On Activism

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I’m sitting at a Macy’s right now, helping my father and brothers find a suit to wear to a wedding we’re attending this weekend. I don’t know much about suits, or sizing, or how they’re supposed to fit, but by virtue of the extra X in my cells and being off on break, I’m the on-call fashionista. Them slipping into the dressing room is time I’m using to catch up on everything I’ve missed since isolating myself on the island that is medicine-and it’s been a lot.

This time last year the world was shocked to learn that Donald J. Trump became president-elect of the Divided States of America. The country was on edge, protests announcing “not my president” sprang from sea to shining see. Americans who had so much more than economics and policies to lose over the election had a difficult time processing what this actually meant: our neighbors validated a campaign that built its success on sentiments that were misogynistic, xenophobic, homophobic, racist-the list went on and on.

I remembered how I felt. Bewildered at this reality. Absolutely frightened, as a visible hijab-wearing Muslim woman. Hopeless because I never thought that the America I was born in, one that prided itself in life, liberty, pursuit of happiness, on freedom of expression, religion, speech, and press, could and would culminate to this.

I remember coming out of the 2016 election revitalized to join the resistance, to be among coalitions formed beyond race, religion, sex, orientation, to build the groundwork for the future. I witnessed that despite what the election meant, a movement of unity was brewing. I wanted to be a part of it.

Now that it’s the end of 2017 I’ve come to reflect that I haven’t been as vocal with politics as I have previously because it’s a lot of hurt for something I don’t have the capacity to change. It was the Muslim Ban, the Woman’s March, the continuous harassment allegations that seemed to change nothing, the tweets, the almost world wars, the continued loss of lives to senseless gun terrorism. Instead I’ve focused on what I’m capable of: impacting the lives around me, protesting through my existence, my love, my hope, ideas part of a future generation building acceptance and solidarity by waking up to the injustices of this world and revolting.  Reading, watching, being informed (with correct information), discussing. But I’m here.

So here I am, sitting in a Macy’s, waiting as the men of my family suit up, thinking that perhaps I should use this time to make good to the spirit of me from a year ago ready to be a civil rights warrior. These are causes that could use a little more help:

DACA and the Dreamers

DACA stands for the Deferred Action for Childhood Arrivals program. It was an immigration program signed in 2012 by then President Obama in response to the failure of the DREAM act (path to citizenship for those who have only known America as their home) to pass both houses. DACA allowed undocumented immigrants who arrived to America before their sixteenth birthday to temporarily live, study, and work in the United States with options to renew every two years. A couple months ago Trump called an end to this program, which left thousands of Dreamers with an impending date in which their permit with permission to be in the US would expire and they would become “illegal” and vulnerable to deportation. The number of those affected by this decision: almost 800,000.

If deported these Dreamers will be returning to a country they only know of from stories and pictures. Their whole life has been built in the United States-they are our neighbors, our leaders, and contributing members of society who are oftentimes working twice as hard for half of what this country can give.

As a person who missed the dreamer deadline by luck of timing, I stand with DACA, I stand with Dreamers.

Congress has six months to pass a bill protecting Dreamers. Currently the only way to keep DACA going by the end of the year is to pass Dream Act legislation by leveraging votes for a must-pass spending bill going through Congress right now, but the idea of shutting down the government has dwindled support for this. It looks more like early next year before the topic can be successfully bridged again.

Dreamers are out in DC right now, risking deportation, pushing members of Congress to support them and everyone like them who have only ever known this country.

Here are some resources I’ve found:
Holiday Dreamer Action Plan
United We Dream
#OurDream
National Immigration Law Center
ACLU

CHIP

CHIP stands for the Children’s Health Insurance Program. It’s a program that was signed in 1997 that allowed the federal government to match funds to states in order to help provide health insurance to children of families with incomes that neither qualified for Medicaid nor private insurance. The program also supports women who are expecting. All states have taken advantage of this program that now covers 9 million children, granting them access to health care they otherwise wouldn’t have been able to afford: routine checkups, immunizations, medications, sick visits, hospital care etc.

Congress was so consumed with the repeal of the Affordable Care Act and the tax reform bill that they allowed funding for CHIP to expire-for the first time since it was signed-without renewal in early October. This means that the federal government can no longer match funds to the states. Without reauthorizations, states will and have already started running out of funds and consequently 9 million children in the United States will lose access to a basic human right beginning in 2018.

