Healing Politics: A Doctor's Journey into the Heart of Our Political Epidemic

By Abdul El-Sayed and Ady Barkan

A memoir about restoring the health of our people, and our democracy, from a physician and “one of the brightest young stars” of the progressive movement (Sen. Bernie Sanders).

A child of immigrants, Abdul El-Sayed grew up feeling a responsibility to help others. He threw himself into the study of medicine and excelled—winning a Rhodes Scholarship, earning two advanced degrees, and landing a tenure-track position at Columbia University. At thirty, he became the youngest city health official in America, tasked with rebuilding Detroit’s health department after years of austerity policies. 

But El-Sayed found himself disillusioned. He could heal the sick—even build healthier, safer communities—but that wouldn’t address the social and economic conditions causing illness in the first place. So he left health for politics, running for Governor of Michigan and earning the support of progressive champions like Congresswoman Alexandria Ocasio-Cortez and Senator Bernie Sanders.

This memoir traces the life of a young idealist, weaving together powerful personal stories and fascinating forays into history and science. Marrying his unique perspective with the science of epidemiology, El-Sayed diagnoses an underlying epidemic afflicting our country, an epidemic of insecurity. And to heal the rifts this epidemic has created, he lays out a new direction for the progressive movement. This is a bold, personal, and compellingly original book from a prominent young leader.

“In Healing Politics, Abdul El-Sayed doesn’t just diagnose the causes of our broken politics; he gives us a prescription and treatment plan.” —Representative Pramila Jayapal

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Mar 31, 2020
• ISBN: 9781683358138

Book preview

PROLOGUE

About two weeks after I launched my campaign for governor of Michigan, Sarah, my best friend and wife of eleven years, suggested we grab some dinner. Rather than a casual meal at home, she opted for something more special, and chose one of my favorite spots: Supino Pizzeria, in the heart of Detroit’s Eastern Market, just steps from where I had launched the campaign.

Sarah had news to share. After we finished off the last slice, she grabbed both of my hands and looked me in the eyes: You’re going to be a father.

I had figured that this was the news. After years of waiting to finish our educations—Sarah’s also a doctor, and we were in college when we got married—we had started trying to get pregnant a few months back. But nothing prepares you for the emotion that comes with those words. Some odd combination of elation and fear swept over me as we hugged. We were going to be responsible for a tiny human life—some part each of us, but altogether new. But there was also a third emotion I had not expected: inspiration.

I had always been circumspect about the idea of having children. After all, there are so many parents struggling to care for their own kids. I wanted to dedicate my life to supporting them. Would having a child of my own detract from that mission? And then there are so many children who don’t have parents at all. Why bring a child into this world when there are so many who need parents already?

Then my cohort of friends started to have kids. I noticed that when they talked about the downsides, they used language I could relate to: you don’t get any sleep; they’re expensive; you’re no longer the person your partner is most interested in. But when they described the benefits, their words were emotional, hazy: It’s just this . . . feeling, this love, one said.

As a scientist, I tried to deduce what I could from this observation. If my friends could all describe the negatives in very clear, relatable language but could only describe the positives in far less specific terms, then having a child must be a unique human experience, unlike any other.

My work has always been about supporting and protecting children and their parents, whether it is understanding the circumstances of their births—and deaths—as a researcher focused on prematurity and infant mortality, or in preventing those things from happening as a public health official. And yet, hearing my friends, I came to appreciate that while I could understand that people love their children—and will do anything for them—I had never known the love of my own child, an experience for which it seems I could simply find no analogue.

Of course, Sarah had gotten there far faster. She’d always wanted children—which is why I probably would have ended up having them anyway—but, as usual, her emotional intelligence far surpassed my own. We were having a baby. And on the Sunday after Thanksgiving in 2017, when Emmalee was born, with her first tiny whimper, she took my breath away. I performed the Muslim traditions of birth, reading the call to prayer in her ears and chewing a small piece of date to feed her—the tears flowing down my face salting the sweet taste of the date in my mouth. Sarah, tired after eleven heroic hours of labor, held her to her skin.

