What the Eyes Don't See

by Mona Hanna-Attisha

  Patience isn’t my strength, but I needed it now most of all. I wanted to release the results as soon as possible and get the state to deal with this crisis, but that would require a framework of support and unassailable political backing. I couldn’t go it alone. I needed a team.

  “Don’t let Edwards see anything,” Elin said.

  “Don’t worry.”

  “Jordan in Representative Kildee’s office should be the first, if anybody.”

  “I can’t share anything yet.”

  Elin considered that, just as a wayward soccer ball sailed toward us and we silently dodged it, still lost in thought. My younger daughter, Layla, looked over, laughing, and ran away.

  “The whole thing is so hard to believe,” I said, shaking my head. “What is wrong with MDEQ? Isn’t safe drinking water their job?”

  “They must be idiots,” Elin said. “Clear disregard for people—and public health.”

  * * *

  —

  AS SOON AS I got home from soccer practice—cleats and shin guards off, the girls showered and fed—I sent an email to Melany Gavulic, the Hurley CEO and my boss. I had written her a couple of days before, on September 8, to let her know about the investigation and that our first data set from our clinic patients showed an increase in lead levels. Now I needed to follow up.

  Melany is a Flint native, a Kettering University graduate, and a former nurse who rose steadily in the ranks at Hurley to become CEO in 2012. She’s a strong, levelheaded, and insightful leader, and of course, I hoped she would support what we were trying to do. So far, I had had no indication that she wouldn’t. But Hurley is a city hospital, and our board is political—each member was appointed by the city. As CEO of a public hospital, Melany had to placate an array of conflicting agendas and a lot of strong personalities who were city movers and shakers. My findings had to be carefully and skillfully handled, because there was a lot at risk, not just to my job, reputation, and credibility, but to the reputation of Hurley itself.

  Looking ahead, if the IRB application was approved and I received permission to run the county numbers that were stored at Hurley, and if Kildee’s office helped me obtain access to data from the state, what should I do next? Considering the deafening silence coming from the state and county health departments, and the attacks on Edwards—and all the previous attacks on residents who tried to raise concerns about the water—it was painfully obvious that this was going to be a political issue. But how political, and how heated?

  I tried to guess at the timeline. It was Thursday night. Jenny and I would be writing our application to the IRB over the weekend, then we’d submit the data request. Once we got the data, we’d review and crunch the numbers, and then we’d probably want to double- and triple-check our analysis before we shared anything with anyone. Jenny had already heard from the folks in the IRB office that they were determined to move the process along as fast as they could. Rather than spend one or two weeks to review our application, they might take just a few days. After that, I suspected everything would have to be cleared by Hurley’s legal office, and maybe the PR folks would get involved in some way.

  Things could start happening quickly after that.

  “I think all this is going to significantly explode next week,” I wrote to Melany. “We can be part of the chorus (for health and kids) or an absent voice.”

  Within six minutes, she wrote back.

  “Oy! This is a political mess and given our relationship to the city…we could really create a mess if we don’t give them a heads up. Alongside that, we are the children’s hospital in this region and we have a duty to advocate for child health. Do you have some time tomorrow to talk a bit more about this and what you know will be coming out? I’d like to pull in some others and certainly not blindside the city.”

  * * *

  —

  PER HER REQUEST, JENNY and I had an urgent meeting with Melany the next day, Friday, September 11. We prepared a short summary of our preliminary clinic results and brought Melany up to date on the process so far—namely, how many ways I had tried to get more data from the county and state, and how many dead ends I’d encountered despite my continued requests. I was still trying to figure out exactly why I kept running into dead ends, and every theory I had was alarming.

  The health departments were blatantly covering up, stalling, or inefficient and slow to respond, or they truly didn’t care. It could be laziness or, worse, an indifference to poor black and brown people. They didn’t hear the sirens I was hearing, while I couldn’t get them out of my head.

