by Amy Stewart
These studies contrast with the Cochrane reviews of bed rest, which represent the most comprehensive assessment of the available science, and draw from dozens of peer-reviewed papers. Those have consistently shown no proven benefit from the treatment and do not recommend it. A 2013 study of pregnant women with short cervixes found that preterm birth was more likely among those placed on activity restriction. Other studies have shown that pregnant women are particularly vulnerable to the negative side effects of bed rest: an increase in clotting factors during pregnancy makes patients more likely to form blood clots, and immobilization compresses the veins further, putting patients at even greater risk. (Pulmonary embolism is the cause of 10 percent of pregnancy-related deaths.)
Obstetricians who have research experience are far less likely to recommend bed rest than those who do not. “Out in the community, you’re going to have doctors that say, ‘Absolutely, you should be on bed rest,’” said Cynthia Gyamfi-Bannerman, an associate professor of obstetrics and gynecology at Columbia University Medical Center, where the staff actively discourages the practice. “One of the most common questions I get from my pregnant patients is, ‘When am I going to be on bed rest?’ We tell them, well, hopefully, never. It’s harder, almost, to say, ‘You don’t need it,’ than to say, ‘OK, sure, go ahead.’”
Most of the Cochrane reviews on bed rest were published within the past 10 years. Christina Herrera, who is a fellow in maternal-fetal medicine at the University of Utah, said that she learned about the general complications of being confined to bed in medical school but didn’t encounter clinical research about the risks of the practice for pregnancy until her residency. Herrera now tells her patients to avoid strict bed rest at all costs.
Through some combination of ignorance and wishful thinking, bed rest survives. In 2009 a young woman named Samantha Burton experienced symptoms of preterm labor 15 weeks before her due date and went voluntarily to Tallahassee Memorial Hospital. She was seen by a doctor who told her that she would have to be admitted and remain in bed. Burton, who had two small children, agreed to rest but wanted to go home. She also wanted a second opinion. The doctor told her that she would not be allowed to leave and initiated legal proceedings to confine her to the hospital. A judge found in favor of Tallahassee Memorial and issued a court order mandating hospital bed rest, medication to prolong her pregnancy, and, if necessary, forced delivery. Three days later, Burton delivered a stillborn baby by cesarean section.
My first night in the convent, I had a quick dinner of scrambled eggs and bagels with the nuns and oblates in the cafeteria. They were kind enough to let me undergo my bed-rest experiment on their grounds, in a wing of the complex meant for spiritual retreatants—all of whom had taken vows of silence for the duration of their stay there, except for me. The nuns were extremely kind and friendly, and unabashedly curious about me, the only visitor to their retreat center who was allowed to talk to them. They asked me about bed rest, why I was doing it, what I thought I would find out. They introduced me to the oldest sister, who had been a nun for more than 70 years. They thought she might be able to tell me about a time when people took to bed more often. (She couldn’t.) They wished me mental and spiritual peace even though they knew that was not what I was there for. Before I left the table, a nun blessed me, blessed my article, and blessed my writing. These were the last people I’d speak to face-to-face for the next five days.
I told the nuns that I expected my time on bed rest to make me better rested, and probably very bored. At that point, I had no idea how draining it would be to adjust my body continuously, as one part after another complained about each new position. I lay on my back or on my side, watching a small rectangle of light blaze and flicker in the afternoon, dimming as the day turned to evening. I breathed deeply even though it felt like my lungs were trapped beneath an invisible new weight. I learned to lie on my side with one leg straight and one bent to avoid the pain of my knee digging into the increasingly tender flesh of the leg beneath. My whole body felt weak and sore and sensitive by day two—but I still felt generally healthy, as though I could shake off this new frailty if I were just allowed to go for a long walk.
By the third day, I found myself thinking that something had gone wrong inside my body, that there was something besides the experiment harming me. What else could explain how unwell I felt? The muscles of my neck and shoulders were alternately sore and numb; my legs hurt when I rested them against each other and ached when they were apart; my heart raced when I turned from one side to the other. I felt sad for no good reason, unfocused but undistractible—I couldn’t seem to get my mind off how I felt, but I was unable to bring the experience into sharp-enough relief to analyze it. It’s more difficult to think when you’re horizontal: alertness comes in plains and troughs rather than in peaks. None of my thoughts had any lift to them.
