The Air They Breathe: A Pediatrician on the Frontlines of Climate Change

The Air They Breathe: A Pediatrician on the Frontlines of Climate Change by Debra Hendrickson, Simon & Schuster 

Looking at the news from just the past week, we see that more than 1,300 pilgrims (including at least 11 Americans) died during this year's Hajj in Mecca due to extreme heat, and a recent study found "the frequency and intensity of extreme wildfires have more than doubled in the last two decades." Even in places where it used to feel like a distant phenomenon, climate change is becoming local news. CNN chief climate correspondent Bill Weir recently wrote a piece about "Why TV Weather Forecasters Can No Longer Avoid Climate Change," but when they do cover it—even when they are hired specifically because of their expertise and ability to cover it—the blowback can feel like a derecho.

But meteorologists aren't the only ones who find climate change increasingly relevant to their profession and who encounter the politicization of the issue while doing their jobs.  

Debra Hendrickson is a pediatrician in Reno, Nevada, the fastest-warming city in America. Heat itself can be deadly, but dealing with the health effects of nearby wildfires is now a yearly occurrence. The names of the worst fires in recent years are mentioned so often that they become like characters in her new book, The Air They Breathe. Still, she has found herself reluctant to talk about the root cause of these fires in her practice.

I don’t usually dodge difficult topics, even when parents and I disagree. But decades of propaganda and partisan warfare had made climate science political. Saying out loud what we could all see happening—out the window, on television, in this pediatric ward—risked something I treasured: my relationship with patients’ families. 

But in 2018, after more than three weeks of living under a blanket of gray smoke coming from the Carr and Mendocino Complex fires in Northern California, a boy snuck outside to play for a moment and wound up in Dr. Hendrickson's hospital on an oxygen machine. The boy's father sat on the edge of his three-year-old son's hospital bed, looking out the window, and asked, "What is happening?" 

Dr. Hendrickson couldn't help but reply with the overwhelming yet unspoken truth of that moment, "It's climate change." She had come to a clear realization: 

There was no way to protect their own children without fighting for all children. The only medicine we had was each other. The only thing we could do was speak up, together, against the corporations whose decisions had led us here.

Debra Hendrickson was an environmental planner before she was a pediatrician. I suspect, because of the politicization of climate change, some will use that fact as confirmation bias that she was a climate activist before becoming a doctor and is simply finding ways to shoehorn the two together. If that is you, I doubt I'll be able to persuade you otherwise here.  

But what if I told you that her previous job entailed, more specifically, "analyzing how rivers are affected by land use changes in their watersheds," and that through that work, she has a deeper training in and understanding of how interconnected our world is, how human activity can alter the literal flow of things, and how that might affect human health down the line? If I told you she left her first career to stay home with her kids and started her second career of caring for others' kids only after what she describes as a "sudden and traumatic divorce," would that make her own journey seem more relatable? If I told you that she regularly traveled from Reno to Sacramento, California, to complete her pediatrics residency while keeping shared custody of her own children, would that help you understand the depth of her dedication? You can see why she is an ideal candidate to author a book on why the climate crisis is also a health crisis, especially for children. 

Even though, as a pediatrician, she has at her disposal medical interventions that would have been considered miraculous just a few generations ago, she knows that the environment is still the ultimate determinant of human health. In the book, she shares a moment of observation when the veil dropped away and she saw this reality clearly. She was standing in a glass walkway at the hospital as a light rain began to fall after a brutal heat wave and wildfire smoke had blanketed their valley. Kids could finally play outside without worry. Observing a boy she knew joyously trying to catch raindrops on his tongue, she saw, in that moment, all the connection to the wider environment around him.  

And those connections with his environment, though invisible from where I stood, were more fundamental to his health than any of the dazzling medical technology in the building behind me.  

It wasn't the first time she'd contemplated these connections. In a beautiful but frightening passage about almost skidding off a cliff on an icy road above the Donner Pass while returning from her residency in Sacramento one evening, she writes about how her breath fogged in the car, even as "the simple beauty of just breathing became startlingly, crystal clear": 

I had realized, in medical school years before, that air and blood flow like rivers through the lungs, in tributaries of airways, veins, and arteries, nature mimicking itself as Earth’s favorite forms are reflected in the structures of our body. I had seen that we are not separate or different from the environment I had studied in my prior career; We are entirely of it. 

I had watched so many babies enter this world with that dramatic first cry, the first act of life, a breath. Now I saw that the last act, too, is a breath, and that breath and every one preceding it integrates us with, and binds us to, this world. We pull the atmosphere into our lungs, we breathe it out, we live.

The quality of the writing matches the depth of her feeling and thinking, as well as the importance and urgency of the crisis we face. But Hendrickson is just as adept at tightening the focus on one telling or startling statistic to explain its significance, or explaining a single aspect of our physiology, like the function of the alveoli, "clustered like grapes at the end of the tiniest airways" that absorb oxygen and from the air and into our bloodstream through capillaries. She describes how different children's still-developing respiratory systems are from adults, and how much more susceptible to chronic air pollution and the particulate matter in it they are. There are behavioral factors, like the fact that they tend to play outside more than adults, but there are also biological factors, like the fact that children just breathe faster and have a larger lung surface relative to their overall size: 

More breaths, more lung surface area, and more air exchanged mean children are exposed to higher doses of air pollution, pound for pound, than adults. 

So, when wildfire smoke covers a city as it inevitably does somewhere in America every summer: 

Bits of what once was, particles can be carried for thousands of miles in the wind. Because of their minute size, they can also be pulled deep into the lungs; the smaller the particle, the more invasive and hazardous for human health. The finest particles easily cross the alveoli, enter the bloodstream, and wreak havoc on multiple organs, including the heart and brain.  

Sometimes we can see the danger clearly, like when wildfire smoke darkens the skies. But they are ever present, even when unseen, a significant percentage of them a direct result of burning fossil fuels. Regulations have helped, but the damage is still being done, and we have a lot of work left to do.  

Over the last half century, the Clean Air Act reduced emissions from tail pipes and smokestacks across the country. Yet scientists estimate that in 2018 an astounding 13 percent of all deaths in the United States—and 8.7 million deaths worldwide—were caused by particles from fossil fuels.  

The scale of the problem seems staggering, and we can't even see it much of the time. But she can. She explains losing a child to an asthma attack in the ER. 

It is one thing to cite those statistics. It is another to have it happen in your hands. 

There is a moral clarity to The Air They Breathe, one that ultimately shows that when it comes to climate change, it is not just statistics; it is in our hands. And for our children's sakes, we must change.