SPIRIT OF MAN LECTURE
LOS ANGELES, CA

JUNE 12, 1990

C. EVERETT KOOP, MD

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GREETINGS, ETC.
IT IS AN HONOR FOR ME TO BE WITH YOU TODAY, TO JOIN THE
RANKS OF THE DISTINGUISHED ”SPIRIT OF MAN” LECTURERS. AS
YOUR FORMER SURGEON GENERAL, A PUBLIC HEALTH OFFICER

CONCERNED ABOUT THE WHOLE HEALTH OF THE WHOLE

 

AMERICAN PEOPLE, | APPLAUD THE COMPREHENSIVE THEME OF

THIS LECTURE SERIES.
OUR JUDEO-CHRISTIAN TRADITION VIEWS HUMAN BEINGS AS A
Beowe A Sovt, PossfStrwe A Bebe AwD HAVE

TRINITY, POCCROCIOraDORIEeOmhD A SPIRIT.

PHYSICIANS AND OTHER HEALTHCARE WORKERS KNOW WELL
THE BODY AND THE SOUL, BUT SOMETIMES THE SPIRIT OF MAN
SUFFERS FROM NEGLECT, FROM MALNUTRITION.

| AGREE WITH THE PSALMIST: ”WE ARE FEARFULLY AND
WONDERFULLY MADE.” WE NEED TO NOURISH AND EXERCISE

OUR ENTIRE BEINGS, BODY, SOUL, AND SPIRIT.
GPFFeR MY REMARKS TODAY IN THE SPIRIT OF CALDWELL
ESSELSTYN, SHARING HIS ASPIRATION THAT SOCIETY’S MOST
PRESSING MEDICAL CARE PROBLEMS WOULD BE ADDRESSED
NOT ONLY BY OUR SCIENTIFIC EXPERTISE, BUT ALSO BYA

NOBILITY OF SPIRIT.

TODAY ID LIKE TO TALK TO YOU ABOUT SOMETHING THAT WE
ALL ONCE WERE.... SOMETHING TO WHICH WE ALL LOOKED
FORWARD....SOMETHING TO WHICH MANY OF US LOOK BACK
WITH FOND MEMORIES....,BUT SOMETHING WE DIDN’T LIKE ALL

THAT MUCH AS IT HAPPENED.
PD Leve te fenow wat Win l tHe

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@i® THAT MAGICAL, NECESSARY, TROUBLED PHASE OF LIFE WE

CALL ADOLESCENCE.
HISTORICALLY SPEAKING, ADOLESCENTS ARE A RATHER RECENT
INVENTION. OF COURSE, THERE HAVE ALWAYS BEEN PEOPLE IN
THE AGE BRACKET WHERE WE NOW FIND ADOLESCENTS --FROM
ABOUT TWELVE UNTIL THE EARLY TWENTIES-- BUT UNTIL
RECENTLY SOCIETY HAD A PLACE FOR ONLY TWO GROUPS:
CHILDREN AND ADULTS.

YOU WERE EITHER ONE OR THE OTHER. AND SOMETIMES THE
ADVERSITIES OF LIFE FORCED CHILDREN TO GROW UP VERY

FAST INDEED.
EVEN IF WE REPLACE THE TRADITIONAL ADULT/CHILD DIVISION
OF SOCIETY BY A GENERATIONAL ONE, WE FIND NO ROOM FOR
ADOLESCENTS.

TWO WEEKS AGO WHEN | GAVE THE COMMENCEMENT ADDRESS
AT VASSAR COLLEGE, | LOOKED BEYOND THE YOUNG
GRADUATES SEATED BEFORE ME, TO THE AUDIENCE IN WHICH I
WAS PLEASED TO SEE A LOT OF GREY HEADS. | SAID THAT I WAS
DELIGHTED TO SEE SO MANY GRANDPARENTS THERE, ALONG
WITH PARENTS AND CHILDREN...... BECAUSE MOST OF US SPEND

OUR LIVES IN 3-GENERATIONAL WORLDS.
AS WE GO THROUGH LIFE WE CHANGE PLACES MN 3-
GENERATIONAL WORLD. AND IT DOESN’T SEEM TAKE LONG FOR
US TO GO FROM ONE GENERATION TO ANOTHER.

1 TOLD THOSE YOUNG GRADUATES THAT IT SEEMED LIKE ONLY
YESTERDAY WHEN | WAS RUNNING AROUND THE VASSAR

CAMPUS AS A DARTMOUTH BOY, VISITING THE VASSAR GIRL WHO
WOULD BECOME MY WIFE. NOW MY WIFE AND | HAD RETURNED,
BOTH WITH GREY HAIR, BUT | WARNED THEM THAT IT WOULDN'T

REFoe!e
BE LONG @@8F97 HEY WERE THE ONES WITH THE GREY HAIR.
| REMINDED THE YOUNG GRADUATES, THOSE CHILDREN, THOSE
YOUNG ADULTS, THOSE ADOLESCENTS, THAT THEY MUST

THE
ALWAYS REMEMBER THAT WE ALL NEED Weill OTHER TWO

GENERATIONS....AND ARE NEEDED BY THEM.

BUT EVEN IN A THREE-GENERATIONAL VIEW OF SOCIETY --
CHILDREN, PARENTS, GRANDPARENTS-- IT IS HARD TO SEE

WHERE ADOLESCENTS FIT IN.
PERHAPS THEY BEGAN TO CARVE A PLACE FOR THEMSELVES AT
THE BEGINNING OF THIS CENTURY, OR AS LATE AS THE 1920S,
WHEN COMPULSORY SECONDARY EDUCATION STRETCHED OUT

THEIR CHILDHOOD, CHANGED THEM, PERHAPS FROM CHILDREN

TO YOUNGSTERS.

10
BUT IT WASN’T UNTIL AFTER WORLD WAR II, --THIS
DEVELOPMENT WAS ARTIFICIALLY POSTPONED, FIRST BY THE
GREAT DEPRESSION AND THEN BY THE SECOND WORLD WAR---
WHEN IN THE 1950S MORE AND MORE OF THESE YOUNGSTERS
HAD DISPOSABLE INCOME, WHEN THEY WERE TARGETED BY
ADVERTISERS, WHEN THEY BEGAN TO DEVELOPE THEIR OWN
MUSIC, LIFE STYLES, AND ”YOUTH CULTURE”...IT WASN’T UNTIL

THEN THAT WE BEGAN TO HEAR A LOT ABOUT TEENAGERS.

11
AND WE ALSO BEGAN TO HEAR ABOUT THE PARTICULAR

PROBLEMS OF ADOLESCENCE.

SINCE THE CREATION OF A DISTINCT AGE --OR CULTURE-- OF

ADOLESCENCE WE HAVE SEEN TWO OTHER DEVELOPMENTS.

FIRST, A LENGTHENING OF THE ADOLESCENT PHASE OF LIFE,
THROUGH ON ONE HAND THE CREATION OF MORE ADULT
OPPORTUNITIES FOR SOME, THOSE WHO ATTEND COLLEGE AND
EVEN GRADUATE SCHOOL FOR YEARS BEFORE ENTERING THE

ADULT WORKFORCE,

12
ON THE omtéR HaAwd,
AND, IRONICALLY, THROUGH THE ELIMINATION OF MORE ADULT

OPPORTUNITIES FOR OTHERS, THE HIGH SCHOOL DROP-OUTS,

LANGUISHING IN CHRONIC ADOLESCENT UNEMPLOYMENT.

SO, WE PRODUCE MORE AND MORE ADOLESCENTS, WE KEEP
THEM IN THAT PHASE OF LIFE LONGER AND LONGER, BUT WE
OFFER THEM LESS AND LESS, AND STILL DON’T KNOW WHERE

THEY ”FIT IN”.

13
NOT REALLY A GENERATION, NOT REALLY A PART OF OTHER
GENERATIONS, THEY SUFFER FROM A STRANGE MIXTURE OF
INDULGENCE AND NEGLECT.

SOCIETY CRITICIZES ADOLESCENTS FOR HAVING NO
EXPECTATIONS, BUT THEN SOCIETY HAS NOT CONVEYED TO
THEM WHAT IT EXPECTS OF THEM.

THERE ARE MANY CRACKS IN OUR SOCIETY, AND ADOLESCENTS

ARE PRONE TO FALL THROUGH THEM.

14
ADDED TO ALL THESE PROBLEMS STEMMING FROM AN
UNCERTAIN PLACE IN OUR SOCIETY, MOST ADOLESCENTS, AT
ONE TIME OR ANOTHER, SUFFER REAL AND UNIQUE PROBLEMS IN

HEALTH.

15
| IMAGINE WE’VE ALL BEEN AROUND HOSPITALS ENOUGH, AS
PATIENTS, VISITORS, OR HEALTHCARE WORKERS, TO HAVE OUR
BLOOD RACE A LITTLE FASTER WHEN WE HEAR THE WORDS
”*CODE BLUE”.

*CODE BLUE”, TWO SHORT WORDS THAT MEAN THAT A LIFE IS

ABOUT TO BE CUT SHORT.

”CODE BLUE” SIGNALS A LIFE-THREATENING SITUATION, AND
SUMMONS ALL THE RIGHT PEOPLE TO THE RIGHT PLACE AT THE

RIGHT TIME....TO SAVE THAT LIFE.

16
"CODE BLUE” IS THE PHRASE USED RECENTLY BY A NATIONAL
COMMISSION ON ADOLESCENT HEALTH --ON WHICH | SERVE AS
CHAIRMAN OF THE NATIONAL SAFE KIDS CAMPAIGN-- TO SIGNAL

THE CURRENT CRISIS IN ADOLESCENT HEALTH.

“CODE BLUE” IS THE URGENT CRY WE MUST HEED TO MEET THIS

DEBILITATING AND YET MOSTLY HIDDEN NATIONAL EMERGENCY.

17
THIS ENDANGERED AGE GROUP IS BUT A FEW YEARS FROM
HAVING A PROFOUND RESPONSIBILITY FOR THE REST OF US, A
PROFOUND IMPACT ON EACH OF US.

IN A FEW YEARS THEY WILL BECOME, NOT ONLY THE LEADERS OF
THIS NATION, BUT ALSO THE PARENTS OF THE NEXT
GENERATION, THE PARENTS OF THE NEXT WAVE OF
ADOLESCENTS.

UNLESS WE RESPOND CORRECTLY TO THE CURRENT CRISIS IN
ADOLESCENT HEALTH WITH COMPASSION, URGENCY AND SKILL,
THE PROBLEMS FOR OUR SOCIETY WILL NOT ONLY ADD UP, THEY

WILL MULTIPLY.

18
AT THE OUTSET WE NEED TO DISABUSE OURSELVES OF SOME
COMMON MISCONCEPTIONS.

FIRST, WE MUST PUT ASIDE THE NOTION THAT ADOLESCENCE IS
A TIME OF NATURAL GOOD HEALTH, A TIME WHEN CHILDREN
BLOSSOM BEAUTIFULLY INTO YOUNG ADULTS, A TIME OF HIGH

ENERGY AND WELL-BEING.