I was carrying a lot of guilt that day. In recent months I hadn’t been the kind of supportive husband and future father I’d aspired to be. In fact, I was hardly ever there at all. I had been crisscrossing the state of Michigan, spending evenings and weekends at town halls and county fairs. Every night I’d call Sarah, checking in to see how she was doing. We had long since moved in with her parents, and her mother—half angel, half maternal ninja—was a far better supporter than I could ever be. But I like to imagine there is something about a partner’s presence and love that’s uniquely comforting, and I was rarely there to provide it during her pregnancy.

In truth, there was some small risk I wouldn’t be there for her at all. Our campaign had received a surprising number of death threats: people from all parts of the country had taken to Facebook to tell me that I was taking my life in my hands. As the first Muslim-American to make a serious run for governor in any state, I knew what I was getting into. But only after our campaign started to pick up national attention did the hatred rise to a level that warranted serious concern. There’s still a Facebook chain post floating around that reads Don’t say you weren’t warned—‘He IS on his way’ . . . PRESIDENT ABDUL EL-SAYED? Etch this man’s name in your mind. His name is Abdul El-Sayed . . . He is handsome, articulate, charismatic and smart . . . Perversely flattering, maybe, but our campaign decided to invest in a full-time bodyguard. And just in case the future didn’t work in my favor, I wrote a long letter to my unborn child to be opened on her eighteenth birthday. In the letter, I ventured to introduce myself and explain the world as I see it. At best, it would be a personal time capsule we could read together in eighteen years. At worst, it would serve as an introduction to a father she’d never get to know.

Months later, well after the campaign had ended, I thought about the letter again when I got a concerned call from my father-in-law. A Detroit police officer had come by the house and said that he needed to speak with me. I was in no trouble but I should call him as soon as possible. I called my lawyer and asked if she might reach out on my behalf. When she called me back, I could hear the fear in her voice. Are you sitting down? she asked.

Yeah. What’s up? I responded, concerned.

You know that guy who mailed all those bombs to CNN and Democratic politicians? She was talking about Cesar Sayoc, a Florida man inspired by Donald Trump, who pleaded guilty to having mailed sixteen explosive devices to various Democratic politicians, Democratic supporters, a former director of national intelligence, a former CIA director, and CNN in October 2018. Well, you were in his list of Google searches. And they wanted to make sure you know. I’m grateful that it was a police officer—and not an explosive—that came to our door. My daughter lived behind that door.

* * *

That day at Supino’s, I asked Sarah if she wanted me to drop out of the race. I had quit my job as health director of the city of Detroit to campaign full-time, meaning I had no income. We were relying on Sarah’s psychiatry residency salary. That would have been fine for just the two of us, but caring for a child was another matter entirely.

Sarah said no. Our daughter’s name, Emmalee, means my hope in Arabic. She is ethnically half Egyptian and half Indian—and 100 percent American. She’s growing up in a Muslim household. I know many of the ways she will be told that she’s not enough: I experienced some of them firsthand.

The best thing you can do for this kid is go out and win that race, she said. Once again, Sarah had gotten there far faster than I did.

* * *

On the campaign trail one day, a woman who looked like a seventy-year-old Shirley Temple grabbed my face, squeezing my cheeks. Her light brown eyes radiated a warmth and honesty. Son, she asked, are you listening to me? She had waited in a reception line after a town hall at a church in suburban Detroit. Her blue HELLO, my name is sticker gave her name, Sally, in big, bold, curling cursive.

Ma’am, with all due respect, you’ve got your hands on my face. Yes, I’m listening to you, I said through my smooshed lips. I’m already feeling kinda young, I thought to myself, and this lady’s making me feel like I’m twelve. To be sure, campaign stop eight that day had just become the most notable.

Son, you’ve got a great smile, Sally said. And I hope you keep smiling. A lot of people are going to say terrible things about you—I’ve already heard it—but you gotta keep smiling. Because it’s really hard to hate someone who’s smiling at you.

On the one hand, it would have been easy to react to this Pollyannaish advice with sarcasm. You think a smile is going to solve racist death threats? But on the other, I had been coming to the same conclusion.

