May 7, 2015
On Eating Crow and the Point at which Reality and the Movies Diverge
I grew up on movies. They are in my blood. Not only that, they have shaped the way in which I see the world and the role of the individual in it. See, in movies, the individual is often open to something that society is closed to; he often sees something sinister where everyone else sees something decent. In particular cases, the individual sees optimism and the potential for change, while the group remains pessimistic and stuck in old, tried-and-true ways. Think movies like Patch Adams, Extraordinary Measures, and I, Robot. In movies like these, it is the individual that refuses to go along with the system who is ultimately triumphant. These movies all contain the same message: Don’t go along with the majority just because they outnumber you, for they could all be blind to the truth. Life is not a movie, of course. If it were, a recent incident would have turned out much differently for me than it did.
A few months back, my wife and I took our newborn daughter in to get two vaccinations. On the way there, I made a simple request: that both shots be given in the thigh and not the shoulder. I had reason to believe that the thigh was a safer location for shots and that shots administered in the shoulder were more likely to result in scarring and have more potential for complications later on. I thought this would be a simple matter, yet when the request was made, it was immediately shot down. The reason: They just didn’t do it that way. In the movie world, this was the perfect set-up for a “man against the system” storyline.
Taking on the role of the lone crusader, I refused to allow my daughter to be administered the vaccine in what I deemed to be an unsafe location, and I became determined to find a doctor who shared my way of thinking. During this stage of my experience, at each turn, my adventure became increasingly similar to one of those cinematic conflicts that pitted new ways of doing things against the rigid, backward thinking of hospitals and health administrators. In my movie, they simply refused to listen to reason and had no explanation for their actions other than vague administrative procedures. At one point, they even justified their actions by saying that schools needed the shot to be done in the shoulder so that on the first day of school, students could line up, lift up their shirts, and reveal that they had all been vaccinated. Needless to say, this argument did not persuade me.
At some point in movies like this, the protagonist always finds an ally, something who shares his beliefs but had previously considered himself too powerless to act alone. For me, this person came in the form of relatives in the United States who confirmed by suspicions and acquaintances who shared with me their own experiences. Their doctors, they maintained, had administered the shots in the thigh, and they just couldn’t understand why other doctors wouldn’t. Now my story resembled a movie even more, for I was building a community of people with like-minded concerns. There was also the sudden revelation of an underground group of doctors who shared my concerns and were themselves fighting against the system. At one point, I even thought I had found a doctor who would buck the system, yet just as quickly as he appeared, his presence in the film came to an abrupt end. His clinic, I learned, did not give the desired vaccination. In the cinematic world, this would have been evidence of the system getting to him, of someone somewhere having pressured him to conform to rules that ran counter to his beliefs.
In the cinematic version of my story, the wall would narrow and people once considered allies would begin to distance themselves. Inevitably, someone would tell me, “Give up. You’re all alone on this.” – a la Gary Sinese in Snake Eyes. But would I give up? Of course not. I would persevere, fight through adversity, and eventually brings about change. In fact, in my film’s final scene, I was convinced I would stand victorious and that those who had come to believe what I had fought so hard for would show their newfound appreciation by breaking into spontaneous applause or presenting me with an award for my tireless efforts. A new day would begin, and humanity would be better off because of the efforts of this one lone fighter.
So what happened in my case? After two months of stubborn persistence, I was finally able to discuss my situation with a pediatrician I had known for a few years. She listened patiently and understood my concerns, yet, in the end, she questioned my information slightly. According to her, I seemed to have a misunderstanding of the most common vaccination sites. How could this be, I wondered? Wasn’t I the hero in this medical drama? As it turns out, I was not. Instead, I was just a concerned parent who didn’t have a complete understanding of the issue I was railing so hard against. The situation, however, had been worsened by medical officials who quoted administrative policy instead of explaining the medical reasons behind the particular vaccination in question.
So let’s rewind back to the beginning. The immunization in question was the BCG vaccine, which is used to prevent tuberculosis and to treat some forms of bladder cancer. It is typically administered in the shoulder and has been credited with leaving scars that can range considerably in size and severity. However, it is not given in the United States, a fact which explains why nurses there might not be as aware of it as nurses in other countries. Most vaccinations fall in the category of IM vaccinations, the I standing for intra, which means within. The M is short for muscular. Most childhood vaccinations fall into this category, and they can be administered in either the thigh or the shoulder. However, almost every medical organization recommends the thigh for the first one to three years of a baby’s life because the skin is thicker there. This is the information that I went into that initial hospital with. It was - as I will explain – incomplete.
The BCG vaccine happens to fall into a different category. It is considered an ID (intradermal) vaccine, and this kind of vaccine has to be administered in a place where the skin is thinnest. That place just happens to be the shoulder, although there are apparently three other places that have equally thin skin. My argument was essentially wrong. I was asking doctors to do something that made very little medical sense to them. But what about the scarring that I was so worried about? The fault for that, I learned, was the inclusion of the smallpox vaccine in the BCG vaccine, a practice that was discontinued a few years ago. Some of this information I vaguely recalled having read somewhere, yet I either hadn’t processed it or had mentally dismissed it, as it did not conform to ideas that I was convinced were accurate.
It should be clear by now that I am not the hero of my own movie. Hollywood will not be knocking down my door begging for the rights to the story, and the medical profession is not better off because of my efforts. If there is an upside to all of this, it is that I am now more knowledgeable about vaccines, and I can share my experience with other people. And maybe, just maybe, my story can demonstrate the irrationality of quoting policy to concerned parents instead of the reasons for medical procedures. After all, incomplete knowledge can be just as worthless as vague justifications based on hospital policy or where you happen to live.