hiatus

Hemodynamics is on hiatus. Thanks for stopping by, though, and I am sure it will start back up at some point, in some form. In the meantime I share links and T-cell news at tcells.tumblr.com.

The mammal's brief moment of sorrow

Photo: Jacob in the movie Twilight, being a mammal.

Sometimes when we're leaving for work, the cat follows us to the door. As we go out, there's a glass-paned door that we shut between her and us. She will have been following us, looking up at us. Then there's a sad little moment. As we put our shoes on outside the door, she sits down on the floor on the inside, and then she stops looking at us and looks at some distant space on the floor a few feet away.

It's a moment we all recognize. This gesture, this way of experiencing a moment, this passing brief sad look, is something that cats and dogs do, and people do. We are all social mammals. And this little look-down-at-the-floor maneuver is something we do when we are feeling small, feeling that someone who we want to pay attention to us is no longer concerned with us.

I have felt that way at various times; we all have, right? Any teen movie is full of that look. So many times in my life, I've looked just like the cat looks when we leave for work. And if you had asked me at any such moment how I was feeling, I could have put words to it, likely embedded in the context of the particular moment. But I think there are a lot of things that we feel that are just mammalian. And this is one of them: it's a small melancholy moment of a social animal feeling alone. It is deep wiring, not in the sense of being a deeply-felt feeling, but in the sense of being some long-ago-evolved part of being a social mammal. It is some basic part of who we are, our animal selves, not our language and culture selves.

They've gone away and I'm still here. There's the floor. I'm alone here. A moment to absorb this. OK.

And then it passes: you look somewhere else, think about the next thing to take your mind to something else, comfort you: you turn to go find a little bit of food, or a blankie, or maybe a new email that might have arrived on your iPhone.

Eric Balderas is free, for a little while

Eric Balderas, a Harvard College sophomore studying molecular and cell biology, was recently granted a stay of deportation. Eric was picked up by immigration authorities after trying to use a Harvard ID card to get on a plane. His story is one of many arguments for the DREAM Act, which would enable undocumented young people, brought to the United States as children, to earn citizenship if they met a specific set of conditions (earning a high school diploma, college degree, or serving in the military). This would transform the lives of many members of our society, including some who matter very much to my family and me.

Around these parts, Harvard actually has a significant number of students in this situation, in part because it can offer full financial aid to young people who are not citizens or legal residents. But it is only a temporary refuge, as an article from the Crimson explains. The article puts particular focus on one Harvard student who is applying to medical school this year; I don't know when and whether she'll go, but I can only hope that she joins us in the hospitals and clinics, as a colleague who never has to doubt that she has a place here.

Here's a Crimson news video from earlier on in the saga, interviewing Eric Balderas.

why I walked

I admit I only signed up for the AIDS Walk because L, the HIV social worker in my clinic, was the captain of the team and intercepted me on the way to the hospital cafeteria with her strategically placed table.

And when I got to the walk this morning, many of our "Team Members" had evidently contented themselves with having raised a little bit or a lot of money--most didn't show up to our team meeting spot on the rainy morning of the actual walk. That's fine, really; our hospital employee team was a "Gold Team", and as a medicine resident from a rival hospital sheepishly noted, our hospital's team raised more money than that other bigger hospital's team did. Really, everyone who shows up and takes a tote bag and water and granola bars is probably just costing the AIDS Action Committee money--so maybe it's a favor to raise money and then bag the walk--there's even a category called "virtual walkers" to describe this strategy.

Still, it seemed like I was supposed to be there, so I went.

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By mile 2 or 3 I'd separated from my fellow employees and could have easily hopped the T and gone home. Our hospital had done its bit--a community relations person had waved our sign around, we'd raised our money--and now it was time for the teams of the corporate sponsors, college charity groups, and AIDS non-profits and government agencies to finish the walk. Or so I thought for a moment. And then I started really making note of a small but persistent group of teams, each with their team t-shirts, made to memorialize a family member.

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It was the 25th annual AIDS walk in Boston--they've been doing these things since 1985. A long time. Walking on my own, I was speeding up to get back to the finish line. I thought some about the morning teaching session I need to do on Wednesday--I think I'm going to do it about a patient of mine with AIDS.