Sally was reminding me that people are good—even if sometimes the things they say and do are not. Everything that Trump has unleashed in our politics is motivated by fear. And there is something about the empathy in an honest smile that uniquely melts through fear and cuts through hate.

And in a small way, this is what I was trying to do. Even though I was a thirty-two-year-old Muslim-American named Abdul and a doctor who had never been elected to office, I declared my candidacy for governor of Michigan in February 2017. I had served the city of Detroit as health director—my only government experience—having rebuilt the Health Department after it was privatized in 2012, when Detroit was facing municipal bankruptcy. Prior to that, I had been an epidemiology professor. But in the aftermath of the Flint water crisis and Donald Trump’s election, I felt that perhaps my skills as a physician and epidemiologist could help heal my state—and my campaign as the son of an Egyptian immigrant and the stepson of a Daughter of the American Revolution could remind us who we are as a country.

Over eighteen months, I visited more than one hundred fifty cities and nearly all of the eighty-three counties in the state of Michigan. I had thought that I was leaving the epidemiologist in me behind when I chose to become a candidate for office. Rather, I found myself subconsciously applying my scientific training across the thousands of people I met.

As an epidemiologist, I was trained to coax stories from inanimate lines of data to find the elemental truths buried within them. As a candidate, I was hearing those stories in living color. I would listen to a single mother, or a retired Iraq War veteran, or a little eight-year-old girl sharing story after story of pain or hardship, of pride and triumph. I could watch their eyes, appreciate the emotional weight that hunched a back, and feel the emphasis in the extra squeeze of my hand.

I found myself during the long car rides back from distant parts of the state trying to identify the patterns in what I’d learned, to test my hypotheses. In Marquette, an older gentleman, Jake, told me how he deeply believed in gun rights, having gone hunting every year since he was a child. But his little girl had been murdered by her ex-husband, using a gun that a man with a history of domestic violence should never have had.

Rebecca from Grand Rapids told me her son Jason had already beaten cancer twice; he was eight. She fears it’ll come back when he’s older and worries that even if he beats cancer a third time, he could be bankrupted by the cost of medical care.

Shaun came out as transgender in high school and began his transition in the face of hatred and bullying. And yet he graduated at the top of his high school class. His mom worries about how they’ll afford his college tuition.

Keisha was one of the top graduates from her high school in Flint, but she had to drop out because the job at McDonald’s that pays her bills won’t give her regular hours. Unable to afford auto insurance, she has to take the bus, tacking an extra hour to and from work onto her already precarious work schedule. She’s taking online classes but doesn’t know if she’ll ever get her degree.

My heart ached for these folks, for the struggles they have endured, for their futures hanging precariously in the balance. My mind raced to make sense of them.

On those long car rides, those endless days of campaigning, I came to appreciate that the justice each of us wants is simple. We want to know that we can work an honest job, make a fair wage, afford the roofs over our heads, and put meals on our tables—and have a little something left over to enjoy. But more than that, we want the peace of mind to look at our children and believe that their lives will be just a little bit better than ours. And we want to know that we can enjoy these things together, as communities. This is the American dream as I understand it.

It’s not a tall order, yet so few in our society have it. The median household income in Michigan—the amount the Michigander right in the middle makes—is $49,847 per year.¹ After taxes, that’s about $3,311 per month.² The median mortgage sits at $1,217, leaving about $2,100 per month. If you have student debt, that’ll be an average of $304 off the top every month.³ Silver plan health insurance takes another $305. The average car payment for a used car is $381—not to mention auto insurance and gas.⁴ Then there’s groceries and utilities and any necessary childcare or senior care. The costs add up fast.

