Saturday, October 31, 2009

What Should Really Scare Us This Halloween?

About 94% of kids will be out trick or treating tonight. Most of them, particularly the little ones, will be with a parent or other adult. Most of them will be told not to eat their candy until they get home, where an adult will look it over or at least tell them not to eat anything that looks suspicious. We, as a society, believe Halloween to be fun but also risky, and we take numerous precautions to avoid those risks.

But what are those risks? Let's start with the treats. 40 years ago, it wasn't uncommon for people to make popcorn balls or give out apples on Halloween. Over time, we came to understand that eating unwrapped food was dangerous, because the distributor might lace it with poison, put a needle or a razor blade in it, or otherwise try to hurt the kids coming by for treats. Now, I know of no one who would let their child eat an apple from their treat bag. So what do you imagine is the average number of treat tampering cases per year in this country? Is it more or less than it used to be? How often does someone tamper with candy and then distribute it on Halloween?

Never. According to research, there has never, ever been a case of someone poisoning or lacing or putting something in the treats they give out to children. There have been cases of poisoned candy, to be sure, but they have mostly turned out to be an adult's attempt to harm a specific child and blame it on a stranger. Back in the '70s, there were some highly publicized cases. One turned out to be a parent poisoning his own child for life insurance money, and another that was blamed on heroine in candy was actually a child getting a hold of a relative's stash. The candy kids get from the neighbors is safe.

The next thing we think we know about risks on Halloween is that you should go with an adult. Strangers are dangerous, and if you shouldn't talk to strangers then you shouldn't talk to strangers, period. What might surprise you, however, is that there is no increase in sex crimes against children on Halloween, either. All sorts of law enforcement efforts go into making sure that registered sex offenders don't answer their doorbells for the little ghosts and goblins, but it really doesn't make a difference. Children are at risk from predators every day, and Halloween is no exception, but it is not the bonanza for pedophiles we think it is.

So what really is the biggest risk to kids on Halloween? What makes it more risky than the day before or the day after for our kids? You probably can figure it out if you think about it. Halloween is the one time all year when children are walking around in the dark. The number of children who are killed being hit by a car on Halloween is more than double the number for any typical night, simply because there are more children out there. In fact, if you account for the massive increase of children walking outside between 4 and 10 PM on Halloween night, the rate of childhood pedestrian death per pedestrian may actually be lower. Oh, and when I say "doubled," it goes from one child per night to 2.2 on Halloween -- in the whole country.

Despite all of this, we all pay a lot of attention to safety on Halloween. I think that has nothing whatsoever to do with the odds of something happening to our kids. It has to do with our image of ourselves as protectors of them. We see ourselves as being able to keep our children safe, and we are pretty good at that. On Halloween, we afford them a teeny bit of independence. We let them ring doorbells they would never ring any other day, and talk to people they would never talk to. We loosen the apron strings just a little bit, and compensate by creating a lot of rules and procedures to make sure they're still OK when we do.

To be sure, there's nothing wrong with being careful on Halloween. There's no harm in trying to keep our little ones safe, and avoiding unnecessary dangers. It just probably would make the evening a little more fun for the whole family if we all kept in mind that the biggest chance we take with our kids on Halloween probably has more to do with tooth decay and childhood obesity than with the evening itself.

Thanks to Quarterbacker Alan over at Poor Mojo Newswire for the article about candy tampering.
Friday, October 30, 2009

Pediatric H1N1 Deaths: Compared to What?

Deaths of children due to Novel Influenza A H1N1 rose 20% in just the last week.  So far 114 children have died.  That's what Bloomberg is reporting this afternoon, following the weekly update on the CDC website.  Bloomberg's coverage then continues with this penetrating commentary from Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University:
This is very unsettling news for parents, particularly when coupled with the shortage of the vaccine. The situation is much more fluid and uncertain than the government expected and than the public is comfortable with.

So, let's face it.  A lot of us very naturally look to the news to tell us how scared we should be.  If something makes the news, we figure we should pay attention to it.  If it's bad, we figure we should worry about it.  In the case of something like a pandemic, the news is our major source of information.  So a 20% rise in pediatric deaths in one week scares us, and now we have an expert telling us that this is unsettling news, so we feel, well, unsettled.

Bloomberg, as the press often does, is violating the Quarterback's 5th commandment of H1N1 communication:
Thou shalt put thy information in appropriate context so that thy public may understand the dangers they face with relation to other dangers, and not overreact to thy numbers.
The fact of the matter is that nowhere do we have a sense of comparison between the number of pediatric deaths from H1N1 and other causes of death for children.  We don't know how many children have H1N1 in the first place, so we don't know what the chances of any given sick child dying might be.  We don't know how many children tend to die from seasonal flu, nor how many of these children were medically fragile and likely to die from something else if they hadn't contracted the flu.

The death of any child is a tragedy.  The highly publicized death of a child is scary to parents.  But the naked number "114" has no meaning whatsoever.  And the statistic "20% in one week" is unbelievably misleading -- I certainly didn't think the number was going to be in the low three digits when I saw that.

Which brings me around to Professor Redlener, who really ought to know better.  Not only does he tell us to be scared without any context at all (although, to be fair, he might have given context that was edited out), but he then goes on to tell us that this is much "more fluid and uncertain" than predicted.  That is patently false.  Back in August, the President's Council of Advisors predicted between 30,000 and 90,000 deaths from H1N1, which translates to between 5,400 and 16,200 pediatrict deaths.  We've had 114.  I would say that if we are more uncertain than we thought we would be, it's because the big shoes have yet to drop, not because there have been so many deaths.

Reporters are trying to sell newspapers, and fear sells papers.  An honest headline this week like, "Yep, Still Lots of Swine Flu" would not sell papers, so that's not what Bloomberg picked up.  They need to remember that hysteria is a lot more contagious than any flu can ever be.

Thursday, October 29, 2009

The H1N1 Vaccine Shortage: Hate to Say I Told You So . . .

Here in Washtenaw County, Michigan, we've been told for months that there is going to be H1N1 vaccine for everyone who needs it. In my school district, three clinics were scheduled to vaccinate anyone who wanted it at the three biggest high schools in town during the first two weeks in November. Similar clinics were scheduled at a variety of school sights around the county.

Then a couple of weeks ago, the word went out that actually, not everyone was going to be able to get vaccinated. In fact, these clinics would now be limited to health care workers, pregnant women, caregivers of children under 6 months, children from 6 months through 4 years old, and children ages 5 through 18 with underlying health conditions. One of our district's three clinics was canceled.

Clinics were set to begin this past Tuesday. In the days leading up to the first clinic, the word went out that only 1,000 people would be vaccinated at the clinic on Tuesday. The idea, apparently, was to spread the vaccine around to the various locations. What was not shared was how many doses of vaccine were dedicated to all the clinics put together, just that it wasn't nearly as much as originally hoped, but more was trickling in.

Monday's clinic, at our local Intermediate School District, was slated to run from 2:30 - 9:00 PM. The first person lined up at 9:30 AM. People parked 1/4 of a mile or more away from the building to get in line. By 5:00, the clinic was closed. My son was among the many people in the designated groups who planned (or whose parents planned) to get vaccinated that day who didn't even bother to get out of their cars.

That was Monday. By this morning, all of the school-based clinics had been canceled, and the convocation center at a local university is the location for a new, "mass vaccination clinic" for the same high risk groups next week. It suddenly seemed like a better idea to try to do as many people as possible all at once rather than have people go from clinic to clinic, hoping to be in line early enough to get their shot.

While the shortage of H1N1 vaccine may not have been predictable, scenes like this one certainly were. Anyone who's ever tried to get tickets for a popular rock concert can tell you what happens when you publicize that there is only a certain amount of something that people really want and that it will become available on a certain day, at a certain time, in a certain place. Its a wonder the Health Department didn't give out wrist bands ahead of time -- they might consider that in the future.