As I walked, I noticed that the AIDS Walk had put up these little signs noting each year of the walk and events in AIDS history. I started doing AIDS work and volunteering in 1991, when I arrived in San Francisco. It was the red ribbon/Magic Johnson year, the signs reminded me--the year that AIDS most clearly became a part of mainstream culture. Sometimes I can be hard on myself about why it was I started then, when it was easier, and not in 1988, after I found out that my student government teacher had died, or in high school, in the mid-eighties, when passing out condoms would have been a radical act. (To ease up slightly on myself, it's true that I hadn't yet really had sex myself, so the gesture would have been a complicated one.) But then the next panel reminded me: that next year, 1992, was the year that AIDS became the biggest cause of death for young men in the United States. And in 1992, it only seemed like it was going to get worse.





1991-2010: I've been somehow involved in AIDS work almost all of those years, with a few small breaks for parts of my medical training. More than half the epidemic--in fact, now, about two-thirds of it, minus the very worst years. Next year will be 20 years, out of 30. I don't know what to say about that exactly. I could have stopped in 1997, since from 1991 to 1996 I said I would stop doing AIDS work and start doing something else "when the crisis is over" and when I said crisis I meant the kind of mass death that ended in San Francisco with highly active antiretroviral therapy.

But I didn't stop, though most of my friends who were also there for the crisis did. I'm still not sure why I didn't go do something else. For a brief moment in 1997, I almost went to work for an ad agency but I got another AIDS job instead, and I was relieved and knew I'd made the right choice. During a year in a lab, I found that I was depressed until I started volunteering for a needle exchange program.

No one I was super close to died or even got sick. There wasn't some big cathartic event, other than living in San Francisco in the early 1990s, that kept me going. I just kept thinking about AIDS because I kept thinking about AIDS, even though there would have been a lot of other alternative paths for me in which I probably could have done greater good for a greater number of people. So it's not like I'm claiming a moral high ground. I'm just observing the persistence of a theme. It is what it is.

Given that I have kept doing this work, kept connecting myself to this epidemic, I'm glad I got out in the drizzle and walked. Not for my hospital. And only partly because of the AIDS Action Committee--since the money raised was raised whether or not I walked, and they probably could have given my tote bag to encourage one of their nutrition clients to go to the farmer's market or something.

Mainly, I was glad to walk because those little clusters of families with their team t-shirts deserve to have lots of people around them when they gather together to remember someone now gone. It also gave me a couple of hours to think about how long this epidemic has kept pulling me back towards it, for reasons I don't entirely understand.

If you want to give some money to the AIDS Action Committee--they're good people. I know them personally because they're getting food and other services for one of my patients who's really sick, and a few years ago they got me down to the statehouse to help lobby for their (successful) effort to decriminalize syringes and make clean needles available in pharmacies in our state. They do a lot of other great stuff too. Here's the link to my AIDS Walk fundraising page.

And: thanks so much to that small but sweet group of friends and family who donated--it means a lot to me. It's true that because of your donations, I qualified for a tote bag; but more importantly, my patient will get some food. And trust me: he needs it.

Stop Obama's misguided global AIDS policy

Photo: Kaytee Riek, whose other photos of this recent demo can be found at kayteeriek.com

President Obama is making big mistakes on global AIDS. Click to read South African AIDS activist Zackie Achmat explaining why.

See also:

TakeANumber.org

New York Times

Zackie Achmat in New York, May 13 2010:

1996: protease inhibitors were confusing

For my zine, I wrote this; although my life changed in other ways shortly afterwards, and somehow that also meant that I stopped publishing my zine. Those were in the days before blogs, children; in the days of photocopiers when self-published writers had to go to the Leather Tongue video store and drop off five copies of the zine for the magazine rack, in hopes that there might be only two when they returned a month later.

Not long after this I ended up going to work for an HIV vaccine research group, which restored my sense of urgency. It also stalled the question of doctor or account planner (see previous 1996 post); then I learned immunology, did some needle exchange, and with much more excitement and no inertia, I decided to become a doctor.

October 14, 1996

At my job [at an HIV prevention agency in San Francisco] another person has quit; everyone seems disspirited and low. To some extent, that’s because of the particular politics of the agency: personnel absences, departures, events, personality changes, etc. But I’ve been wondering, on my return, whether there’s something deeper. The advent of the new drug treatments, and the incredible promise of the protease inhibitors, may have subliminally actually depressed people.

The idea that we are an important lifesaving effort is slowly losing focus; if people are staying alive with HIV, then we are disease prevention specialists, not the first line of defense in a community under siege. In itself, that would be great news, but unfortunately, no one knows for sure what the truth is.