  Melany worried about the study being leaked or released before we were ready. I told her about the lunch meeting with Marc Edwards scheduled for the following Tuesday, and I assured her I would not share the clinic results with him. I knew we needed to control the release of information and make sure our findings were unassailable.

  Afterward I went back to my office and started pacing. There was so much going on, so much to think and worry about. I hadn’t slept well in days—two weeks now—and I was having weird dreams about lead; my mind never stopped thinking about the study or strategies. The knot in my stomach wouldn’t go away. I was on a coffee-only diet. Some people might stop drinking so much coffee as a way to calm down. But the only thing that worked for me was moving forward—doing something, trying a new angle, pushing every button.

  So I stopped pacing and called somebody I’d been thinking about lately, an older superrespected pediatrician and friend. Dr. Lawrence Reynolds was the CEO of Mott Children’s Health Center, a nearby facility where lots of Flint kids are also treated. An African American who has always been a champion for underserved kids, for reducing racial disparities, and for pediatric advocacy, Dr. Reynolds had served on so many state boards, it was hard to keep track of them. They included a childhood lead-poisoning commission and an infant mortality initiative, and he was just wrapping up a stint as president of the Michigan Chapter of the American Academy of Pediatrics (MIAAP).

  If I wanted to get anywhere in Flint and with city politics—which I didn’t really know—I would need his support and his gravitas in my corner. Whatever our study showed, and whenever it was released, having Dr. Reynolds behind it would give it more credibility and impact.

  He answered the phone, but I could barely hear him. His voice was foggy and thick. He explained that he was sick—battling a bad sinus infection for the last week. I apologized for bothering him, he was clearly quite ill, but I kept talking. “Dr. Reynolds, have you heard about the water? There are news reports of lead—by a Virginia Tech researcher—and my friend, a water expert, has shared some information with me about this.” I wasn’t sure how far to go with it.

  “No, I’ve been sick all week. I haven’t heard a thing.”

  “Well, let me ask you this. Any chance you guys have looked at your lead levels in clinic? We are looking at our levels.”

  Lead. At just the mention of it, his voice grew stronger, almost as if he were no longer sick. He asked me what I’d learned.

  I couldn’t reveal that we’d pulled up results already, because he might ask what they showed. “I’m not having a successful time getting blood-lead data from the county or state,” I added, and shared my frustration about the jurisdictional breakdown—how the presence of lead in water somehow made it a public works issue, not a concern of the health department.

  We hung up quickly after that, and he got to work right away. Before an hour had passed, he sent me an update. I had a comrade-in-arms.

  FROM: Lawrence Reynolds

  TO: Mona Hanna-Attisha

  SENT: Friday, September 11, 2015, 1:14 P.M.

  SUBJECT: Re: Lead levels

  Will have to check for HIPAA compliance and some advice from your research staff, clarifying the use of the data. In the meantime we can do our own query for the same data base.

 
I left messages with the state. All out until Monday.

  Working on DEQ water quality people next.

  * * *

  —

  EVERY FRIDAY AFTERNOON AT Hurley, we have something called “resident conferences,” when medical experts in different fields cover a topic. That day’s conferences were about pediatric gastrointestinal issues. My office is right next door to the classroom, and as usual, I slipped into the conferences and sat up front. It was my chance to see everybody each week and to be seen. I liked being a fixture at the conferences and prided myself on being intimately involved in my residents’ training.

  But that week, as I listened to the reflux discussion, I felt the knot in my stomach tighten. I couldn’t remember the last time I’d had a real meal—or eaten more than a few bites. I was losing weight. My pants were baggy and my white lab coat was starting to swim on me, as if I’d borrowed it from somebody else.

  During a break between lectures, I slipped out to make a call in my office and was followed in by Allison, my second-year resident whom I’d known since she was a second-year medical student. I’ve always had an open-door policy, trying to be accessible to my trainees.

  I could tell from Allison’s face that she was worried about something.