Back in July I predicted what a shortage of vaccine, or a prioritization of who can be vaccinated, or a rationing of health care during the pandemic, might do to people psychologically and how it might cause people to act. I'm not expecting that the powers that be read this blog, but if I can figure it out, so can they. Planning clinics based on the idea that you can vaccinate a certain number of people per clinic over a certain number of clinics over a certain number of days is all well and good, but you have to take into consideration how many people will want to be vaccinated each day. Around here, the Health Department seemed genuinely shocked by the notion that significantly more than 1,000 patients showed up for a 1,000 patient clinic.

This really shouldn't be that hard. You select which groups can be vaccinated based on which groups you think you can vaccinate without turning anyone away. You set up a mass clinic with lots of parking, and you publicize that everyone in those groups who wants to will be vaccinated. You allow people to make appointments, or get wrist bands, or something to spread out the crowds. And you hold the clinic until everyone who is entitled has had their shot. When more vaccine becomes available, you do it again. And you stop being shocked that the public's priorities and ideas about how to proceed do not include the convenience of the Health Department. That ship sailed a long time ago.
Tuesday, October 27, 2009

The Richmond High Homecoming Attack

Saturday night was the annual homecoming dance at Richmond High School in Richmond, California. A 15 year-old girl walked out of the dance and was invited or lured or brought to a secluded area to drink with a group of other people. When she was quite intoxicated, she was attacked and gang raped in an assault that lasted more than two hours. Not only were people present who watched and did nothing, but reportedly people went back into the dance and talked about the attack and others came out to watch. Only after it was over and some of the witnesses were overheard talking about it were emergency personnel called. The victim was found unconscious and admitted to the hospital in critical condition. She is still hospitalized in stable condition.

This is the point in this blog where I usually talk about what a crisis response team ought to be doing for this community. But I have to admit that my first reaction to this story was complete and utter revulsion, to the point that I had to stop reading the coverage to pull myself together. I'm used to helping people who witness violence. But in this instance, the witnesses were accomplices. At first blush, it seems like there isn't anyone (other than, of course, the victim) to help.

In fact, however, that isn't true. There have to be lots of girls at Richmond High School looking over their shoulders this week, wondering how close they have come to being victimized themselves. School can't seem all that safe to them anymore. I'm sure their parents are beside themselves as well, wondering about their daughters' safety and the choices they make that influence that safety. There are boys who are being painted with the same brush as the witnesses and the attackers, and are looking at friends they thought they knew in a whole new light. Administrators are asking themselves what they could have done differently, and teachers who thought they knew their students aren't so sure anymore.

There is plenty of work to do, and that's not even counting the very specialized assistance that the victim will need once her physical wounds have healed. Two suspects have been arrested and a third is being questioned. One of them isn't even a student at the school. I doubt the victim will ever be able to return to Richmond High School. I doubt Richmond High School will ever be the same.

Monday, October 26, 2009

Death at Jellybean Junction

At 9:15 this morning, two bodies were found in an SUV parked outside the Jellybean Junction daycare in Fairfield, OH.  They have been identified as Evelyn and Francisco Restituyo, who were either divorced or separated from one another.  They both had gunshot wounds.  They had no connection to the daycare center at all, and it's not clear why their bodies were there.

There's a lot of speculation that this was a murder-suicide, and that does seem pretty likely to my untrained eye.  Who knows where they were going or which one of them may have been alive when they pulled into that parking lot, or why that lot was chosen instead of another.  We may never know.  This is a tragedy that happens all too often, and that I've had way too many opportunities to blog about.

This situation is just a little different, though, because of where it happened.  Imagine you are the director of a daycare, and one of the guys who works on your lawn comes in and says to call 911, there are dead bodies in the parking lot.  Imagine you are a parent, and you get a call from your child's daycare saying that everything is fine, really, but the center is on lockdown for the morning because the police are trying to figure out why there are apparent homicide victims in the parking lot, so you can come get your child if you like.  I'd have to imagine in both instances it would seem awfully surreal.

Whatever danger there ever was to the kids at Jellybean Junction was long over when the bodies were found.  There was no shooter skulking around in the parking lot, and that was pretty obvious early on.  And yet, the center locked down.  Why?

As a school administrator, I have two answers to this question.  The first is that "lockdown" means you are controlling who goes in and out, and it is the quickest and easiest way to keep the kids inside and everyone else -- the press, gawkers, etc. -- outside.  You clearly don't want the children playing on the playground as the bodies are being removed by the medical examiner.  They don't need that exposure, and neither do you.  So you lock down to make sure that no one unwittingly takes children into view of what is happening outside, and to make sure no silly reporter comes in and tries to interview a 4 year old about their reactions.

The second reason, honestly, is that locking down makes it look like you're doing something.  While children were not in danger, there is something viscerally upsetting about dead bodies being found outside your child's daycare.  The world seems a little out of control.  You want to know that someone is Doing Something.  And there is some reassurance, as irrational as it may be, in knowing that the center is on lockdown.  They are taking extra good care of your kid in an unsettling situation.  That has to be good.

It says something about the times we live in that a place called Jellybean Junction has a lockdown procedure.  It says something even more that they had to use it.  I hope this is the only time, and I certainly hope they never have to use it for any reason more serious than keeping the kids from seeing something icky and reassuring the parents that yes, their kids are fine.

Sunday, October 25, 2009

The Puerto Rican Earthshattering Kaboom

Last night, I asked a friend, "Did you hear about the explosion in Puerto Rico?" He hadn't. About 1500 people near San Juan have been displaced by an explosion at a Caribbean Oil storage facility in the wee hours of Friday morning. The explosion registered 2.8 on the Richter scale, which isn't much for an earthquake but is one heck of an explosion. Yesterday brought fears of increased casualties as the wind brought the cloud of smoke over San Juan, but so far no major injuries have been reported and the wind has shifted in the other direction, although the fire is still burning out of control, almost 60 hours after it started.

This morning, that same friend asked me, "Did you hear the news?" He wasn't talking about the fire in Puerto Ri
co, though. He was talking about the fire at Pinball Pete's, a former pinball emporium in downtown Ann Arbor, MI. The building has been vacant for a while, but the fire caused the temporary evacuation of a nearby student housing high rise. The pictures are pretty spectacular.

The fact that the Caribbean Oil fire hasn't gotten all that much coverage in the mainland US should not be surprising. As I've often said, we pay attention to things that are horrible, unexpected, and happen in places and to people we identify with. It will give you some idea how much we in the United States identify with Puerto Rico that has been running its coverage in its "World" section, not in its "U.S." section. As they say in the musical "West Side Story,"
Nobody knows in America
Puerto Rico's in America
The Washington Post has this story in the Nation Digest, so at least they've located it properly. It's the third story in the digest. Balloon Boy is number one.

Both of these fires are exciting. To the people who are right there, they are also probably traumatic. One man in Puerto Rico was quoted as saying,
I didn't expect to see a mushroom cloud from my house
For most of us, though, these stories are attention grabbing if we live nearby or know the area, and mildly interesting otherwise. That's because we know that fires happen, we hope they don't happen to us, and no one was seriously injured in either blaze. We love stories like this. We can sit back and watch, admire the power of fire to destroy and its beauty in the night sky, and not really worry about it. We are voyeurs at heart, and in these cases, we can do it with impunity.

Saturday, October 24, 2009

The Sound and the Fury of the H1N1 Emergency

President Barack Obama declared a national emergency for H1N1 today. Technically speaking, this allows the Health and Human Services Secretary to waive some bureaucratic requirements in an attempt to help states cope with the spread of the virus. This sort of declaration, along with declarations of states of emergency of various kinds, stems from regulations that say that the government can do certain thing if certain people determine that an emergency exists. This is the President saying, "Yep, sure looks like an emergency to me. Go forth."

These declarations always strike me as somewhat odd. They are always reported breathlessly on the news, but in fact, they are not a change in the state of affairs, they are a recognition of what already exists. The President's declaration of a national H1N1 emergency did not change the number of people who have the disease, the number of people who have died, the number of people who will get the disease, or the number of people who will die. It did not even represent the outcome of some set of information that he has and we don't. It literally is him looking at the same statistics we all have access to and deciding, as many of us have, that it looks bad.