CHIP has always been bipartisan. The lack of coverage and concern for children of this nation who fall between the health insurance gap is alarming.

Net Neutrality

Net neutrality, a term coined by Tim Wu, is the concept that the internet should remain a neutral ground in which every person with access to the internet should have equal access to all the content available at their fingertips, regardless of the provider that gives them their internet services, whether it be AT&T or Comcast, or by any other means of discrimination based on age, sex, application, website, platform, etc. The concept of net neutrality isn’t new and there has been a verbiage war for decades. For the purpose of this post, 2015 was the year that the FCC (Federal Communication Commission) reclassified broadband as a telecommunication service. That is, the internet would be under the same federal regulation as our telephone services. Internet Service Providers (ISPs) were no longer allowed to block content, slow down services, or request fees for specialized access.

On Dec 14th the FCC (Federal Communication Commission) voted to repeal Net Neutrality. That is, they are removing all regulations that once ensured the internet would remain a free space to all those who accessed it.

Opponents say that removing Net Neutrality does nothing and that the world should calm down because the internet worked fine before Net Neutrality was enacted in 2015-but if you actually looked into this you’d see that the FCC had to throttle attempts by ISPs to block certain services, like that one time AT&T told Apple to block users from using Skype to make phone calls over wifi when AT&T had exclusive iPhone rights and when Google Wallet was shunned by AT&T, Verizon, T-Mobile, and Sprint. Even Netflix had an outcry of hypocrisy when it came out they were slowing down streaming speed for those using AT&T and Verizon. Tim Wu phrases this much more eloquently than I-

Basic economic theory suggests that operators have a long-term interest coincident with the public: both should want a neutral platform that supports the emergence of the very best applications. However the evidence suggests the operators may have paid less attention to their long-term interests than might be ideal. A 2002 survey of operator practices conducted for this paper suggests a tendency to favor short-term results. In that year, evidence of a discrimination problem became clear from several sources, including consumer complaints about operators who ban classes of applications or equipment, like servers, Virtual Private Networks, or WiFi devices,  and in filings at the Federal Communications Commission by application developers.  The survey in this paper shows that operators indeed had implemented significant contractual and architectural limits on certain classes of applications. Operators showed an unfortunate tendency to want to ban new or emerging applications or network attachments, like WiFi devices or Virtual Private Networks, perhaps out of suspicion or an (often futile) interest in price discrimination.

Now it’s up to Congress to use something called the CRA: Congressional Review Act, which allows Congress up to 60 days to reverse regulatory actions to save net neutrality. Organizations like the ACLU are on the forefront of making sure this happens.

So what can we do?

Call, call, call. Let your congressman/woman know that you are not a bystander and that they cannot sit in a governmental office without representing you:

Click here for contact information for your House representative.
Click here for contact information for your Senate representative.
Click here for contact information to your representative’s local district offices.

General Advocacy tips:

  • When making a phone call, consider telling the staffer you don’t need a response. It’ll get you off the phone faster (so more people can call) and contribute to the tally staff aids usually keep for a cause. You don’t need a long message, or a rant. Short, sweet, and to the point is more than enough:
    • “Hello, my name is _________. I’m a constituent from (state), (zip code) ____. I strongly support the passage of a Dream Act and encourage Senator/Rep (your representative) to support legislation that will protect our undocumented youth and ensure a path to legal citizenship for those who have only known America as their home. Thank you!”
    • “Hello, my name is _________. I’m a constituent from (state), (zip code). I strongly support renewing funding for CHIP and encourage Senator/Rep (your representative) to continue to support access to healthcare for the children of our state. Thank you!”
    • “Hello, my name is _________. I’m a constituent from (state), (zip code). I strongly support net neutrality and encourage Senator/Rep (your representative) to repeal any legislation that does not defend non-discriminatory internet access. Thank you!”
  • Paying visits to offices make a huge impact, and if you have the means to do so/live nearby, it is definitely worth the effort to make an appointment. Do not go empty handed though. Staffers love when you bring in a quick summary sheet of the cause you’re advocating for complete with research and the numbers of applicable bills that are on the floor. If you have a new cause you want to get policy drafted on they’ll oftentimes use your research to draft the bill.
  • Consistency is key. Do not drop a cause you’re passionate about. Change takes patience and time. Continue to call offices. If you have the means, join advocacy groups. It’s a numbers game-the more people they see/hear from, the more likely they are to lean to a certain view and cause. Join groups, advocate together.