19
NOT TOO LONG AGO, ON ONE OF OUR MOST POPULAR TV
PROGRAMS, THE BILL COSBY SHOW, THE FATHER, AN AGING
TRACK STAR --LIKE COSBY HIMSELF WHO PLAYED THE ROLE--
JOKINGLY TOLD HIS WIFE HE HAD SEEN SOMETHING BEAUTIFUL.
"WHAT WAS IT?” SHE ASKED. ”NINETEEN,” HE SAID..... HE HAD
STOPPED TO WATCH A NINETEEN YEAR-OLD RUNNER SPRINTING
AROUND THE TRACK, AND THAT CONJURED UP AN IMAGE OF
PERFECT HEALTH AND ENERGY. THAT’S NOT THE WAY IT IS FOR

MANY OF AMERICA’S NINETEEN YEAR-OLDS.

20
SECOND, WE MUST SET ASIDE THE ASSUMPTION THAT
ADOLESCENT HEALTH PROBLEMS ARE LIMITED TO COMMUNITIES
PLAGUED WITH HIGH RATES OF CRIME AND POVERTY.

NO, IT IS IN ALL COMMUNITIES, IN EVERY NEIGHBORHOOD
ACROSS THE COUNTRY, THAT WE FIND PROBLEMS AFFECTING

ADOLESCENT HEALTH.

21
TRUE, MANY OF THESE PROBLEMS DO STEM FROM POVERTY.
BUT AFFLUENCE IS NO PROTECTION.

IN FACT, THERE ARE A HOST OF ADOLESCENT HEALTH
PROBLEMS AFFLICTING THE CHILDREN OF AFFLUENCE, THE
OVERLY-DRIVEN CHILDREN OF DEMANDING MIDDLE CLASS
PARENTS: AFFLICTIONS LIKE ANOREXIA NERVOSA, BULIMIA, AND

percents

SIMILAR DISORDERS.

22
A GENERATION OR TWO AGO, THE CHIEF THREATS TO THE
HEALTH OF AMERICA’S ADOLESCENTS LAY IN THE VARIETY OF
INFECTIOUS DISEASES TO WHICH THEY MIGHT FALL VICTIM.

BUT AS MEDICAL SCIENCE HAS MADE GREAT STRIDES IN
ERADICATING OR CONTROLLING MANY OF THOSE INFECTIOUS
DISEASES, THE HEALTH OF OUR ADOLESCENTS HAS NOT SHOWN

THE EXPECTED IMPROVEMENT.

23
IN FACT, ADOLESCENTS ARE THE ONE GROUP OF AMERICAN
SOCIETY WHOSE HEALTH HAS NOT SHOWN IMPROVEMENT OVER

THE LAST 70 YEARS.

OUR CHALLENGE TODAY STEMS FROM THE NATURE OF THE
ADOLESCENT HEALTH PROBLEMS.

NO LONGER INFECTIOUS OR OTHER ”PHYSICAL DISEASES”
LINGERING OUT THERE TO PREY UPON UNSUSPECTING AND
INNOCENT VICTIMS, THE THREATS TO ADOLESCENT HEALTH LIE

IN THE REALM OF BEHAVIORAL PROBLEMS.

24
IT IS WHAT ADOLESCENTS CHOOSE TO DO THAT BRINGS THEM
TO THE HEALTH PROBLEMS THAT THEY SUFFER.

THE LIST IS ALL TOO FAMILIAR:

DRINKING, SMOKING, AIDS, PREGNANCY, SEXUALLY TRANSMITTED
DISEASES, VIOLENCE, SUICIDE.

TRUE, SOME OF THESE PROBLEMS MAY TECHNICALLY OR
LEGALLY HAVE A PHYSICAL OR BIOLOGICAL BASIS AND HENCE
BE TERMED A DISEASE, BUT THEIR DANGER LIES IN THEIR LINK

WITH ADOLESCENT BEHAVIOR.

25
THIS OF COURSE MAKES TREATMENT AND PREVENTION
DIFFICULT AND COMPLICATED, BECAUSE HEALTH PROBLEMS
STEMMING FROM BEHAVIOR INVOLVE NOT ONLY PHYSICAL
ASPECTS, BUT ALSO THE EMOTIONAL, SOCIAL, AND EVEN
ECONOMIC AND POLITICAL DIMENSIONS AS WELL.

To Gt SURE,

GRO THis Is A FACTOR AFFECTING THE HEALTHCARE OF
THE ENTIRE NATION - - THE BLURRING OF PURE MEDICINE AND

THE SOCIO-ECONOMIC MILIEU IN WHICH IT IS PRACTICED.

26
A YEAR OR TWO AGO I WAS ASKED TO TAKE GRAND ROUNDS IN
PEDIATRICS AT A MAJOR TEACHING HOSPITAL.

WHEN | WAS FINISHED LISTENING TO THREE CASES, HAVING
DONE THE BEST I COULD WITH THE PROBLEMS, | HAD TO REMIND
THE RESIDENT STAFF, WHEN THE AUDIENCE LEFT, THAT | WOULD
NOT HAVE GOTTEN AWAY WITH PRESENTING THOSE THREE
PATIENTS THE WAY THEY JUST DID WHEN | WAS IN THEIR
POSITION BECAUSE THEY HAD NOT PRESENTED STRICTLY
MEDICAL PROBLEMS:-- WHAT THEY HAD PRESENTED TO ME
WERE SOCIO-ECONOMIC PROBLEMS THAT HAD COME TO THE

HOSPITAL BECAUSE THE PATIENT HAD AN ILLNESS.

27
THE PROBLEMS OF ADOLESCENT HEALTH OFTEN CAN BE TRACED
TO THE GROWING GAP BETWEEN ADULTS AND ADOLESCENTS IN

COMMUNICATION AND UNDERSTANDING.

ADOLESCENTS SEEM TO THINK DIFFERENTLY.

THEY SEEM TO BE INHERENT RISK-TAKERS.

ALL EVIDENCE TO THE CONTRARY, THEY HAVE A SENSE THAT
THEY ARE IMMORTAL.

SO THEY HAVE AN SEEMINGLY INSTINCTIVE RESPONSE TO TUNE

OUT ANY ADMONITION THAT BEGINS WITH ”DON’T”.

28
| SHOULD SAY AT THIS POINT THAT MY CONCERN ABOUT THE
PROBLEMS OF ADOLESCENT HEALTH COMES DIRECTLY FROM MY

TWO MEDICAL CAREERS.

AS YOUR SURGEON GENERAL, AS THE NATION’S CHIEF PUBLIC
HEALTH OFFICER FOR EIGHT YEARS, IT BECAME APPARENT TO >
ME THAT MANY OF THE PUBLIC HEALTH ISSUES I DEALT WITH —--
SMOKING, AIDS, ALCOHOL, AND SO FORTH-- HAD AN ESPECIALLY

ALARMING ADOLESCENT DIMENSION.

29
AND, FOR FORTY YEARS BEFORE THAT, AS A PEDIATRIC
SURGEON, | BEGAN TO HAVE REAL CONCERNS ABOUT WHAT
WOULD HAPPEN TO THE TINY INFANTS ON WHOM | OPERATED...
WHEN THEY BECAME ADOLESCENTS. +GRIEVED ME TO THINK
HOW | AND MY ASSOCIATES CORRECTED LIFE-THREATENING
DEFECTS IN THE FIRST HOURS OR DAYS OF LIFE, ONLY TO HAVE

THAT PRECIOUS LIFE IMPERILED BY ADOLESCENT BEHAVIORAL

HEALTH PROBLEMS.

30
AND THOSE PROBLEMS ARE ALL TOO REAL.

STATISTICS DON’T TELL THE STORY, BUT EVERY SPIRIT OF MAN
LECTURE SHOULD HAVE A FIRM DATA BASE AS A FOUNDATION
FOR ITS CALL TO ACTION. SO, A FEW COMPARISONS, A FEW

NUMBERS:

31
IN 1965 THERE WERE ABOUT 4 CASES OF GONORRHEA AND

SYPHILIS FOR EVERY 1,000 AMERICAN ADOLESCENTS.

IN 1985 THAT NUMBER HAD CLIMBED TO 12 REPORTED CASES
PER 1,000, WITH SO MANY MORE UNREPORTED THAT THE
CENTERS FOR DISEASE CONTROL ESTIMATED THAT EACH YEAR

2.5 MILLION ADOLESCENTS CONTRACT A SEXUALLY TRANSMITTED

DISEASE.

32
IN 1965, 16.7 OUT OF 1,000 UNMARRIED GIRLS AGED 15-19 GAVE

BIRTH.

TWENTY YEARS LATER, 31.6 PER 1,000.

AMERICA’S TEENAGE PREGNANCY RATE IS 1 TEENAGE GIRL OUT

OF EVERY 10, A RATE DOUBLE THAT OF ANY OTHER

INDUSTRIALIZED SOCIETY.

33
IN THE 1950S LESS THAN 5% OF YOUNG PEOPLE HAD TAKEN AN

ILLICIT DRUG;

BY 1987, THE NATIONAL ADOLESCENT STUDENT HEALTH SURVEY
INDICATED, 77% OF EIGHTH GRADERS AND 89% OF TENTH
GRADERS HAVE USED ALCOHOL;

15% OF EIGHTH GRADERS AND 35% OF TENTH GRADERS HAVE

USED MARIJUANA;

34
AND AMONG THE CLASS OF 1987, 5.6% HAD USED

CRACK-COCAINE.

IN REAL NUMBERS, STANDING FOR REAL PEOPLE, THAT MEANS
MORE THAN 3.5 MILLION YOUNG TEENS (12-17) HAVE USED
MARIJUANA,

AND OF THESE ONE THIRD ARE REGULAR USERS. |

OVER HALF A MILLION HAVE USED COCAINE, AND HALF OF THESE

HAVE BECOME REGULAR USERS, OR | SHOULD SAY ABUSERS.

35
SADLY, MANY TEENAGERS DON’T SURVIVE THEIR TEENS.

OVER 50% OF HIGH SCHOOL SENIORS GET DRUNK AT LEAST
ONCE A MONTH, AND THE DEADLY COMBINATION OF DRINKING
AND DRIVING RANKS NUMBER ONE AS A KILLER OF

ADOLESCENTS.

TEN TEENAGERS ARE KILLED EVERY DAY IN ALCOHOL-RELATED

TRAFFIC FATALITIES.

36
SUICIDE RANKS SECOND AMONG KILLERS OF TEENS, WITH 10
PERCENT OF TEENAGE BOYS AND 18 PERCENT OF TEENAGE
GIRLS ATTEMPTING SUICIDE. AND WHILE IT IS TRUE THAT THE
BLACK COMMUNITY SUFFERS A DISPROPORTIONATE BURDEN OF
SOME ADOLESCENT HEALTH PROBLEMS, IT IS IN THE WHITE

POPULATION THAT SUICIDE TAKES IT GREATEST TOLL.