The few times a day when I let myself out of bed, I could feel how different my body had become. Standing up made me dizzy and set my heart pounding. Walking 20 paces to the kitchen exhausted me and left me feeling empty, my legs shaking. I felt as though I’d ended up on the wrong planet, or in the wrong body. I knew from reading NASA’s bed-rest studies that the first week is supposed to be the worst, full of strange pains and headaches, urgent discomforts that last for hours and then fade away. I didn’t know if the second week is easier because the body has adapted, or whether after a week in bed it just gets harder to remember what being out of bed used to feel like, what having a body used to feel like. By the fifth day, I felt as though I’d aged 20 years.
I had read papers that described the dramatic effect of immobilization on the human psyche. Adolescent girls in full-body casts viewed the motion of others with jealousy, tracking them with their eyes, simulating movement with twitches and fidgeting. Individuals forced to rest acted out emotionally, manifesting fear, guilt, and anger. Immobilization altered the perception of weight, pressure, temperature, pattern, and form, and it distorted the experience of time.
The day I left the convent, I wheeled my small, heavy rolling luggage back up the road that led to the bus stop. The distance seemed to have dilated, the inclines and slopes had become steeper. A walk that had taken me 10 minutes on the first day now took me closer to 30.
Lying in bed on my last day of rest, I thought about the phrase “First, do no harm,” which is commonly believed to be part of the Hippocratic oath even though it appeared much later. Intuitively, bed rest feels like it should be a harmless therapy: What danger could there be in doing, for an exaggerated period, something we do every night? If there’s no benefit in it, at least there should be no harm. But in every other branch of medicine, we insist that a treatment justify its use through empirical evidence, through proof of its capacity to help. There’s no excuse for letting any patient suffer the known harm of immobilization without compelling evidence of its benefits. We should recognize bed rest for what it is: not an escape from risk but the adoption of a new risk, one whose outcome is uncertain, but not unknown.
ELIZABETH KOLBERT
The Siege of Miami
FROM The New Yorker
THE CITY OF MIAMI BEACH floods on such a predictable basis that if, out of curiosity or sheer perversity, a person wants to she can plan a visit to coincide with an inundation. Knowing the tides would be high around the time of the “super blood moon,” in late September, I arranged to meet up with Hal Wanless, the chairman of the University of Miami’s Geological Science Department. Wanless, who is 73, has spent nearly half a century studying how South Florida came into being. From this, he’s concluded that much of the region may have less than half a century more to go.
We had breakfast at a greasy spoon not far from Wanless’s office, then set off across the MacArthur Causeway. (Out-of-towners often assume that Miami Beach is part of Miami, but it’s situated on a separate island, a few miles off the coast.) It was a hot, breathless day, with a brilliant blue sky. Wanless turned onto a side street, and soon we were confronting
a pond-sized puddle. Water gushed down the road and into an underground garage. We stopped in front of a four-story apartment building, which was surrounded by a groomed lawn. Water seemed to be bubbling out of the turf. Wanless took off his shoes and socks and pulled on a pair of polypropylene booties. As he stepped out of the car, a woman rushed over. She asked if he worked for the city. He said he did not, an answer that seemed to disappoint but not deter her. She gestured at a palm tree that was sticking out of the drowned grass.
“Look at our yard, at the landscaping,” she said. “That palm tree was superexpensive.” She went on, “It’s crazy—this is salt water.”
“Welcome to rising sea levels,” Wanless told her.
According to the Intergovernmental Panel on Climate Change, sea levels could rise by more than three feet by the end of this century. The United States Army Corps of Engineers projects that they could rise by as much as five feet; the National Oceanic and Atmospheric Administration predicts up to six and a half feet. According to Wanless, all these projections are probably low. In his office, Wanless keeps a jar of meltwater he collected from the Greenland ice sheet. He likes to point out that there is plenty more where that came from.
“Many geologists, we’re looking at the possibility of a ten-to-thirty-foot range by the end of the century,” he told me.