2018 is a midterm election year. Keep reading, keep up with the effort. Be informed, be engaged. Hold each other accountable. Change can be made, we have Alabama to thank for giving us hope that what comes next is ours for the voting.

All of this, at the end of the day, is for our future. It’s time we start building it.

On Hearts

heartWhen I was a little girl and people asked me what I wanted to be when I grew up I told them a heart surgeon. They would laugh that sweet laugh adults laugh when cute, naive children speak of that which they know not of. As I grew older I started vocalizing that dream less, partly because I was tired of being reminded that I am a woman, partly because I became self-conscious that perhaps I wasn’t capable. Though I shoved it deeper and deeper into my subconscious, that idea never entirely dissipated.

I was in the OR the other day preparing for a coronary artery bypass when I struck a conversation with a man who asked me if I wanted to be a surgeon. I let him know that I haven’t entirely ruled it out yet. I’ve found that I enjoy working with my hands, that there’s something miraculous about using these fingertips to perform procedures that were once taboo, once unknown, but now saves lives. He reminded me, quite kindly, that I had to evaluate my goals in life. To be a surgeon takes many years of training, many hours, more than not of them spent in the hospital, is high stress, and not very family friendly. This I was very familiar with. This I noticed, when on the first day of the service I found myself to be the only woman, when I walked past the wall of memorialized medical giants and found all of them to be older white men. I could have been defiant, sassy, fiery with a response but I recognized the truth in his words and the kindness in which he spoke. And I want everything-the independence, the career, the family, the happiness, at levels perhaps others would call me insane. And I can. I told him it’s like a puzzle. Your pieces need to fit. I have to find all the pieces that fit.

At the stroke of midnight I witnessed a heart transplant. Someone died. Someone was dying. A group of world-trained surgeons gave a person a second chance at life. A medical student who was once a naive, little girl dreaming of fixing broken hearts had the privilege of witnessing a medical miracle.

This could not be a coincidence.

She is still deciding who she wants to be. She is still trying to figure out how the pieces of her puzzles will fit. Everyday continues to be a lesson in balance, progress, grabbing opportunities. Sometimes she wishes she could just know the future so that decisions wouldn’t be as hard, but it’s okay. She knows she’s getting closer, twenty-four hours at a time.

To the little girl I once was, look at where we are now. You are a woman. You are capable. This isn’t a dream anymore.

2017 is for Growing

In my planner, under goal for the month, I simply wrote Growth. I wanted to take January slow, to properly ponder what I truly wanted for 2017-⠀

~

My aunt stopped me in the kitchen one day. She sat me down and told me, I know you’re going to be a doctor, but remember before anything you are a Woman first. Take care of your body. I was starving myself, feeding only the mental, emotional, spiritual parts of me. I wasn’t balanced. Find balance.

~

Once, in a class analyzing a literary work, the professor asked if the author was too self-aware. Do you think it turns the reader off? No-embrace your awareness. There’s honesty, and difficulty, in seeing yourself for who you are, in striving to fix the parts you don’t like. As long as it doesn’t cripple you, as long as there’s gratitude in the journey. We are works constantly in process. Remember there’s beauty in appreciating every step of the way. ⠀

~

I’ve realized that the hardest part of letting go is having to construct a future different from what you envisioned. It’s trying to have full faith and trust in the fact that there is no one single path. We move, we stop, we adjust, we move, we stop, we adjust, and somehow in the end we’ve zigzagged around but in that zigging and zagging we’ve picked up people and stories and lessons and memories and the full confidence that everything happens for a reason. I’ve accepted what happened. I’m embracing the unknown.⠀

~

Be light, my dear. Be light, with your thoughts, with your actions, with your self-criticisms, with your anger, with the heaviest of burdens that sits in your throat, on your chest. Be light. Be light. Be light. Breathe deeply, think clearly. Be light.

Intersections II

These are just points. Points that become lines, and lines that become crosses, and crosses that keep intersecting, like those Etch A Sketches we used to play with as kids.