37
HOMICIDE, THE LEADING CAUSE OF DEATH AMONG 15-19 YEAR

OLD BLACKS, CLAIMS 26.6 PER 100,000.
PART OF THAT TERRIBLE PROBLEM CAN BE TRACED TO THE
135,000 AMERICAN TEENAGERS WHO CARRY GUNS TO SCHOOL

EACH DAY.

CRIME AMONG TEENS HAS LED TO A THIRTY-FOLD INCREASE IN

THE NUMBERS ARRESTED SINCE 1960.

38
THE KILLER EPIDEMIC OF AIDS HAS BECOME A SERIOUS THREAT
Aerie
TO OUR ADOLESCENT POPULATION. AS OF ni990; THERE HAVE

2156
BEEN CASES OF AIDS FROM BIRTH TO 13 YEARS OF AGE.
THERE HAVE BEEN $i 3 CASES IN TEENAGERS 13 Mi Sete
Uy MALE —" Fadler. tore FI Curis Mat
TO 19 YEARS OF AGE. , ROTC awn. WITH THE (hath
LONG INCUBATION PERIOD FOR HIV INFECTION, LOOK TO THE
PREVALENCE OF AIDS IN THE 20-30 YEAR GROUP TO GET AN IDEA

OF WHEN HIV INFECTION TAKES PLACE -— IN THE TEEN YEARS.

APRIL
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39
MORE THAN 2 MILLION ADOLESCENTS SUFFER ABUSE AND
NEGLECT REPORTED TO THE AUTHORITIES, BUT PROBABLY AN

EQUAL NUMBER GO UNREPORTED.

AND, OVER HALF A MILLION TEENS ARE RUNAWAYS, ANOTHER
HALF A MILLION AREN’T IN THEIR OWN HOMES BECAUSE THEY

ARE PLACED IN FOSTER HOMES OR OTHER INSTITUTIONS.

Att 1w Aer
42 MILLION ADOLESCENTS HAVE SEVERE PROBLEMS.

40
AND ALL OF THESE ALARMING FIGURES ARE SPREADING, THEY
ARE SPREADING TO YOUNGER AND YOUNGER TEENS, TO

CHILDREN.
IN EVERY STATE THE AGE AT WHICH CHILDREN BECOME
INVOLVED IN RISKY BEHAVIOR --DRINKING, SMOKING, SEX,

GANGS-- GETS LOWER EACH YEAR.

AN EXAMPLE: IN 1965 ONLY 3% OF GIRLS WERE SEXUALLY

ACTIVE BEFORE THEIR 16TH BIRTHDAY, BUT NOW OVER 15% ARE.

41
LOOKING TOWARD THE OLDER YEARS, WE SEE THE EFFECT OF
THESE BEHAVIOR-LINKED PROBLEMS LASTS LONGER AND

LONGER INTO ADULT LIFE.

THE BEST, THE WORST, EXAMPLE, OF COURSE IS AIDS.
UNPROTECTED SEX AND/OR IV DRUG USE CAN READILY LEAD TO

HIV INFECTION THAT LASTSTHE REST OF A LIFE NOW CUT SHORT

ee ay Th wa, As
BY MANY DECADES. OTHER ‘STDS: CAN LEAD TO LONG-LASTING

a
al

HEALTH PROBLEMS AND EVEN STERILITY.

42
CRACK COCAINE CAN MAINTAIN ITS GRIP ON AN ENTIRE LIFE,

AND ALSO REACH OUT TO RUIN LIVES JUST STARTED, AS THE

To Cotamée- AGUSIAG
ALARMING INCREASE IN BABIES BORN ABR SEES RDRS

 

EFS --375,000 OF THESE

PATHETIC INFANTS LAST YEAR.

43
TRAGICALLY, ONE OF THE MOST COMMON RESULTS OF THIS
SELF-DESTRUCTIVE BEHAVIOR IS TO PASS IT ON ALL THE MORE

QUICKLY TO THE NEXT GENERATION.

ITIS OFTEN THESE PROBLEM-RIDDEN ADOLESCENTS WHO TEND
TO BECOME PARENTS AT A YOUNGER AGE, AND THEN TO START
THE CYCLE AGAIN.

WE KNOW THAT ABUSED CHILDREN, OFTEN OF ABUSED PARENTS,

BECOME THEMSELVES ABUSERS OF THE NEXT GENERATION.

44
ALCOHOLIC PARENTS PASS ON BEHAVIOR PATTERNS, AND WE
NOW SUSPECT, EVEN GENETIC TENDENCIES, ENCOURAGING

ALCOHOL ABUSE IN THEIR CHILDREN.

 

AS WITH ANY PROBLEM, WE’D LIKE TO SORT OUT THE CAUSES
AND EFFECTS, FOCUS ON THE CAUSES, AND THEN SOLVE THE
PROBLEMS.

BUT IT IS NOT THAT EASY.

45
UNFORTUNATELY, LISTS OF CAUSES AND SYMPTOMS SEEM TO BE

INTERCHANGEABLE.

I'LL READ OFF A FEW ITEMS FROM LISTS OF FACTORS RELATED
TO ADOLESCENT HEALTH PROBLEMS. SOME OF THESE WERE
LISTED AS CAUSES, SOME AS SYMPTOMS. BUT PLL MIX THEM UP
AS | READ THEM, AND AS I GO, YOU WILL SEE HOW DIFFICULT IT

IS TO DECIDE WHETHER A CERTAIN ITEM IS A CAUSE ORA 2@¢€34*T.

46
SUBSTANCE ABUSE, UNSTABLE FAMILIES, AIDS, EARLY
PREGNANCIES, POOR PARENTING SKILLS, EMOTIONAL
DYSFUNCTION, POOR PEDIATRIC CARE, ETHNIC HOSTILITY,
POVERTY, VIOLENT BEHAVIOR, POOR SELF IMAGE, POOR
MATERNAL HEALTH CARE, EDUCATIONAL FAILURE, LONELINESS,
STRESS....

WELL, YOU GET THE PICTURE.

47
AT THE TOP OF THE LIST OF CHRONIC PROBLEMS, FINDING ITS
CENTRAL PLACE IN THE CIRCLE OF CAUSE AND EFFECT IS
POVERTY .....

THE ALARMING AND RAPID INCREASE IN POVERTY, ESPECIALLY
AMONG CHILDREN.

TWENTY FIVE PERCENT OF THE ADOLESCENTS OF THE 1990S ARE
ALREADY LIVING IN POVERTY.

THAT REFLECTS A NATIONAL POVERTY RATE TWO OR EVEN
THREE TIMES HIGHER THAN THAT OF OTHER INDUSTRIALIZED

SOCIETIES.

48
ONE HALF OF ALL BLACK AND HISPANIC CHILDREN UNDER 6 ARE

POOR.
IN THE LAST FIVE YEARS, THE NUMBER OF FAMILIES IN POVERTY

HAS GROWN BY FORTY PERCENT, WITH FAMILIES BECOMING THE

FASTEST GROWING SEGMENT OF THE HOMELESS POPULATION.

49
(HERE, CEK CONVERSATION WITH HOMELESS KIDS.]

50
ALL THIS AMOUNTS TO POORER HOUSING, UNSAFE LIVING
ENVIRONMENTS. ..... POORER HEALTH FOR AMERICA’S
ADOLESCENTG......

MORE STRESS ON FAMILIES.

AND THIS COMES AT A TIME WHEN FAMILIES ARE LESS ABLE TO

BEAR STRESS.

51
THERE ARE SIGNIFICANT CHANGES IN TRADITIONAL FAMILY
STRUCTURES AND ROLES.

THE AMERICAN FAMILY, AS WE HAVE KNOWN IT EARLIER IN THIS
CENTURY, HAS FALLEN APART.

IN 1965 11.3% OF AMERICAN CHILDREN LIVED IN SINGLE-PARENT
HOMES. BY 1987 21% OF AMERICANS UNDER 18 LIVED IN HOMES

WITH A SINGLE PARENT.

52
DIVORCE, REMARRIAGE, DESERTION BY ONE PARENT OR THE
OTHER.... ALL THIS HAS TORN FAMILIES APART, AND LEAD TO THE
RESTRUCTURING OF FAMILIES IN NEW, SKELETAL, AND OFTEN

DYSFUNCTIONAL FORMATIONS.

GENERATIONAL LINES ARE BLURRED BECAUSE GRANDMOTHER,
MOTHER AND GRANDCHILD ALL HAVE CHILDREN BEING RAISED

TOGETHER.

53
PARENTS INCREASINGLY DON’T ASSUME PARENTAL FUNCTIONS.
IN SOME CASES THIS IS BECAUSE THEY ARE TOO YOUNG, ~
CHILDREN HAVING CHILDREN, BUT IN OTHER CASES THE
PARENTS MANIFEST ILL-HEALTH, PERSONAL EMOTIONAL

TRAUMA, AND THE INABILITY, OR EVEN UNWILLINGNESS TO COPE.

54
AS THE MIDDLE CLASS #@ SHRINKS, LARGER NUMBERS OF

FAMILIES HAVE FEWER RESOURCES FOR SURVIVAL.

AND AS NUCLEAR FAMILIES BREAK DOWN, THE NEXT LEVEL OF
SUPPORT --EXTENDED FAMILIES AND NEIGHBORHOODS--
SUFFER SIMILAR DISINTEGRATION IN A MORE URBANIZED, MORE

MOBILE, MORE ANONYMOUS AMERICAN CULTURE.

55
THIS MEANS THAT WITH EACH PASSING YEAR, AMERICAN
CHILDREN AND ADOLESCENTS HAVE LESS AND LESS CONTACT
WITH ADULTS.

PARENTS WORK, RELATIVES AND NEIGHBORS MOVE AWAY OR

ARE DISINTERESTED, YOUNGSTERS ARE LEFT ALONE.

THE AVERAGE CHILD SPENDS LESS THAN AN HOUR A DAY WITH
HER OR HIS MOTHER, AND LESS THAN 5 MINUTES WITH THE

FATHER. AND MANY DON’T HAVE ONE PARENT AROUND AT ALL.

Omer GFR oF CHtenpRin «a THe v.$. LIVve

= art S
within WACH ae Diy eet ac é eof SRAWOPAREP

56
EVEN WHEN BOTH PARENTS ARE PRESENT WE SEE AN ALARMING

TENDENCY TO PASS THE BUCK OF PERSONAL RESPONSIBILITY.

PARENTS LEAVE TO THE SCHOOLS THE ENTIRE TASK OF
EDUCATING THEIR CHILDREN, WHEN NOT LONG AGO PARENTS
CLAIMED THE EDUCATION OF THEIR CHILDREN TO BE THEIR
PRIVILEGE AND OBLIGATION, EVEN IF SHARED WITH THE

SCHOOLS.