Meanwhile, we have some jurisdictions and federal officials throwing around the word "peak" to describe what is happening in flu cases. That feels like just the opposite of an emergency. The peak means it's all downhill from here, at least to most people. Only that isn't what it means. When they talk about the "peak" in this instance, they are referring to previous seasonal flu seasons, when widespread flu activity in most states (right now it's in 46) represented the full force of flu season arriving. If you look at graphs of flu activity from previous years, sometimes the "peak" looks like a peak and sometimes it looks more like a rolling hill -- in other words, the peak can last for a pretty long time.

It's also impossible to know whether the shape of the graph for this year will look like other years, because we haven't had pandemic flu in a while and this one came at an odd time of year. Right now, flu activity is well past what was the peak of the 2007-2008 flu season (which was pretty bad) but not to the point of the peak of the 2002-2003 flu season. Yes, it's bad, but it could get worse. It could get better. We just don't know.

So, is this an emergency? Depends on what you mean. I'd say that if your child has secondary pneumonia right now and is in the hospital, this feels like an emergency. And if no one you know has been sick, or they have but not very sick, then it probably doesn't. For the first person, the emergency declaration is too little too late, and for the second it's likely to make them more nervous than they might need to be. It's easy for those "in the know" to forget that what they mean when they use words that are so emotionally charged is not necessarily what people understand when they hear them. Maybe it's time to reexamine how those words are used, at least in public.

Thursday, October 22, 2009

Somer Thompson: Hearing the Unthinkable the Wrong Way

The body of 7 year-old Somer Thompson was found in a Georgia landfill yesterday. She was on her way home from school in Orange Park, Florida on Monday when she ran ahead of her friends and disappeared. The landfill where her body was found is about 55 miles north of there, and receives garbage from the Orange Park area.

As a mother, I cannot imagine anything worse than the murder of your child. It upsets what all of us perceive to be the natural order of things -- that parents outlive children, and children are protected. I imagine that Somer's mother had considered the possibility, between Monday and Wednesday, that Somer was dead. Still, I don't think anyone can truly prepare themselves to hear something like that.

The Clay County, Florida Sherriff, Rick Beseler, reflected this when he shared how hard it was to notify Somer's mother. He said,
It was the hardest phone call I've ever had to make in my life, and I hope I never have to make another one like that.

This quotation gave me a great deal of pause. First of all, I believe it comes from the heart. I'm sure that was an awful conversation to have. I'm sure it's not the only time he's had to do a death notification, but I am willing to believe it was the most difficult. What made me reread that quotation several times, however, is that he is talking about a phone call. He did a traumatic death notification by phone.

Think about the cop shows you've seen on TV. Think about how death notifications are done in the military. Someone goes to the house and rings the doorbell and sits down with the family. There are really good reasons for that. You are delivering news that will cause a traumatic stress reaction in the listener. You want to be there to assist when that happens. You want to make sure they are not alone afterwards. You want to get medical attention for them, as needed. You want to be humane. You want to make sure they understand what you are saying, and they know you are not joking. And you want, when they remember this awful moment, for them not to remember that you didn't have the decency to drive to their house.

There are people in law enforcement and the military who are specifically trained to do death notifications. In my wallet, I have an entire set of 5 credit-card sized cards with notes on how to deliver bad news. This isn't easy, and it's easy to mess it up. You can't make the truth of the situation any more palatable. But at least you can be compassionate enough not to deliver that truth over the phone.

Wednesday, October 21, 2009

H1N1: It All Becomes Real

Several months ago, I blogged about what I thought was going to happen when people who are used to getting what they want in health care were told that they couldn't get the H1N1 vaccine right away. That scenario completely failed to recognize the possibility that people actually wouldn't want the vaccine at all. It turns out that both are true. About half of the population does not intend to be vaccinated, and the other half is facing something of a shortage, at least in the short run.

Here in Washtenaw County, Michigan, the supply of vaccine is coming in slower than planned. This means that scheduled H1N1 vaccination clinics are being postponed or scaled back. My school district had intended to hold 3 clinics during the first 2 weeks of November and vaccinate anyone who wanted it. Today we got the word that one of those clinics was canceled and the other two would only vaccinate high priority subgroups.

This was, in almost all respects, a possibility I was prepared to deal with. I was not prepared, however, to deal with perhaps the hardest crisis communication audience I ever have to face: my daughter. My daughter is 11 and healthy. Her brother is 4. That means that he is a high priority for H1N1 vaccine, and she is in the next tier down. This means that, at the beginning of November, instead of the whole family going to the clinic for our vaccinations, we will just take my son.

My daughter has a mom who does crisis and crisis communication for a living. She's used to talking about some pretty heavy things around the dinner table, and to weighing some difficult ethical topics. She gets why my son gets the vaccine and she doesn't, at least intellectually. And yet, it's hard enough when your baby brother gets all the attention and the presents and gets away with everything and everyone says he's cute (at least that's how it seems sometimes). Now he is a higher priority for healthcare. This is a form of sibling rivalry few of us have experienced.

I am telling myself that I'm OK with not getting the vaccine right away, and with waiting to get it for my daughter. I also know we have two students at school who have secondary infections following presumed cases of H1N1. They are very sick, and they've been out for a long time. I know the numbers and the odds -- I write about them incessantly. But those two kids are much more real than all the numbers in the world, and I identify them much more with my own daughter. I'd be lying if I said I didn't want an extra dose, just for her.

Tuesday, October 20, 2009

Murder at UConn: What If It's Not a One Time Thing?

University of Connecticut football player Jasper Howard got the game ball in the win over Louisville on Saturday. The next morning, he was dead, stabbed to death outside a college dance in the wee hours of Sunday morning. This case has all the criteria to catch the public's attention and traumatize a lot of people. Howard was young. His death was sudden. He was an expectant father. It's football season, and he was a college football star. He died on a college campus.

The memorials for Howard are underway. The team will wear his initials on their helmets when they play West Virginia this Saturday, and the campus is observing a "day of silence" for Howard today. The University Black Students Association is asking everyone to wear dark clothes in his memory as part of that observance. A candlelight vigil will be held tomorrow.

Properly honoring the memory of students who die suddenly is a tricky situation for schools and colleges. Obviously, educational institutions want to be respectful of students who are mourning and send a clear signal that they care about their own. In cases of violence, like this one, they are also trying to send the message that violence will not be tolerated on their campuses, and to give the community an outlet for their grief and a chance to come together rather than retaliate (if there is someone to retaliate at).

All of this, however, is predicated on the idea that such incidents are so rare that the observances are one-time events. If this is only going to happen at UConn once, then pulling out all the stops in honor of Howard's memory is more than appropriate. The problem, however, is that large campuses usually experience traumatic deaths more than once. Even though such an event is rare, someone else at a university as big as UConn either has been or will be murdered, be killed in a car accident, or die suddenly by some other means.

So, what is the UConn community willing to do in memory of these other students? Does it intend to hold vigils and proclaim days of silence for every student who dies? Every student who dies suddenly? Every student who is murdered? What are the criteria they are going to use to decide who gets a community-wide observance and who does not? And what will they say to the family and friends of the person who dies next week or next year and who want to know why their loved one is not as important as Howard?

When I talk to school administrators about appropriate ways to memorialize a student who died, I always advise them to consider whether what they do for that student is something they are willing to do for any student under the same circumstances. You cannot do something big for a popular student and ignore one who was less popular -- that is likely to be a disaster for everyone involved. You also have to be careful what you commit to. There are schools where they have commited to plant a tree in memory of every student or faculty member who dies, and the result is a "grove of death" which in some places is an attractive nuisance and in other places is a large area of campus where no one wants to set foot. If the death is a suicide, you have the additional concern that you don't want to make such a big deal out of honoring someone that others get the idea that suicide is a good way to get attention.

