Tuesday, June 16, 2009

Doctors, nurses, and medical students in Iran, June 16


Above: a video from YouTube, with the title
16 JUNE 2009 - Doctors and nurses are protesting in a major hospital in Tehran - Iran
with the following caption:

At 1:41 one of nurses is shouting "8 people died in this hospital last night". of them1 died by a headshot...which said that poor brave man shoted by sniper. at 1:35 you can see on that board which writen in persian "28 wounded...8 died"

Morning of 16 June...Rasoul Akram Hospital's doctors and nurses are protesting about what happened in the last night gunshots by Goverment's militia (basij) and police. 36 people shots By Gun 8 dies and 28 injured .


And...
From Nico Pitney at the Huffington Post, an email from an Iranian medical student:


Hello,

It's painful to watch what's happening.

I don't want anything to do with what has been said this far, as I neither have the strength nor the resilience to face all these unfathomable events.

I only want to speak about what I have witnessed. I am a medical student. There was chaos last night at the trauma section in one of our main hospitals. Although by decree, all riot-related injuries were supposed to be sent to military hospitals, all other hospitals were filled to the rim. Last night, nine people died at our hospital and another 28 had gunshot wounds. All hospital employees were crying till dawn. They (government) removed the dead bodies on back of trucks, before we were even able to get their names or other information. What can you even say to the people who don't even respect the dead. No one was allowed to speak to the wounded or get any information from them. This morning the faculty and the students protested by gathering at the lobby of the hospital where they were confronted by plain cloths anti-riot militia, who in turn closed off the hospital and imprisoned the staff. The extent of injuries are so grave, that despite being one of the most staffed emergency rooms, they've asked everyone to stay and help--I'm sure it will even be worst tonight.

What can anyone say in face of all these atrocities? What can you say to the family of the 13 year old boy who died from gunshots and whose dead body then disappeared?

This issue is not about cheating(election) anymore. This is not about stealing votes anymore. The issue is about a vast injustice inflected on the people. They've put a baton in the hand of every 13-14 year old to smash the faces of "the bunches who are less than dirt" (government is calling the people who are uprising dried-up torn and weeds) .

This is what sickens me from dealing with these issues. And from those who shut their eyes and close their ears and claim the riots are in opposition of the government and presidency!! No! The people's complaint is against the egregious injustices committed against the people.

Monday, June 15, 2009

The AMA doesn't speak for me

I've started a Facebook group:
"I'm a doctor, and the AMA doesn't speak for me"
I hope my colleagues will consider joining.

One of the group members linked to this article:
Abraham Verghese on the AMA

Monday, June 8, 2009

the future of the future



Wikimedia commons photo: Samuel Delany. NASA photo: Charles Bolden in 1992


Yesterday, I was registering the fact that President Obama has appointed Charles Bolden, an African American astronaut, to run NASA. I googled him, thinking about how it's not that incredible anymore to have black people go up in space, and that therefore it doesn't seem incredible that there's a black astronaut in charge of NASA. And then one article, which included various people gushing about Bolden, included a comment from his astronaut buddy Franklin Chang-Diaz, whose daughter is a Massachusetts politician with the same last name.

I don't want to dwell on the point, but "Franklin Chang-Diaz" used to not be an astronaut kind of name, nor a Boston politician name either. In fact, it is hard to know which would have seemed more improbable in 1950, or 1960, or even 1970.

I don't want to be the white guy who looks on in wondrous rapture about little victories of diversity as a way of ignoring inequality and discrimination. So let me pause and register that the world is still what it is; inequality still is the rule, not the exception. At the same time, the world is different than it used to be.

NASA made a decision, when it started the shuttle program, to change what astronauts looked like. Now, many years later, there are a fair number of black astronauts, women astronauts, astronauts from different parts of the world. Some of them are rising through the ranks. There are still plenty of white guy astronauts and white guys slapping each other five in Mission Control--the world hasn't changed so much--but it's different than Apollo.