How many people will really benefit from the protease inhibitors? The most optimistic school of thought has it that the protease inhibitors, if used for somewhere around the range of three years, might be able to help some people’s immune systems to entirely eliminate HIV from the body--in other words, that in a couple of years, we might have a partial cure blossoming in front of our eyes! Others are more skeptical and uncertain about the longterm prospects of the new drugs; if this group of people is more correct, we will only see people with AIDS die a couple of years later than they would have before.

So we can’t yet cheer the end of an era. On the other hand, the urgent language of our previous era is fading and cracking under the dim light of future prospects. We are left with no sure knowledge of our role, no clear sense of how important our work will be, and no overtly stated acknowledgement that things have changed. I am beginning to suspect that inertia is the result.

1996: what color was my parachute?

I was looking through old files for something else, and found this. Since you're reading this blog, you know what finally happened. Math was hard, but I stopped letting that stop me. I bought an algebra book, re-learned algebra and trigonometry, took science classes, went to medical school. Apparently What Color Is Your Parachute? knew what it was talking about. Maybe.

Also I had kind of forgotten how into REM I was back then.


Whenever someone asks me what I’m up to these days, I say, “Oh, trying to figure out what I’m doing with my life.” Then they chuckle. Heh heh. They’ve been there.

But were they ever really as desperate as I am now? Because I’ve turned not once, but twice to What Color Is Your Parachute? It’s maybe the most famous self-help book ever--so I must be in bad shape, right? The concept of the book is that if you follow its instructions, you’ll not only find just some job, but you’ll figure out exactly what your ideal job is and then get it. I’m a product of the culture that this book helped to create--it was first published a year after I was born. Maybe that’s why I hold on to the belief that it is actually possible to find an ideal job, a true calling, even outside of “Lottery Winner.”

A while ago, I was housesitting in a house so beautiful that I went out and bought twenty lottery tickets so maybe I could buy a house just like it. At least one of the beautiful house’s owners had read an early edition of What Color Is Your Parachute? which they still had laying around, marked up with notes. So, after my lottery tickets yielded no results, I sluffed my way through a few of the book’s career exercises. I came up with a plan, which was a pretty good plan except that it depended on some people who didn’t agree with it. After that, I managed to ignore my career woes for a while. Actually, I was sort of ignoring my career, period. My new boss, the smarty-pants bastard, eventually sat me down and told me that I’d better start shaping up. Which reminded me--oh yeah!--I still hadn’t figured out what I was doing with my life.

So--back to Parachute. This time I started in on informational interviews. A series of what-do-you-dos and how-do-you-like-its yielded a great deal of interesting information, not least of which was that if you sit people down and ask them about themselves, some of them don’t really want you to leave. Maybe ever. A couple of people told me I should be a doctor. Sounded cool, but difficult. I’m like that talking Barbie--math is hard. Plan B was a little more accessible: account planner at an ad firm. Until I realized that having Plan A as “Be a doctor” and Plan B as “Be an account planner” was a little too much like talking Barbie. I still really hadn’t figured it out.

So, back to the book. I started doing all the exercises, not just the few I didn’t find depressing. While I was writing a list of everything that I had ever learned, I was listening to an REM song and it occured to me that part of what bothers me most about submitting to the indignity of this kind of exercise is the overwhelming sense that most of my heroes never really did this. When REM were a bunch of students in Athens, GA, they just started playing music because they loved playing music, and then they started putting out singles and albums and videos, until they became the huge phenomenon they are today. I just can’t see that there would have been any career self-help books in the process.

From when I was fifteen to when I was twenty-four or so, I had a calling. I wanted to be a movie director and I wanted to make frequent interview appearances in oversized magazines and late night talk shows. But let’s not speak of those mistaken notions now. Let’s focus on the future: I need a new plan. I know that What Color Is Your Parachute? should help me find some reasonably satisfying direction, but I yearn for something more: a new calling, a new certainty that what I want is what I will be best at and enjoy the most and give the most to the world by doing. And also that it will be infinitely glamourous and make me famous and loved.

The problem is that this book, this Parachute is designed to move you away from obvious answers and convince you that, for instance, everything you like about being a movie director is actually fulfilled by being a freeway engineer. The idea is, obvious answers aren’t always the best answers. Sometimes you’d actually be happier designing freeways or selling plastics. But in the direction of obvious answers also lies the allure of glamour--of what everyone wants, or thinks they want. Diving with sincerity into a career self-help book is a sure sign that you’re giving up glamour. An important step, no doubt, but also, inevitably, a sort of depressing one. This isn’t going to be about your calling, the moment in Athens, Georgia where everyone realized you really had something. This is about settling down and going to work.