To predict the future, look at the past.
One of my wife’s favorite observations.
I spent most of my career in acute care hospitals, where people often die with and of infectious diseases. So, sad to say, I saw a lot of death. I think I remember them all, as death does make an impression on you. I’m not a fan.
The first corpse I ever saw was our cadaver for dissection in gross anatomy. Between the smell of preservatives and what those preservatives did to tissues, the cadavers didn’t look like a dead person, more a statue made of pungent beef jerky. Still, I was oddly moved by the discovery that her last meal had included French cut green beans.
The first acute death was during my first rotation in the hospital. Late at night I went to use the restroom. The door opened about a foot and stopped for no reason. So I gave it a shove and found a twenty something bearded man on the floor, dead from an overdose. He was unsuccessfully resuscitated, also my first. Then we had to get the body up on a gurney. I took the wrists and my resident the legs, and on three heaved the body up. As the arms came together under the weight of the body, the air remaining in the lungs forced out and the body gave a huge groan. I actually screamed and let go. Fortunately, the momentum carried the body onto the gurney. For the rest of my career, I opened the bathroom doors in the hospital cautiously. I think everyone in health care has mild PTSD from training and education.
I remember the first time I had to declare a person dead, a young black woman with metastatic breast cancer. 3 a.m. on a freezing Minnesota winter. I remember the cold and the frost on the windows. A year earlier, I had sat in with the (dirtball) oncologist who had repeatedly used the word cure. Pisses me off to this day.
The first autopsy on one of my patients. Unexpected undiagnosed melanoma around the heart. Unfortunately, not the last patient whose diagnosis would remain unknown until autopsy. I retain the memory of the smell of the open body of the recently dead. There is no smell quite like it.
The young female with cardiomyopathy with a cardiac arrest who, after a 45-minute code, was declared dead. I broke the news to the family, and left to write a note. A nurse came running up saying she has a pulse of about 10. What do we do? We repeated the resuscitation and she survived another 24 hours. Talking with the family was, let me say, a unique experience.
But that was residency. I went on to an infectious disease career, and after that virtually all the deaths were due to, or complicated by, infectious diseases. Not often. Most of my patients were a cure. But not always, and I think I remember them all.
When the current administration’s policies are said to increase deaths, I know exactly what that means. I have seen the deaths from infections and they are not pretty.
Take the USAID, which
From 2001 to 2021, USAID programs were estimated to save between 4.1 and 4.7 million lives per year, including between 1.2 and 1.7 million children under five.
Now funding has been gutted and as a direct people have and will die:
A study published in June 2025 estimated that funding cuts and the abolition of the agency could result in at least 14 million preventable deaths by 2030, 4.5 million of which could be among children under 5 years old. Another estimate (by epidemiologist and health economist Brooke Nichols) is that, over a period of one year from when they began, the cuts will result in the deaths of as many as 262,915 adults and 518,428 children.
Big numbers. How to wrap your head around 518,000 dead children (the population of Kansas City), much less 4.5 million (the population of Kentucky)? It is impossible. But I have witnessed many a death from infection, so while I may not be able to comprehend all of Kansas City dying, I certainly understand how each individual will die. And I can multiply.
People have and will die of AIDS, tuberculosis, malaria, infectious diarrhea, starvation and more.
No surprise, I have never seen a human die of starvation, a dreadful way to die. And malaria is uncommon in the Pacific NW, although I have had a few patients get very close to dying from malaria. The shaking chills, drenching sweats and prostration for a week or more is miserable.
Tb? Unfortunately, tuberculosis is not the good death that we all hope full. To not see the bullet coming, to die in our sleep like my dad, not screaming in terror like the passengers in his car. Yep. Went there.
The old term from Tb was consumption, as patients wasted away from the infection. There is the misery of tubercular meningitis. The worse TB cause of death is a ruptured Rasmussen’s anyerism, where a pseudoanyerim in a tubercular lung cavity ruptures, filling the lungs with blood, drowning the patient relatively slowly. I saw two deaths from that complication. One patient refused treatment, and I remember his body in the ICU, leaning forward, clutching his blood drenched pillow.
My career coincided with the onset of the AIDS epidemic. Early in the epidemic we could little to slow the progression of the disease. Young men have good cardiovascular systems, so most of the infections that eventually killed them were slow and painful, often taking weeks and months of unremitting suffering before death from a variety of infections.