And that’s the middle household. Poverty—defined as earning less than $24,600 for a family of four—afflicts nearly one in six Michiganders. For children under five years old, it’s one in four.⁵ Poverty is not borne equally. In Michigan, nearly 30 percent of Black-Americans live in poverty. Contrast that with the fact that Michigan’s twelve billionaires—all white—have a combined net worth of nearly $41 billion.⁶

As a candidate, I reflected on these realities, the women and men whose hands I was shaking, and the girls and boys they worry about. As an epidemiologist, I was coming to a clear pattern of what ailed them—what ails us all. We are suffering a collective epidemic that threatens our social, economic, and political futures. It’s an epidemic that is fundamentally reshaping our politics. It affects nearly all of us, eroding our chances of achieving the American dream, and it has the potential to erode our highest national ideals. It is an epidemic of insecurity.

Yet, as a doctor, it’s not enough to diagnose a disease; one has to treat it. This epidemic of insecurity leaves us in need of a new politics, one that recognizes the structure, culture, and consequences of insecurity—a new politics that equips us with the moral and tactical tools to address our most serious problems.

That’s what I hope this book can offer. In Part I, I intersperse chapters introducing myself and my science—and how epidemiology helped me make sense of my own life. In Part II, I diagnose the insecurity epidemic and its causes, working outward from the individual to society and tracing its mechanisms of spread. And in Part III, I reflect on how we’ll need to reframe our politics around empathy if we aim to take on insecurity and dismantle the systems that have perpetuated it.

I am writing to share my vantage point on America as a first-generation son of Egyptian immigrants, raised in a mixed household, from which I came to understand who I was—and who we are. Calling on my training as a scientist, a doctor, and my work in public health and politics, I want to share the evidence I’ve collected about how our epidemic of insecurity is squandering the potential we have—and what we’ll have to do to cure it. And underlying all this, I want you to see that both appreciating the challenges we face and then doing the work to address them will take a reframing of our politics around something we’ve been starved of for a long time: empathy. I hope to show you why America is ailing, and why all of us must do all we can to heal her.

PART I

PRACTICUM

CHAPTER 1

Home away from home.

In June 1998, I waited in Detroit Metropolitan Airport to board a flight to Egypt for just the second time in my life. I was thirteen. This would be my first visit in ten years—since I had spent a few months there after my parents’ divorce. This time I was traveling without any immediate family. I was nervous. My parents thought it was about time for me to reconnect with the family I had not seen in so many years and to brush up on Arabic—my first language. As a hyphenated-American kid, I had all but jettisoned this native tongue. What was Arabic good for, anyway? I reasoned. No accent meant less teasing. Never mind the worlds and the people it could connect me to.

I boarded the plane to the harmonizing tune of Puff Daddy’s Notorious B.I.G. elegy, I’ll Be Missing You, a track on the Abdul’s Summer Mix CD my friend had burned for me. If I was going to be leaving America, I was at least going to take a piece of it with me.

I am Egyptian-American. In some ways I am both, in some ways neither.

That summer, some small part of me worried that the balance across the hyphen would shift indelibly—that I would forget how to be American. I was afraid that I’d have to start all over when I got back home—from home—in the fall.

Although hyphens are short, they take up a lot of space in the minds of hyphenated kids. W. E. B. DuBois, writing about the psychic load Black-Americans had to bear, called this a double-consciousness. Not only must you move in your spaces aware of the world, but you must also be aware of the way the world is aware of you. It’s a lot of work, especially for a kid.

For me, nothing quite reflects that double-consciousness like my name. Most everyone knows me as Abdul. But that’s not my full name, which is Abdulrahman. It means Devotee of the Most Merciful. In the Muslim tradition, it is one of God’s most beloved names, which is why my parents chose it (before they realized I would be growing up in America). I love my name, reflecting a connection to a character of the divine that is so lacking in humanity: mercy.

I didn’t become Abdul until about a week before I started preschool. My stepmom, Jackie, realized that with its full complement of eleven letters Abdulrahman might be a challenge. She gingerly broached the topic with my father, Mohamed.

The traditional Arabic nickname for Abdulrahman, Boody, pronounced like the body part, was a non-starter for obvious reasons. That was the summer of 1989. Billboard’s number-one hit song was . . . Straight Up, by Paula Abdul. And Kareem Abdul-Jabbar had just wrapped up his stellar basketball career. Unlike Abdulrahman, with its deep meaning, Abdul is nonsensical in Arabic, roughly translating to Devotee of the, but given its references in pop culture, it took on meaning in America. So on my first day of preschool in 1989, I introduced myself as Abdul, and I’ve been Abdul to most of the world ever since. I still prefer Abdulrahman, if people can say it. One person, two names. Two consciousnesses.