57
CHILDREN LIVE IN THEIR OWN CULTURE, REMOTE FROM ADULTS,
DOMINATED ONE YEAR BY TRANSFORMER TOYS, THE NEXT BY
CABBAGE PATCH DOLLS, THE NEXT BY TEENAGE MUTANT NINJA
TURTLES.

THEY LEAD LIVES DETACHED FROM PARENTAL CONCERN OR
INTEREST, TURNING TO PEERS FOR THE GUIDANCE OR EVEN
PLAYFUL COMPANIONSHIP THAT PARENTS AND GRANDPARENTS

USED TO PROVIDE.

58
INTO THE VACUUM CREATED BY THE ABSENCE OF ADULTS HAVE
MOVED TELEVISION, RADIO, MOVIES, AND VIDEOS, OFTEN WITH A
CONSTANT MESSAGE OF SEX, VIOLENCE, AND GREED.
RELIGIOUS TEACHING AND ETHICAL VALUES, IF THEY ARE
INSTILLED AT ALL, ARE NOW LEFT TO CHURCH OR SYNAGOGUE. .

. OR MTV.

59
AS WE MOVE INTO THE LAST DECADE OF THE TWENTIETH
CENTURY, OUR NATION HAS YET TO ENACT A NATIONAL YOUTH
AGENDA THAT

ADDRESSES THE NEEDS OF ADOLESCENTS COMPREHENSIVELY.
EXISTING SERVICE DELIVERY SYSTEMS DO NOT FUNCTION IN
WAYS THAT CHERISH AND PROVIDE FOR ADOLESCENTS AND
THEIR FAMILIES. IT IS TIME TO RE-EXAMINE THE WAYS IN WHICH
WE LOOK AT ADOLESCENTS AND THEIR SPECIAL HEALTH
PROBLEMS —- TO REALLOCATE RESOURCES AND TO REDESIGN
SERVICE DELIVERY SYSTEMS IN WAYS THAT HELP ALL OF OUR
YOUNG PEOPLE, AND THEIR FAMILIES, COPE WITH THE
CHALLENGES ASSOCIATED WITH BECOMING WELL-EDUCATED

AND HEALTHY CITIZENS.

60
WHAT CAN WE DO?

WELL, I’VE GIVEN THIS A LOT OF THOUGHT, ESPECIALLY IN THE
LAST FEW WEEKS WHEN I HAVE SPENT SO MUCH TIME WITH
ADOLESCENTS, INTERVIEWING THEM IN CONNECTION WITH MY

COMING NBC TV PRIMETIME SPECIAL ON ADOLESCENT HEALTH.

61
’LL MAKE A FEW SUGGESTIONS, BASED UPON THE EYE-OPENING
FILMING OF THE LAST FEW WEEKS, BASED UPON MY YEARS AS A
SURGEON OF CHILDREN AND ADOLESCENTS, AND BASED UPON

MY EXPERIENCE AS YOUR SURGEON GENERAL.

62
IN THAT LAST CAPACITY, ALTHOUGH I MAY HAVE RECEIVED
PUBLIC ATTENTION FOR MY EFFORTS AGAINST AIDS, SMOKING,
AND DRUNK DRIVING, | TAKE THE GREATEST SATISFACTION FOR
AN INITIATIVE | WAS PRIVILEGED TO LEAD THAT REDESIGNED THE
WAYS IN WHICH CHILDREN WITH SPECIAL HEALTH NEEDS --
SOME CALLED THEM HANDICAPPED CHILDREN-- COULD TAKE
ADVANTAGE OF THE TANGLED WEB OF HEALTHCARE AND SOCIAL

SERVICE AGENCIES THAT MIGHT HELP THEM.

63
THOSE OF US INVOLVED IN THIS INITIATIVE FOR SPECIAL NEEDS
CHILDREN WANTED TO MAKE SURE THE SERVICES WERE
PLANNED AROUND THE NEEDS OF THE PEOPLE WHO NEEDED
THEM, RATHER THAN FORCING THE PEOPLE TO ADAPT TO THE

SERVICES.

WE NEED THE SAME APPROACH FOR ADOLESCENT HEALTH

PROBLEMS.

64
A FEW SIMPLE CONCEPTS SHOULD GUIDE US.

ALL OUR EFFORTS SHOULD BE:

FAMI LY-CENTERED
COMMUNITY-BASED
CULTURALLY SENSITIVE
COORDINATED
CONFIDENTIAL

ADEQUATELY FINANCED.

65
FIRST, FAMILY-CENTERED:

EVEN THOUGH THE BELEAGUERED AMERICAN FAMILY IS OFTEN
UNLIKE THAT IDEAL FAMILY OF THE STORY BOOKS, WE NEED TO
DEAL WITH THE FAMILIES OF ADOLESCENTS, IN THEIR VARIOUS
PERMUTATIONS, THE WAY WE FIND THEM, NOT THE WAY WE
WOULD WISH THEM TO BE.

EVEN THOUGH FRAGMENTED, THE FAMILY IS THE CONTINUOUS

PRESENCE IN THE LIFE OF THE ADOLESCENT.

66
FAMILIES, EVEN IN UNUSUAL FORMS, SHOW A STEELY
RESILIENCE. IN WHATEVER SERVICES WE OFFER THE

‘Mw
ADOLESCENT, WE MUST INCLUDE THE FAMILY,THE
DEVELOPMENT AND APPLICATION OF POLICIES THAT AFFECT
ADOLESCENT HEALTH CARE. SERVICES MUST BE FLEXIBLE AND

RESPONSIVE TO FAMILIES.

WE NEED TO VIEW FAMILIES AS PRIMARY CARE PROVIDERS, AND

GIVE THEM THE INFORMATION AND SUPPLIES THEY NEED TO DO

THIS JOB.

67
WE NEED TO PAY HEED TO THE SINGLE PARENT FAMILIES OR

AGGREGATE FAMILIES.

IF WE FIND FAMILIES WEAK, WE NEED TO STRENGTHEN THEM.
WE NEED TO STRENGTHEN PARENTING SKILLS, REMEMBERING
THAT IN SOME DYSFUNCTIONAL FAMILIES THE PARENT ROLE MAY
BE ASSUMED BY AN OLDER SIBLING OR EVEN A SURROGATE

ADULT.

68
FURTHERMORE, OUR CONCERN FOR FAMILIES MUST ENCOMPASS
AN AFFIRMATION OF BASIC VALUES. HEALTH IS A MATTER OF
THE SPIRIT AS WELL AS THE BODY. PROVISION OF A SPIRITUAL,
A RELIGIOUS DIMENSION AMONG THE SERVICES OFFERED
ADOLESCENTS AND THEIR FAMILIES WILL REAP LASTING

REWARDS.

69
OUR CONCERN FOR ADOLESCENTS MUST BE

CULTURALLY SENSITIVE:

SERVICES NEED TO BE SENSITIVE TO DIFFERENT CULTURAL
VALUES AND CUSTOMS. FOR EXAMPLE, MORE THAN 80% OF
CHILDREN WITH HIV INFECTION ARE BLACK OR HISPANIC.
SERVICES MUST FOCUS ON THE STRENGTHS AND NEEDS OF
THESE GROUPS. MINORITY LEADERS SHOULD BE CENTRAL IN
PLANNING AND STARTING SYSTEMS OF SERVICES FOR CHILDREN

AND THEIR FAMILIES,

70
EVEN AFTER A GENERATION OF LEGISLATIVE, JUDICIAL AND
PERSONAL EFFORTS TO ELIMINATE RACIAL INEQUALITY, AMERICA
IS STILL PLAGUED BY RACISM, AND THERE ARE MANY WHO SEE
ETHNIC HOSTILITY AND DISCRIMINATION ONLY INCREASING IN

THE YEARS IMMEDIATELY BEFORE US.

DESPITE THE FACT THAT OUR COMMUNITIES ARE MORE
CULTURALLY DIVERSE, SOCIAL INSTITUTIONS HAVE NOT ADAPTED
TO THESE CHANGES. PROFESSIONAL INSENSITIVITY TO
CULTURAL DIFFERENCES AND LANGUAGE

BARRIERS IMPEDE ACCESSIBILITY TO SERVICES FOR

CULTURALLY DIFFERENT FAMILIES AND ADOLESCENTS.

71
AS WE KEEP OUR FINGER ON THE PULSE OF THE FAMILY, AS WE
ARE SENSITIVE TO CULTURAL DIFFERENCES, WE NEED TO

GROUND OUR SERVICES IN THE COMMUNITY.

COMMUNITY-BASED SERVICES ARE THE KEY TO WINNING THE

STRUGGLE AGAINST ADOLESCENT HEALTH PROBLEMS.

72
OUR COUNTRY IS RECOGNIZED INTERNATIONALLY FOR
SOPHISTICATED TERTIARY CARE AND TECHNOLOGICAL
ADVANCES; YET WE LACK ACCESS AND EQUITY FOR BASIC
SERVICES AT THE FAMILY AND COMMUNITY LEVEL. WE ARE THE
ONLY DEVELOPED NATION THAT DOES NOT GUARANTEE HEALTH

CARE TO EVERY CITIZEN, i777" E ER CEP Few 0

Sov7w AFRICA,

‘SERVICES NEED TO BE PROVIDED IN OR NEAR THE HOME
COMMUNITIES OR NEIGHBORHOODS OF CHILDREN AND THEIR
FAMILIES. FAMILIES SHOULD NOT HAVE TO TRAVEL LONG
DISTANCES FOR SERVICES. AND WHENEVER POSSIBLE,
CHILDREN SHOULD BE CARED FOR AT HOME RATHER THAN INA

HOSPITAL.

73
| HAVE BECOME CONVINCED THAT FINDING THE RIGHT PLACE

FOR ADOLESCENT HEALTH CARE WILL WIN HALF THE BATTLE.

EVEN WHEN ADOLESCENTS DECIDE TO SEEK A PHYSICIAN,

FINDING A DOCTOR IS USUALLY A LOST CAUSE FOR MANY OF

THEM.

| SPENT MUCH OF MY PROFESSIONAL LIFE MAKING SURE THAT
CHILDREN WITH SURGICAL PROBLEMS CONTINUED TO RECEIVE
GOOD COMPREHENSIVE CARE IN THE ADULT WORLD, SO I KNOW
THAT ONE OF THE PERSISTENT PROBLEMS OF AMERICAN
MEDICINE IS THE DIFFICULTY OF TRANSITION BETWEEN ~

PEDIATRIC AND ADULT MEDICAL CARE.

74
SOME ADOLESCENTS DON’T LIKE TO KEEP GOING TO THEIR
PEDIATRICIANS, THE "BABY DOCTOR”, AND SOME PEDIATRICIANS
' ARE GLAD, FROM A PROFESSIONAL IF NOT PERSONAL POINT OF
VIEW, TO SEE THEM MOVE ON.