This got me thinking about science fiction. I've mostly left the genre behind in my own reading over the last few years. My friend S. knows it better and is able to write about it more seriously. Still, from the reading I did in years past, I can say there are a few different versions of the society of space in science fiction. One of those versions comes from an often quietly utopian impulse, which involves more small-bore problems of dealing with difference, or of trying to make a better society, or of living in a different way than we now imagine. It does not describe utopias, but its broad imagination, its sense of possibility, is a form of utopianism. It is a way of saying, anything is possible. This genre uses science fiction as a way of stretching our imaginations about what could be. Some of the practitioners of this kind of science fiction, people like Octavia Butler or Samuel Delany, were African American, and the humans who inhabited their worlds were often of many colors, not to mention genders and sexual orientations. In fact, not at the time, but retrospectively, some people call them pioneers of Afrofuturism.

There is no immediate relationship between Samuel Delany, a gay man with a big unruly beard who now teaches creative writing at Temple, and Charles Bolden, a former Marine and astronaut, who will now run NASA. They are both black men who are interested in outer space, but then, so was Sun Ra. I can't really imagine Borden and Delany at the same event. And though there must be someone who knows them both, I don't think they travel in overlapping circles. They have outer space in common, sort of (though Samuel Delany does not even depend on that trope). But one of them is interested in imagining different planets as metaphors for different ways of living. The other is interested in specific real different planets as places we might drive a space ship to. Delany is wildly progressive; Bolden is not, at all.

When NASA chose its astronaut corps for the shuttle program, it did so for political reasons that were very much of the here and now. NASA understood then and understands now that its work can either seem like an inspiration, a bold project of building human capacity, a project on behalf of nothing smaller than humanity itself; or, alternatively, a wasteful boondoggle and gadget racket that has nothing to do with anyone's concrete problems. Choosing a diverse astronaut corps helped keep NASA looking like it was staying on the right side of that line. That has nothing to do with anything as edgy or visionary as Samuel Delany. Yet, if you would have written a science fiction story, in 1969, that imagined a black president and NASA chief, you would have placed yourself firmly in the left wing of the genre.


There are all sorts of possibilities come true lately, which I've been noticing simultaneously. Less lofty but maybe more spectacular: in my pocket, my iPhone seems more spectacular than a lot of gadgets I read about in science fiction books when I was a kid, exactly because it is an everyday device. Without any mythic resonance, an improbable-seeming thing I carry in my pocket, the iPhone is not a super phaser or a scanning diagnostic tool that instantly does my medical work for me. It's just a phone, a newspaper, a street map of the developed world, a global positioning device (the very existence of which is improbable, much less that it is in my pocket), a massive encyclopedia written by a global collective, a camera, some video games, a music player, a way to write people brief letters or read letters from others, and other things as well. And I put it in my pocket and carry it around! Every so often, we do make note of how incredible this seems. Perhaps I'm just getting older, and remember more and more time, more and more of my own history, that took place before we could take such things for granted.



Whether for the head of NASA, or my iPhone, the future is harder to accurately imagine than it first seems, and not just because you thought the phone/clock/navigational device would be a Dick Tracy-style watch and not some pocket version of the monoliths from 2001: A Space Odyssey. Once the future arrives it seems ordinary. To imagine the future puts a wondrous glow on it.

The future is not simply a time like other times; it is a time when anything is possible and therefore it is a time made up of a larger-than-appropriate proportion of our hopes and fears. When we find ourselves in the time that used to be the future, there is no such resonance. Some things are newly possible, others not possible anymore, and we simply find ourselves in a new set of circumstances. We fear and hope for new things. AT&T sends a bill for the iPhone minutes. The future is no longer the future.

But there is something about this year, and I know I'm not the only person to feel this way, that feels a bit more like science fiction than most years. The dull apocalyptic dread of the American economic empire in collapse; a black president with a Muslim name; iPhones in our pockets; gay marriage through all of New England but not in California or New York; a black astronaut in charge of NASA. Some Puerto Rican lady gets appointed to the Supreme Court and it is the exact person that the press has been predicting all along, which makes her appointment seem like an almost unadventurous boring political move by our president, who--we're almost used to it now--is a black man named Barack Obama. (Afrofuturism, indeed.) We take the internet for granted but we're still figuring out how to use it; we're also now used to things like dance music made entirely by computer programming; and we forget how extraordinary it is that in so many ways, from dumb television to crucial navigation, we depend on satellites orbiting the earth.


