Writings from Daniel P.

Dear Congressman,

As a resident pediatrician at Indiana University School of Medicine and a voting member of your district, I am writing today to ask for the addition of questions related to adverse childhood experiences (ACES) into the Indiana Behavioral Risk Factor Surveillance Survey (BRFSS). I provide primary care at the Pediatric and Adolescent Care Center across from Methodist Hospital in Indianapolis. In my brief time of training, I have already noticed a troubling disconnect between the medical services we provide our children and the actual outcomes they experience. Why is that?

I commonly see children with severe asthma who have been prescribed all the right medications—inhalers, nebulizer solutions, and pills—who nevertheless visit the emergency department 3-4 times a year for flare-ups in their symptoms. Such visits might necessitate transfer to the ICU or insertion of a tube into their lungs to help them breathe.

The risk factors associated with poor control of asthma are numerous, including environmental, genetic, and behavioral issues. ACES are a lesser-known class of risk, including such various problems as abuse, violence, and poor caregiver relationships. Exposure to these stressors over time causes persistent harm to the developing brain and immune system, which associates with increased risk for poor physical and mental health. For example, an American child with asthma who has 2 or more ACES has 3.5 times the risk of experiencing moderate/severe symptoms than a child who has no ACES.

Given the far-reaching impact of ACES, one might be tempted to feel disheartened were it not for the many organizations here in Indianapolis who intervene to mitigate their effects in some our most burdened youth. One such group is VOICES, which partners with the Department of Child Services and Juvenile Probation to offer healing-centered engagement through education and self-expression. In order to understand the true impact of their programming, they need accurate data about the prevalence of ACES and their associations in the local Hoosier population.

BRFSS is already administered by the state of Indiana as part of a national endeavor seeking to better understand modifiable risk factors that negatively affect children’s health. Many states have already chosen to add a module of questions regarding ACEs to their questionnaires. I urge you to include such a module in Indiana's version of the survey. I am happy to provide assistance in this endeavor.

Thank you,

Daniel Riggins

If you were to reset your life back to the end of high school and follow a different path, where would it lead?

While posing for an Instagram photo yesterday, it struck me how happy I felt holding hands with a tree we had freshly rooted in the earth. Three hours earlier, Lauren and I had met up with her friends Maddox and Krupa on a random street in Indy to volunteer with the seriously dope organization Keep Indianapolis Beautiful (KIB). We got a quick demo on proper tree planting technique—“the volcano is no bueno”—and set to work. I loved being able to escape the LED lights of hospital workrooms into the cold crisp air of late Indiana Autumn. The feeling of using my fitness and muscle to accomplish a task. The laughter we spewed over funny voices, punning, and fictional product endorsements. It was pretty much my perfect way to spend a Saturday morning.

However, it wasn't just the activity, but also its implications that so filled me up. Combining our work with others, we had planted dozens of trees that would now be sequestering CO2 from the atmosphere, beautifying the street, raising property values, and acting as focal points of purpose for teenagers employed to tend to their well-being. What grand aspirations for these spindly saplings now lining the streets.

I love activities that accomplish layers of impact for the well-being of people and their community. I love being a pediatrician, and I feel empowered to accomplish this mission as the years go on, but there's more than one way to serve. If I were to start over at the onset of college, I would aspire to do the work of groups like KIB, Rock Creek Conservancy with their youth corps in Washington, DC, or Plant Chicago with its radical construction of circular economies. These organizations still cultivate the well-being of youth and their communities, while enabling more physical activity and time outdoors.

The good news is I can still engage with this work as pediatrician, especially in the future as I gain more autonomy over the ways I spend my time. Perhaps my medical training could enable ways to integrate small acts of healthcare into the work of such organizations. Rather then pining after the outcomes of alternative timelines, I'd rather merge them into my current reality.

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This morning in the newborn nursery, we listened to Dr. Matory lecture on neonatal abstinence syndrome—medical jargon for a newborn going through withdrawal if Mom was using drugs during her pregnancy. Opioids lead to the worst symptoms immediately after birth, but most any drug can have negative effects, perhaps the most overlooked of which is alcohol.

While the complications of alcohol are well understood, I was struck by how little we know about Mom's use of substances like heroin may affect a child's ability to grow, learn, and socially thrive years down the road. It underscores the importance of building a system that nurtures mothers and children over the long-term—before, during, and after the actual pregnancy.

How would you nurture a family struggling with substance dependency or disorder?

Until the gate breaks open— this baby with a mohawk, golden eyes, and a bow who got a third a chance of dying within the year.

Sometimes I need to steal behind a bathroom door after I press her swollen belly

and the tears burn an ache behind my hairline.

Or sometimes less expected,

like when the nurses tell me I listen good

or I talk the students through some jargon and it flows out like some sense.

But the mothers always get me— rousing in the morning when I dim up the lights

and ask how they slept through the beeping vital checks and line jams.

Their children gasp in air around hollows of pus,

or retch against the telescoping of their bowels.

It's the disoriented urgency as these mothers wake. They are here, struggling to gain some way to salve their kids.

It breaks me open and

I feel exposed.

The numbers wisp right out of my head.

But their love cuts my doubt.

Thank you Ladies and Gentlemen, you've been wonderful. For my last trick this evening I will bring before you the one, the only, the creator of the Heavens and the Earth, Yahweh himself!

By doing so, I hope to prove with

incontrovertible clarity

the existence of this

elusive

yet influential historical figure who has been present throughout our species' storied history.

If we are lucky, perhaps he will regale us with tales of his intimate involvement

with Noah and the Great Flood the building of the Great Pyramids and, of course, the founding of this, our Great Nation!

Regardless, I am quite sure that you will be struck at first sight by the sheer MAGNIFICENCE of his very presence.

Those steely grey eyes, the impressive white beard, his dashing, yet modest pinstripe attire, (which you too may purchase at our local department store), Not to mention the finest sculpted muscles seen on any man save for our very own Zoran— the Bone Crusher!

And, Ladies and Gentlemen, with his first appearance will come understanding. You will gaze upon his mighty presence and suddenly

you will know things

you never thought possible.

The laws of Physics, Physiology, Psychology, Sociology, Gastroenterology—

in a moment, ALL will merge into ONE Grand Unified Basis by Which Each and Every One of You may understand the workings of the very Cosmos.

And in this moment, Ladies and Gentlemen,

when all has become clear,




POOF!!




I will make him disappear.

each night I rub my jittery

heart thumps into her belly.

with two snorts and a wheeze,

she nuzzles back.

a tether at the edge of my ribs,

she anchors as I pull to breathe.

her stripes give me peace.

Brianna