In the Spotlight

By Charles F. von Gunten, MD, PhD

I made a home visit to an elderly woman with advanced myelodysplastic syndrome-a kind of cancer where the bone marrow stops producing enough red blood cells, platelets, and white cells to fight off infection. She wanted advice about pain and sleeplessness.  She gets weekly blood tests and near weekly infusions of either blood or platelets. There is no treatment that can make her bone marrow start working again. She has been offered enrollment in hospice care, but has refused.

On my examination, she was forgetful and frail in appearance. There was some mild confusion. She has hip pain mostly when she walks, but she is comfortable when she is sitting. I was able to provide her medications to improve her pain management. Her nurse practitioner (case manager) said the change in her quality of life was dramatic!

When I walked into her home for a follow-up visit, I expected this patient to be satisfied with having her pain under control; instead, when I asked her what she thought about her pain being managed, she replied “So what?! So what if I am sleeping well and have minimal pain, and can think clearly. So what if my daughters aren’t as worried about me—is it just to go back and forth to the outpatient infusion center and live to the next infusion?”

Her response to me was a great reminder that palliative medicine is not just pain and physical symptom control; neither is it just ‘good communication skills’ to get people to tackle the physical, emotional, practical and spiritual dimensions of an incurable illness. Those are the entry-way or baseline things we do—but the goal is to move beyond just countering deficits to healing—making a person whole again. Whole persons need meaning in their lives—you can’t give it to them (like a pill or a procedure) they need to find it for themselves, but with some support.

The beauty of Palliative Medicine is in the investment in whole-person care. In addition to pain and symptom management, the importance of looking at the emotional, spiritual and social needs to find meaning and value in living. Perhaps in this situation, using healing modalities such as art therapy (she use to paint), dignity therapy, and pet therapy—can help patients find meaning in their current situation.

Although this patient wasn’t enrolled in a hospice program where those things are easy to include in the plan of care, it doesn’t mean I can’t inform her of these available resources—it may be more work on my end to help identify these additional therapies; but, if I think of these things as ‘non-medical, and not part of the physician’s job’ as I so often hear from medical students and residents, then I am only a symptomatologist, and not a palliative medicine clinician. This patient is just one example of all of those with serious advanced illness who need the healing we have learned how to provide—the challenge is how to make it meaningfully available when the person is not yet enrolled in a hospice program.

Charles F. von Gunten, MD, PhD is the Provost at The Institute for Palliative Medicine at San Diego Hospice. As one of the foremost experts in the field of palliative care. Dr. von Gunten has published and spoken widely on the subjects of hospice, palliative medicine, and pain and symptom control.

Charles F. von Gunten, MD, PhD is the Provost at The Institute for Palliative Medicine at San Diego Hospice.  As one of the foremost experts in the field of palliative care. Dr. von Gunten has published and spoken widely on the subjects of hospice, palliative medicine, and pain and symptom control.

Our knowledge about relieving the suffering associated with serious illness has never been more powerful in the years of recorded medical history than it is now—but it isn’t a standard for health care. Hospice care was the first place where new approaches to relieve suffering and improve quality of life have been developed over the last 50 years. Just like other improvements developed first in the terminally ill, those discoveries don’t apply ONLY to the terminally ill, but to those with chronic illness. Consequently, the development of palliative care programs in hospitals and clinics throughout the country and around the world has followed. Palliative care is a way to make all that new knowledge available to people before they are dying—when they have months and years to reap the benefits—even if they are cured!

Palliative Medicine is the fast growing new medical subspecialty that concerns itself with the relief of suffering. Have you heard of it? Is it in your community? Physicians are part of the interdisciplinary palliative care team with the chief aim to provide quality-of-life.

Does it matter? About half of all hospitals have some aspect of a palliative care consultation service. If you are a glass-half-full kind of person, its good news. More people are getting better attention to their symptoms and the other components of suffering. If you are a glass-half-empty kind of person, you’ll note that composition and quality is variable. The Institute for Palliative Medicine at San Diego Hospice has the largest training program for physicians specializing in this new field—they go on to be consultants in the nation’s hospitals and hospices.

What’s missing? Consumer demand. In contrast with the revolution in birthing that happened when women demanded that their needs be better met, there is little demand for improvement in the relief of suffering that accompanies serious illness. Consequently, there is little pressure to accelerate the pace of change.

