Staying at a friend's house; in the morning, D, a 3 and a half year old person who addressed me while wearing her princess dress, noted that I was wearing my jammies. "Yes," I said, "They're my jammies, and I also go to work in them."
Pause. Look of trying to figure out whether I am scamming her, followed by optimism that in fact I am being serious and that there are people who go to work in their jammies. I call Ms Hemodynamics who is with R and G, all of whom also go to work in their jammies. It's pretty amazing, when you think about it, that we all go to work in our jammies.
Because it told me that someone from Fleishman Hillard, a PR firm that represents Abbott, was doing an internet search with the key words "Abbott Kaletra" and landed on... my dumb blog post about what I was going to wear to the protest, which I'll write about more in the next day or so.
Now, that makes me feel stupid because it would have been nicer if that Fleishman Hillard intern landed on a post that said something like... something like the title of THIS post. Or at least, something that wasn't my little throwaway observations about the semiotics of hospital fashion when protesting. How embarrassing is that?
So, now I've got my post title all set up for tomorrow, which I hope will bring another blog search from the good folks over there at Fleishman Hillard. And maybe, just maybe, a low-level PR employee will take a moment to wonder... is this really the work that represents who I am as a human being? Am I really being the best person I can be today?
Or, more likely, just glance at this and be annoyed that they have to enter the link into some Excel spreadsheet that indexes "Blog Mentions: Positive" "Blog Mentions: Negative" "Blog Mentions: Mixed."
Photo: Treatment Action Campaign and Student Global AIDS Campaign protesters at last year's International AIDS Conference, part of a coalition opposing Abbott Laboratories' approach to access to AIDS drugs.
I'm going to be taking part in a global day of action to condemn Abbott Laboratories for their attempt to block compulsory licensing of one of their AIDS drugs, known in the United States as Kaletra. This is an important medicine for people with AIDS, and Thailand wants to produce generic versions of it for impoverished people living with HIV and AIDS, who could not otherwise afford it.
The Bangkok Post has an editorial which lays out the legal issue from a Thai point of view. This one is pretty stark: Abbott is deliberately trying to roll back agreements about international trade rules, because the company doesn't like them.
There's more to say about Abbott, but I'll save that for now. In the meantime, I am now wrestling with a less important problem familiar to all 4 or 5 regular Hemodynamics readers, and a problem that afflicts all casual activists who only attend protests now and then: what to wear.
On its face, this is a silly thing to spend much time worrying over. But protests in the television age, and even more so in the digital image age, require careful attention to symbolism. And it turns out that as a future doctor I've got a lot of symbolism to think carefully about.
Medical students have often worn white coats to protests, as have doctors. This is a way of bringing professional credibility as a form of solidarity. But I've never done this, and though I thought about it earlier this evening, I don't think I will this time either.
This particular issue is fairly clear: when people don't get medicines to treat HIV, they often die of AIDS. Incredibly enough, and despite everything bad you can say about an organization like the World Trade Organization, nations around the world have agreed on ways that countries can make sure people get medicines. If you want to reap the benefits of global capitalism you should at least play by its very limited rules.
This message does not require a white coat for its credibility.
To say that you should listen to my views about intellectual property policy because I'm going to be a doctor would be absurd. After all, so many other doctors have been so egregiously wrong about this kind of issue that I would hate to encourage people to listen to doctors about patent policy. As far as the embroidery on my white coat, it says "Harvard Medical School" and it doesn't say my name. And I don't believe there's anything about my Harvard Medical School education that makes me any more equipped than any other reasonably well-informed person to express my opinion about Abbott's approach to intellectual property. All I know now that I didn't know before is the details of how people die from lack of medicines, and what happens to their various organ systems as they get more ill.
You could argue that wearing the white coat is a kind of threat to Abbott, along the lines of the anti-Abbott coalition's suggestions for doctors that they prescribe equivalent generics instead of Abbott products, refuse to talk to Abbott drug reps, and refuse to accept gifts from Abbott reps. But for me, this would not be sending the right message: whether or not Abbott cares about Thai people living with HIV and AIDS, I will prescribe generics when I can, I won't talk to drug reps, and I won't accept gifts. If I was the kind of doctor who was actually thoughtlessly prescribing unneeded overpriced brand name drugs and getting chummy with drug reps, I probably wouldn't be going to a protest at Abbott headquarters anyway.
Another entirely opposite direction would be the Treatment Action Campaign's "HIV Positive" t-shirt. But I've always felt that this shirt has a different meaning in the United States than it does in South Africa, and it definitely means something different when worn by groups of people which do not include many people living with HIV. In the US, the meaning of this shirt can be helpful but it can also be presumptuous; tomorrow, at least, I'm not taking this approach.