OTHER ADOLESCENTS ARE RELUCTANT TO CHANGE, WHILE SOME
PEDIATRICIANS FEEL TOO MUCH OF A PROPRIETARY INTEREST IN
THEIR GROWING PATIENTS, AND CLING TO ADOLESCENTS WHO

WOULD BE BETTER SERVED IN AN ADULT PRACTICE.

75
BUT THEN, MANY INTERNISTS WITH AN ADULT PRACTICE ARE NOT

THAT ANXIOUS TO TAKE ON ADOLESCENTS AS PATIENTS.

SO, AGAIN THEY FALL THROUGH THE CRACKS.

76
SERVICES MUST NOT SIMPLY BE IN THE COMMUNITY --AS
IMPORTANT AS THAT IS-- THEY MUST ALSO BE

COORDINATED

ONE OF THE MAJOR PROBLEMS IN DEALING WITH ADOLESCENT

HEALTH NEEDS IS THE PROBLEM OF FRAGMENTED SERVICES.

77
SO FAR THE RESPONSE OF CONCERNED CITIZENS AND
LEGISLATORS HAS BEEN TO SET UP A NUMBER OF PROGRAMS
OR SERVICES, EACH DESIGNED TO DEAL WITH A SPECIFIC
PROBLEM: AIDS, CHILD ABUSE, TEENAGE PREGNANCY, DRUGS,

AND SO FORTH.

BUT THE LACK OF COLLABORATION BETWEEN THESE PROGRAMS
CAN BLUNT THEIR SUCCESS, OR EVEN DOOM THEM TO FAILURE.
BUREAUCRATIC MYOPIA, RIGID REPORTING PROCEDURES,
OVERLY RESTRICTED FUNDING, AND PLAIN INSENSITIVITY TO THE
LARGER PICTURE OF THE ADOLESCENT’S WORLD CAN DOOM THE

BEST INTENDED PROGRAM.

78
FRAGMENTATION OF SERVICES CAN LEAD TO BITTER
FRUSTRATION.

FOR EXAMPLE, AN ADOLESCENT WHOSE NEEDED MEDICAL CARE
IS PAID FOR BY MEDICAID CAN LOSE ELIGIBILITY FOR MEDICAID

IF HIS MOTHER GOES TO WORK OR REMARRIES.

OR A TEEN ALCOHOL ABUSER MAY FINISH AN ALCOHOL ABUSE
PROGRAM, BUT IN THE MEANTIME HAS TAKEN TO COCAINE,
BECAUSE THE PROGRAM HAS NOT TOUCHED THE BASIC

BEHAVIORAL PROBLEM.

79
A TEENAGE MOTHER MAY BE DENIED ENTRY INTO A PARENTING
PROGRAM BECAUSE SHE HAS NOT DROPPED OUT OF SCHOOL

AND THEN RE-ENROLLED. |
AMoMELESS P&Ea ACFE May $& Dewien A VARIETY

DE SERVICES GecHusl HE[sHe ARE We POORESS ,

/SERVICES MUST BE COORDINATED TO BE RESPONSIVE TO
ADOLESCENTS AND FAMILIES TO PREVENT GAPS IN SERVICE, AND
TO KEEP SERVICES FROM BEING PROVIDED SEPARATELY FROM
EACH OTHER.

STRONG LEADERSHIP AND COMMITMENT ARE NEEDED AS
PEOPLE AND GROUPS WORK TOGETHER TO IMPROVE DELIVERY

OF SERVICES. /

80
THE FURTHER THE ADMINISTRATION OF THE PROGRAMS GET
FROM THE LOCAL LEVEL, THE LESS SUCCESSFUL THEY WILL BE.
LOCAL GROUPS SEE THE LOCAL PROBLEMS THE MOST CLEARLY.
/aey NEED TO BE GIVEN THE POWER AND THE FUNDS TO DO
WHAT NEEDS TO BE DONE FOR THEIR YOUNG PEOPLE. THEY
KNOW HOW TO LINK SELF-HELP GROUPS WITH HEALTH
PROGRAMS. THEY ARE THE ONES WHO CAN INSURE

COLLABORATION WITHOUT BAFFLING COMPLEXITY. /~

81
4

THE PLACE WE NEED THE GREATEST COORDINATION, THE
CLOSEST COLLABORATION, IS BETWEEN THE HEALTHCARE

SERVICES AND THE SCHOOLS. ~

THE CLOSE CONNECTION BETWEEN THE PROBLEMS OF
ADOLESCENT HEALTH AND THE PROBLEMS OF ADOLESCENT
EDUCATION HOLD THE PERIL OF COMMON DESTRUCTION..... OR

THE OPPORTUNITY OF JOINT SOLUTION.

82
THOSE ADOLESCENTS WHO HAVE GOOD HEALTH, A STRONG
SELF-IMAGE, WHO ARE PHYSICALLY FIT, WILL BE LESS INCLINED
TO RISK A BRIGHT FUTURE BY ENGAGING IN RISKY BEHAVIOR, IN

DRUG OR ALCOHOL ABUSE.

BUT THE ADOLESCENT DOING POORLY IN SCHOOL, FACING A

DARK FUTURE, MAY READILY SEEK ESCAPE IN DRUGS, ALCOHOL,

GANGS, AND THEN OF COURSE, FALL EVEN FURTHER BEHIND.

83
A MINNESOTA STATE-WIDE STUDY CONFIRMED THAT
ADOLESCENTS WITH LOW GRADES IN SCHOOL WERE TWO TO
FIVE TIMES MORE LIKELY TO SMOKE DAILY, USE ALCOHOL
EXCESSIVELY, BE SEXUALLY PROMISCUOUS, AND ATTEMPT
SUICIDE THAN TEENS WITH ABOVE-AVERAGE GRADES. THIS
FINDING WAS ACROSS THE BOARD, FOR ALL RACIAL AND ETHNIC

GROUPS.

84
IT IS FOOLHARDY FOR AMERICANS TO BE CONCERNED ABOUT
THE AMERICAN SCHOOLS WITHOUT SIMILAR CONCERN FOR THE
HEALTH OF AMERICAN SCHOOL CHILDREN AND ADOLESCENTS.
HEALTH AND EDUCATION CAN NO LONGER BE TREATED AS
SEPARATE SPHERES.

ALL TOO OFTEN, TODAY, THE SCHOOL NURSE, THE NUTRITION
COUNSELOR, THE PHYSICAL EDUCATION PROGRAMS ARE SIMPLY
NOT MEETING THE REAL HEALTH NEEDS OF ADOLESCENT

STUDENTS.

85
FOR EXAMPLE SUCCESSFUL ”MAINSTREAMING” SPECIAL NEEDS
STUDENTS REQUIRES INTENSE COLLABORATION BETWEEN

HEALTH AND EDUCATION PERSONNEL.

EDUCATIONAL AND HEALTH SERVICES DEAL WITH MANY OF THE

SAME PROBLEMS, SO THEY SHOULD GET THEIR ACTSTOGETHER.

86
Z
BUTWE NEED SCHOOL-HEALTH COORDINATION NOT ONLY
BECAUSE THE PROBLEMS ARE INTERTWINED, BUT ALSO
BECAUSE FOR HEALTH SERVICES TO 8 REACH ADOLESCENTS

THEY MUST BE CONVENIENT TO USE.

AND SINCE SCHOOL IS ONE PLACE THE ADOLESCENT SHOULD BE,
IT IS THE BEST PLACE TO LOCATE A PRIMARY HEALTHCARE
FACILITY. AND MAYBE HAVING THE SCHOOL AND CLINIC
TOGETHER WILL MAKE THE ADOLESCENT MAKE BETTER USE OF

EACH.

87
RIGHT NOW, THINGS DO NOT OPERATE VERY EFFECTIVELY.

AT POLICY AND POLITICAL LEVELS WE HAVE RESPONDED WITH
SINGLE ISSUE OR CATEGORICAL PROGRAMS AS EACH HUMAN
SERVICE CONCERN IS BROUGHT TO NATIONAL ATTENTION. IN
THIS COUNTRY, HEALTH AND EDUCATION SERVICES ARE
PROVIDED BY A COMPLEX MIX OF PUBLIC, PRIVATE AND

VOLUNTARY AGENCIES AND ORGANIZATIONS.

88
WE MUST DEVELOP NEW ORGANIZATIONAL RELATIONSHIPS
AMONG SCHOOLS, PHYSICIANS, PUBLIC HEALTH AGENCIES AND
SOCIAL SERVICE ORGANIZATIONS. IN ADDITION, FEDERAL AND
STATE SYSTEMS MUST ALLOCATE NECESSARY RESOURCES AND
ESTABLISH CONDITIONS THAT FACILITATE THE DEVELOPMENT OF
THESE NEW ORGANIZATIONAL RELATIONSHIPS IN LOCAL

JURISDICTIONS.

89
WE MUST ORGANIZE HEALTH AND EDUCATION SERVICES IN WAYS
THAT ACKNOWLEDGE THE COMPLEXITY OF SOCIAL
ENVIRONMENTS AND ADDRESS SUCH CONCERNS AS THEY
EMERGE.

AS THE NEEDS OF CHILDREN AND FAMILIES EXPAND AND
BECOME MORE COMPLEX, IT IS MORE AND MORE APPARENT
THAT BOUNDARIES OF PROFESSIONAL RESPONSIBILITY AS
REFLECTED IN OUR EXISTING SERVICE DELIVERY SYSTEM ARE

OFTEN DYSFUNCTIONAL.

90
THERE ARE SEVERAL POPULATIONS OF ADOLESCENTS
CURRENTLY BEING SERVED INDEPENDENTLY BY HEALTH AND
EDUCATION PROVIDERS. INSTEAD, WE MUST MAKE CHANGES IN
THE SERVICE SYSTEM THAT ALLOW PROFESSIONALS TO PROVIDE
SERVICES TO ADOLESCENTS AND FAMILIES COLLABORATIVELY
BECAUSE OF THE CHANGING SOCIAL CONTEXT WHERE
ADOLESCENTS COME TO SCHOOL WITH EDUCATIONAL
PROBLEMS WHOSE ORIGINS AND SOLUTIONS LIE AS MUCH IN
THE AREA OF HEALTH AS IN EDUCATION.

HEALTH AND EDUCATION SERVICE PROVIDERS MUST CREATE
CHANGES IN THE EXISTING SERVICE DELIVERY SYSTEM THAT

ENABLE EFFECTIVE COLLABORATION.

91
OUR MANY FRAGMENTED ATTEMPTS TO DEAL WITH THE HEALTH
AND EDUCATIONAL PROBLEMS OF ADOLESCENTS HAVE
PRODUCED AT LEAST ONE GOOD MODEL OF A COORDINATED
PROGRAM. THE SPECIAL EDUCATION EXPERIENCE OF THE
LAST TWO DECADES IS ONE EARLY EFFORT TO ENCOURAGE
COOPERATION BETWEEN HEALTH AND EDUCATION

PROFESSIONALS.