Hyphens connect things—people, places, ideas—but they also bisect, separating out the pieces of those things. I prefer to think of my hyphen as a connector. But that, too, takes work—the constant upkeep of belonging. I imagine that, for most folks, home is an effortless place to be. The rules are automatic. For the hyphenated, home is not one place but many places, and with each home there’s a different set of rules. Make a mistake, break a rule, and you’ll show yourself to be an outsider, even in your own home.

As I boarded that plane, I imagined the home I would find at the other end of my journey. My father had left Egypt behind in his mid-twenties to pursue a PhD in mechanical engineering at Wayne State University in Detroit. Like many children of immigrants, I grew up hearing the legend of my parents—first in their class at this and that. My father was the archetype. After finishing at the top of his class at his public high school in Alexandria, he finished near the top of his class in engineering at Alexandria University, all while working full-time to support his family. He was chosen to join the teaching faculty, where he excelled in front of the classroom. But his political agitation against Egypt’s increasingly brutal military dictatorship, coupled with his proximity to young minds, made him a threat to the regime.

He had to leave. There were a few options. But Detroit, Michigan, was the most compelling. Detroit was, after all, in the United States of America, where his name, the color of his skin, and how he prayed shouldn’t matter. He could be just as American as anyone else. America was also the home of democracy, that thing he had so wanted for Egypt. And Detroit was synonymous with the car, a mecca for this budding automotive engineer. Besides, if it didn’t work out, he didn’t intend to stay forever anyway. He figured that after he’d gotten his fancy American degree, he’d be free to return to Egypt and have his pick of good jobs.

Detroit’s near-arctic winters felt like a personal insult to my father, whose childhood was saturated with the warmth of the Mediterranean sun, but he found Wayne State welcoming. Still, he was lonely. His heart had been broken a number of times before his transatlantic migration, so he decided to apply the exactitude of his engineering training to the work of finding love. He wanted to find a partner who shared his faith-driven values and his intellectual ambitions and who might join him in Detroit while he finished his PhD. My grandmother started to work the horn on his behalf, in a process that sounds more like the pre-auction marketing of a prized bull than romantic courtship.

She kept hearing about Fatten, a medical student and leader on campus. She was the eldest daughter of a biologist and had spent most of her childhood abroad after her mother passed when Fatten was thirteen. Fatten was a mother figure to her siblings and a loving, devoted daughter to her father. She, too, was a top student. Smart, warm, and charismatic, she seemed the right match, at least on paper. They met in person only once when my father had come back to Egypt over the summer. Under the watchful eyes of their parents, they chatted for twenty minutes. Everything looked to be in order. My father was smitten—perhaps less with the complex reality of the person he met than with the idea of her. She was equally taken with the idea of him.

But the future started to flicker. Both of their fathers were strong-willed, uncompromising men who wanted only the best for their eldest children. My paternal grandfather had already scuttled two relationships over petty slights at twenty-minute meetings that devolved into all-out feuds. My father was determined not to lose a third. Mohamed and Fatten married by phone a few months later.

My parents both take after their fathers. Both are strong-willed, charismatic, charming—and both are uncompromising, not only in their beliefs, but also in their approaches to life and their way of doing things. Their traits may make for excellent leaders and empowering parents, but they did not make them excellent life partners for each other. They divorced within a few years. My parents’ relationship had one lasting outcome: me. I comfort myself by thinking that if my parents were a band, they would have been a one-hit wonder.

