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Our Most Intimate Adversary

By Brian W. Simpson

My father William, my brother Spearman, my uncles Jesse, David, James and Tom, my aunt Mercy, my father-in-law John, my grandparents Walter and Elnora and Jesse and Sara, my childhood friends Clay and Darren …

Death claims ever-widening circles of family, friends and acquaintances until it envelops us. It is inescapable, inevitable and irredeemably sad. So why would we want to devote an entire issue to death?

I began to ask that question myself on Monday, December 3rd at 10:30 a.m. Art director Robert Ollinger, designer Konrad Crispino, photographer Chris Hartlove and I were in the Office of the Chief Medical Examiner (OCME) of Maryland in West Baltimore. We were there for the photo shoot for our “Lessons from the Dead” story. Robert had chosen one of the main autopsy theaters for the photo because it appeared empty from our vantage above the room. After we had corralled our live subjects for the photo, however, we discovered two autopsies were under way.

An OCME staffer asked renowned injury prevention expert Susan Baker if she would be comfortable walking past the autopsies. Not particularly eager myself to witness the bodies in various stages of forensic investigation, I hoped she would balk at the prospect. But the 82-year-old Baker, who spent the early years of her remarkable career in the ME’s office, didn’t hesitate. She said, “Sure, let’s go” and walked nonchalantly past the cadavers. As we walked through the room, I kept my eyes keenly focused on Konrad’s heels.

“Death is very democratic,” the staffer told us, nodding toward the autopsies. His point was that rich or poor, big shot or average Joe, everyone ends up the same. He’s right. One way or another, we will all be there. The breath will stop. The blood will stop. The spirit will depart. All that’s left behind will be muscle, bone, sinew, organ.

After a while, curiosity trumped queasiness. I stole a few glances at the autopsies in progress. Now, I see that moment as instructive. I wanted to avoid death and its unpleasant reality. However, that’s not what public health is about. Public health is not about flowers and sunshine. It’s not about eyes averted. Its purpose is not to avoid but engage with our most intimate adversary—to stare, to probe, to investigate, to understand, and then to fight. All with the promise of making a difference and saving lives.

Public health has delivered on this promise again and again. From safe drinking water to vaccines, vitamin A, smokefree public places and many other hard-won successes, public health has extended lives and secured health for millions of people.

And, as this special issue of the magazine demonstrates, still more thrilling work is being done. The stories gathered here (and in the powerful essays and poems by our alumni at magazine.jhsph.edu/extras) tell us more. They also demonstrate how final and personal death is.

Cousins Jim and Bill Krantz (above) know this as well as anyone. They count 13 of their 18 family members have been diagnosed with cancer. Like many others in Frederick, Maryland, they blame the nearby Army base that developed bioweapons and buried chemical waste. They quite reasonably want to know what killed their loved ones and how others can be spared in the future. Untangling genetics, behavior, exposures from decades past, and other factors in cancer represents one of the great challenges of public health. Armed with science, data, knowledge and intuition, researchers and public health professionals peer into that blackness, seeking light.

At some point after my visit to the medical examiner’s office, I had an enlightening (and lightening) conversation with my son. I often ask him big questions out of the blue to gain insight into a 7-year-old’s world. I asked him what he would like to do with his life. He thought a moment and then said, “Spend more time with it.”

Yes! That’s what it’s all about. The hard work of public health, the experiments, the slow accumulation of knowledge, the journal articles, the grant applications, the meticulously planned interventions—all seek to ensure people have enough time in their lives to work, to add something to the world, to live to their potential, to realize their dreams.

To spend more time with life.