You can make a difference. Speak up about the suffering associated with your illness. Expect that your physician will either address the pain and suffering that you and your family experience, or expect that the doctor will be able to ask for a consultation within your health system to provide the expertise. With this knowledge one shouldn’t have to make a choice between cure of illness and relief of suffering – they should go hand-in-hand and patients should demand as much.

by Laura Martin, MD

When I was still in medical school, my grandmother had a massive heart attack.  I vividly remember the rush to the hospital and how the doctors said she’d lost much of her heart function.  When I visited her in the ICU she looked weary, but calm. We talked about her life and my life as a student and my plans for the future.   We both enjoyed the visit.

Little did I know at the time, but that was the last chance I had to speak with my grandmother.  The next day I got the call.   Her heart had stopped.  The doctors performed full resuscitation — chest compressions, electric shocks, and placement on a breathing machine.  Her heartbeat returned with these measures.

My next visit with her was dramatically different.  When I walked into her room, I noted that my grandmother was propped up in bed with a tube in her throat and the machine breathing for her.  She had a wild, pained look in her eyes.  She squirmed in the bed and looked very uncomfortable.  She seemed like she wanted to say something, but was unable to speak.

A day later my grandmother passed away.

Fast forward to today.  I feel very fortunate to have had the opportunity to have a heart to heart talk with my grandmother before she died. My memories of this conversation are wonderful.  But, I can’t help but think her last days could have been more comfortable and peaceful.

Palliative care, a specialized form of medical care that focuses on treating pain and other symptoms in patients with serious illness, was not available years ago during my grandmother’s hospital stay. That’s changing.   Many hospitals today have palliative care teams. And a growing number of doctors– I’m one of them– specialize in palliative care.

A palliative care consultation likely would have helped make my grandmother’s death less painful and frightening.

Another focus of palliative care is advance care planning.  My grandmother had not filled out a living will prior to her having the heart attack.  Ideally a discussion concerning a living will – where a person expresses his or her wishes concerning medical care in the event they become incapacitated –  is done when a person’s health status is stable.

On my grandmother’s first day in the hospital, it would have been a huge help if a doctor or nurse had spoken with her about whether she would want or not want resuscitation if her heart stopped.  Not knowing her wishes either way, the doctors were compelled to perform resuscitation when her heart stopped the next day.

In my mind, several questions linger. Did resuscitation and treatment with a breathing machine truly help my grandmother or did it merely cause pain and prolong her dying process?

And did my grandmother really want to be resuscitated and placed on a breathing machine or would she have preferred to have passed more peacefully?

Situations similar to my grandmother’s happen in ICUs across the nation every day.   No matter how aggressively people want to be treated, a palliative care consultation can make a huge difference in the impact of serious illness on patients and their families.

Note:  As we approach the anniversary of the terrorist attacks of September 11, 2001, WebMD’s In the Spotlight blog will feature different perspectives on the tragedy and its lasting impact. Here, we feature comments from WebMD Community members who were asked how the terrorist attacks changed them.

From angelswife:
“I lost a good friend as a result of 9-11. He didn’t die in the explosions, but he had a heart attack after, when he was helping to recover the bodies. I didn’t find out until two weeks after the funeral, so I never got to say goodbye. I still miss him.

I don’t even turn the TV on when it’s the anniversary of the bombings. The news has a bad habit of focusing on just the losses (I am not trying to minimize them, by the way). There is very little said about all the good things that grew from the tragedy, and virtually no mention of all the heroes that survived. It’s like they don’t even exist.

My friend was a hero; but since he didn’t die on the actual day, his name is not one that is called. I celebrate him in my own way, with both laughter and tears. I don’t need television to do that.”

From melissiahead:
“It was at that point that I realized that my brother was fixing to be deployed overseas and that was something that was hard to swallow. I knew it was his job because that is what he signed up for when he joined the military but it is not any easy on the family left behind at anytime. He was over there almost 2 years before he came back state side and I tell him constantly how proud of him I am and the rest of our military.”

From Wpooh27 :
“You know I honestly don’t think that we learned anything from this. There is more hate in the world now then there was and I am not saying that has anything to do with that. But we should learn to love more since that tragedy than hate more. So I honestly don’t think we have learned anything.”