My father decided to stay in America, and after finishing his degree he went to work for General Motors. He would never admit it, but he is a hopeless romantic. He was always destined to marry for love, not convenience. And he met—and soon married—a colleague at GM, one who could not have come from a more different a world. Jackie Johnson was the eldest daughter of Judith Ann and Jan Johnson. Her family has had roots in America since before the Revolution—she being a distant descendant of Abigail Adams. Jackie’s connection to the lands of mid-Michigan was generational. She had been born in Flint, while my Grandma Judy was in nursing school and my Grandpa Jan was studying at General Motors Institute (now Kettering University). Although they moved often, they raised their children in the Midwest. For people like my grandparents, home is etched into who they are. Jackie is smart, hardworking, and warm, a tenacious counter to my father’s hard-driving character.

Mohamed and Jackie met over a conversation about an obscure engineering concept: Mohr’s circle, a graphical representation of how an object changes under varying external stresses. My siblings, Osama and Samia, and I became a sociocultural application of that concept. We grew up in the home they made together, children raised by an immigrant from Egypt and a Daughter of the American Revolution.

My mother remarried as well, to a translator with whom she would live all over the world. Tragically, he passed young, the victim of a heart attack. I have two sisters on that side, Eman and Arwa, as well as a stepbrother, Adam. Collectively, I have five half- or stepsiblings; our love is whole, even if the bloodlines are not.

* * *

On the other side of my two-leg, fifteen-hour journey, I came home to the working-class neighborhood in Alexandria where my father grew up. For a kid raised largely in the bland suburbia of 1990s America, this other home—one I had only imagined—offered a glorious assault on the senses, from the street vendors hawking mish, a caramel-brown fermented cheese dip that looked and smelled like a bad moment on the toilet; to the soot of the air polluted by the tailpipes of 1970s-era Soviet Ladas; to the majesty of watching the sun set from the Corniche over the rocks jutting out of Alexandria’s Mediterranean waterfront; to the mystic cacophony of every muezzin’s adhan simultaneously calling the pious to prayer. The place didn’t even really wake up until after the sun went down; people filled the cafés and restaurants until well past 2:00 a.m. The manicured lawns and strip malls of Detroit’s sleepy suburbs were no match for the energy and authenticity of this place.

Yet poverty and its consequences abounded. The ubiquitous beggars and garbage pickers who spent their days sorting through the refuse of the lives of others were the visible tip of an iceberg of poverty. Egyptian society is segregated, though differently than ours is. To be sure, there are posh neighborhoods, exclusive to the ultra-rich, yet many wealthy Egyptians live on the upper floors of apartment buildings shared by a cross-section of all of Egyptian society. At the very bottom were the bawabs, an army of doormen who serve as the social mortar that holds together the bricks of Egyptian life.

The face of Ali, our bawab, bore the crags of his many days under an unmerciful sun spent fetching this or haggling over that. Ali wore the traditional Egyptian galabia, a gray, loose-fitting, collarless version of the robes made famous by the Saudis. Ali’s family had been in the bawab business for a generation, and he became my Sherpa, helping me decode the sights and sounds of Egyptian life. Because his role was to be the monitor, arbiter, and catalyst of all that went on in building, he knew the secrets held just beyond each apartment door. He knew about the crooked businessman on the eighth floor—and his mistress younger than his daughter—and the young woman on the fourth whose parents wouldn’t let her go to medical school. When I had questions that I was too embarrassed to ask my family, I would ask Ali.

Why can’t the farmers who bring their goods to market on a donkey afford a truck?

Why is there a group of young women who come to that coffee shop a few blocks away every night, and why do they leave with different men?

Why does that man beat his son?

His answers were almost always the same: "Miskeen." Because, Ali said, they were poor.

I began to realize just how narrow was the tightrope my predecessors had walked, how circumstances had threatened to knock them off at every turn—and just how fortunate I was that they never fell off. My people, too, had been poor.

Teta, my grandmother, was illiterate. She is the wisest, most intelligent person I have ever met, but she never spent a day in a classroom. She was denied that right. The fifth of nine children born to a streetlamp repairman and his illiterate wife, my grandmother grew up between her parents’ home and that of an eccentric couple without children who lived a few floors up. The husband was an inventor who had made his money designing quick-action cameras that could be used to snap photos of tourists on the Corniche.