92
P.L. 94-142 INSURED THE PROVISION OF FREE, APPROPRIATE
PUBLIC EDUCATION SERVICES TO CHILDREN WITH SPECIFIC
HANDICAPPING CONDITIONS. IT ALSO OUTLINED A PROCESS
WHEREBY THESE CHILDREN WOULD, TO THE EXTENT POSSIBLE,
BE EDUCATED IN THE LEAST RESTRICTIVE ENVIRONMENT.
BECAUSE MANY OF THESE CHILDREN WERE MEDICALLY FRAGILE
OR HAD SPECIAL HEALTH NEEDS, HEALTH PROFESSIONALS
BECAME INVOLVED IN DESIGNING {AND OFTEN IMPLEMENTING|,

INDIVIDUAL EDUCATION PLANS FOR EACH CHILD.

93
IN EFFECT, THE LEGISLATION MANDATED COOPERATION
BETWEEN HEALTH AND EDUCATION PROFESSIONALS,AND
SYSTEMS WERE PUT INTO PLACE TO STREAMLINE THIS SERVICE
COORDINATION IN WAYS THAT WOULD BEST ADDRESS THE

NEEDS OF THIS CATEGORICAL PROGRAM .
P.L. 94-142 DEMONSTRATED THE NEED FOR A BETTER WAY TO

COORDINATE A BROAD RANGE OF SERVICES FOR CHILDREN WITH

HANDICAPPING CONDITIONS.

94
WHILE IT DID NOT FORMALLY ENCOURAGE COLLABORATION
BETWEEN THOSE WHO PROVIDE HEALTH AND EDUCATION
SERVICE, IMPLEMENTORS IDENTIFIED SEVERAL ISSUES RELATED
TO SERVICE COORDINATION THAT NEEDED TO BE ADDRESSED IN

ORDER TO BETTER SERVE THE TARGETED POPULATION.

FOR THE FIRST TIME IN THE FEDERAL EDUCATION LEGISLATIVE
PROCESS, STATES WERE CHALLENGED TO MAKE CHANGES IN
EXISTING SERVICE SYSTEMS THROUGH A COORDINATED,

MANAGED EARLY INTERVENTION PROCESS.

95
SOME OF THE MOST CREATIVE EXAMPLES OF COLLABORATION
BETWEEN EDUCATION AND HEALTH PROFESSIONALS CAN BE
FOUND IN THE EXTENSIVE INTERAGENCY PLANNING PROCESS
THAT IS NOW OCCURRING AS STATES CREATE SERVICE DELIVERY
SYSTEMS IN LOCAL JURISDICTIONS FOR INFANTS AND TODDLERS

WITH HANDICAPS AND THEIR FAMILIES.

IN SUCH A SYSTEM, PUBLIC AND PRIVATE HEALTH, EDUCATION
AND SOCIAL SERVICE PROFESSIONALS COORDINATE THEIR
SERVICES IN THE INTERESTS OF CHILDREN AND FAMILIES
RATHER THAN IN THE INTERESTS OF THE SERVICE SYSTEMS. IN
THIS WAY, ADEQUATE RESOURCES ARE GARNERED AND

PROVIDERS ARE APPROPRIATELY SUPPORTED AND REIMBURSED.

96
COORDINATING THE SCHOOLS AND HEALTHCARE SERVICES WILL

MEAN SHELVING SOME OLD SUSPICIONS.

ONCE | TRIED TO GET SOME SCHOOL-BASED CLINICS GOING IN __
Mit waveE€ | BUT IMMEDIATELY RAN INTO OPPOSITION BECAUSE
MOST PEOPLE ASSOCIATED SCHOOL-BASED CLINICS
EXCLUSIVELY WITH CONTRACEPTION AND PREGNANCY ISSUES.
ACTUALLY, GOOD SCHOOL-BASED CLINICS FIND THAT
CONTRACEPTION OR PREGNANCY ISSUES AMOUNT TO ONLY 6

PERCENT OF THEIR WORK.

97
ANOTHER GOOD REASON TO PLACE CLINICS AND SCHOOLS

TOGETHER IS THAT IT WILL ENABLE HEALTH CONSULTATIONS TO

OCCUR WITH GREATER

CONFIDENTIALITY.

CONFIDENTIALITY IS ESSENTIAL.

THERE IS A PERVASIVE DISTRUST IN THE ADOLESCENT

COMMUNITY.

98
WHEN I WAS FILMING FOR THE TV SPECIAL ON ADOLESCENT
HEALTH, | ARRANGED FOR SOME CANDID TALK WITH KIDS IN
MINNEAPOLIS. MEETING WITH THEM INVOLVED GOING THROUGH

STEPS LIKE THOSE WE SEE IN MOVIES ABOUT THE MAFIA: |
A TEEWD OLLET IL CA REC

RENDEZVOUS IN DINGY RESTAURANTS, BOOROUTS'ATTHE

pwas tw pene t

PORSAND-WINBOWS, AND SUSPICION SO THICK YOU COULD

   

   

CUT IT WITH A KNIFE.

99
MY INITIAL GREETING BY ONE OF THESE YOUNGSTERS WAS, ”I
DON’T TRUST YOU. I DON’T LIKE YOU. YOU WORKED FOR THE

GOVERNMENT, SO YOU MUST BE A LIAR.”

/

OBVIOUSLY, DISTRUST OF PUBLIC OFFICIALS MUST BE
OVERCOME IF WE EXPECT THE PUBLIC SECTOR TO HAVE A
POSITIVE IMPACT UPON ADOLESCENTS AND THEIR HEALTH.

ASSURING CONFIDENTIALITY IS ESSENTIAL,//

100
ADOLESCENT FEAR OF LACK OF CONFIDENTIALITY IS A MAJOR
REASON WHY THOUSANDS OF ADOLESCENTS AVOID HEALTH
CARE FACILITIES.
EVEN THOSE WHO CAN AFFORD MEDICAL CARE BECAUSE THEY
ARE COVERED BY THEIR PARENTS’ INSURANCE WILL AVOID
NEEDED HEALTH CARE IF INSURANCE COVERAGE MEANS A
BREACH OF CONFIDENTIALITY.

y
TRUE, PARENTAL INVOLVEMENT IN ADOLESCENT HEALTH IS
IMPORTANT, BUT IT CANNOT BE ALLOWED TO STAND IN THE WAY

OF ADOLESCENT HEALTHCARE.

/

101
AS IS THE CASE WITH SO MANY PROBLEMS, SOONER OR LATER

WE NEED TO TALK ABOUT MONEY.

ADOLESCENT HEALTH CARE MUST BE

ADEQUATELY FINANCED.

102
ALL ADOLESCENTS NEED TO BE GUARANTEED ACCESS TO
HEALTH CARE, REGARDLESS OF ABILITY TO PAY.

IT IS A NATIONAL TRAVESTY TO HAVE SO MANY OF OUR CITIZENS
LIVE AMID THE SIGNS OF AFFLUENCE AND OPULENCE, BUT

UNABLE TO AFFORD BASIC HEALTH CARE.

FAR TOO OFTEN ACCESS TO HEALTH CARE FOR ADOLESCENTS
DEPENDS ON THE FAMILY’S FINANCIAL CIRCUMSTANCES, AND
EVEN UPON THE STATE IN WHICH THOSE CIRCUMSTANCES

OCCUR.

103
ABOUT 15 PERCENT OF ALL 10 TO 18 YEAR-OLDS LACK PUBLIC
FINANCING OR PRIVATE INSURANCE FOR HEALTH CARE COSTS.
IN FAMILIES LIVING UNDER THE POVERTY LEVEL, FULLY 35

PERCENT OF SCHOOL AGE CHILDREN LACK HEALTH INSURANCE.

92.6 Ae.

THERE |S AQP DIFFERENCE BETWEEN BEING

INDIGENT AND BEING MEDICALLY INDIGENT. “1, Deva?
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104
[FOR EXAMPLE, THE POVERTY LEVEL ESTABLISHED BY THE
FEDERAL GOVERNMENT FOR A FAMILY OF 3 IS $10,500.

DECLARE THAT
ma PERCE 74 CP

POVERTY LEVEL TO QUALIFY FOR MEDICAID SHALL BE @a® OF

 

BUT S09 STATES, (eee

THE NATIONAL LEVEL.

Fuot GEXA uM Pie
Pewee IF A FAMILY OF THREE IN TEXAS EARNS MORE

THAN $3,000 ANNUALLY, THEY ARE TOO RICH FOR MEDICAID.

105
THIS HAS A DEBILITATING EFFECT NOT ONLY ON HEALTH, BUT
ALSO ON MORALE. THOSE AMERICANS IN POVERTY AND ON
WELFARE WHO ARE DETERMINED TO WORK THEIR WAY UP, RUN
THE RISK OF WORKING THEMSELVES OUT OF POVERTY: INTO
MEDICAL INDIGENCE. AS THEIR INCOME RISES SLIGHTLY, THEY
EARN TOO LITTLE TO LIVE ON, BUT TO MUCH TO GET MEDICAID.
MEDICAID IS A MESS, AND IT IS BEGINNING TO COST LIVES,

RATHER THAN TO SAVE THEM.

106
INSURANCE COMPANIES HAVE RESPONDED TO THE CRISIS IN
ADOLESCENT HEALTH, AND THE CRISIS IN HEALTHCARE IN

SEE mM Avs pEeRHaps Srtqvee fF
GENERAL, IN WAYS THAT S2O=FS6? UNETHICAL, Heske@" ILLEGAL.

PREMIUMS SUDDENLY GO UP AS SOON AS MEDICAL BILLS COME
IN WITH ANY REGULARITY. OLDER ADOLESCENTS SUFFERING A
CHRONIC PROBLEM OR DISABILITY OFTEN FIND THEMSELVES
UNINSURABLE. AT AGE 22 THEY CAN FIND THEMSELVES
DROPPED FROM A PARENTAL POLICY --IF INDEED THEY WERE
EVER COVERED-—- AND THEN, THANKS TO COMPUTER DATA
BANKS, THEY ARE BLACK-LISTED BY ALL INSURANCE

COMPANIES, ~~ wS UMM ICH Ree

107
WE NEED TO MOUNT PUBLIC PRESSURE AND DIRECT
LEGISLATION TO IMPROVE PUBLIC AND PRIVATE INSURANCE.
OUR CURRENT SYSTEM OF HODGE-PODGE AND SHELL GAMES IS

A NATIONAL DISGRACE.
AT CHILDREN AND ADOLESCENTS SHOULD HAVE ACCESS TO

ADEQUATE HEALTH CARE INSURANCE. IT MUST COVER CHRONIC

CARE AND CARE IN THE COMMUNITY.