This is tricky, and I don't in any way mean any disrespect to the UConn community or Jasper Howard's family. They need to do what is right for them to process, heal and grieve. I just hope they are thinking this all the way through.

Monday, October 19, 2009

Death at the Marathon

The last time someone died during the Detroit marathon was in 1994, when a 42 year-old runner died of a heart attack. That is until yesterday, when 3 people died in a span of 16 minutes while running the half marathon. They weren't running together, and the weather wasn't hot -- it was in the 40s here in Michigan yesterday.

This is troubling on a number of levels. First of all, we really don't think of runners as people in danger of dying. People who are in good enough shape to run a half marathon are not supposed to be in bad enough shape that it will kill them. This seems to counter the natural order of things.

Add to that the fact that two of these runners were young. One, Jon Fenlon, was 26 and one, Daniel Langdon, was 36. The third, Rick Brown, was 65, and while his death is not any less tragic, on a gut level it does not offend our sensibilities quite as much. Again on a gut level, 65 year old people do die from time to time. I'm sure that if I knew Brown I would know him to be healthy and vigorous, and my worldview would be shaken by his sudden death. But I didn't have the good fortune to know him and so, perhaps heartlessly, it doesn't bother me nearly as much. Fenlon and Langdon, on the other hand, were not only in good enough shape to be running this race, they were both younger than I am. That's not how it's "supposed" to work.

There is a real temptation as well to see a nefarious pattern in these deaths. After no deaths for 15 years, three in 16 minutes sounds like a lot. I went looking for some data, and found references to two studies, one of the London Marathon and one of the New York Marathon. In the London study, the risk of death was found to be 1 in 67,000 runners. In New York, it was 1 in 320,000. That's a big difference, but for the sake of argument, let's take London number.

There were somewhat less than 20,000 people in yesterday's Detroit marathon. At that rate, we should have about 1 death every 3 or 4 years in Detroit, so three in a day is a lot. The odds of that happening are about 3/10 of one percent. On the other hand, if you look at the stats since 1994, there have been 4 deaths in 15 years, which is just about right. It's all how you look at the numbers. And the fact that the three who died yesterday died in rapid succession isn't really surprising at all -- they were all between an hour and a half and two hours into the race. If you're going to have a health issue, it's reasonable to assume it's more likely once you're a fair amount into the race.

Any death during a marathon is horrifying. If it could happen to them, it could happen to anyone. It's just important to keep in mind how unlikely it was to happen to them in the first place.

Sunday, October 18, 2009

Balloon Boy and the Punking of America

OK, I admit it. I got suckered. So did most of you. The Falcon Heene Balloon Boy story was a publicity stunt, and his parents are now looking at felony charges. We're all feeling pretty silly, especially those of us who blogged about this story, because now we can't very well pretend we knew all along. However, this is still a current event and that's what I blog about, so I'd like to explain exactly what is wrong with what the Heenes did, from a crisis intervention point of view.

First of all, I think their plan was doomed to failure. As a school Principal, I have been saying for years that I ought to write a book called "How to Misbehave in School" which would include such tips as, "Do not sign your own name to graffiti" and "When the Principal asks you if you know why she called you to the office, say no!" If I were writing a book called "How to Punk America" it would definitely include the tip, "Make sure your plan does not rely on a 6 year-old being able to keep a secret." That was a fatal flaw, in my humble opinion.

This also reveals something more serious, which is what this incident does to the children in the Heene family. One of the basic tenets of talking to children about traumatic events is that you should never lie to children. When you get found out, and you will get found out, they will have no reason to trust whatever you tell them next, and no reason to believe the comforting words you offer them when they're scared.

Now add to that the fact that, in this situation, the Heene boys themselves were told to lie, and they watched their parents lie. Falcon, at six, is still at an age where reality and fantasy sometimes merge, and certainly where it's hard to determine what in the world is really dangerous and what is a remote possibility. How is he supposed to know whether to trust his parents and siblings now, when they've shown such a willingness to lie? How is he supposed to trust them to keep him safe, as all kids must, when they were so willing to use him to achieve their own aims? When they tell him there are no such thing as monsters, or whatever he might fear, why should he believe them? Is it any wonder this kid was throwing up on Friday? Is it any wonder the charges against his parents include contributing to the delinquency of a minor?

The Heenes have also done a tremendous disservice to every parent who has ever had a child go missing, face real danger or die. When their real nightmare is trivialized by a publicity stunt, it makes us as a society that much less likely to be supportive of their traumatic reactions, not to mention less likely to believe what they tell us happened.

In addition, how many people died or were injured near the Heene residence on Thursday who might have had a better outcome but for the delayed response of rescuers who were stretched thin chasing a balloon? How many children could have been fed or clothed or saved from abusive situations with the money spent on this search?

I got punked. And yes, I'm embarrassed about that and I want someone to blame. It turns out that in this situation, there is someone to blame, and you'll excuse me if, in this one instance, I don't mind doing it.
Saturday, October 17, 2009

Assigning Blame in a Circular Firing Squad

In June of 2007, a University of Michigan Survival Flight crashed into Lake Michigan, killing the pilot, co-pilot and four members of a medical transplant team which was transporting human organs to patients in Ann Arbor, Michigan. The local community here in Ann Arbor, where U of M is a major fixture and a major employer, took this crash very personally. It was covered very much as "our story," and we all struggled to understand how something had gone so wrong with a medical provider who we all consider to be good, particularly when it comes to transplants.

This past Wednesday, the National Transportation Safety Board issued its findings on the crash. They found that the pilot mishandled a problem shortly after takeoff, the co-pilot was poorly prepared and got in the way of an emergency landing, the carrier did not address safety issues and the FAA did not properly force the carrier to address those issues.

On Friday, the pilot's family issued its own statement, fiercely rejecting the NTSB findings. They believe a mechanical problem caused the crash, and they are suing Cessna, the maker of the airplane. In a statement, they said,
the NTSB's depiction of Capt. William Serra reflects the myopic view often induced by the search for scapegoats rather than causes for accidents.

By way of disclaimer, I should say that I know absolutely nothing about the technical aspects of aviation. I know how to make a reservation and find the cheapest price for a flight, and I let the professionals handle the rest. What interests me about this story is the family's accusation that, in the wake of a crash, the NTSB is looking for someone to blame.

It is certainly the case that, following a tragedy, we naturally tend to try to find fault somewhere. We are naturally wired to find patterns in the world, and random events are extraordinarily uncomfortable for us. Random events cannot be predicted and cannot be avoided, and that terrifies us. So we look for someone to blame. If we can't find someone outside of ourselves, we will blame ourselves. So yes, the investigation of a crash is, in part a search for a someone to blame.

For the family of the pilot, the search for blame is a little different. They, too, are hoping to find a reason for what happened. But since their experience is that this event happened to their loved one, they are going to be extraordinarily reluctant to blame him for what happened. They have assigned fault to the manufacturer of the plane.

What's interesting to me is that the family is accusing the NTSB of looking for a scapegoat when, in fact, they appear to be doing the same thing. It's possible the NTSB is wrong. It's possible the family is wrong. It's possible both are wrong, and it's possible both are right. But it certainly is the case that both the NTSB and the family have very good, healthy reasons to be pointing fingers. Adding to that by accusing the other of simply wanting to blame someone is, in the end, the pot calling the kettle black.

Friday, October 16, 2009

Carolina Forest High School: Not By the Book

There was a school shooting in Myrtle Beach, South Carolina this morning, and a 16 year old boy is dead. That, by itself, is very upsetting, certainly to the people who were there, but also to society as a whole, as we reflect on what our world has come to that someone can be shot in school. And that's where it gets, well, weird.

The details are still dribbling in, but as best as we can tell, Trevor Varinecz, a junior at Carolina Forest High School, asked to see the school resource officer -- a police officer stationed at the school -- at about 8:25 this morning. The door to the room where the two met was closed, so no one knows for sure just yet, but it appears that Varinecz stabbed Officer Marcus Rhodes and Rhodes shot Varinecz in self-defense. Rhodes is in the hospital. Needless to say, if there is such a thing as a "typical school shooting," this is not it.