From Jis4Judy:
“I think at that time I didn’t believe what I was seeing but the after effect had me having dreams of firemen telling me I was ok and stop worrying. It was a total change in my feelings of being secure. I didn’t know anyone that was directly affected by this tragedy. But I do think it shook us all awake and made us more aware of differences in the people of this world.”

From lasttoknow:
“The Twin Towers was where we went every year on school trips, and to see it gone was unreal… I saw Ground Zero about a year after the attacks and just kept thinking of all the people that died, thousands. It still seems like a dream…9/11 has made me more fearful, but at the same time more dependent on someone greater that myself or those attackers. I just take life one day at a time and enjoy my family and children, because you don’t know when it can all end.”

Note:  As we approach the anniversary of the terrorist attacks of September 11, 2001, WebMD’s In the Spotlight blog will feature different perspectives on the tragedy and its lasting impact. Here, WebMD Medical Editor Louise Chang, MD, recalls working in a New York hospital near Ground Zero when the 9-11 attacks occurred.

On the morning of September 11, 2001, I was in my office at St. Vincent’s Hospital in Manhattan’s West Village.  I was a chief resident there at the time.

We got a call in our office that a plane had hit the World Trade Center.  When I answered the call, I remember thinking at first that it had to be another drill. But it wasn’t.

St. Vincent’s hospital was the nearest level-one trauma center to the World Trade Center, so the ambulances were coming to us first. I went with another chief resident to the ER to assess readiness for what we expected to be an onslaught of patients. I remembered thinking that we were prepared.

The chiefs and department leaders split up duties. I took on the initial job of freeing up as many beds in the hospital as possible. This meant going from floor to floor, assessing patients and working with the doctors to see which patients were OK enough to be discharged, so that hospital beds would be available for WTC victims.

Trying to Focus
I was so busy that I didn’t have time to get all the news about what had actually happened. I was considering it a plane accident and preparing as we had been trained to prepare the hospital for patients coming in.

Then the second plane hit. TVs were on in patients’ rooms, and as I went from room to room talking to patients and assessing them for expedited discharge, I caught snippets of information:  terrorist attack, more planes.

I remember thinking, Would other planes be crashing in the city? How many?

I quickly blocked those thoughts and focused on my job. My coworkers and I were following our crisis protocol and everyone was ready.

Charred View
I worked my way down from floor to floor, taking the stairs. Next to the stairwell door, on every floor, was a large window with a clear view of the World Trade Center.

My first view was a charred and ragged black hole and thick smoke coming out of it. I remember making an effort not to look out the windows. It was too upsetting.

The patients’ rooms also had clear views.  At some point, I heard a patient scream. I looked up and one of the towers was gone.

Patients and their visitors were traumatized and panicked with what was happening before their eyes. Many were tearful and in disbelief. Some reported chest pain and problems breathing. Many patients were worried about the safety of the hospital and other parts of the city. Phones were not working well at the time, so it was difficult for people to check in on family or friends.

I found myself reassuring patients as best I could in the few minutes I had, holding hands and giving hugs.   I didn’t look out any of those upper hospital windows again for several days.

Waiting for Patients Who Never Came
I believe EMS crews brought a few hundred people rescued from the WTC site or surrounding area to St. Vincent’s — far fewer than what we’d prepared for.  Some of the hospital staff went to Ground Zero in organized groups. We saw patients with severe burns, respiratory problems, trauma from falling debris or glass, chest pain. 

In the days that followed, many of those who came to the hospital for treatment were rescuers, paramedics, fire fighters, police, emergency workers. Even search dogs covered in dust and soot were brought to the ER for some rest and showers.

Most of the hospital staff, including myself, lived a couple of blocks from hospital within an area blocked off by the city in the wake of the attacks. Walking to and from the hospital, taking the normally bustling 6th or 7th Avenues, was like walking in a dead zone.

I will never forget the burning smell of the air, the fighter jets over the city patrolling the skies, and the big trucks that rumbled back and forth on 6th and 7th Aves,  loaded with debris. My third-floor apartment faced 6th Ave., so the only traffic I would see and hear for some time was from those trucks.

Acts of Kindness
Most importantly, I remember the kindness of countless people in the West Village and beyond.  People from all walks of life came together to support us and each other. 

I remember being in the emergency room late on the first night when a young man came into the ER with a large cardboard box, passing out peanut butter and jelly sandwiches to everyone.