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2iPM009 by Magdalena Fernandez

What this photo deprives you of is the sound in the background-rain. Starting off with a couple of drops, pianissimo, then crescendo to thunder with bright, blinding flashes of lightening, but only for a brief second before going into a steep decrescendo, morendo. The points and lines and crosses become less and less until you’re engulfed in darkness. As soon as the silence settles in, your eyes adjusted to black, your ears pick up the sound of distinct rain drops beginning once again. Dal niente.

And you can sit, in the exhibit, on a bench, just listening and synchronizing. After a couple of cycles, if you’re paying attention, you’ll realize that the sound you’re hearing isn’t rain. It’s a chorus, clapping and snapping and whistling, in imitation of one of the most calming, one of the most frightening moments of nature.

I’ve been reflecting a lot, about the crazy world we’ve learned in history books but never imagined experiencing. About how, this moment, right now, will be in the same history books. Future generations, of a future, hopefully more united world, will analyze this. They’ll ask what happened. Sit in an exhibit, on a bench, question.

Alone, we are just points in space. When we mobilize we start forming these lines. When we organize, when we connect, when we make an effort to intersect, we cross into each other’s paths. When we take all of our collective actions, all our efforts to attempt change, we’ll form a thunderous applause.

That’s history. Injustice crescendos until we can’t take it anymore and we fight back. And right now it’s overwhelming, and there’s tension and discord, and your heart drops at every breaking news report, but we’re experiencing a moment that will define the future. We’re reaching the thunder, with the bright, blinding flashes of lightening, and we’re the chorus in one of the most frightening moments of our history.

Keep clapping, snapping, whistling, doing what you can. Take those points, turn them into lines, and become crosses that keep intersecting.

Let There Be Light

I took a mental day off. Or at least tried to. I laid in my bed watching lights dance across my wall for the better half of my early morning-

Last night, once again, I found myself amongst classmates discussing death. How do we define it, how do we define personhood, what is a soul, does a soul even exist, what is man, is man man if there is no neocortical function, is neocortical function the essence of man, who are we to come up with guidelines based on samples and statistics, are we using science to ignore philosophy?

And that’s how I fell asleep, with heavy thoughts that neither I, nor anyone else, could satisfactory answer. In all our scientific brilliance we accepted humility in the face of the unfathomable.

That’s the problem with rationale. There comes a point where you no longer have the answers and you have to accept. If not, you go in circles and you lose something so critically important-empathy. In all of our equations, we will never have a definite variable for H. Human. And for me, G. God.

You change, when you’re twenty-three and you’re discussing death, when you’re having conversations questioning if the methods you’re learning will be debunked years from now, when you’re constantly refining your morals and values, when you have to make your heart big enough to hold everything your mind can’t answer, when you think of the day you have to stand before a family and say that their loved one is brain dead. Even if through a machine their heart is beating, even if they are still breathing, even if there might be a twitch here or there that gives some hope of life but science tells you it’s improbable, it’s meaningless. And you have to suggest to them that it’s time to let go. And you have to be confident in that suggestion. You have to be confident in how you defined death and meaning.

You change, when you’re twenty-three and you get up in the morning knowing you need a mental day off because that’s the first thing in your mind. But simple things, like watching light dance across the wall makes you feel warm and acutely self-aware of mortality and how alive and blessed you are.

When I Was a Pre-Med

My professor told us his daughter was dying.

Though he said it matter-of-factly, his tone and body language told us everything. His voice was softer and lower than usual, his eyes were downcast, his fingers frozen on his phone, his shoulders hunched. He remained in that position, still, as the silence following his words washed over the classroom.

My professor told us his daughter will die and no one knows why.

Immediately I felt an overwhelming sense of emotions, the first being guilt. I felt guilt because in a room of about twenty students, I was the one pursuing medicine. I was the one who had to understand that death is inevitable, that medicine has its limitations, that doctors are not the cure all and they sure do not know all. I felt guilt because despite that understanding I was hearing this news from the parent of a patient who wanted and needed answers. I cannot tell him death is inevitable, that medicine has its limitations, and that doctors are not the know all, cure all answers. When so much faith is placed on medicine to deliver answers and delay death, how could I?

No one knows why.