When you train as an early crisis responder, you learn that there are certain patterns that different types of incidents fall into. While each incident is different, there are predictable themes that come up. Suicides cause one set of reactions, natural disasters another, domestic violence yet another. You can expect different things from those who have been involved in car accidents than from those who witnessed a mass shooting. No two incidents have exactly the same reactions, but you can prepare. From time to time, as a responder, you work on an incident and come out saying, "that was page 73 of the textbook." Sometimes it is that cut and dried.

A good Critical Incident Stress Management Team knows what to expect from an officer involved shooting. They know what to expect when an officer is injured. They know the patterns when a child dies, and those from violence in a school. They even know that sometimes two types of incidents combine into one event.

All that having been said, I don't think there is a team in the country that feels truly prepared for what happened at Carolina Forest High School today. There is no page in the textbook for the injury of an officer at a school in an incident resulting in an officer involved shooting of a child. As a school CISM Team Leader myself, I look at this incident and have to take a few moments just to swear under my breath before I can even consider where I would start.

This is just one more reminder that emergency preparedness isn't just about practicing for every awful event you can imagine. It's also about developing a tool kit of skills and the creativity and flexibility to use them in new ways, when those things that you can't possibly imagine in a million years happen on your watch.

Thursday, October 15, 2009

All's Not Well, Even When It Ends Well

Update: Falcon Keene was found hiding in the attic of his home about an hour after I wrote this post. I know all of us are grateful for the happy ending. Best of luck to him and his parents recovering from this day!

As I write this, searchers are looking for 6 year-old Falcon Heene. He's the little boy who reportedly climbed into the basket that was attached to a giant Mylar balloon, which in turn was tethered to his family's home in Fort Collins, Colorado, this morning. According to his brother, he then untied the balloon and it floated away with him in the basket. After an hour and a half and a rescue attempt by the Colorado Air National Guard, the balloon landed. Falcon wasn't in it.

There are now two possibilities. One is that Falcon was not, in fact, in the balloon when it took off. He untied it, it floated away and he got scared, perhaps because he knew he was going to be in big trouble, and went to hide somewhere. This, of course, is what everyone is hoping for. The other possibility is that he fell out of the balloon sometime during its flight, and is injured somewhere below its flight path.

I am going to think positive thoughts for the Heene family, and presume, for the sake of this blog post, that Falcon is found alive and well -- that he's hiding or, if he fell, he was not seriously injured. I don't think there's anyone who would disagree that that is the desired outcome here. And certainly, if and when it occurs, Falcon's parents will be relieved.

I would like to argue, however, that even with that positive outcome, this will still most likely be a critical incident for the Heene family. If a critical incident is one which has the power to overwhelm one's usual coping skills, this one certainly qualifies. Even after Falcon is back home, safe and sound, his parents will have some serious processing to do. They won't have to process a death, but there are many losses nonetheless.

The Heenes have lost the idea that they can and will keep their children safe. I say that without casting blame in any way. Whenever a parent experiences a dangerous event involving their child, they have to confront the reality that we cannot protect them from everything. That is hard. We are evolutionarily inclined to view our number one job as parents as maintaining the health and safety of our children. Failing at that, in a big or a small way, is fundamentally disturbing.

The Heenes will also have the added burden of knowing that they, themselves, could have prevented aspects of this from happening. The balloon was accessible and they were not there when Falcon decided to untie it. As hard as it is to realize you can't protect your children, it's even harder to realize that you could and you didn't. Again, I am not judging. Hindsight is 20-20, as the saying goes, and certainly had the Heenes known this was going to happen they would have stopped it. But they didn't know, and they didn't stop it, and that's going to take some time to deal with.

Once again, I am sending all positive hopes to the Heenes and their community, and wishing them good courage as they try to understand this event in the days to come.

Wednesday, October 14, 2009

Odd Odds

Those who read the Quarterback regularly know that we tend to be more traumatized by events that we perceive to be rare. If our worldview suggests that something doesn't happen, it jars us when it does. The trouble with this, however, is that we are actually pretty bad at judging how rare things are. Even for those who, like me, make it their business to go digging up probabilities and statistics on various heinous situations, it's sometimes hard to find the data you need.

So I was very pleased to hear on NPR today about the launch of the website This site is extraordinarily simple. Put in the key word you are interested in, and it gives you a bunch of odds statements involving that key word. For example, if you type in "Naomi," you will discover that the chances of a female born in 1970 being named Naomi is 1 in 3,300. You can then put in the number 3,300 and discover that the odds of me being named Naomi are identical to the odds that an employed person over 16 living in South Dakota is an anesthesiologist. And while those particular statistics may not be very meaningful to you, you can imagine there are others that are.

For example, if you type in "New Hampshire" and "murder," you will discover that the odds of any given person in New Hampshire being murdered in the next year are 1 in 101,200, but the odds of someone living in Washington, D.C. being murdered in the next year are 1 in 3,182. So when I said last week that the murder of Kimberly Cates in Mont Vernon, NH was more shocking because of where it happened, I wasn't just blowing smoke.

If you explore those numbers more carefully, you will discover that the odds of being murdered in New Hampshire are slightly lower than the odds of any given person in the United States having to visit the Emergency Room in a given year because of an accident involving a drinking straw. Meanwhile, the odds of being murdered in Washington, D.C. are about the same as the chances that a woman my age is named Kimberlee. They're also about the same as the odds of someone in Boise, Idaho being a victim of a robbery. Now we can start to see why trauma affects different communities differently. It's not that the incident is less awful to those close to it, it's that it's more shocking to those further out.

This data is also useful in helping us put our fears in some perspective. For example, this summer plane, train and subway crashes were getting a lot of press. It turns out that the chances of dying in a transportation accident -- including a car crash -- in the next year are 1 in 6,212. That's pretty close to the chances of being diagnosed with end stage renal disease. And while both of those things are horrible, we don't live in fear of end stage renal disease. Maybe we should. Or maybe it would help us all to get a little more familiar with some hard numbers.

Tuesday, October 13, 2009

Justice and the Healing of Trauma

Jennifer Schuett was 8 years old in 1990 when she was kidnapped from her bedroom, sexually assaulted, had her throat slashed and was left for dead in a field. Her voice was damaged in the attack and she could not scream for help. She told investigators she knew she was going to die. She didn't. Not only did she live, but she was able to help with a sketch of her attacker and his first name.

Today, 19 years later, modern science did the rest. A suspect was arrested based on a DNA match with evidence at the scene. The suspect's DNA was in the system from a very similar attack on an adult woman for which he has served time. At a press conference, Schuett, now 27, said,
This event in my life was a tragic one, but today, 19 years later, I stand here and want you all to know that I am OK. I am not a victim, but instead, victorious.
Schuett went public with her story in hopes of finally finding the perpetrator. She wants to encourage other victims of violent crime to speak out.

A common and simple summary of this story would say that Schuett will finally get "closure." If authorities have arrested the right man, the perpetrator of her attack is no longer a threat to her and will go to jail. But saying that she now has closure is far too simplistic. Trauma isn't quite that linear and straightforward.

Those who have experienced trauma -- whether from crime or from less nefarious sources -- experience it as a series of events. There is the initial critical incident -- the one that shakes their world view and makes them feel completely off center. Then there are other events, often less severe in their impact, which represent new chapters in their understanding and processing of the experience.

One need only look at the video of Schuett's press conference and listen to her tears to know that this is not "closed." That in no way makes her less of a survivor, or less victorious, or less strong. What it does mean is that once a traumatic incident occurs, it is always a part of the people it impacts. They may process it, incorporate it, and understand it, but it will never be gone.

