Chapters 10–12 Summary and Analysis
Chapter 10
Dr. Hanna-Attisha began to feel despair because the health department would not return her emails; however, Elin had been trying to garner public support and speaking to Flint Congressional Representative Dan Kildee. Later that day, Kildee’s legislative director contacted Dr. Hanna-Attisha, and she requested access to all the blood data of Flint’s children. Additionally, Marc Edwards had posted his findings, which showed that roughly two fifths of houses in Flint had high levels of lead in their tap water. Dr. Edwards was also slated to appear at a town meeting. Dr. Hanna-Attisha looked up Dr. Edwards on the internet, and even though Elin had warned that he had a strong personality that could hurt their cause more than help it, Dr. Hanna-Attisha was taken in by his good looks and goofy panda tie.
Later that day, she received the data from Hurley on blood-lead levels and began working with a statistician from the hospital, Jenny, to analyze it. Throughout the day, she struggled to focus on more mundane obligations, such as responding to emails, meal-planning, and her children’s soccer practice. The next day, she met with her pediatric residents and Jenny and shared the data with them. Although the data appeared to show a general spike in lead levels, they needed to perform more data analysis to be sure that there was a significant increase and that it could be attributed to the water switch. They discussed how they would use the data, looking at which patients to include and exclude (for example, children outside of the Flint area and children who had likely received blood-lead spikes from other sources). Once they determined how to analyze the data for the study, Jenny promised to have something in the next few days. However, Jenny also expressed concern for her son, Drew, who had been exposed to Flint water since his birth. Jenny had taken precautions because of the rumors about Flint’s water, and Dr. Hanna-Attisha attempted to reassure her that Drew would be safe.
The next day, Jenny sent her a preliminary analysis; since the water switch, children five and under had been testing drastically higher for lead in their bloodwork. However, there were very few children tested, and this left room for other variables to be a factor. Dr. Hanna-Attisha decided that she would try to obtain a larger data pool by accessing the entire county’s records, but she needed ethical approval from an institutional review board (IRB) to do this for her research.
Meanwhile, Brad Wurfel, the MDEQ public mouthpiece, was attempting to discredit Dr. Edwards’s research.
Chapter 11
The author describes Charles Kettering, one of GM's lead automotive engineers, who left a legacy after his death in the automotive industry. Although he is usually characterized as a family man and philanthropist, Dr. Hanna-Attisha cannot imagine a greater public health villain. He is responsible for introducing lead to gasoline, despite public awareness that lead could be toxic and fatal. It was not until seventeen people died after exposure to lead gas in a gasoline refinery that the government ordered an investigation into its use. Only one person, Alice Hamilton, a doctor and social justice pioneer, attempted to stand up to GM and show how harmful lead was to the human body. At the time, she was the first woman on the faculty at Harvard University, and despite encountering various sexist regulations, she flourished as an expert on lead poisoning and its ties to industrialization.
In 1925, the Surgeon General called a conference to debate the toxicity of lead. Kettering suggested that because there was too little proof...
(This entire section contains 1574 words.)
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that lead was harmful at the time, it should be allowed in gasoline, and he dismissed Hamilton’s research as hysterical. Although some evidence existed, there was not enough to prove that lead could be linked to poisoning, and it was allowed to be used in gasoline. This became the “safe until proven dangerous” rule that other companies, such as those that produce asbestos and tobacco, used to claim innocence. Since lead was allowed in gasoline, some studies suggest that lead is responsible for nearly half a million deaths and 9.3 million disability claims. This, the narrator tells us, is Kettering’s legacy.
