Jan. 22, 2026

Tucker is an infectious diseases physician at UNC Chapel Hill.

Seeing infectious disease patients at a North Carolina hospital on Christmas Day 2025 could easily make a doctor cynical.

In recent months, I walked through the Raleigh airport where a patient with measles travelled a few days before. I have watched research colleagues wind down promising work on adolescent HIV because of  funding priorities shifted. I see patients in communities where the nearest rural hospital operates one bad quarter away from closure, and where families quietly ask social workers whether food assistance will still be there next month. These are the same patients that I saw over the holiday period this year at UNC Health in Chapel Hill, N.C.

You might think this is the wrong moment to ask patients or their families what they are grateful for. You would be wrong.

Year-round, I ask every patient that question, regardless of income, diagnosis, or background. I do it for three reasons.

First, asking about gratitude strengthens the doctor-patient relationship. Research suggests that even simple expressions of gratitude can build trust and connection. At the end of a clinical visit, the question often lightens what is otherwise a heavy, frightening conversation.

Second, I am genuinely curious about what my patients value most. What anchors them? What gives meaning to their lives beyond lab results and imaging studies?

Third, gratitude can be contagious. In clinics and hospitals, reflecting on gratitude often spills outward into generosity — toward family members, caregivers, and strangers alike. Unlike gifts distributed by chance, generosity has a way of finding where it is most needed.

And yet, over the December holiday period of 2025, the question landed differently.

Three adult patients wept openly when I asked what they were grateful for. This had never happened before in the two years I’ve been asking the same question. These were not quiet tears in private rooms. They were full-bodied sobs, witnessed by family members, trainee physicians, and nurses.

The reactions surprised me. On Christmas Eve, I returned to speak with each of these patients. I gave them each chocolate and tried to understand why a question that usually comforted had instead opened a wound. One wife of a Latin American migrant patient mentioned how the world felt less safe now compared to before. Another said that things felt heavy now. A third was terrified about losing her leg to infection.

For many Americans, being asked to name what they are grateful for now feels uncomfortably close to being asked to accept losses that were preventable: illnesses that should have been stopped, hunger that should not exist, hospitals that should not be closing. Gratitude, when untethered from justice, can sound like a request to look away.

The tears I saw were not a rejection of gratitude. They were grief for what gratitude used to rest upon — an expectation that basic protections would hold. That children would be vaccinated. That preventable disease would, in fact, be prevented. That access to food and medical care would not depend so heavily on income or geography. Gratitude is easier when people believe the floor beneath them is solid.

In medicine, we sometimes talk about moral injury — the distress that arises when clinicians know what patients need but cannot reliably provide it because of systemic constraints. That injury does not disappear on holidays. If anything, it sharpens. Decorations go up while safety nets fray. Celebration proceeds alongside quiet loss.

And yet, gratitude still matters — perhaps more than ever. But not as a demand placed on patients or families who are losing ground. Gratitude should instead be understood as a responsibility borne by those of us with relative stability, institutional voice, and the ability to influence how resources are allocated and protections maintained.

True gratitude is not passive. It is active. It asks: What have we been given, and what would it take to keep it intact? What obligations follow from living in a society where some people are cushioned from loss while others absorb it?

My patients cried not because they had nothing to be grateful for. Each person who cried also told me that asking about gratitude was a good idea. They spoke of family, faith, kindness from strangers, and the presence of loved ones at the bedside. “I am thankful for all of it,” one patient replied. My impression was that they cried because they sensed that the conditions making those things possible were becoming less reliable.

Gratitude, properly understood, is not about pretending everything is fine. It is about noticing what is fragile — and deciding whether we are willing to do the work required to keep it from breaking.

Joseph Tucker is an infectious diseases physician at UNC Chapel Hill writing a book about contagious generosity.

The U.S. Department of the Interior announced on Friday that it is revoking grazing permits in Phillips County that American Prairie had been using to sustain its herd of bison.

The decision comes after a three-and-a-half-year battle between the Montana livestock industry, backed by Gov. Greg Gianforte and the Montana Department of Justice, and American Prairie, a conservation nonprofit working to restore the prairie ecosystem of north-central Montana.

The Montana Stockgrowers Association cheered the news, describing it as a “win for public lands ranching in Montana.”

“MSGA is thrilled to see this decision by the BLM to restore grazing allotments back to their intended usage for production livestock grazing,” MSGA President Lesley Robinson said in a Friday afternoon press release. “MSGA is proud to defend sound, lawful land management. This decision is an incredible win for public lands grazers, ranching families and rural communities across the West.”

American Prairie called the decision a “troubling precedent” for those reliant on consistent, predictable federal land management decisions.

“This decision is not grounded in new impacts or new information — it appears to be completely arbitrary and is unfair,” American Prairie CEO Ali Fox wrote in an emailed statement. “When federal agencies begin changing how the rules are applied after the process is complete, it undermines confidence in the system for everyone who relies on public lands. Montana livestock owners deserve clarity, fairness and decisions they can count on.”