Most likely, Schuett had acclimated to the "new normal" as a tween, teen, and young adult who had survived a vicious attack. Now, she will acclimate to a new, new normal, where the alleged perpetrator is brought to justice. She will come to understand what that means for her, and she will move on to the next thing. While getting there will, hopefully, not be anywhere near as difficult as processing the original incident must have been, it will still take some doing. If her past history is any indication, she is certainly strong enough to accomplish the task.
Monday, October 12, 2009

We Have Met the Enemy, and He is Us

After a while, writing a blog like this, there are certain things you find yourself talking about over and over again. In the blogosphere, those simply become "tags" for your writing. But some themes are more than tags -- I'm talking about the posts your write where you have to go back and look to make sure you hadn't actually written that post before, because it all sounds too familiar. That's how I'm feeling, today, about the issues of distancing and blame.

It seem like coverage of trauma in the news separates itself, rather neatly, into two categories: stories that are tragic but point out the various reasons this tragedy could have been avoided, and stories that express shock that such a thing could happen. These are two sides of the same coin. Saying an incident was avoidable implies that we will be able to avoid it happening to us. Expressing shock implies that it is anomalous -- that things like this are not "supposed" to happen to people like us, and therefore won't in the future. From these stories, we get a very interesting picture of what a victim of trauma or a perpetrator of crime is and is not "supposed" to be like. If you pay attention to the news, particularly the coverage of traumatic incidents, you will find the following:
  • Victims of trauma -- those who die in traumatic incidents -- are supposed to be poor, not white, and live in cities. They are supposed to be stupid and preferably morally questionable. They tolerate domestic violence and marry entirely the wrong people. They don't have the sense to ask for help when they need it. If they are children, then the adults in their lives fit this description.
  • Perpetrators of trauma -- those who cause death by crime or even by negligence -- are supposed to be poor, not white and live in cities as well. They are supposed to not have jobs and to drop out of school. They are supposed to be male. They are supposed to have a history of drug use and have been abused as children. They are supposed to care about nothing but the almighty dollar, and view women as inherently subservient.
Anything that deviates from these patterns is branded as shocking and unpredictable. At best, it is labeled part of a "troubling trend" that you have probably never heard of before reading the article, even if it truly is on the rise. Anything that fits these patterns is described as yet another statistic in a long line of predictable, horrible incidents. The fact that there is a pattern goes without saying.

There are many problems with this way of thinking, of course. The virtual codification of racism, classism and sexism they demonstrate is at best disheartening. Because they sort tragedies into categories, they help us deny the humanity of those affected by trauma. They make it easy to blame.

Fundamentally, they also do a tremendous disservice to our preparedness for trauma. Part of how we become resistant to traumatic stress and resilient following an incident is by having a realistic expectation of what might happen to us and how we will feel afterwards. While it is not healthy to live in fear of rare events, it is also not healthy to believe they are significantly rarer than they are. Perhaps if we were not so busy convincing ourselves that trauma happens somewhere else to someone else, we might be able to face what our actual risks are and prepare to cope with them.

Sunday, October 11, 2009

The Blame Game Rides Again

It started before the names of the dead had even been released.  It started well before we knew anything about the cause of death -- we still don't.  Commenters on blogs and news sites all over the Web, including this one, have an almost universal contempt for those who died or were injured at the Angel Valley Resort sweatbox on Friday, and for James Ray, the man who ran the five-day retreat.

A commenter on this site wrote,
Some people are idiots - my highly educated (one bachelor's and two masters degrees ) sister went to a sweat lodge a couple of years ago at a spa in New Mexico, and hated it - at least she came out alive! She has more money than she knows what to do with - although the tragedy of this incident is undeniable the bottom line is - some people are just plain stupid! They should have spent their money on world hunger, ending war and stopping genocide. They would probably till [sic] be alive. . .
Over at the Houston Chronicle, writers were equally harsh with the dead and with Ray:
He's another one of Oprah's gurus - beware the gods and gurus. Particularly the ones on Oprah.
Here is [sic} Houston, we have people who die from heat stroke because they simply don't have air conditioning, and yet these people THOUGHT it was safe to FAST for 36 hours, then eat a breakfast, fast for another 7 hours, and then go into a sweat lodge for at least 2 MORE HOURS??? I can only HOPE AND PRAY these fools are charged with criminal negligence. People from up North have NO IDEA how dangerous this can be unless they have lived a summer down here.
I don't see why people purposefully would put themselves through something like that. Either way, I think that those who signed up for something like this are solely responsible for what happens to them at one of these retreats.

I find this way of thinking really troubling.  First of all, I know that people all over the world put themselves through all sorts of things in the name of religious or spiritual renewal.  People spend thousands of dollars to their churches, synagogues and mosques and no one bats an eye.  We participate in ritual fasting (full and partial), self-denial of various kinds, rituals of cleansing and penitence, and much more in the Abrahamic religions.  We don't judge the people who do it, because we recognize, on some level, that everyone needs a spiritual home and a way to find meaning in the world.  We know that in order to be helpful and caring and supportive to the rest of the world, we need to care for ourselves, so we don't channel every single penny to the homeless or Darfur, but spend some on our own spirits.

What's more, this wasn't the first retreat Ray had hosted.  I'm sure it wasn't the first sweatbox ritual he had done.  He himself was in the sweatbox when it happened.  Whether it was a smart idea or not, others had done it and come out alive.  On the face of it, then, it wasn't deadly.

But let's just say, for the sake of argument, that Ray is a charlatan and the people who went on this retreats were idiots.  Let's accept, just for the moment, that no one in this situation had a brain in their head.  Is the punishment for being stupid now the death penalty?  Are we really willing to make the leap from "that wasn't a good idea" to "they got what they deserved?"  Do people deserve to die for making a foolish choice?

Most of us would say no, if you think about it that way.  So why are we so quick to judge?  And why, in particular, are we quick to judge the participants, perhaps even more than the leaders?  Because we want to reassure ourselves that this could not happen to us.  If the participants are morons who did something no rational person should do, and we believe ourselves to be rational, then this couldn't happen to us.  If their choices were unambiguously bad, to the point that any fool could have predicted the outcome, then we would not have made those choices.  What's more, we will not make those choices, and we will not end up dead.

We go to enormous lengths to convince ourselves that we can prevent all bad things from happening.  We like the illusion of control.  And it may well be that this tragedy was preventable.  But we'd better be careful where we throw our judgement, blame and disdain.  When trauma comes knocking at our door, people may very well throw it back at us.

Saturday, October 10, 2009

Surviving a Law & Order Episode

It reads like a TV drama.  Sixty people are at a spiritual retreat.  The organizer promises a journey of the spirit, but has participants sign a lengthy release of liability.  The participants are inside a so-called "sweatbox," an imitation of a Native American ritual, when more than 20 fall ill and two die.  Who is to blame?  A criminal investigation begins.  Were the participants fasting?  In ill health?  Who is this organizer?  Did he know what he was doing?  But it isn't a Law & Order episode.  It's an AP news story.  This actually happened last night at a resort near Sedona, Arizona.

So let's try reframing this drama, shall we?  You have been working to better yourself and explore your spiritual side.  You sign up for a retreat where they will be doing hiking, swimming, wilderness survival, and a sweatbox ritual of some kind.  You've read enough to know that things like the sweat lodge can be very powerful in people's personal and spiritual development.  So there you are, in the sweatbox, when people start passing out.  You don't feel so well yourself.  You go out of the lodge and the paramedics arrive.  You see people being brought out.  More than 20 are taken to the hospital.  Two of the people you've been sharing this important life experience with are dead.  No one knows what happened, the press are crawling all over the place, and the police are taking statements.  This is not the life-changing event you had in mind.

I've written a lot in this space about the natural tendency to look for someone to blame when things go wrong.  I've also written about how things seem more traumatic and get more media attention when they are unusual.  Certainly, in this case, the lack of a clear cause makes people hunger for someone to blame, and the circumstances are unusual enough to get everyone's attention.  But there is also a voyeuristic quality to the press coverage.