The only visual signal I might feel comfortable displaying is letting people know that I am a health worker--someone who makes it their life's work to care about the well-being of people who are sick. I'm uncertain about the political value of that gesture, but I think that at least it is a visual reminder that the protest is an issue of health, and survival, and not just an issue of market rules.
In other words, I've reduced my protest wardrobe to two alternatives: I can either dress as just me, a concerned citizen--or I can dress as a health worker. Considering the health worker option, I realized once again that if I take this route, I would not wear the clothes of the profession (the white coat), but of the hospital and all who work on its clinical floors: I would wear scrubs.
The AIDS Action Committee of Boston now has a blog with updates on policy issues and perspectives on various AIDS and service issues. Recently this post made me feel like my instincts about what people living with HIV are looking for in their medical care are at least headed in the right direction... and this post reminded me that the difference between a thoughtful doctor and a thoughtless one makes a huge difference to some of the folks I hope will be my patients.
What makes me feel good about both of these posts is the feeling that people are writing a job description for me that I'm eager to fill.
The Sopranos is a show about the frailty of mafiosi; because of this, it's a show about the power of medicine.
Tony Soprano's sessions with his psychiatrist frame the show by showing Tony's psychological frailty; in fact, the whole show started with Tony going to the psychiatrist because of panic attacks.
After a long struggle, Tony has basically given in to the psychotherapeutic approach to his own narrative. This week, Dr. Melfi asked, "Are you sure you aren't reading too much into this?" Tony replies, "I been comin' here for years. I know too much about the subconscious now."
Another running theme of the show has been the top bosses getting knocked down not by their enemies, but by their own physical frailty.
This week, New York boss Johnny Sack got bad news about his lung cancer, first from a specialist he flew to see, and then from a fellow inmate working as a hospital orderly. The orderly had been an oncologist, specializing in liver cancer, before shooting his wife and two others. "You saw Cohen?" the oncologist-orderly asks Sacks, flipping through Sack's chart when the prison doctor isn't looking. Sacks asks, you know him?
"I saw him talk once at an ASCO meeting." (That's American Society of Clinical Oncology to you, bub.)
First Pollack's oncologist character tells Johnny Sack he should live longer than Dr Cohen has told him. Then, as the disease progresses, he says, "The aggressiveness. It surprises me. I've gotta concur with Cohen."
Johnny Sacks has brain metastases ("The headaches", he says, when Cohen tells him, recognizing the correlation of disease progression and symptoms); Phil Leotardo is still melancholy after his 5-vessel CABG; Tony had his long stay in the ICU.
And Paulie is super-proud of himself for "beating" prostate cancer. He thinks he's a badass for that; when Paulie proudly contrasts his survival to the death of Johnny Sacks, he thinks he's comparing like and like. Actually, comparing localized prostate cancer to metastatic lung cancer is like comparing Paulie Walnuts to Johnny Sack, seriousness-wise. (Though metastatic prostate cancer can be terribly painful and frighteningly lethal, localized prostate cancer is extremely common among older men, and more people die with it than of it.)
The feds make their mark from time to time, but they're mainly annoyances. On The Sopranos, the only people who are always more powerful than the mob–even in prison, there's an oncologist who tells Johnny Sack he's going to die–are doctors.
It makes sense. Doctors are probably the only people who can illuminate a mobster's deep psychological and physical frailty, and still have the mobster thank them for it. That's why a show that is about the frailty of mobsters needs doctors.
Postscript: I was struck by how Leroy Sievers, who's blogging about his cancer on NPR.org, saw this episode differently. He was struck by the episode (and a little bothered by it, despite his wishes not to be) because Johnny Sack's course was so realistic. I was impressed by that too, but I didn't think about it much. It just made sense. If they're going to show the underlings being shot to death, why not show the bosses die of cancer with the same realism? But the fact that the cancer part didn't bother me (while the gunshots still make me wince) probably just confirms that I've spent a lot of time in the hospital, and on oncology floors specifically. Johnny Sack's death seemed ordinary to me. I'm sure that's different from how I would have seen this three years ago.
Providence, Rhode Island, is famous for many things. Paradoxically, one of its most important cultural contributions is called "The New York System". Present-day proponents of the New York System have been able to find no actual historical connection to New York.
One of the most well-known denominations of the New York System is the Olneyville New York System, a two-diner chain. As their website demonstrates, they make the New York System open-source in order to sell its proprietary New York System spicy sauce in their diners and at Shaw's supermarkets around Rhode Island. Their description of how to implement the New York System is detailed and informative. In brief, the New York System involves wieners cut from chains of links (hence they have their ends chopped off and do not look like ballpark franks); put in hot dog buns; and covered in spicy ground beef and onions and mustard. If you order enough at one time, the preparer lines the wieners in buns up his arm and plops the toppings quickly down the arm, hitting each wiener in succession.