Though separated only by a few floors, the two homes might as well have been different worlds. A far cry from the overcrowded rooms downstairs, the upstairs flat was a local salon for intellectuals and activists of the moment. Teta, an apprentice of sorts to the matron, would help with odd jobs around the house. With guests from all over Egypt, North Africa, Europe, and the Levant, she learned to cook in their various styles. Her proximity to the conversations shared over her meals gave her an ease with ideas and viewpoints to which few young women in her social circumstances would have been exposed. They were ever impressed with her wit, her memory, and her grace. And yet it never occurred to any of them that this intelligent, precocious, and charming young woman should be given access to formal education. I often wonder what my grandmother might have achieved had she been born in a different place in a different time.

Teta married my grandfather, then eighteen, when she was just fifteen. Giddo, my grandfather, had an eighth-grade education and sold tomatoes at a local fish market. He had spent much of his childhood as the eldest son of a wealthy landowner in Alexandria. But his father died when Giddo was thirteen, and when his uncles moved in for his inheritance, he was powerless, forced onto the street to fend for his mother and siblings. Although he was a rough man, ground down by life’s misfortunes, my grandfather loved my grandmother, for whom he reserved all the softness left in him. Teta had an extraordinary temperament. She was never angry, only disappointed—and not with you but with the version of you that you were choosing to be at the moment. She had the rare gift of seeing the best in you even when you could not see it in yourself, charming it out with a friendly parable or a caress of the hand. She was a natural leader, a towering figure of all of five feet one inch and much shorter in her usual pose, squatting over a little burner stove from which she would coax feasts of Egyptian cuisine. She’d hold court in that kitchen, helping a cousin with marital issues or settling a dispute between friends—always with a smile on her face, a story on her lips, and her heart firmly on the side of the powerless.

My father had a special reverence for his mother, and among the many gifts she gave me—the one for which I am most thankful—is the capacity for tenderness she showed me in him. My father was the eldest of her eight children, two of whom died before their first birthdays. My grandmother wanted him, her eldest son, to be a doctor. But watching two infant siblings die in hospitals left him with a lifelong aversion to the medical institutions that had failed them. He would oblige her somehow, though, ultimately earning a different kind of doctorate on a path he paved with books. He would start his day in the local market, helping set up my grandfather’s tomato stall before heading off to school, where he was expected to be the best student in his class.

My grandfather wanted better for his kids but knew only one way of wringing it from them: brute force. As you can imagine, my dad would dutifully make his way back to the market after school to help break the stall down. By the time he’d finish his chores in the market, the sun would have gone down. With only one bedroom for a family of eight, he was left to study on the rooftop, by the light of a streetlamp. Night after night, alone on that rooftop, my father studied my future into existence. That summer I often sat in his place, imagining the other versions of my life that might have been had he not sat there so many nights, so many years ago.

CHAPTER 2

An imperfect science.

Most of the time, when I tell people that I am an epidemiologist, they think I’m a skin doctor. It’s a fair mistake, owing to the similarity between the words epidemiologist and epidermis. We’re not skin doctors, and we don’t make nearly as much money.

Epi is Greek for what is upon, and demos means the people. Epidemiologists want to understand what is upon the people, what is plaguing them. Epidemiology is the basic science of public health, the study of the distribution and determinants of disease in populations. We count things having to do with why people get sick so we can understand how often—and why—they happen so that we can stop them from happening.

To get a sense of why this matters, consider this: if I asked you what the biggest health risk was among women, you’d probably think it was breast cancer. After all, everything turns pink every October for breast cancer awareness. But the most common killer in women is actually heart disease. That matters, because it should dictate how and where we apply our resources, concentrating our efforts on the health risks that affect the most people most profoundly. Of course, that is not to say that less common problems are not important, but we want to spend limited resources efficiently.

Our ability to count things systematically and make sense of them is relatively new, because it’s actually quite hard to do. First, we have to collect complete and reliable data about people over time. That requires the infrastructure to keep track of people and make sure we’re measuring what we want, when we want it. That only became possible with the advent of organized, efficient bureaucracies across larger, settled societies. Second, you need the mathematical and