American Prairie’s statement also emphasized bison’s ecological significance to prairie ecosystems, describing it as “a relationship that has been extensively studied and well documented over time.”

In its Jan. 16 letter to American Prairie signed by Sonya Germann, the State Director for the Bureau of Land Management’s Montana/Dakotas office, the Interior Department took issue with how American Prairie has characterized its herd of bison, estimated in 2024 at approximately 900 animals.

American Prairie had been grazing bison on four leases for about three years as the high-profile case wound through the Interior Department’s Office of Hearings and Appeals, a quasi-judicial body that considers issues related to federally administered grazing permits. (American Prairie pointed out in a statement to MTFP that it first received permission to graze bison on BLM land using other leases that were also revoked by Friday’s decision in the mid-aughts and has “done so successfully for the past 20 years.”)

In December, Trump administration Interior Secretary Doug Burgum directed the BLM to reconsider the grazing authorization approved by the Biden administration in 2022, arguing that the 1934 Taylor Grazing Act requires that grazing on publicly owned federal lands be “limited to cases where the animals to be grazed are domestic and will be used for production-oriented purposes.”

That distinction was the justification BLM provided for its decision this week.

“There are multiple times wherein by the applicant’s own admissions it is clear that these are not managed for production-oriented purposes and so do not fall within the meaning of the terms livestock and domestic as those terms are used in the applicable statutory authorities,” Germann wrote in her 24-page decision letter Friday. “Reissuing cattle-only permits on allotments where bison or a combination of cattle and/or bison were previously authorized … ensures that the BLM is acting within the limits of its statutory authority.”

In its 2022 record of decision approving American Prairie’s Montana bison grazing plan, the BLM noted that bison grazing is permitted on leases it administers in Colorado, New Mexico, North Dakota, South Dakota and Wyoming.

“Though the proposal to allow domestic indigenous livestock grazing conflicts with views and opinions expressed among some users of public lands, such unfavorable views of the proposal itself do not constitute a scientific controversy, disagreement about the nature of effects, or provide evidence that the project is not in conformance to BLM’s statutory and regulatory requirements,” the agency wrote then.

American Prairie, which aims to connect 3.2 million acres — “enough to support a healthy prairie ecosystem”—has amassed a vast collection of land holdings and leases to facilitate its rewilding and biodiversity-restoration vision since its founding in 2001. In late 2024, the nonprofit announced that recent large ranch purchases had helped it cross a notable threshold: between its private landholdings and federal grazing leases, it has assumed control over more than half a million acres.

In recent years, the organization, previously titled the American Prairie Reserve, has garnered pushback from Republican politicians and neighboring livestock producers wary of the nonprofit’s substantial — and growing — influence on the cultural, land-ownership and property tax dynamics of central Montana. American Prairie critics, including the United Property Owners of Montana, have rallied support for their cause under a “Save the Cowboy” slogan.

Montana Attorney General Austin Knudsen and Gianforte, who have fought the 2022 decision, described the agency’s reversal this week as a victory for Montana agriculture.

“Canceling the American Prairie Reserve’s bison grazing permit will help to protect the livestock industry and ranching communities in Northeastern Montana from the elitists trying to push them out,” Knudsen said in a statement.

American Prairie hinted in its Friday statement that a legal challenge to the decision in the federal court system might be coming, writing that it is “reviewing the decisions and determining its course of action.”

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This story was originally published by Montana Free Press and distributed through a partnership with The Associated Press.

A newborn baby has died in New Mexico from a Listeria infection that state health officials say was likely contracted from raw (unpasteurized) milk that the baby’s mother drank during pregnancy.

In a news release Tuesday, officials warned people not to consume any raw dairy, highlighting that it can be teeming with a variety of pathogens. Those germs are especially dangerous to pregnant women, as well as young children, the elderly, and people with weakened immune systems.

“Raw milk can contain numerous disease-causing germs, including Listeria, which is bacteria that can cause miscarriage, stillbirth, preterm birth, or fatal infection in newborns, even if the mother is only mildly ill,” the New Mexico Department of Health said in the press release.

The health department noted that it could not definitively link the baby’s death to the raw milk the mother drank. But raw milk is notorious for transmitting Listeria monocytogenes bacterium. The Food and Drug Administration has a “Food Safety for Moms-to-Be” webpage about Listeria, in which it poses the question and answer: “How could I get listeriosis? You can get listeriosis by eating raw, unpasteurized milk and unpasteurized milk products… .”

Listeria is a particular danger during pregnancy. When exposed, pregnant people are 10 times more likely to develop a Listeria infection than other healthy adults because altered immune responses during pregnancy make it harder to fight off infections. Further, Listeria is one of a few pathogens that are able to cross the placental barrier and infect a developing fetus.