  She closed the office door behind her. “Are you okay, Dr. Hanna? Is there something wrong?”

  That threw me off guard. This was the kind of question that I usually asked my residents, not the other way around. “Just busy with the water thing—the research.”

  She nodded sympathetically, but wasn’t convinced.

  I sighed and attempted a reassuring smile back.

  She was going to be a great doctor someday—I could tell that much. A Flint native, she could have trained anywhere for her pediatric residency, but chose to stay and serve the city where she was raised. She is skilled and smart, a hard worker, and has all the science down. But more than that, Allison has incredible emotional intelligence. She is fantastically sensitive and empathetic. She was the first one to notice when another resident was struggling—and the first to alert me. Now she was sending out a new kind of alert. And it was about me.

  ON TUESDAY MORNING, I STOPPED BY Jenny’s office to see if she’d heard back from the IRB about our application. On her phone, she was watching Marc Edwards in front of Flint City Hall. Standing in a double-breasted suit, he was holding up two bottles of water: one was labeled “Flint” in Sharpie marker written on jagged tape, and the other “Detroit.” It was meant to show the difference in clarity. He explained that Flint’s water was nineteen times as corrosive as Detroit’s. The iron pipes in Flint were corroding—and turning the water rusty brown.

  “Are you sure you don’t want to come to the lunch today?” I asked her.

  “I’m sure.”

  “I know you want to meet him. I know you’re curious.”

  We’d been investigating Edwards together, forwarding articles and sending links back and forth. We were both intrigued.

  “I want to go, but I’ll share too much,” she said, her face turning red. “I can’t be trusted. You go. And tell me all about it.”

  We’d worked all weekend and Monday nonstop, like two symbiotic organisms, to finish our research proposal, complete the necessary patient protection forms, and get our IRB request ready to submit. It was one of those mind-tunneling experiences of total focus, like being in an isolation tank or studying for a big math test. On Sunday morning, when I confessed to Jenny over the phone that I was having bizarre dreams, her voice jumped.

  “About lead? Oh my God, I’ve been having them too!”

  * * *

  —

  MY MOM WAS BACK from D.C., so at least we had Bebe—along with her craft projects, her hand-rolled dolmas, and the sweetness and love she brings wherever she goes. Within minutes of returning, even while complaining about how messy we were, she had transformed our house back to an organized, pristine place, and magically, the freezer and refrigerator were stocked with food.

  But not even the fragrant stew on the stove—fasulia wa timen, green beans and onions in a tomato sauce, one of my favorite Iraqi dishes—aroused my appetite. I burrowed into my bedroom, out of sight, to work with Jenny by phone or by email. Every so often, I’d look up and Nina would be standing at the doorway, quietly, kind of forlornly, with her big, dark eyes.

  Or I’d hear Layla coming down the hallway, hollering. She had a totally different approach—always out there with her feelings and demands, always the first to speak out.

  “Mama, come on—Bebe’s making fasulia wa timen, your favorite.”

  “Mama, is your computer more important than me?”

  “Mama, I miss you.”

  When Jenny had to feed Drew, or herself, or take breaks to pump, I tried to engage with my own family. I wandered downstairs and found them watching TV or playing a game. I gave them hugs and smiles, tried to be there. But my mind just wasn’t. My stubborn, goal-obsessed self had taken over. I needed to protect my Flint kids, and to do so, I had to create the most perfect, most unassailable study about children’s blood-lead levels that I could, one that nobody could shoot down.

  * * *

  —

  BEBE WAS THE SECOND PERSON, after Elliott, to notice how skinny I was. I’d given up on most of my pants by then and was wearing sweats with a tie waist or elastic, so they wouldn’t fall down. After being in D.C. for a week, the first thing out of Bebe’s mouth was “You lost weight?”

  “I have?” I said, trying to fake it. I’d been skinny my whole life, but after having the girls, some of that residual baby weight had stuck around. Years passed, and I kind of stopped imagining being thinner. To be honest, I was kind of happy about the weight loss.