We got back into the car. Driving with one hand, Wanless shot pictures out the window with the other. “Look at that,” he said. “Oh, my gosh!” We’d come to a neighborhood of multimillion-dollar homes where the water was creeping under the security gates and up the driveways. Porsches and Mercedeses sat flooded up to their chassis.
“This is today, you know,” Wanless said. “This isn’t with two feet of sea level rise.” He wanted to get better photos, and pulled over onto another side street. He handed me the camera so that I could take a picture of him standing in the middle of the submerged road. Wanless stretched out his arms, like a magician who’d just conjured a rabbit. Some workmen came bouncing along in the back of a pickup. Every few feet, they stuck a depth gauge into the water. A truck from the Miami Beach Public Works Department pulled up. The driver asked if we had called City Hall. Apparently, one of the residents of the street had mistaken the high tide for a water main break. As we were chatting with him, an elderly woman leaning on a walker rounded the corner. She looked at the lake the street had become and wailed, “What am I supposed to do?” The men in the pickup truck agreed to take her home. They folded up her walker and hoisted her into the cab.
To cope with its recurrent flooding, Miami Beach has already spent something like a hundred million dollars. It is planning on spending several hundred million more. Such efforts are, in Wanless’s view, so much money down the drain. Sooner or later—and probably sooner—the city will have too much water to deal with. Even before that happens, Wanless believes, insurers will stop selling policies on the luxury condos that line Biscayne Bay. Banks will stop writing mortgages.
“If we don’t plan for this,” he told me, once we were in the car again, driving toward the Fontainebleau hotel, “these are the new Okies.” I tried to imagine Ma and Pa Joad heading north, their golf bags and espresso machine strapped to the Range Rover.
The amount of water on the planet is fixed (and has been for billions of years). Its distribution, however, is subject to all sorts of rearrangements. In the coldest part of the last ice age, about 20,000 years ago, so much water was tied up in ice sheets that sea levels were almost 400 feet lower than they are today. At that point, Miami Beach, instead of being an island, was 15 miles from the Atlantic coast. Sarasota was 100 miles inland from the Gulf of Mexico, and the outline of the Sunshine State looked less like a skinny finger than like a plump heel.
As the ice age ended and the planet warmed, the world’s coastlines assumed their present configuration. There’s a good deal of evidence—much of it now submerged—that this process did not take place slowly and steadily but, rather, in fits and starts. Beginning around 12,500 BC, during an event known as meltwater pulse 1A, sea levels rose by roughly 50 feet in three or four centuries, a rate of more than a foot per decade. Meltwater pulse 1A, along with pulses 1B, 1C, and 1D, was, most probably, the result of ice sheet collapse. One after another, the enormous glaciers disintegrated and dumped their contents into the oceans. It’s been speculated—though the evidence is sketchy—that a sudden flooding of the Black Sea toward the end of meltwater pulse 1C, around 7,500 years ago, inspired the deluge story in Genesis.
As temperatures climb again, so, too, will sea levels. One reason for this is that water, as it heats up, expands. The process of thermal expansion follows well-known physical laws, and its impact is relatively easy to calculate. It is more difficult to predict how the earth’s remaining ice sheets will behave, and this difficulty accounts for the wide range in projections.
Low-end forecasts, like the IPCC’s, assume that the contribution from the ice sheets will remain relatively stable through the end of the century. High-end projections, like NOAA’s, assume that ice melt will accelerate as the earth warms (as, under any remotely plausible scenario, the planet will continue to do at least through the end of this century, and probably beyond). Recent observations, meanwhile, tend to support the most worrisome scenarios.
The latest data from the Arctic, gathered by a pair of exquisitely sensitive satellites, show that in the past decade Greenland has been losing more ice each year. In August NASA announced that, to supplement the satellites, it was launching a new monitoring program called—provocatively—Oceans Melting Greenland, or OMG. In November researchers reported that, owing to the loss of an ice shelf off northeastern Greenland, a new “floodgate” on the ice sheet had opened. All told, Greenland’s ice holds enough water to raise global sea levels by 20 feet.