108
IT MUST RECOGNIZE THE COMPREHENSIVE NEEDS OF CHILDREN,
ADOLESCENTS, AND THEIR FAMILIES.

IT MUST ASSURE EQUAL ACCESS TO CARE FOR ALL
ADOLESCENTS ACROSS GEOGRAPHIC BOUNDARIES.

ABOVE ALL, INSURANCE COVERAGE MUST BE BROADENED TO
INCLUDE PREVENTIVE PROGRAMS. THAT SAVES MONEY AS WELL

AS LIVES.

109
FINANCING NEEDS TO BE CREATIVE TO ALLOW COLLABORATION
BETWEEN THE VARIOUS PROGRAMS AND PERSONS DEALING

WITH ADOLESCENT HEALTH.

THE COLD ECONOMIC REALITY IS SIMPLY THIS. IT IS A GOOD
INVESTMENT TO SPEND SOME MONEY --BOTH PUBLIC FUNDING
AND UNIVERSALLY AVAILABLE AND AFFORDABLE PRIVATE

INSURANCE-- RATHER THAN MORE MONEY LATER.

110
DOLLARS SPENT FOR HEALTHY CHILDREN AND ADOLESCENTS
WILL SAVE DOLLARS SPENT ON COSTLY ADULT HEALTH CARE
LATER.

IT 1S GOOD COMMON SENSE AND GOOD BUSINESS SENSE TO
RAISE A HEALTHY YOUNGER GENERATION, BUT IT HAS NOT BEEN

GOOD POLITICS.

YOUNG PEOPLE SUFFER FROM GOVERNMENT INATTENTION
BECAUSE THEY DON’T VOTE, AND THEY HAVE NO LOBBY TO
REPRESENT THEIR INTERESTS. SO GOVERNMENT HAS PROVEN
RELUCTANT TO SPEND FOR THE HEALTH OF CHILDREN AND
ADOLESCENTS, EVEN THOUGH THE LONG TERM BENEFITS AND
SAVINGS OUTWEIGH THE IMMEDIATE SHORT TERM

EXPENDITURES.

111
WE NEED TO CHANGE THAT SHORT SIGHTED THINKING.
WE MIGHT LEARN AT LEAST A LITTLE SOMETHING FROM RECENT
BOONDOGGLES LIKE THE S&L CRISIS, THAT CONFRONTING A

PROBLEM EARLY CAN AVOID BIGGER AND MORE COSTLY

PROBLEMS LATER ON.

112
| FEAR THAT THE ADMINISTRATION AND CONGRESS WILL NOT
ADDRESS THE ISSUE OF ADOLESCENT HEALTH ON THE CLEAR
MERITS OF THE SITUATION --IN SPITE OF THE NATION’S
AFFLUENCE AND PROSPERITY. THE DAY WILL COME WHEN THE
BUSINESS COMMUNITY WILL EXERT GREATER PRESSURE FOR
MORE REALISTIC FUNDING OF HEALTH CARE. WE MUST MAKE

SURE THAT ADOLESCENTS ARE NOT LEFT OUT.

113
FORTUNATELY SOME INDIVIDUALS AND CORPORATIONS, NOT
JUST HUMAN SERVICE ORGANIZATIONS, ARE SEEING THE
COMPELLING NEED TO INVEST IN THE HEALTH OF OUR CHILDREN
AND ADOLESCENTS, ...AN INVESTMENT IN THEIR HEALTH, NOT

JUST IN THE TREATMENT OF DISEASE.

WE NEED MAJOR CHANGES IN THINGS THAT ARE HARD TO

CHANGE: SOCIAL INSTITUTIONS AND PROFESSIONAL PRACTICES.

114
THE TASK BEFORE US IS DIFFICULT.

BUT SO ARE MANY OF THE TASKS DISCUSSED IN LECTURES
BEFORE THIS DISTINGUISHED AUDIENCE.

WE ARE HERE BECAUSE WE ARE CONCERNED.

WE ARE HERE BECAUSE WE BELIEVE IN THE ABILITY TO
TRANSLATE THE BEST OF THE SPIRIT OF MAN INTO ACTION, INTO

CHANGE.

115
LIFE AFFORDS NO GREATER RESPONSIBILITY, NO GREATER

PRIVILEGE THAN THE RAISING OF THE NEXT GENERATION.

TO BE TRUE TO THE SPIRIT OF THE SPIRIT OF MAN, I CALL UPON
YOU, UPON US ALL TO MAKE A FOCUSED COMMITMENT TO MEET
THE HEALTH NEEDS OF THIS NEGLECTED SEGMENT OF OUR

SOCIETY, OUR ADOLESCENTS.

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NOW, THERE IS ONE MORE POINT I SHOULD MAKE IF WE ARE
GOING TO BE HONEST WITH OURSELVES IN DEALING WITH THESE
PROBLEMS OF ADOLESCENT HEALTH..... IF WE ARE GOING TO

DEAL WITH THESE PROBLEMS, NOT IN A THEORETICAL OR
%

4

RHETORICAL WAY, PUT IN A DOWN-TO-EARTH, PRACTICAL, AND

PERSONAL WAY.

THE ISSUE SIMPLY STATED IS THIS:

ADOLESCENTS ARE NOT THE EASIEST PEOPLE TO DEAL WITH.

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MANY ADULT AMERICANS ARE SIMPLY NOT DRAWN TO
AWKWARD, ABUSIVE ADOLESCENTS. THEIR ATTITUDES AND
BEHAVIOR CAN PUT OTHER PEOPLE OFF. AND, IN SPITE OF THE
POWER OF PEER PRESSURE, ADOLESCENTS OFTEN DON’T
ADMIRE EACH OTHER. THEY FIND FEW ROLE MODELS AMONG
THEMSELVES. AND THE ONES THEY DO FIND OFTEN LEAD THEM

DOWN THE WRONG PATH.

BUT THE PICTURE NEED NOT BE SO BLEAK. THERE ARE MANY
HEROS AMONG OUR ADOLESCENT POPULATION. IT’S TIME WE
GAVE THEM THEIR DUE, IT’S TIME WE LET THEM DO WHAT THEY

CAN DO AS ROLE MODELS FOR OTHER ADOLESCENTS.

118
TWO OF MY GREATEST HEROS, PEOPLE OF REAL INSPIRATION
ARE ADOLESCENTS. THEY CARRY ALL THE EMOTIONAL BURDENS
NORMAL TO ADOLESCENTS, BUT THESE TWO FELLOWS CARRY

MORE, MORE THAN | COULD BEAR.

PAUL AND CHRISTOPHER HAVE BEEN AN INSPIRATION TO ME,
AND TO COUNTLESS OTHERS, ADULTS, ADOLESCENTS, AND
CHILDREN. PAUL AND CHRISTOPHER HAVE LIVED ALL THEIR
LIVES WITH PROBLEMS THAT WE "NORMAL” PEOPLE LABEL AS ”

DISABILITIES.”

119
BUT THEIR DETERMINATION, THEIR RESILIENCE, THEIR
POSSESSION OF THE BEST OF THE SPIRIT OF MAN MADE ME ASK
MANY TIMES

*"WHO ARE THE TRULY DISABLED AMONG US?”

THERE WERE BEEN MANY TIMES DURING MY CAREER AS A
PEDIATRIC SURGEON, WHEN | HAD TO PUT ASIDE MUCH OF THAT
EXPERIENCE AND THAT RHETORIC -- WHAT MIGHT BE CALLED

THE "CONVENTIONAL WISDOM” OF DISABILITY.

120
PAUL CERTAINLY MADE ME DO THIS. NOT LONG AGO PAUL

. HE

PSRs eer.

 

GRADUATED FROM HIGH SCHOOL #

 

FINISHED WITH A VERY GOOD ACADEMIC RECORD...HE WAS ALSO
ON THE VARSITY BASKETBALL TEAM. AND HE WAS CLASS
VALEDICTORIAN. A RATHER GOOD RECORD, | WOULD SAY.

BUT | THINK THE "CONVENTIONAL WISDOM” OF DISABILITY
WOULD PROBABLY HAVE WRITTEN PAUL OFF MANY YEARS AGO.
PAS IS A GRADUATE NOT ONLY OF SECONDARY SCHOOL -- BUT
OF Be OPERATIONS. EACH OF THEM DIFFICULT, EACH OF THEM

NECESSARY, EACH OF THEM A TERRIBLE, TRAUMATIC

INTERRUPTION IN THE LIFE OF A GROWING BOY.

121
1 KNOW ABOUT THESE OPERATIONS BECAUSE I PERFORMED 37

OF THEM.

BUT PAUL SURVIVED THEM ALL -- AND THE GROWING PAINS OF
ADOLESCENCE, TOO -- AND TODAY HE IS A STRONG, DECENT,
BRIGHT YOUNG MAN, 4 Cote €€& GRanud7e
Douw A PEIPow StACE Ye 8.

LL MAKE A CONFESSION RIGHT HERE AND ADMIT THAT | DON’T
REALLY KNOW HOW HE DOES IT. BUT THROUGH THE YEARS HE

HAS ABSORBED THE SHOCK OF REPEATED OPERATIONS.

122

Peed (Ae

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HE HAS ABSORBED THE HIGHS OF LOVING, TENDER CARE AND

THE LOWS OF REJECTION.

YEAR AFTER YEAR HE HAS HAD TO ABSORB A GREAT DEAL OF
INFORMATION ABOUT HOW TO GO ON LIVING DURING THE
MASSIVE RECONSTRUCTIONS BEING DONE TO HIS FACE AND HIS

BODY.

WE WOULD CALL HIM A ”DISABLED, HANDICAPPED” CHILD. BUT
PAUL...SO COURAGEOUS AND SO VERY INNOCENT... HAS REFUSED
TO BE DISABLED AND HANDICAPPED. AND SO HE HAS ENDED
THIS CHAOTIC AND PAINFULLY LONG PERIOD OF CHILDHOOD,

PUBERTY, AND ADOLESCENCE AS AN IMPORTANT YOUNG MAN.

123
| COULD NOT HAVE DONE IT. | KNOW VERY FEW PEOPLE WHO
COULD. | THINK MOST OF US ARE TOO ”DISABLED” IN FAITH OR
IN SPIRIT OR IN COURAGE TO HAVE GONE THROUGH SUCH AN

ORDEAL OF PHYSICAL AND EMOTIONAL RECONSTRUCTION.

NO, THE ONLY PERSON WHO COULD HAVE SUCCESSFULLY
WEATHERED THE YEARS OF REPEATED SURGICAL ASSAULT IS, OF
COURSE...PAUL HIMSELF. HE HAS THE ABILITY. AND I AM VERY,

VERY PROUD TO CALL HIM MY FRIEND.