It's not future shock I feel; just a sense that the present is improbable, and thus, that the future must be even more so, for better, for worse, or, simply, for different. Really different. All possibilities remain possible. We are in a time that feels like the future even as it arrives. This year, more than most years, I find myself in the future, still catching up.

Friday, May 15, 2009

selfish HMS scientists

Sunday, May 3, 2009

another House of God

A very dear family member of mine, a secular Jew, had chest pain which led to a bunch of interventions. This led to me flying back home to California one recent weekend to see him in the hospital.

His primary care doctor's practice, and his HMO, use a hospital run by a Catholic healthcare network. It has excellent cardiac outcomes, says the Medicare data. So keeping in mind that quality should be measured by outcomes and not by tenure, I haven't pushed for him to go to the academic hospital in town. I think for most people these days, the religious affiliation of a hospital, or the former affiliation, is just kind of a quirky detail. A hospital is a hospital. The HMOs are more powerful than the church. The doctors and nurses matter more than the priests and the nuns.

As far as the doctors, I was frustrated by the hospitalist, who had a Muslim name, and reassured by the pulmonologist, who also had a Muslim name; and I liked the Chinese American cardiologist just fine too. (The experience reminded me that for patients and patients' families, doctors loom large because they are very rarely seen; and nurses loom large because they are always around.)

Their nurses are unionized, but order their scrubs from the same mail order catalogs that our nurses order them from, and probably drive the same kinds of minivans too. There were fewer young nurses with those kinda cooler scrub patterns, more nurse's union pins, more Filipina accents, no one saying "myocahdial infahction". In other words, the variations from my own hospital only emphasized that it too was a hospital above all else, much more than it was a Catholic institution.

But still, on Sunday, there was a prayer over the loudspeaker. "It goes on just long enough for you to start to get irritated, but stops right before you are about to go ballistic," another (definitely not Catholic) beloved family member observed. "They've clearly timed it very carefully."

My dear family member is back home, now back in the warm embrace of secular humanism. Phew.


The hospital focuses on cardiac care...


...but doesn't let you forget that for this hospital administration, there is a celestial nurse manager above all others.


My family didn't know that "S.O.B" stood for "short of breath" so they thought this clinical plan, written next to the bed by the nurse to explain the plan for the day, seemed out of character for the hospital.

Nightfloat pictures from my phone

From a few weeks ago when I was working nightfloat...

From top to bottom:
the hospital at night
hallways
and a sign put outside the rooms of patients on fall precautions.




Tuesday, March 24, 2009

Don't walk. Sit.




Above: employees of an Indiana health plan promote "breast cancer awareness" by wearing pink and making themselves into a ribbon. Below: from Rex Wockner at wockner.blogspot.com; the AIDS Coalition to Unleash Power in Chicago. AIDS activists demanded national healthcare, but mostly didn't figure out how to make common cause with other people with other illnesses.


Over at DuncanCross.net, a blog I've just started reading, the pseudonymous Mr. Cross urges us to consider not walking. Not going on breast cancer walks, Crohn's disease walks, polycystic kidney disease walks, etc, etc. Don't walk, he says:

To me, as a sick person, one of the worst aspects of these organizations is their aggressive insistence that the best way to help sick people is by funding for-cure research. That is a lie. Sick people face a lot of challenges, most of which cannot be deferred until a cure is found. If you’re sick, start talking about those challenges as you face them, and try asking for help.

If your concern is a specific person, get more involved in their life; ask them what you, specifically, can do to help them, specifically. For my friends who are sick, I make an effort to be there - to be available, to help them when they need it, maybe cook a meal or drive them to an appointment, but mostly to remain a presence in their lives. Look at the posters and the ads for these organizations: they’re clearly suggesting that sick people can only find community among their fellow-sufferers, as if our only hope to rejoin humanity is via the distant promise of a cure. That, of course, is false - and you can prove it false simply by refusing to be marginalized if you’re sick, or by being a friend to someone who is sick.


I hope you'll consider heading over there to read this essay in full.