At the opposite end of the earth, two groups of researchers—one from NASA’s Jet Propulsion Lab and the other from the University of Washington—concluded last year that a segment of the West Antarctic ice sheet has gone into “irreversible decline.” The segment, known as the Amundsen Sea sector, contains enough water to raise global sea levels by 4 feet, and its melting could destabilize other parts of the ice sheet, which hold enough ice to add 10 more feet. While the “decline” could take centuries, it’s also possible that it could be accomplished a lot sooner. NASA is already planning for the day when parts of the Kennedy Space Center, on Florida’s Cape Canaveral, will be underwater.
The day I toured Miami Beach with Hal Wanless, I also attended a panel discussion at the city’s Convention Center titled “Eyes on the Rise.” The discussion was hosted by the French government, as part of the lead-up to the climate convention in Paris, at that point two months away. Among the members of the panel was a French scientist named Eric Rignot, a professor at the University of California, Irvine. Rignot is one of the researchers on OMG, and in a conference call with reporters during the summer he said he was “in awe” of how fast the Greenland ice sheet was changing. I ran into him just as he was about to go onstage.
“I’m going to scare people out of this room,” he told me. His fellow panelists were a French geophysicist, a climate scientist from the University of Miami, and Miami Beach’s mayor, Philip Levine. Levine was elected in 2013, after airing a commercial that tapped into voters’ frustration with the continual flooding. It showed him preparing to paddle home from work in a kayak.
“Some people get swept into office,” Levine joked when it was his turn at the mike. “I always say I got floated in.” He described the steps his administration was taking to combat the effects of rising seas. These include installing enormous underground pumps that will suck water off the streets and dump it into Biscayne Bay. Six pumps have been completed, and 54 more are planned. “We had to raise people’s storm-water fees to be able to pay for the first hundred-million-dollar tranche,” Levine said. “So picture this: you get elected to office and the first thing you tell people is, ‘By the way, I’m going to raise your rates.’”
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br /> He went on, “When you are doing this, there’s no textbooks, there’s no ‘How to Protect Your City from Sea Level Rise,’ go to Chapter Four.” So the city would have to write its own. “We have a team that’s going to get it done, that’s going to protect this city,” the mayor said. “We can’t let investor confidence, resident confidence, confidence in our economy start to fall away.”
John Morales, the chief meteorologist at NBC’s South Florida affiliate, was moderating the discussion. He challenged the mayor, offering a version of the argument I’d heard from Wanless—that today’s pumps will be submerged by the seas of tomorrow.
“Down the road, this is just a Band-Aid,” Morales said.
“I believe in human innovation,” Levine responded. “If, thirty or forty years ago, I’d told you that you were going to be able to communicate with your friends around the world by looking at your watch or with an iPad or an iPhone, you would think I was out of my mind.” Thirty or 40 years from now, he said, “We’re going to have innovative solutions to fight back against sea level rise that we cannot even imagine today.”
Many of the world’s largest cities sit along a coast, and all of them are, to one degree or another, threatened by rising seas. Entire countries are endangered—the Maldives, for instance, and the Marshall Islands. Globally, it’s estimated that a hundred million people live within three feet of mean high tide and another hundred million or so live within six feet of it. Hundreds of millions more live in areas likely to be affected by increasingly destructive storm surges.
Against this backdrop, South Florida still stands out. The region has been called “ground zero when it comes to sea level rise.” It has also been described as “the poster child for the impacts of climate change,” the “epicenter for studying the effects of sea level rise,” a “disaster scenario,” and “the New Atlantis.” Of all the world’s cities, Miami ranks second in terms of assets vulnerable to rising seas—number one is Guangzhou—and in terms of population it ranks fourth, after Guangzhou, Mumbai, and Shanghai. A recent report on storm surges in the United States listed four Florida cities among the eight most at risk. (On that list, Tampa came in at number one.) For the past several years, the daily high-water mark in the Miami area has been racing up at the rate of almost an inch a year, nearly 10 times the rate of average global sea-level rise. It’s unclear exactly why this is happening, but it’s been speculated that it has to do with changes in ocean currents which are causing water to pile up along the coast. Talking about climate change in the Everglades this past Earth Day, President Obama said, “Nowhere is it going to have a bigger impact than here in South Florida.”
