up in the to-be-seen rack before it’s too late.