AAP Voices Blog

Night rounds are done, orders are updated, and Bed 17’s labs have been checked. I’m good for a few minutes. I get up and walk down the hall, stopping in empty rooms to flip the surprisingly complicated panel of switches which control the lights. Sometimes, it takes me a few tries to get them all. I stand there in the darkness, glad for the quiet and, yes, a bit self-satisfied. I imagine that most of us have our habits that fill the downtime of our shifts. During residency, turning out lights has become mine.

Sometimes, I get a strange look from one of my colleagues. “What are you doing in there?” But, usually, on a typical night, when the hospital isn’t at capacity, I might turn off the lights in 3 or 5 rooms, each with 5 switches (including the patient bed light which needs to be held down for 3 seconds). Over the course of a 5-night stretch, I probably flip 75 switches.

Recently, one of my co-residents and I were on a late-shift together in the PICU. We passed by an empty room that had just been cleaned by housekeeping, with the lights on. He turned to me with a playful grin, hit the switches, and said, “This is for you, Tim.” When you spend so many hours together, it’s inevitable that people catch on to your quirks. But that’s not necessarily a bad thing, and I really appreciated his gesture.

Individual acts of advocacy

As pediatric providers, advocacy is inherently part of what we do. I think some of my most valuable lessons of residency have come from observing and participating in individual acts of advocacy. Some of these have been more public-facing, like writing an editorial or explaining the health consequences of a bill in the state capitol. But many are private: an attending who adjusted her patient’s epilepsy regimen to longer-acting medications so the family would have fewer co-payments; a clinic scheduler who made sure a patient would be seen early in the afternoon so that a parent didn’t have to worry about getting to her night shift on time; a co-resident who brings his own plate to our mid-day conference instead of using the disposable plate provided. The tangibility of these gestures inspires me.

Like many of us in pediatrics, I am deeply concerned about the impact of the climate crisis on children. I’m training in Houston, where the chronic hurricanes, floods, and heat waves make climate change feel ever present to me. Admittedly, I’m from the northeast and will never be accustomed to it, but the Texas heat is literally getting hotter.

“Like many of us in pediatrics, I am deeply concerned about the impact of the climate crisis on children.”

As our lives have been overtaken by the Covid-19 pandemic and responding to it, I’ve had the instinct to go into triage mode. One global existential threat at a time! Healthcare and climate leaders have recognized the tremendous parallels between the global response to Covid-19 and what we must do to protect the planet and public health from climate change. Staying home is an individual choice that protects our communities and helps slow the global spread, just as commuting from the kitchen to the couch (aka, “home office”) is one car fewer on the road.

Earlier this month in Pediatrics, Maya Ragavan, Lucy Marcil and Arvin Garg wrote an excellent article in which they called for the pediatric health community to treat climate change as an essential social determinant of health. I share their view and support their call to action that “the pediatric community must consider ways to thoughtfully address climate change through medical education, clinical practice, community and scientific partnerships, and professional responsibility.” This last point—professional responsibility—is the one at the back of my mind when I hit the lights on my nightly walks through the wards.

Dr. Ragavan and colleagues cite a 2016 study in PLOS One which estimated that the U.S. health care sector accounts for 10% of annual greenhouse gas emissions in the United States and are direct contributors to climate change. To put that figure into context, if the estimated emissions of the U.S. health care sector were itself a country, it would be the 13^th largest emitter in the world. Using the same analogy, the organization Health Care Without Harm which works with health systems to reduce the environmental impacts of medicine, estimated in 2019 that if the global health care sector were a country, it would be the 5^th largest emitter with the U.S. responsible for 27% of all emissions. If climate change negatively impacts health, then practicing medicine in a non-environmentally-friendly way ultimately makes our work harder.

Recently, a new paper in Nature Climate Change by Corinne Le Quéré and colleagues estimated that daily global CO2 emissions decreased by 17% (–11 to –25% for ±1σ) by early April, the height of the global lockdown in response to the pandemic. This could reduce annual emissions in 2020 by 4 to 7% depending on how countries reopen. As the authors point out, this reduction approaches, but doesn’t reach, the cuts needed to meet the goals set out in the 2015 Paris Climate Agreement to limit climate change to a 1.5°C warming. Of course, we can’t rely on pandemics to be the catalyzing force for emissions reductions.

Reason for hope

I find this study hopeful. Nearly half of the reductions were the result of changes in everyday transportation, including cars, buses, trucks, as well as shipping of goods. This means that people staying home—an individual action—had a tremendous global impact. In working to flatten the curve, we have demonstrated an ability to make individual sacrifices that benefit everyone else. We need the same unity as we take on the climate crisis.

I realize that turning off extraneous lights in the hospital is just a drop in the bucket. But in this moment, as much as ever, we are reminded that our individual actions can make a difference. There is something we can do. Making one or two or even three personal environmental choices in how we practice medicine is an act of advocacy for child health. The AAP offers wonderful guidance for us as to what some of those choices might be. For me, after night rounds, I turn off the lights.