Long lines of people waiting patiently to donate blood wrapped around the block. Physicians and nurses from outside the city and those who had been visiting as tourists from other countries called our office to volunteer their services.

The James Beard Foundation and local restaurants provided food and drinks for medical and emergency staff. Homeless people helped along side celebrities serving food outside the hospital.

Remembrance, Hope, and Faith
At the back of the hospital, near the ER, there was a portico where people posted hundreds of flyers with pictures and descriptions of missing family and friends. Those pictures showed smiling, happy faces — a stark contrast to the situation we were living through.

It helped to be able to make and post flyers. I also added some to the wall. It became a makeshift Wall of Hope and Remembrance.

Practicing medicine at St. Vincent’s, I had become accustomed to issues of life and death, poverty and excess, pain and recovery of acute illness, and the struggle of chronic disease.

But the events of September 11 forced me to realize the extremes of how horrible and precious life can be.  I was pregnant at the time, and on Sept. 11, I felt despair and worry about bringing my baby into such a world.

But as I saw all of us come together and heal as the days passed, my hope and faith for a better world for my son was restored.

Over the years, I’ve shared only pieces of my 9-11 experience with my son, but he understands the impact it has had on me and others. It has grounded me and helped me appreciate family and happiness all the more.

Note: As we approach the anniversary of the terrorist attacks of September 11, 2001, WebMD’s In the Spotlight blog will feature different perspectives on the tragedy and its lasting impact. In this post, WebMD Executive Editor Sean Swint talks about the impact of 9/11 on his two sons.

On the morning of 9/11, I was driving into my job in Atlanta at WebMD when I heard about a small plane hitting one of the buildings of the World Trade Center. It wasn’t until I got to work and saw my colleagues staring up at the T.V. in a corner office that I learned, along with everyone else, that it was much worse. We all sat in near-silence as the iconic images of the Twin Towers collapsing and the Pentagon in flames became seared on our brains. My reactions probably were not very unique: horror, an almost surreal detachment, and curiosity. Who? Why? Is this really happening?

For the rest of the day, I probably was a bit protected by my journalistic distance as my colleagues and I worked to figure out what we could write and do at WebMD to help. But eventually, like everybody else, I had to go home, driving on near-empty streets, underneath a sky empty of airplanes, something unusual in a city with the country’s busiest airport.

My first day’s feelings were probably not unique. What I really want to write about is what impact 9/11 had on my two sons, then and now.

My Two Sons

I honestly have to say, I don’t remember what I talked about with my family when I got home that day. I’m also not sure how much I tried to protect my sons from the looped carnage playing over and over again on T.V. My wife Christine reminded me that we didn’t keep the T.V. on around them, and that we lit a candle at the base of our fireplace and all sat around it. We just observed; it wasn’t much, but at least an attempt to acknowledge the solemnity of the day, and the loss.

I’ve learned now that moments of ceremony and remembrance like that are important to healing. I’m almost ashamed to say that it took this 10th anniversary for me to actually talk to my sons about what that event meant to them. My oldest son Casey was 11 on 9/11 and blogged about how it had a profound impact on him.

My son Dylan was 8 at the time. For some reason I thought he would have less to say about it because he was younger, and that seems foolish to me now. He was my “little” boy then, but he’s never been little in spirit. He’s always been exuberant and sensitive to people and his surroundings. Ask him how his day went, and he has always answered “great!”

So when I was recently driving him to his freshman year at art school in Baltimore, I asked him if he had many memories and feelings associated with 9/11. He essentially answered, “Are you kidding?” When the planes hit, he and his third-grade classmates were told about it. The kids were scared, and wanted to go home. Dylan says he specifically remembers his mother picking him up that day.

As adults, many of us in high rises felt a shiver for years when we heard a thump or saw a nearby plane. Dylan said for years, whenever he saw a plane in the sky he had a fear it might fall on him. He didn’t make the connection to 9/11 until years later. Dylan said he doesn’t even remember seeing all the T.V. images until a while after it happened, but when he eventually did, they obviously became tattooed on his brain and in his heart.

He is now an artist (and probably was then), and told me that to this day, sometimes when he just lets his hand loose and draws from his unconscious, he often draws crumbling buildings, with people falling out or dying. This is ten years after 9/11. I told my wife this story when I came back from Baltimore, and she pointed to one of Dylan’s many paintings we have on our walls, and said “take a look at that.” I was floored.