How could I explain why we do not know why? How could I explain that throughout the whole span of human history the most significant medical advance happened 88 years ago? How could I explain that the first organ transplant was 62 years ago? How could I explain that the war on cancer was announced 45 years ago? How could I explain that we think we are in a golden age of medicine with our wars against diseases, yet we have not even taken one step towards what lies at the horizon, nonetheless beyond it. The life-changing medical advances we know have yet to celebrate their centennial. We are constantly doing research, and we are making progress, but there is still more to gain, and for those who fall between the crack we are trying to learn why.

How can medicine explain to a parent of a child with an unknown disease that we simply do not know and we cannot help? We are not, and never will be, masters. We are simply apprentices. But how can we explain to the suffering that we are simply humans when they come to us seeking divinity?

I felt guilt because medical professionals are expected to carry humanity in their hands and perform miracles with the snap of a finger but cannot always come through. I felt guilt because my professor wanted answers but no one could give it to him. I felt guilt because ten years from now, when I am working in a hospital, I am going to have to tell a patient that it is their time, or a loved one’s time, to confront death and I do not know why. I will tell them I tried the best I could, that I did everything I was taught, and I will apologize that it wasn’t enough. I will hold their hand, I will give them a hug, I will perhaps shed a tear, but I won’t be able to feel their immense loss, their hope, their reliance, their disappointment.

Death will always be our limitation and no matter how hard we try it is something we cannot grasp. It will always beyond our reach, in territories that will forever be uncharted. Yet medicine is evolving in a manner that views death as a failure and actively seeks to avoid it.

That is what I felt. I felt failure.

I felt guilt because I felt failure and I felt failure because I felt responsible. I know it sounds ridiculous but I felt it. Now that I am in medical school, now that I have taken ethics, now that I have thought and discussed death, now that I am wiser for it, I still can’t shake that feeling off.

So where have I failed?

Intersections

It was the afternoon of a so far productive day. We woke up early, found our way into a new favorite coffee shop, and engaged our brains in a four hour, memorize everything you can about Cardiology and Heme/Onc, study session. As a scientific break we stopped by the Contemporary Art Museum and found an interactive exhibit by Mark Flood. Canvases of harsh realities, critical views, and political incorrectness spanned the walls. The interactive part was simply a like sign, to place in front of the work that touched you the most.

This was mine.  Continue reading

On Perspective

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FLOW 流 by Jae Ko

You’re checking the blood pressure of a Syrian Refugee. It’s a community health fair, she’s only been here a couple of weeks. You find it high and ask her if she has hypertension and she says yes, but she hasn’t had access to medication in months. You tell her to hold back on the salt until she can get some meds. It’ll help a little. She responds it’s not the salt that is causing her the hypertension. It’s the nightmares. They won’t end. Even when she closes her eyes. They won’t end.

You’re taking history from a Latina woman admitted to the ER. She has a long history of hospital visits in the past week that you’re trying to get straight so you can find out what led to today. You’re having a congenial conversation when she takes her hand, puts it on your arm, looks you in the eyes and tells you she’s going to tell you something she hasn’t told anyone, not even the attending. The reason why she came to this hospital, a hospital that’s nearly an hour away from her home, why she left the one she was in last, was because someone over there accused her of being an illegal alien. She has been a US citizen for decades. She thanks you for treating her like she’s human.

You’re at a community clinic and a daughter is concerned about her diabetic mother. Blood pressure readings tell you that right now she should be in the hospital, it’s a hypertensive urgency, but she’s sitting fine, looking fine, talking in a tongue you can’t understand fine. It’s the end of your shift but you stay back to help. Do a manual check, using your own cuff, your own stethoscope. The daughter asks you to teach her so you sit her down and hand her your tools. Hear the beat there, see the reading here? She tells you that back home she used to be a nurse, but since she moved she hasn’t practiced in years. She checks her mother’s pressure, thanks you, and gives you a hug. I have only known you today, she says, but you are like a daughter to me.

You’re sitting home on a Sunday night, have a candle lit to ease the anxiety, staring at notes taking up all the space on your L-shaped desk. Right now you’re thinking really small. You’re considering physiology and pathology, sometimes your mind wanders to philosophy and policy. You have forgotten that all this, all this would be nothing if it weren’t the stories you have experienced with real people. Real humans. How they felt comfortable enough to open up and share with you, to let you in, to let them in. So your perspective shifts-

You’re sitting home on a Sunday night, have a candle lit illuminating memory by memory the experiences that motivate you, staring at notes that will one day aid you in helping, maybe saving, a life.

And that’s perspective.