124
BUT LET ME ADD JUST A WORD ABOUT HIS FAMILY.

SOME YEARS AGO, WHEN PAUL WAS ABOUT TWO-THIRDS THE
WAY THROUGH HIS LONG SURGICAL ORDEAL, | WAS ASKED BY A
CANADIAN UNIVERSITY TO DELIVER A LECTURE ON A TOPIC
RELATED TO PAUL’S EXPERIENCE. | APPROACHED PAUL'S
MOTHER AND ASKED HER FOR ANY OBSERVATIONS SHE MIGHT
WANT TO MAKE. FOR EXAMPLE, | ASKED HER, "WHAT WAS THE

WORST THING THAT HAS EVER HAPPENED TO YOU IN YOUR

LIFE?”

125
AND SHE ANSWERED, "HAVING OUR SON BORN WITH ALL THOSE

DEFECTS THAT REQUIRED 37 OPERATIONS TO CORRECT.”

| WASN’T SURPRISED BY HER ANSWER. BUT | ALSO KNEW SHE
HAD A STRONG FAMILY, A DEVOTED HUSBAND, AND THREE
OTHER CHILDREN WHO WERE BORN HEALTHY AND HAVE BEEN
LOVING SIBLINGS TO HER SON. SO ! ASKED HER, ”ALL RIGHT,
WHAT WAS THE BEST THING THAT EVER HAPPENED IN YOUR

LIFE?”

AND SHE ANSWERED, "HAVING OUR SON BORN WITH ALL THOSE

DEFECTS THAT REQUIRED 37 OPERATIONS TO CORRECT.”

126
LET ME TE&L YOU ANOTHER STORY ABOUT AN ADOLESCENT,
ANOTHER FORMER PATIENT OF MINE.

THIS ONE IS ABOUT A YOUNG MAN NAMED CHRISTOPHER. | MET
LITTLE CHRISTOPHER ABOUT 20 YEARS AGO WHEN HE WAS ONLY

4 DAYS OLD. AND HE WAS A MESS.

127
A MAJO. 6 Aad Thee pe testiurwe OF LECT
HE HAD N@*Q9MNM. AND HE WAS A FLOPPY BABY. HE LOOKED

LIKE HE MIGHT BE MILDLY RETARDED. THREE OTHER
PHYSICIANS HAD DECIDED THAT CHRISTOPHER WOULD NOT BE
WORTH THE EFFORT AND THE COST OF REPARATIVE SURGERY.
AND THEY TOLD CHRISTOPHER’S MOTHER SOMETHING THAT
NOBODY CAN EVER PREDICT: THAT IS, THE KIND OF LIFE A CHILD

IS GOING TO HAVE.

128
CHRISTOPHER HAD A LEARNING DISABILITY. FROM THE VERY
BEGINNING, HE NEEDED A LOT OF HELP AND A LOT OF LOVE.

AND HE GOT BOTH.

CHRISTOPHER’S FAMILY HAD STARTED OUT PRETTY MUCH LIKE
MOST AMERICAN FAMILIES. REALLY, | THINK YOU CAN MEET
PEOPLE LIKE HIS MOTHER AND FATHER ALMOST EVERY DAY

ANYWHERE IN THIS COUNTRY.

BUT THEY HAVE A SPECIAL ADVANTAGE: THEY’VE HAD

CHRISTOPHER.

129
CHRISTOPHER HAS TAUGHT THEM A GREAT DEAL ABOUT LIFE.

AS A DISABLED CHILD, THEN AS A DISABLED ADOLESCENT HE

MADE THE REST OF HIS FAMILY...

ABLE TO CARE DEEPLY ABOUT EACH OTHER...

ABLE TO GIVE EACH OTHER GENUINE, UNABASHED LOVE AND

AFFECTION...

_ AND MADE THEM ABLE TO EXTRACT FROM THEIR OWN HEARTS

AND SPIRITS THE FINEST, PUREST INSTINCTS OF HUMANITY

130
CHRISTOPHER BROUGHT ABOUT AN EXTRAORDINARY CHANGE IN
THE LIFE OF THIS OTHERWISE ORDINARY FAMILY. HE HAD
ENRICHED IT SO, THAT HIS FAMILY MADE A MOMENTOUS
DECISION. THEY MOVED TO A LARGER HOUSE ON A FARM
OUTSIDE OF TOWN AND ADOPTED 12 MORE RETARDED CHILDREN.
THEY BROUGHT THOSE KIDS INTO A SNUG, LOVING HOME, WHERE
EVERYONE GROWS UP WITH A RATHER SPECIAL, RATHER
PRECIOUS ABILITY TO CARE VERY DEEPLY ABOUT THE PEOPLE

SITTING ON THEIR RIGHT AND THEIR LEFT.

131
WHEN CHRISTOPHER ENTERED ADOLESCENCE HE JOINED THE
BOY SCOUTS. HE TOLD ME ABOUT IT DURING A VISIT TO MY
OFFICE AT THE CHILDREN’S HOSPITAL OF PHILADELPHIA. HE
SAID THAT HE HAD A GREAT AMBITION. HE HOPED ONE DAY TO

BE AN EAGLE SCOUT.
YOU SEE, CHRISTOPHER DID NOT REALLY ACCEPT THE FACT

THAT HE WAS A DISABLED ADOLESCENT WITH LIMITATIONS ON

HIS PERSONAL LIFE AND AMBITIONS.

132
I SAID, *>CHRISTOPHER, I’M TICKLED THAT YOU’VE JOINED THE
SCOUTS. AND ! WANT YOU TO PROMISE TO TELL ME WHEN YOU

BECOME AN EAGLE SCOUT. I WANT TO BE THERE WHEN YOU GET

YOUR BADGE.

HE PROMISED HE WOULD TELL ME. AND HE DID

133
A FEW YEARS LATER | WENT FROM WASHINGTONTO 7 Howe Mae”

Pewee TO A LITTLE CEREMONY IN WHICH I PINNED THE
EAGLE SCOUT BADGE ON MY FRIEND CHRISTOPHER. HE STOOD
ON THE STAGE AND THANKED HIS PARENTS, HIS SCOUTMASTER,
HIS DOCTOR, HIS FIVE HEALTHY, NORMAL SISTERS, AND HIS 12
ADOPTIVE BROTHERS AND SISTERS. HE THANKED US ALL FOR
THE HELP AND ENCOURAGEMENT WE’D GIVEN HIM SO THAT HE
COULD ACHIEVE HIS AMBITION OF BEING AN EAGLE SCOUT. |

THOUGHT WE ALL SHOULD HAVE THANKED HIM.

134
CHRISTOPHER WAS A TEXTBOOK EXAMPLE OF A "DISABLED,
HANDICAPPED” ADOLESCENT. OF COURSE, IT’S OUR
TEXTBOOK...NOT HIS. AND THANK GOODNESS FOR THE

DIFFERENCE.

THESE TWO YOUNG PEOPLE -- PAUL AND CHRISTOPHER -- ARE
JUST TWO OF A LARGE NUMBER OF DISABLED CHILDREN AND
ADOLESCENTS THAT I’VE HAD THE PRIVILEGE TO KNOW AND TO

HELP DURING MY PROFESSIONAL LIFE IN MEDICINE.

135
THEY ARE ALL VERY SPECIAL PEOPLE TO ME. THEY WERE ALL
BROUGHT TO ME BECAUSE THEY WERE IN SOME WAY HURT OR
DAMAGED OR INCOMPLETE. THEY WERE, IN THE EYES OF

MEDICINE AND SOCIETY, TOO,

DISABLED...HANDICAPPED...IMPERFECT...DIFFICULT... THE SAME
TERMS SEEM TO BE APPLIED BY SOCIETY AT ONE TIME OR

ANOTHER TO ALL ADOLESCENTS.

136
BUT I’VE LEARNED IMPORTANT THINGS FROM EVERY ONE OF
THEM. AND I’VE HAD TO ASK MYSELF, "JUST HOW COMPLETE
AND ABLE AND PERFECT AM I, IF THEY CAN TEACH ME SO MUCH
ABOUT THE WONDER OF LIFE?” AND THE ANSWER IS QUITE
HUMBLING, WHICH IS A REACTION NOT COMMONLY FOUND

AMONG SURGEONS.

137
NOW, THERE IS A DANGER IN ROMANTICIZING ILLNESS AND
DISABILITY. THAT’S NOT A HEALTHY THING TO DO. AND I HOPE
YOU DON’T THINK THE STORIES OF MY TWO YOUNG FRIENDS
WERE ROMANTIC OR FANCIFUL. THEY AREN'T. QUITE THE

OPPOSITE. THEY ARE VERY REAL YOUNG MEN.
THE WAY THESE ADOLESCENTS TRIUMPHED OVER

DISADVANTAGE AND DISABILITY MADE ME ASK AGAIN ”WHICH

OF US IS DISABLED?”

138
IS IT THE YOUNG MAN WITH THE MUSCULAR DYSTROPHY WHO
RESOLUTELY NEGOTIATES THE SCHOOL HALLWAYS AND STAIRS
SO AS NOT TO BE LATE FOR ANYTHING? OR IS IT THE THERAPIST
WHO SEES THAT YOUNG MAN ONLY AS A DISABLED VICTIM OF

THE DISEASE.

139
IS IT THE MILDLY RETARDED YOUNG WOMAN WHO IS IN
PERPETUAL MOTION, CONSTANTLY DOING A HUNDRED-AND-ONE
LITTLE CHORES FOR HER FAMILY AND FRIENDS. OR IS IT HER
TEACHER WHO METICULOUSLY CONCENTRATES ONLY ON A

HANDFUL OF BASIC SKILLS.

140
IS IT THE TEENAGER WITH IMPAIRED VISION, NEARLY BLIND, BUT
STRUGGLING TO LEARN PIANO? OR IS IT THE NEIGHBOR WHO

SAYS SHE CAN’T PUT UP WITH THE NOISE FOR ONE MORE DAY?

141
| SUPPOSE IT WOULD BE NICE TO BE ABLE TO SAY THAT I CAME
ToOOAY

HERE 6-E4S4GNG TO DELIVER A BRAND-NEW MESSAGE. BUT |

CAN MAKE NO SUCH CLAIM. MY MESSAGE IS REALLY VERY OLD.

THE TEXT IS FROM THE ETHICS OF ARISTOTLE, WHO MADE THIS

 

LITTLE OBSERVATION SOME 2400 YEARS AGO. I DON’T ALWAYS
AGREE WITH ARISTOTLE, BUT I’LL NEVER QUIBBLE ON THIS

OBSERVATION: ~

ARD1C1E.
“THE NATURE OF MAN,” RE SAID, “IS NOT WHAT HE WAS
BORN —~ AS, BUT WHAT HE WAS BORN FOR.”
\

142
AS MORE AND MORE OF OUR ADOLESCENTS ARE ALL TOO

READILY DISMISSED FOR WHAT THEY WERE BORN AS, WE NEED

 

TO EMPLOY THE BEST OF THE HUMAN SPIRIT, BREATHED INTO US
BY GOD, TO SEE THAT THEY CAN BECOME ALL THAT THEY WERE

BORN FOR.

143