What I saw is the painting you see in this blog. I saw a resemblance of the gnarled steel after the buildings’ collapsed, bursting up and out of the painting. I saw chaos and what looked like tears. All that was missing was the smoke. But I also saw warm colors, and dare I say a feeling of hope, that exuberance Dylan has always shown. Now, I may be taking license here, and can’t promise that was Dylan’s intent. But he professes that he doesn’t like to tell people what his art means. He wants them to have their own reaction. So this was mine, and it certainly dovetails perfectly with my memories.

Evil Lives

Dylan told me one other thing in the car that day. He said until that point, he knew there was good and bad, as in video games and cartoons. But life was sunny. On this day, Dylan said he learned that real evil existed, and it changed him. Here was undiluted evil on display. Many adult Americans, so cloistered from much of the real world’s problems, might have had such an awakening that day.

But I also remember firemen and rescue workers running into the burning buildings when people were running out. I remember “average” people on a plane saying their final goodbyes to their loved ones on cell phones, and then saying “let’s roll.” And I see Dylan’s painting. Despite the carnage and pain, the disbelief, and the ongoing damage that day caused, I now see re-birth, beauty, and dare I say, hope.

Note:  As we approach the anniversary of the terrorist attacks of September 11, 2001, WebMD’s In the Spotlight blog will feature different perspectives on the tragedy and its lasting impact. In this post, WebMD Healthy Skin expert Debra Jaliman, MD, who works in Manhattan, recalls her memories of that day.  

It was a beautiful, crystal-clear day. I had the television on as I got ready for the three-hour car ride to the Hamptons, where I was supposed to shoot a piece on skin care with Christie Brinkley. The first bulletin said a small aircraft had crashed into the World Trade Center, where my brother worked as a business consultant. It sounded like an accident at first, but by the time I got in the car, it was evident that it was a terrorist attack. The craziest part was that the producer kept calling to make sure that I was on my way, as if filming was more important than what was happening in Lower Manhattan.

I was desperately trying to reach my only brother, who stayed at the downtown Hilton during the week, just a couple of blocks from the World Trade Center. When he finally answered, my normally calm brother was distraught. He had stayed in his room later than usual making calls. I am forever grateful for that, because had he gone to his office at his usual time, he would have died with all his co-workers, people he had known for years and considered close friends. Now he was stuck at the Hilton, powerless to help, as smoke and panic filled the streets. What he saw haunts him to this day.

We continued our insane trip to Long Island. For nothing, as it turned out, because the producer had come to his senses and realized that the day our nation was being attacked was not the right moment to film. The driver and I turned back, but now all the highways were closed. Only my medical credentials got me through the checkpoints. All over Manhattan, hospitals had swung into emergency mode, preparing for the torrent of patients we all thought was coming, and physicians and surgeons were speeding back to do help in any way. The Long Island Expressway, normally packed with traffic, was eerily empty as we sped back to Manhattan, with the column of black smoke from the towers always in front of us. At one checkpoint, a top aide to Mayor Rudolph Giuliani who was trying to make his way back to the city got into the car. I remember the grim silence in the car and the sense of unreality as I realized that we were the only car on the highway.

I finally reached Mount Sinai Medical Center, where I have taught and worked for more than 25 years, to report in and see if I was needed. That was when I saw what to me was the worst part: the entire hospital staff was outside, waiting for the injured who would never come, for their bodies were buried under the rubble of the towers.

I knew my nine-year-old daughter was safe, because she went to school in a part of the city that was not affected. But the bridges were closed and I could not get to her school. My daughter proved herself a true New Yorker. She was resourceful enough to know that she had to get to Manhattan before all access was closed, so she got a ride in with a schoolmate. She could not get home, because of the panic in the streets, and I did not see her for many hours. But at least now I knew where she was.

The rest of the day is a blur. Since my services were not needed at the hospital, I walked all over Manhattan, taking my daughter’s classmates who had made it in back to their families; I did not know it then, but some of them had parents who would never come home again. No cabs, no buses, no subways, just streams of dazed-looking people making their way across the bridges and up the streets. I do remember how people helped each other. I walked more than 70 blocks in high heels; every time I stumbled, somebody always caught me. By now all I wanted was to hold my daughter.