This isn't Law & Order.  This was not ripped from the headlines, it is the headlines.  Real people died.  Real people saw them die.  Real families are traumatized and grieving.  So are real survivors.  For those who chose to be at that resort this week, who chose this retreat and this way of bettering themselves, the scrutiny and attention being paid to the "this is weird" aspect of the story has to be complicating their processing.  It's hard enough to question what you could have done or should have known, and to come to peace with the fact that others died while you watched and you lived, without also having to worry about whether the rest of the world thinks you're nuts.

I'm not suggesting in any way that it's not important to investigate this incident.  Knowing what happened is important in helping the survivors cope and in preventing it from happening again.  If someone is criminally negligent here, they should be held accountable.  But in our rush to place blame, let's not lose sight of the real lives lost, and the difficult journey still ahead for those they left behind.

Thursday, October 8, 2009

Cause of Death Matters

Elizabeth Barrow was 100 years old and lived in a nursing home in Dartmouth, Massachusetts. She was in pretty good health, but it was hardly a surprise that she died last month. Hundred year old people die. What was a shock was how she died. She was strangled in her bed and a plastic bag was placed over her head and tied in place with a shoelace. When her family first learned of her death, they assumed that the bag had been placed there by someone trying to cover her body up, and that she had died of natural causes. The medical examiner suspected she might have killed herself. Now that it is clear that the cause of death was strangulation, a criminal investigation has been undertaken.

I don't think I've ever read about a situation that more clearly demonstrated the difference between trauma and grief. Obviously, Ms. Barrow's family was saddened by her death. She was a fixture in the family and they will miss her. But they were not shocked by her death initially. There was nothing particularly unexpected about a 100 year old person dying. As best as I can tell from various interviews that her son has given, the family experienced her death as a loss but also took time to celebrate her life, as we so often do when someone very old dies.

When the autopsy results ruled her death a homicide, the family was thrown out of the natural grieving process and straight into trauma reactions. Trauma also challenges what we think we know about life and death. In this case, that challenge was very literal -- the family thought they understood how Ms. Barrow had died, and then, all of a sudden, they didn't. It didn't help matters that the news that her death had been ruled a homicide was released to the press before the family, so the family learned of it from reporters. Several articles covering this story have used the word "reeling" to describe the family's reaction.

The reaction of the nursing home, while not terribly well worded, also hints at the way the cause of death in this case has thrown everyone for a loop. A statement released yesterday said,
We prepare for these eventualities as persons caring for the elderly who die of natural causes. This situation is especially tragic because the exact chain of events may never be known.
And that is the heart of the matter. Yes, a death is a death. But a traumatic death offends our sensibilities, and we want to understand how it could happen. I hope the Barrow family gets their answers.

Wednesday, October 7, 2009

Mont Vernon, NH: It Happens Everywhere

This weekend, a woman and her daughter were attacked during a 4 AM home invasion on an isolated road in Mont Vernon, NH.  Kimberly Cates, 42, was killed in the attack.  Her daughter, Jaime, 11, survived and is in intensive care.  Four teenagers who live about 15 miles away have been charged in the attack.  The allegation is that these young men selected the house at random because of its isolated location, and agreed to kill whomever they found inside.  Depending on which coverage you read, they either intended to rob the house and would kill the occupants if necessary, or they went in with the sole intent of killing the occupants.

This is a horrific crime by any standard.  It is made to appear even more awful by the fact that the last violent crime in Mont Vernon, before this one, was 10 years ago.  The statements being made by residents and even officials in the aftermath of this incident reflect the fact that the traumatizing thing about this crime is not just the crime itself, but how unexpected it was in this town:

From the Senior Assistant Attorney General:
"This type of murder does not happen very often. This is something out of the ordinary."

From the senior photo editor of the Nashua (NH) Telegraph:
"The people up here aren't used to this kind of thing. This never really happens."

From a resident:
"I've lived in Mont Vernon for 40 years, and this is just unbelievable."

From the chair of the Mont Vernon board of selectmen:
“It’s very much that bucolic, Norman-Rockwell-type New England setting. . . . This brings it home, that people who do bad things are everywhere, not just in big cities.”

From a neighbor:
"It's just unbelievable that this could happen next door to us."

I will admit that none of these statements sat well with me at first blush.  On the one hand, I certainly understand that violence is more prevalent in some places than in others, and that Mont Vernon, before this weekend, had been one of the "others."  On the other hand, it can appear that by saying, "this isn't supposed to happen here," people imply that it is supposed to happen somewhere else, when of course it shouldn't happen anywhere.

At the same time, I think we all intuitively understand that violent crime is more shocking when it occurs in a place with very little violence.  It's not too hard to imagine why, either.  The more violence you are exposed to on a regular basis, the more your world view incorporates the possibility of violence.  When a violent death occurs, it is not as violating of your deeply held beliefs, because those have already shifted ahead of time to accept the possibility that something like this could happen.  In some sense, people who live in violent communities get their pre-incident inoculation training simply by living where they do every day.

It's important to remember, however, that no amount of pre-incident inoculation can prepare you for this happening to someone close to you.  It is one thing to know that violence happens in your community and to not be traumatized when it occurs around the corner or down the block.  It is quite another to be "used to" someone in your family being murdered in their own home.  I don't think that is possible.  While our world view may come to incorporate the possibility of violence, it can't really incorporate the sudden and violent death of someone important to us.

When it comes right down to it, the greater power of incidents like this murder in Mont Vernon is its effect on the community, not on those closely tied to the victim.  Whether you live in Mont Vernon, NH or Detroit or L.A., if someone you love is murdered in their bed you will be traumatized.  The power of the Mont Vernon murder is in its impact on the other residents.  No one in Detroit or L.A. thinks this sort of thing doesn't happen here.  For Mont Vernon, this is a very traumatic wake-up call.

Tuesday, October 6, 2009

Pregnant and Scared, But Should You Be?

Yair Anthony Carillo is back home with his mother tonight, after a first two weeks of life with more drama than most adults can even dream of.  Carillo was kidnapped last Tuesday at the age of 4 days.  His mother was stabbed and left to bleed to death by a woman who, apparently, was intent on passing him off as her son, adopted from a "friend" who was "going to jail."  He was found on Saturday, but after a brief visit with his mother both he and his three siblings were placed in foster care while child welfare personnel investigated an allegation that someone in the family had tried to sell the children.  Yair's parents have now been cleared.

Every so often, one of these stories grabs our attention.  A woman late in pregnancy or having just given birth is attacked and often killed. The baby is stolen.  Often, we later learn that the kidnapper has been telling friends she is pregnant or, less frequently, about to adopt a baby.  The stories make news because they are sensational, and America loves anything having to do with a baby.  From time to time we get word of a missing pregnant woman, and those stories also get a fair amount of attention.  Most commonly, those women are white and relatively affluent.  They are frequently found dead or never found at all.  And, most commonly, their husbands or boyfriends are charged with the crime.

The fact of the matter is, homicide is the second most common cause of non-health-related death for pregnant women.  It is more common than suicide and somewhere behind car accidents.  Headlines on this topic say things like "Homicide:  A Leading Cause of Death Among Pregnant Women."  The stories then go on to tell us that one third of pregnant women who are murdered are murdered by their intimate partner.

All of this is enough to whip you into a frenzy, but as with most statistics it's a good idea to look a little deeper.  First of all, the leading cause of death among pregnant women is not homicide.  It is pregnancy.  About 7.5 pregnant women die per 100,000 live births in the United States right now (down, I should point out, from about 850 per 100,000 in 1900) due to pregnancy-related complications.

Second, the homicide rate among pregnant women is actually lower than in the population at large.  While the homicide rate in the United States in 2008 was 5.4 per 100,000, the rate among pregnant women is somewhere around 1.7 per 100,000.  So how can homicide be both at a lower rate for pregnant women and a leading cause of death?  It's all in how you look at the data.

Pregnant women are less likely to die from some other causes of death than the general population.  Their suicide rate is somewhat lower, as is their rate of auto accidents.  The fact that homicide appears higher in the list of causes of death, however, does not mean that pregnant women are more likely to be murdered than other women.  They're not.  They're just more likely to have been murdered if they die at all, if their death was not caused by the pregnancy, than they are to have died by some other means.  That's a lot of ifs.