One thing that Mr. Cross briefly considers is the origin of all of this walking, and of this marketing strategy. He traces it to breast cancer. My own read is that the breast cancer marketers (as opposed to breast cancer activists) got it from certain parts of the gay community's efforts to respond to AIDS in the 1980s. It seems to me that the Avon-sponsored pink ribbon element of the response to breast cancer must have looked quite closely at AIDS, then tried to find all of the elements of the successful response to AIDS that could be made completely banal.

There are always people in every disease organization who try to defy the vague sense of corporate uplift to have some relationship to the real lived experience of people with the disease. That's because the basic impulse of these organizations--try to work to stop diseases that make people suffer--is a genuinely decent one. But once they start taking sponsorships and decide to stop making tough political choices they will inevitably succumb to banality, because that is what they believe is required to make this kind of fundraising strategy work.

In the case of breast cancer, it is also partly a a story of how the practical innovations of feminism are often appropriated and then depoliticized. Barbara Ehrenreich has a brilliant description of her own reaction to the kitschification of breast cancer in a now-classic essay, Welcome to Cancerland. A brief excerpt of this essay, which merits reading by anyone who has felt a vague discomfort about pink ribbons but has never been able to say exactly why:

It is the very blandness of breast cancer, at least in mainstream perceptions, that makes it an attractive object of corporate charity and a way for companies to brand themselves friends of the middle-aged female market. With breast cancer, "there was no concern that you might actually turn off your audience because of the life style or sexual connotations that AIDS has," Amy Langer, director of the National Alliance of Breast Cancer Organizations, told the New York Times in 1996. 'That gives corporations a certain freedom and a certain relief in supporting the cause." Or as Cindy Pearson, director of the National Women's Health Network, the organizational progeny of the Women's Health Movement, puts it more caustically: "Breast cancer provides a way of doing something for women, without being feminist."

There have actually been plenty of AIDS versions of this kind of strategy--but that is for a longer post than this one.

Seeing the worst excesses of these ways of doing things, one would wonder, as Duncan Cross does, why anyone would want to do disease-specific activism of any kind. In the case of AIDS it was because of the very specific stigma associated with the disease. People with AIDS in the early 1980s died social deaths--people wrote them off as essentially dead before they were biologically dead, and ostracized them--unless they demanded a place both in their own communities and in the larger world. The medical community mostly avoided AIDS whenever it could and often responded poorly when they couldn't avoid it. And most leading researchers were uninterested in the problem; pharmaceutical companies had not yet jumped in because they couldn't see that there was going to be any significant market to be gained out of it. Organizing around their disease identity was built around a very specific and urgent political situation. And the urgency of AIDS activism came not only from the agenda of advocating for people with the disease, but also from trying to defend the communities that were under the threat of so many people dying.

The question is, does that situation exist anymore? Or is there more hope in people with different diagnoses banding together?

The disability rights movement in its modern form did not exist before the late 1960s and early 1970s. The seminal moment in the United States came in 1977 when the various disability organizations--organizations for the blind, the deaf, disabled veterans, and so on--came together to fight for implementation of Section 504 of the Rehabilitation Act of 1974. It was a relatively obscure piece of legislation but it made a huge difference in employment opportunities for people with disabilities, forced school systems to provide real education for a new generation of disabled people, and ultimately led the way to the Americans with Disabilities Act. A dramatic sit-in in San Francisco, including people with all kinds of disabilities, got the legislation passed and created the new face of the new, united, and militant disability rights movement. The movement saw a political opening--Jimmy Carter getting elected--and used it. ( Joseph Shapiro is a fantastic NPR reporter who has made disability his beat: his description of the 504 sit-in is here.) The key element of this movement and its success was the decision by many different disability constituencies to unite.

For people who need change because their own bodily circumstances require assistance from society and from the healthcare system, the history of AIDS activism and the disability rights movement show two things:

1. the credibility of your own circumstances can be a potent political weapon.
2. though that first central tactic can win victories, the largest and most enduring gains are won by tying your own circumstances to those of others.


***

I hope to write more about these two points, but in the meantime, here is an 18-minute documentary about the 504 protests that shows these two points in action. And below, a link to what the folks over at Breast Cancer Action are up to these days: their annual Think Before You Pink effort to end what they describe as "pinkwashing". ThinkBeforeYouPink.Org

The Power of 504:
part 1, followed by part 2