 Outside the hospitals, hundreds of people had come to donate blood or volunteer in any way they could. Relatives were frantic for news and had already started posting pictures of their loved ones. On Fifth Avenue, one woman held up a picture. “Has anybody seen my daughter? She worked on the 98th floor of the North Tower. Has anybody seen my daughter?” 

Her words followed me all afternoon, even when I was finally reunited that evening with my own precious little girl. To this day, whenever I remember the World Trade Center and how many parents never saw their children again, how many children would grow up without parents, I start to weep. And when I do, I reach for my daughter, either to call her or to hug her as tightly as she will allow.

Note:  As we approach the anniversary of the terrorist attacks of September 11, 2001, WebMD’s In the Spotlight blog will feature different perspectives on the tragedy and its lasting impact. Here, Casey Swint, a  senior at Georgia State University, recalls what it was like to be 11 years old on Sept. 11, 2001.

I think it’s a common misunderstanding among young people in America that we are somehow removed and totally protected from world events.  Ignoring unpleasant current happenings is as simple as turning off the T.V., and with the ocean of distraction that is the Internet we are in (seemingly) complete control of all information that reaches our conscious mind. 

Looking back on 9/11 shows me just how wrong that mindset is.  That day inexorably altered my life and the lives of everybody else on this planet. From the very moment I saw those burning buildings around noon in my middle school art class, the atmosphere of my social existence was permanently altered.

Unfortunately, I cannot help but dwell on the negative in regards to September 11.  Immediately after the disaster had occurred, I remember the rampant speculation occurring among my 6th grade peers as to who did it, much of it baseless, but probably not too much different from adult workplaces that day.

 Some of the comments hit closer to home:  ”We’re all gonna be drafted get ready!” (I’m only 11, holy cow).   

And then some were just inane: “The Japanese have an army of 10,000 ready to fight back!” (uhh, Japan doesn’t have an army). 

But before long, the tragedy came into focus and we all knew a little bit more about Middle Eastern names.  Osama bin Laden became an instant celebrity of evil, and the millennium had begun in proper.           

The coda to September 11 occurred the day America declared war on the Taliban and al-Qaida in Afghanistan.  This fully justifiable conflict was inevitable, but I still remember the palpable fear I felt when I learned that we were no longer in true times of peace. 

The moment of realization remains vivid in my mind. It was the afternoon of a sunny day, my front yard with pine trees all green brown, the sun shining dark yellow outside our window.  On the TV to my left, images of the towers falling were juxtaposed to bin Laden’s horrifyingly serene visage.  And all of a sudden, it was much apparent that these two realities were clashing: the seemingly remote, media-sent world of geopolitics and my idyllic suburban stomping grounds. 

I felt caught in something larger than myself, reasonably enough, I suppose.  Now, in 2011, I hope it can be viewed objectively enough that we as a nation can put it behind us and try to build a world where something of that nature never happens again.

Casey Swint is a history major in his senior year at Georgia State University.

Note:  As we approach the anniversary of the terrorist attacks of September 11, 2001, WebMD’s In the Spotlight blog will feature different perspectives on the tragedy and its lasting impact. In our first post, WebMD senior writer Dan DeNoon talked to several experts about how the attacks affected those who were children at the time.

What about the children? On and immediately after September 11, 2001, this was among the questions most-asked of  WebMD about that horrific day.

Ten years later, questions persist. Here’s what several experts had to say:

How did the 9/11 terrorist attacks affect U.S. children?

Remarkably little is known for sure, says child trauma expert Roxane Cohen Silver, PhD, of the University of California, Irvine.
 
Symptoms of trauma were most likely in children directly affected by the attacks — who witnessed the events, who lost family members, or whose family members escaped. Nevertheless, kids far from the scene of the crimes — even in nations outside the U.S. — also were traumatized by dramatic media coverage.

But even among children who lived in New York City, Silver found, “the psychological and behavioral outcomes of 9/11 often have been found to be relatively modest.”

A few months after the attacks, Silver said, “very few studies found symptoms in children.”

One interesting phenomenon is what happened when Osama bin Laden was killed by U.S. soldiers. There were wild celebrations in the U.S. — but the vast majority of those celebrating were college-age young adults who were 10 to 12 years old in 2011.

The son of a colleague at WebMD was among the celebrants. When she asked him about it, he explained, “Mom, bin Laden is our Hitler.”