  Bebe cocked her head and studied me a little closer. “What’s going on?”

  “Nothing.” I shrugged.

  “Men saduk?” Bebe wanted the truth.

  “The usual stuff. September is always busy. You know.”

  I wanted to explain what was happening, but I knew I had to take special care with Bebe. She falls easily into dark holes of anxiety and dread. Anything I said would spur a race of new worries in her mind.

  The ghosts of Iraq were hard to beat down. She would fear that my life was in danger. She might worry that I could “disappear,” the way some of her friends and family members had in Baghdad, especially those from disfavored groups, like Shiites and Kurds, and leftists like my parents. Bebe had seen too many bad things, or heard about them, to trust authority. She’d seen political violence and sudden death. I remembered going to a dissidents’ meeting with my parents when I was young and noticing an old man who was walking with a pronounced and visibly painful limp. Bebe told me later that he was a poet and had been tortured, electrocuted, for writing poetry.

  Experience had taught her that leaders can be evil and do evil—not just Iraqi leaders but people in power anywhere, anyone who sees people as disposable instruments in their own plans.

  I had more faith and, I guess, more trust. But a part of me too knew what Bebe knew. Mark and I grew up surrounded by stories of her sorrows and losses. We felt them, absorbed them, as if they were our own. I had no illusions about humankind and its potential for carelessness, selfishness, and misuse of power. My parents had taught us, without even needing to say the words, to believe in a better future and to work to create it—one that was fairer and kinder, that drew from the best in us.

  But first she would worry.

  * * *

  —

  ELIN ARRIVED AT THE Hurley clinic in the late morning. It was her first time in Flint—I was surprised to learn she hadn’t been to AutoWorld with her GM family. I gave her a short tour of our new clinic and introduced her to a few residents. Then we braced ourselves for lunch. We were meeting Marc Edwards and were both a little nervous.

  Lunch would be at
Steady Eddy’s, my favorite go-to place inside the Flint Farmers’ Market, just downstairs from the clinic. Located next to the stalls of fresh produce, local honey, and a great deli, Steady Eddy’s is one of those classic crunchy hippie cafés with sprouts in the sandwiches, vegetarian chili, tofu, and fantastic, fresh multigrain bread.

  Elin and I arrived first, followed by Dean Dean. I had invited him too, wanting to bring in his background, experience, and military commando confidence. I had no idea that a decade earlier, he’d had several tense encounters with Edwards, in Dean Dean’s days as the Ingham County health officer in Lansing. Elin shook his hand, and I covertly looked around, then pulled my clinic results from my bag to share with him. He read the pages carefully, nodding. His brow furrowed as he asked about the results, pre– and post–water switch.

  “What was the standard deviation?” he asked.

  I saw Marc Edwards making his way toward us and quickly put the results back in my bag. He was gaunt, wearing the same oversize suit he had been wearing in the video I saw on Jenny’s phone and the same necktie with Serengeti water buffalos on it. He was with Siddhartha Roy, his skinny PhD student. They both looked tired and rumpled, as if they’d just been through something awful. Sid was lugging a video camera and tripod—not something you expect an engineering PhD student to keep in his toolbox—which I guessed he’d needed at the Flint City Hall press conference.

  We said our greetings, moved the chairs around, and nervously reached for our water glasses. But then we stopped. Nobody wanted to sip the water.

  Dean Dean studied Edwards, maybe waiting for a moment of recognition, but there wasn’t one. In 2004 there had been reports that Lansing had elevated lead levels in its water. At the time, the conventional wisdom propagated by the CDC was that lead in water was a minor concern—very minor compared to lead paint exposure. However, Edwards argued otherwise and was brought in by state senator Virg Bernero, who later became the mayor of Lansing. Dean Dean didn’t buy Edwards’s analysis at the time.