What's more, the typical homicide of a pregnant woman, furthermore, is not a kidnapping attack, nor is it the murder of a white, affluent woman.  It is very disproportionately the murder of an African-American woman who is poor and has not received adequate prenatal care and who is murdered by her spouse or boyfriend.  It is a sad commentary that those cases almost never make the news at all.

So before we all get into a panic about the safety of pregnant women and their babies, it might be a good idea to take a deep breath and realize that what we're really reacting to isn't really the rate of homicide.  It's the fact that pregnant women are murdered at all, which offends our sense of motherhood and pregnancy as being sacrosanct.  We imagine that someone who would kill a pregnant woman would kill anyone, which makes us all feel unsafe.  In the end, however, while any homicide is a traumatic tragedy, the murder of a pregnant woman isn't really that different than the murders we ignore in this country every day.

Monday, October 5, 2009

The H1N1 Vaccine

The H1N1 vaccine began being shipped today.  The nasal spray version (which is only for patients ages 2-49) is being given started today, and the injectable version should begin to be available later this week.  I want to say at the outset that it is none of my business whether you choose to get the vaccine or to immunize your children.  I would not presume to make that decision for someone else -- it is between you and your doctor -- and I would hope that others would give me that same courtesy.

I do, however, have a particular interest in how the roll-out is being handled, and some interesting patterns are already beginning to emerge.  There seem to be three major issues rearing their heads:

1) People want the vaccine who cannot yet get it.
A story in today's New York Times indicates that doctors in the New York area -- and I doubt they are alone -- are getting swamped with calls from patients wanting the vaccine for themselves or their children.  But the vaccine is not available to the general public, and what's more, the people who are calling for it are not going to be getting it in the first wave.  If they think they can get it now, I can't imagine they're going to be thrilled when their doctor's office actually has it and they still can't get it.

2) The system for getting the vaccine is a mystery to most people, including doctors.
Did you know that the vaccine is free?  On the other hand, did you know that if you get it from your local health department you probably won't pay at all, but if you get it for your doctor you (or your insurance) may pay for the administration of the injection but not the vaccine itself?  The public health strategy is to get as many different places administering the vaccine as possible, but because when it will be available is somewhat up in the air, there is no systematic process for making sure that the people who need it all get it.  Ironically, our health care system is ill prepared to use its non-single-payer structure to administer a single-payer vaccine.

3) There isn't a single, strong, systematic message about the vaccine coming from the government.
There are a number of conspiracy theories out there, which I won't bother going into.  There is also a fair amount of misinformation (e.g. you can get the flu from the shot) in addition to some legitimate questions (e.g. has the shot been adequately tested?  Are manufacturers responsible for the safety of the vaccine?) that are being raised.  While there are public officials addressing these things as they come up, no one seems to be anticipating the controversy and trying to give a coherent, comprehensive message about the vaccine, its importance and its safety.

I think what has happened here is that we had a pandemic flu plan for a deadly flu strain.  We imagined what it would take to get vaccine manufactured and out to the public to save thousands or hundreds of thousands of lives.  What we didn't plan for was a pandemic of a fairly ordinary strain.  As one commentator on the New York Times website said today, the difference is not the virus, it's the epidemiology of the virus.  We did not anticipate having to convince people to get vaccinated.  If this were killing the way the 1918 flu did, few people would resist vaccination.  The government is way behind in its ability to talk to the American people intelligently about this vaccine.

In my school district, what started as a discussion of having children vaccinated during the school day has changed to a plan to hold three clinics in the district after hours for children and families.  That is probably just as well -- the thought of immunizing children with an injection during school made staff's blood pressure go through the roof.  My analogy was that this would be just like picture day, only with pain.  What a logistical nightmare.  Even the limited clinics that we have planned are controversial for some.

Again, it is none of my business whether people vaccinate themselves or their children.  I just think that, if the government wants people to get vaccinated, they need to make it much simpler to do and easier to understand why they think you should do it, or a lot of people will be lost to poor information and logistical hassles.

Sunday, October 4, 2009

Do You Have to be an Amateur to Be a Hero?

You may have seen the video. A Bronx, New York apartment building is on fire. A man, a civilian is on the top of the fire escape outside a fourth floor window. A firefighter hands him an unconscious 4 year-old boy, and he begins to walk down the fire escape. At the next landing he stops, lies the boy down and does something for a few seconds. Then he gives the thumbs up sign and yells "he's OK."

The man is Horia "Billy" Cretan, 33. He is a Romanian immigrant who owns an electronics store in the building. When the fire broke out late Wednesday afternoon, he heard the boy screaming and went up the fire escape to try to get to him. After firefighters arrived, one went into the apartment and handed the boy out to Cretan, who has become something of an instant hero as the video of the
rescue circulates.

But, of course, there are two heroes in this story. Cretan is getting a lot of attention because he is a civilian who risked his own life for a little boy, and because the rescue was captured on video. Getting less attention is Jimmy Senk, the Bronx firefighter who entered the burning apartment and found the boy after he, as young children often do, moved away from the window just as Senk arrived on a ladder to rescue him. Senk went in the window next to where the boy wound up, and so handed him to Cretan rather than take him down the ladder.

Interestingly, this is not the first person Cretan has rescued from a fire. When he was 12, he rescued his own sister from a fire that killed his father. This makes me wonder whether he was motivated more by his own experience of fear and loss from his childhood or by his own experience of success in rescuing someone before. Either way, you have to imagine that this incident triggered some feelings and reactions related to that past trauma.

Senk, on the other hand, doesn't seem too phased. The fact of the matter is, firefighters are trained to do this. A successful rescue is a triumph, not a trauma. Firefighters are prepared for the fact that they will be working in burning buildings. The rest of us expect our buildings to, well, not be on fire. So an experience of successfully saving someone from a burning building, while joyous for everyone, is also traumatic for civilians. It isn't, necessarily, for firefighters.

That difference is part of the reason why Cretan has gotten all the attention. Senk did what he was trained to do. Cretan made a very risky choice that no one would expect of a civilian. Let's not forget, though, that working in a burning environment is dangerous for everyone, and rescuing someone from it is heroic regardless of whether it's your job or not.

Saturday, October 3, 2009

Abnormally Normal

Yesterday, I spent the day training crisis team members in Group Crisis Intervention. A big part of the material for the first day of the class is learning to distinguish normal stress reactions after a traumatic event from those which may require more intervention. Sometimes, the difference is pretty obvious (shaking is normal, bleeding is not). Sometimes, however, pretty disturbing symptoms are considered normal. For example, it's not at all unusual for a traumatized person who is usually quite calm and collected to jump at even relatively small noises. I think about 80% of the benefit of early crisis intervention comes from telling people that they are normal.

However, I never use the world normal to describe these things, because they don't feel normal. Someone who cannot concentrate for 30 seconds on the simplest task does not like to hear that he or she is normal, because that seems to be saying that they should feel OK about it, and they don't. I prefer to tell people that their reaction is a typical reaction of a normal person to a very abnormal event. That sits easier with most people.

Traumatic events feel inherently random. They disrupt our sense of order in the universe. So it's hard to imagine, sometimes, that either the events themselves or our reactions to them could possibly fall into predictable patterns. On the face of it, that implies that the events themselves are predictable and, by extension, preventable, even though often they are not. The fact that you can make predictions about an event or people's reactions to it once it has happened does not mean that the event is any less horrific or that it could have been foreseen.

I thought about this last night as I read the news that a suspect has been arrested in the beating murders of five members of the Gee family in Beason, Illinois last month. The suspect is the former son-in-law of one of the victims. In other words, a man is suspected of beating his former father-in-law and his family to death. The fact that the suspect is a family member is predictable. Family annihilation murders are often committed by male family members. In fact, I actually predicted that this was committed by a family member when it first happened. This pattern is typical. But I still find it hard to call something so awful by the label "normal."

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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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