“One thing terrorist attacks can do is identify an enemy,” Silver says. “The fact that young people celebrated the killing of Osama bin Laden suggests very strongly that they grew up under the shadow of 9/11.”

“For those who were 8 or 10 at the time of 911 it was a defining moment in their lives,” Karen Remmler, PhD, an expert in the remembrance of tragedies at Mount Holyoke College, tells WebMD. “It is a defining moment that will ground any other experiences of trauma or political attacks, even natural disasters.”

On a positive note, young people are working particularly hard to understand and bring meaning to the 9/11 tragedy, says political science professor Stephen R. David, PhD, vice dean for undergraduate education at Johns Hopkins University.

“Right away it was clear students were anxious about what had happened and craving a sense of what all this was about,” David told me. “One difference with this generation is their increased interest in study of terrorism and how America can protect itself. They are going deeper, with interest in studying Arabic and the countries of the Middle East. They have a desire to understand why people hate America so much. Courses on and travel to the Middle East are much more popular than they were.”

How do children typically respond to trauma?

No two children will respond to trauma in exactly the same way. Their reactions depend on the degree of their exposure to the event, on their individual nature, on their age and stage of development, and on their parents’ level of distress.

As child mental health expert Robin Gurwitch, PhD, notes in a news release from the American Psychological Association, children’s responses to trauma fall into four categories: feelings, thoughts, actions, and physical reactions.

According to guidance issued by the American Academy of Pediatrics, these responses occur in stages:
• Immediately after a disaster, children may be afraid, disbelieving, in denial, grieving, and, if people they know have not been harmed, relieved. Interestingly, children at this stage may be very generous and are looking for ways to help others. This may be a sign that a child is particularly resilient.
• Days to weeks after a disaster, traumatized children tend to regress developmentally. They may show signs of emotional distress such as anxiety, fear, sadness and depressive symptoms, hostility and aggressive behavior, apathy, withdrawal, sleep disturbances, physical symptoms, and pessimistic thoughts about the future. Their play may act out themes related to the traumatic event.
• These symptoms are normal and should last a few weeks. Silver found that in the small number of long-term studies of children affected by 9/11, these initial distress symptoms “seemed to diminish over time.”

Children with stress reactions and behavioral symptoms a month after the event are at increased risk of PTSD or violent/delinquent behavior later in life. Treatment from a mental health specialist “is appropriate and necessary” for these children, the AAP advises.

What effect will the 9/11 10th anniversary remembrances have on children?

Media coverage of the 9/11 tenth anniversary may be anxiety provoking for children with direct experience of the events of 9/11. This likely includes children whose parents are or were involved in the military response to 9/11.

The 9/11 10th anniversary is a good opportunity for parents to talk with children about what they are seeing, hearing, and feeling. It might be a good idea to watch or read some of the coverage with them.

Parents should decide is appropriate for their children — but Silver says there’s no point in replaying graphic images of the violence.

“Whatever is being shown I would encourage parents to discourage children from watching graphic pictures. Parents too. I don’t see any psychological advantage to repeated exposure,” she says.

Instead of wallowing in the tragedy, Silver advises positive steps.

“There are age-appropriate ways to recognize the lives lost, to acknowledge the heroes of that day, to remember how our country came together,” she says. “Families may choose to donate money or blood, or to make displays of patriotism such as flags in the home. These kinds of things enhance recognition of lives lost and ways in which people came together to help those who were bereaved.”

by Laurie David

The overconsumption of meat in the United States is a relatively new problem. American’s now eat 150 times more chicken than we did only eighty years ago. When our grandparents were our age, meat was harder to come by, and was considered a luxury. They didn’t have steak every night. They had soups and pastas and vegetable stews. Meat was used to add flavor or as a side ingredient, more an embellishment than the center of attention. Today we are doing something that was unheard of not too long ago: eating meat for breakfast, lunch and dinner. The average American is consuming about eight ounces of met every single day – which is 45 percent more meat than the USDA recommends!

Today we challenge you to step back and take a look at what and how you eat. The first thing you need to conquer is the belief that eating vegetarian doesn’t mean that you are doing without. Whip up this meatless dish (without saying a word about its contents) and start the vegetarian conversation. After they wipe the plates clean and ask for seconds, you might be surprised at how well they receive the idea of meatless meals! (more…)