The first AIDS death, after months of diarrhea and fevers, who on autopsy had more MAC than human cells. Those who slowly suffocated from refractory PCP. Months of migraine level headaches from Cryptococcal meningitis. Blind from CMV. Wasting away from uncontrollable diarrhea. And on and on. So many ways to die, all of them horrible. At least in the West we could lessen the suffering somewhat with medications. Not so in the areas served by USAID.
I suppose the good news, he says with deep sarcasm, is the severe starvation will likely hasten the deaths from infectious diseases, shorting the duration of suffering. I keep in mind that pain and suffering is currently a feature, not a bug, of the administration.
Musk and Rubio have insisted no one has died from the USAID cuts. I do not doubt, from their perspective, they are telling the truth: No one who matters has died.
The big beautiful bill cut health care funding for millions, and death will follow.
Before Obama care, I was involved with patients who could not afford health care and let their diabetes, hypertension, and AIDS go untreated, with fatal results. Most common for my practice was the uninsured diabetic who could come to the hospital with progressive gangrene of the leg or perineum and sepsis. Another smell you don’t want to encounter. Too often fatal because they presented with advanced disease. Having your leg and groin rot off is not a good death. All preventable with routine health care.
Expect a return of death from lack of insurance in the years to come. I once noted that the three most dangerous words in medicine were In My Experience, but in truth they are I Lack Insurance.
Then there are vaccines, or the lack thereof.
I saw no end of influenza and COVID deaths, although most were sedated on a ventilator and didn’t see the bullet coming. Still, we all want time to get affairs in order, say our goodbyes, and exact our revenge when we know the end is nigh. It is sad these patients were denied those opportunities and it compounds the family’s grief.
As an adult doctor (who I cared for, not necessarily how I behave) I rarely took care of vaccine-preventable childhood infections. Those I saw were often disasters.
Chicken pox? The worst case was an unvaccinated pregnant patient who caught chicken pox from her unvaccinated child. Not good. Pregnancy makes progressive varicella pneumonia, a rare complication, more likely. The mother died after a month in the ICU of refractory lung failure. Never saw another case, but I expect there will be others. And a couple of cases of necrotizing fasciitis complicating adult unvaccinated chickenpox, one of whom lost a breast from the infection.
Of all the diseases whose routine vaccination is on the chopping block, the one I most feared for my kids was Meningococcus, because of the rapidity with which it kills. I took care several cases where the young woke up fine and was brain dead by dinner due to meningitis. Whenever my children had a fever, I continuously looked for the rash associated with the disease so there would be minimal delay in therapy.
And meningococcus, along with a few other bacteria, can cause purpura fulminans, where there is massive clotting leading to the death of arms, legs, noses and ears. I saw several cases due to the pneumococcus who lost parts of their extremities from this complication. There was a child often seen at the hospital who lost both her arms and legs from meningococcus. Awful diseases.
I have noted in the past the ID is like birding, only interesting. There are all these pathogens that can infect people (I estimated 1300 or so common pathogens) and you have a life list of diseases you have seen. Some, like plague or measles or smallpox, you do not really want to take care of. No one wants to be an unusual or interesting case for an ID doctor.
But any number of usual infections will be making a comeback with resultant morbidly and morality. All those lucky doctors who get to see diseases that I considered as only of historical interest: measles and H. influenza and diphtheria and whooping cough and more, all emptied from the dustbin of history. More needless death and suffering, much of it preventable.
Many will see the statistics for these unnecessary infections and deaths. A few will map those numbers on to the patients they cared for and know how they died. And remember the immense suffering of these preventable deaths.
I do have a solution. Declare all humans to be a fetus and lack of health care and vaccinations a form of abortion. Those who cannot even recognize what a war is will certainly fall for the ruse, to the benefit of society.
For Whom the Bell Tolls 2026 Edition
I am an island,
Entire of myself.
You are a piece of the continent,
A part of them.
A clod to be washed away by the sea, I couldn’t care less.
I will not vaccinate.
Or support healthcare outside of a manor of thine own
Or fret of thine friend’s medical needs.
Each man’s death? Doesn’t bother me,
For I don’t care for mankind.
Therefore, send not to know
For whom the bell tolls,
No concern of mine.
John Donne