(This maneuver is rumored to be the source of Rhode Island School of Design alum and former Original New York System employee David Byrne's mysterious chopping dance for the Talking Heads' song "Once in a Lifetime", seen in this video where he makes chopping motions up his arm at 3:56, and in many other performances of this song, as he shouts "Same as it ever was! Same as it ever was!" Please note that this original post mistakenly said that Mr. Byrne worked at Olneyville New York System. This is incorrect. He worked at the rival Original New York System. Hemodynamics apologizes for the error. Please see this Boston Globe article for a more complete account.)
The Olneyville New York System also offers coffee milk, which is milk with sweet coffee syrup, like chocolate milk, but it's not chocolate. It's coffee. Coffee milk.
Long-time residents of Providence no doubt take these wonders of American regional cuisine for granted, but Ms. Hemodynamics and I did not. ONYS is an old-style diner with a long counter and little waist-high booths throughout. An especially large and friendly man greeted us and took our orders, talked to us about Boston, and made us feel welcome. (Although after I admitted that I had not previously partaken of the New York System, he shouted, "We got virgins! Virgins here!" Olneyville New York System does not shy away from schtick.) We started in on our coffee milk and then soon were digging in to our ONYS wieners.
Here are some of the most important things to know about the Olneyville New York System wieners, from a health perspective.
First, we were pleased to see that no acute coronary syndromes were in progress among the patrons, most of whom were men on the older and larger side, who we guessed might be mostly descendants of people from the northern shores of the Mediterranean (let's say Greece, Italy, and add in Portugal even though it's on the other side of the peninsula), and who appeared to be ONYS veterans. This suggests that the ONYS may have mysterious healing powers that counteract the effects of its ingredients. (See below.) Admittedly, perhaps some other aspect of their diet cancels the ONYS out; but perhaps the ONYS sauce has some kind of anti-oxidant ingredient. Further research will be required.
The second lesson was learned by a black woman who came in with her daughter, and immediately looked worried. (If you looked at the clientele, and you were a black woman, you probably would have been at the very least uncertain, although while we were there no one gave any special cause for worry.) Sensing this, I think, the warm counter man took great pains to make the mom and daughter feel welcome. He described the ONYS wiener to them, with enthusiasm. She said, "It's a chili dog." (She was clearly torn: compelled enough by this strange place to see what it was, yet also not wanting to let anyone get one over on her.)
"No, no, it's not a chili dog," he said, with a small, confident smile. "You'll see." We didn't stick around long enough to see her reaction, but we hope she liked it as much as we did.
Later that day, I talked to my friend R. who had called me about planning a trip. I told him about the wieners.
"It's a chili dog," he said.
"No," I said, "It is not a chili dog."
It is not a chili dog.
It is very very tasty, however. It also contains what may have been 1.5 kg of fat, although it was hard to be sure; and this was our third health lesson.
The ONYS wiener is not a heart-healthy meal. Accompanying your ONYS wieners with coffee milk and a plate of fries, as we did, does not help matters.
Although the cardiac effects of ONYS are probably mostly long-term, the gastrointestinal effects are not. About fifteen minutes after completing my ONYS meal, I felt as if my stomach was squeezing down on a rock. I had some acid reflux. The rock stayed in my stomach for hours thereafter. My esophagus burned for hours.
And yet, I wouldn't have traded it.
We were not two bites into our ONYS wieners when Ms Hemodynamics said, "This was worth the trip right here." (She was referring not only to the wiener but the combination of wiener and ambience.)
There was nothing healthy about the ONYS wiener, from a physical standpoint. But the psychological effects were overwhelmingly positive. Sure, there was the fat-triggered dopamine surge. But we also felt happy and cared-for at Olneyville New York System. And we felt proud: after a confusing drive past iron-barred corner stores and many Guatemalan and Salvadoran restaurants ("Have you ever had pupusas?" I asked Ms Hemodynamics, as we looked for ONYS and I started thinking about back-up plans) finding the ONYS suddenly in front of us felt like a victory in itself.
So although the ONYS wiener had immediate and obvious effects on our physical health, it was our mental state that took priority. The ONYS was definitely bad for my heart and my GI tract. But it was good for my soul.
A last note: the host pointed to a gentleman who looked to be in his 70s, and said, "My uncle. 101 years old. My late mother, his sister, said, God forbid if I should go before him, take care of him. And she didn't mean like a nursing home. She meant, TAKE CARE of him, like with a gun. But I didn't do it. So here he is. My uncle. A hundred and one." (He was not 101 years old.)
"What's the secret?" I asked the uncle, who had clearly heard this schtick before, and was digging into his wiener without comment. "Is it the wieners?"
Hemodynamics is a blog I worked on mostly as a medical resident; I keep it up for historical interest only. Still I would keep the same description and disclaimer: This is a blog about the social world of medicine, and sometimes about other things that interest me. It is not a good place to seek medical advice. None of it should be read as medical advice.
