Every Wednesday at 3:30, my friend Pari and I have a one-hour meeting; we both run our own businesses so we discuss our challenges and share ideas.
But I wasn’t expecting to meet at 3:30 on Wednesday, December 17. Pari and her husband Keith had a major appointment later that evening: Pari would be giving birth to their second child, Charlie.
But why should that disrupt our routine? she said. As long as the baby didn’t come early, she would be perfectly capable of talking—so why not?
This made me happy—because it reminded me of how far civilization has come in making childbirth safe for both mother and child. A day later, the memory was bittersweet—as what my friends had every reason to believe would be a normal childbirth turned into a nightmare that would test the very limits of our medical progress.
Childbirth Through the Ages
Just 200 years ago, the chances that Pari’s son would die during childbirth were one in four. Imagine that someone tells you that he is going to flip a coin twice, and if it’s heads twice in a row, your child will die. Those were the odds mothers faced.
Today, the chances of living to age 1 are over 99%. The major reason is modern medicine—we now have far more medical professionals with far more knowledge and far more technology than ever before to deal with the many inherent dangers of childbirth, from low birth-weight to infection.
Today, Pari and Charlie could be tested by full-time professionals with advanced training using advanced machines to catch nearly any possible problem in advance.
Which means that mothers-to-be can be serene that their child will be healthy when he is born—serene enough to have a relaxed conversation just hours before.
It’s important to understand what makes medical progress possible, so that we can keep improving—every baby lost is an unforgettable tragedy for a family—and so we can understand what is necessary to help others around the world with far higher infant mortality.
Childbirth in the Underdeveloped, Energy-Poor World
One rarely-discussed essential of medical progress—the kind of progress that made a healthy birth for Charlie a near-certainty—is cheap, plentiful, reliable energy. Where such energy is lacking, such as in the underdeveloped world, the state of medicine is tragically bad. In my book The Moral Case for Fossil Fuels I share the following story I read about energy and childbirth in The Gambia:
At 4 p.m. on a Saturday afternoon, I was startled when the lights came on; the lights never came on after 2 p.m. on the weekends. The adrenaline really kicked in when I was invited to observe an emergency cesarean section— a first for me. When the infant emerged I felt my heart racing from excitement and awe! But no matter how many times the technician suctioned out the nose and mouth, the infant did not utter a sound. After twenty five minutes the technician and nurse both gave up. The surgeon later explained that the baby had suffocated in utero. If only they had had enough power to use the ultrasound machine for each pregnancy, he would have detected the problem earlier and been able to plan the C-section. Without early detection, the C-section became an emergency, moreover, the surgery had to wait for the generator to be powered on. The loss of precious minutes meant the loss of a precious life. At that time, in that place, all I could do was cry. And later, when the maternity ward was too hushed, I cried again. A full-term infant was born weighing only 3.5 pounds. In the U.S., the solution would have been obvious and effective: incubation. But without reliable electricity, the hospital did not even contemplate owning an incubator. This seemingly simple solution was not available to this newborn girl, and she perished needlessly. Reliable electricity is at the forefront of every staff members’ thoughts. With it, they can conduct tests with electrically powered medical equipment, use vaccines and antibiotics requiring refrigeration, and plan surgeries to meet patients’ needs. Without it, they will continue to give their patients the best care available, but in a country with an average life expectancy of only 54 years of age, it’s a hard fight to win.
This story should remind us of how “unnatural” our lives are—and why that’s a good thing. It’s easy to take for granted that we have the ability to detect early problems with babies—not thinking that absent the machine that can detect those problems and the energy to power that machine, human beings past and present have lost untold millions of babies. It’s easy to take for granted that we have the ability to keep a three-and-a-half-pound baby alive—not thinking that absent the machine that can incubate it and the energy to power that machine, most of people’s beloved children who were born underweight would have died.
If the machines that move modern medicine don’t have energy, they are useless.
Energy and Medical Progress
Charlie’s expected healthy birth depended on energy in other ways: it is only with vast amounts of energy that we are able to have large numbers of medical professionals with ever-more knowledge.
Being a medical professional or medical researcher is not a normal human activity, historically speaking. Historically speaking, we spend our time doing manual labor to provide the basic needs of survival—food, clothing, shelter, warmth—which means very few of us are spending our time discovering new knowledge and creating new inventions. There are no doubt many potential brilliant medical researchers in Somalia, but most of that potential is lost because of the daily struggle for survival.
The more energy we can produce, the greater our ability to use machines to improve our lives, the more time we buy ourselves to spend our time learning and inventing and creating, the faster we can get to the next cure.
Testing the Limits of Medical Progress
I thought of this when I heard bad news Thursday, December 18 from Pari—against the odds, baby Charlie was very sick as the result of an initially undiagnosed infection. The first thought that crossed my mind was, “Thank civilization that we have made much progress—he’s got a great shot.” The second thought was “If this kid doesn’t live, it’s on the head of everyone who ever slowed down progress.”
There is a helplessness that we all experience when a friend or loved one is sick with an uncertain outcome. It’s not that we’re helpless to act, but we’re helpless to change the state of medical progress. We can seek to get the best there is of treatment, technology, knowledge—but we know that the best may not yet be good enough.
Charlie’s parents certainly pursued the best. Charlie was moved to the state of the art NICU featuring a state of the art ECMO machine at a state of the art hospital with dedicated nurses and doctors researching every avenue. Gradually—painfully gradually—he started to improve, thanks to machines that he depended on for his life. I thought of the importance of these machines—including the reliable energy that they require every second without fail—when Pari wrote: “We got good news that Charlie is down from relying 100% on a ventilator to 55%. This is a sign that the antibiotics are working and he is getting stronger. ”
But partially relying on a ventilator is only good news because we have ventilators and the energy to power them. With no ventilator he would have no life.
Every day the reports on Charlie became a little bit more positive—and every day it’s because of some technology, some piece of medical knowledge, some full-time medical job that would only exist and will only exist so long as we have a high-energy, highly-industrialized civilization.
The Imperative of Progress
Every day some family’s Charlie is dying because the right knowledge hasn’t yet been discovered, or the right technology hasn’t yet been developed.
I believe a lot of this knowledge and technology would already exist were it not for pervasive, insidious restrictions on every aspect of progress. In my field, energy, it is considered politically correct to call for drastic reductions in fossil fuel energy, which provides 87% of the world’s far-too-low energy use, in the name of empty promises that it will be replaced by unreliable solar and wind sources.
Every time we do something to slow down progress, someone suffers. Often you can’t point to that person. How do you know who couldn’t afford a safer car and died in a car accident as a result? How do you know who died because a life-saving drug was unnecessarily held up? How do you know who froze to death because the price of energy was too high? How do you know which babies died because progress was too slow?
Fortunately, our progress-to-date has been fast enough for Charlie.
This past Monday I saw him in person for the first time. He is wonderfully normal—not a trace of the vicious infection that tried to take his life from him. He sleeps most of the time, with perfect serenity, no capacity to remember the fight he went through or the forces for good that caused him to win it. But for my friends and me, he will always remind us that progress is precious—and that we can never have too much.