Since the 1970s, the US and European governments have recognized the toxicity of lead and started to phase it out, and since the new millennium, it has essentially been removed from all gasolines. Research has shown how dangerous lead consumption can be to the human body, and since the 70s, there has been a steady decline in US blood-lead levels. Still, many houses have lead paint residue in them, and this can be eaten by children or inhaled by the inhabitants. Lead also exists in soil, and, as Dr. Hanna-Attisha notes, it is now problematic in plumbing. Despite laws that help to prevent lead exposure, there are still many loopholes, and often it is impossible for some places to follow these laws perfectly, especially low-income neighborhoods with lead plumbing features. The lead in water is particularly insidious because unlike paint chips, it cannot be seen, and we trust our public water sources.
Chapter 12
Dr. Hanna-Attisha continued to consider reaching out to Dr. Edwards, but Elin advised against it. Eventually, she convinced Elin to email Dr. Edwards, who responded immediately, saying that the highest risk population was children under fifteen months on formula, so he wanted data on those children. Dr. Hanna-Attisha told him that she was working with this data and proposed a meeting. He explained that he had requested the same blood-lead data from the county that Dr. Hanna-Attisha had. Since he and his assistant, Sid, would be in Flint in a week, he suggested they have lunch together.
Meanwhile, Dr. Hanna-Attisha worked with Jenny on refining the blood data findings. She also had to contend with the demands of home life and take her daughters to soccer practice, as Elliot’s shoulder problem continued to worsen. She decided to meet with Elin and show her the initial findings from the data that she and Jenny were using. Meeting on the soccer field amid screaming children, she showed Elin the data. After Elin read it, the two women shared a quiet moment, and on the verge of tears, they realized the importance of their work. Elin and Dr. Hanna-Attisha made a pact not to share the findings with any external parties, including Dr. Edwards, until they had access to more data and could make a stronger case.
Back home, Dr. Hanna-Attisha sent a letter to Melany, the CEO of Hurley, detailing the findings. Within minutes, Melany voiced support for the research and set up a meeting for the next day. During the meeting, Dr. Hanna-Attisha explained all the steps that she had gone through to obtain blood-lead data from the county. Afterward, she called Dr. Reynolds, the CEO of another hospital, to garner his support. At the mention of lead, he seemed alarmed and asked what she had found. She sidestepped the question and asked if he would be willing to share the blood-lead data from his hospital, which he agreed to. Later that day, one of her residents cornered her in her office, calling attention to the fact that Dr. Hanna-Attisha was clearly not emotionally or physically well. Indeed, Dr. Hanna-Attisha had not eaten or slept much in weeks.
Analysis
Throughout these chapters, the toll that the Flint water crisis is having on Dr. Hanna-Attisha’s mind and body becomes clear. Chapter 10 begins with the despair and frustration she feels toward the health department for not returning her calls or emails. Chapter 12 ends with her commenting on the fact that she has not slept well in weeks, and she is losing weight because she has not been eating properly. In earlier chapters, she detailed what happened to John Snow and Paul Shekwana, and in chapter 11, she lauds Dr. Hamilton for her tireless and thankless work to stop the spread of lead poisoning. In all of these cases, there is sacrifice. In these chapters, there are parallels to the historical figures that the author has been writing about; just as they met with frustration, pushback, and failing health, she is also so wrapped up in the Flint water issue that her body is beginning to show signs of failure.
Additionally, these chapters show how Dr. Hanna-Attisha integrates some of her teaching philosophy into her text. Earlier in the narrative, she asserted that a doctor must be trained to see what the eyes cannot. This means having an understanding of the historical, environmental, and socioeconomic factors in the lives of one’s patients. We now have several chapters in the text that, at first glance, may seem to have nothing to do with the events of the Flint water crisis. Chapter 4 is about the author’s grandfather, chapter 9 is about the history of the Flint economy, and chapter 11 is about the history of the lead industry, especially related to its use in gasoline. While these may seem like disconnected issues, Dr. Hanna-Attisha wants readers to draw parallels and to see how these historical events situate and anticipate the Flint water crisis. Such an issue is complicated, with no single cause. By tying in the history and contexts of Flint and the lead industry to the current crisis, she forces her readers to engage in what might be called literary community expeditions, just as she does for her pediatric residents.
