o brother who art thou?

"i will maintain the honor and noble traditions of the medical profession.  

My colleagues will be my brothers and sisters."

- hippocratic oath, geneva 1948

on august 24th i will wear white and i will pronounce vows of lifelong dedication and fealty.  perhaps someone will throw rice.

the event won't take place in church but it takes me back to many a hymn - songs dense with rhyming creed that often would be a lie to sing.  i used to improvise on the spot, swapping out offending terms or principles for something i could comfortably put to tune.  other times i would just let the line go by in silence, unable to repair the sentiment of wretchedness or trite absolution that didn't taste quite right in my mouth.  likewise, the statement above makes me reach for a glass of water.

sharpened to an even finer point by my recent work in biomedical ethics, i feel strongly that one need wield the hippocratic oath with care and sincerity.  this pledge is not just an elaborate password to get into the clubhouse, but is a thousands-years-old covenant, invoking history and tradition - once upon a time even the name of apollo!   i believe in promises, in the power of saying "i will" and meaning it.  i see the hippocratic oath as the vow that physicians commit to all their future patients (not to the college, each other, or the school), till death do them part... and for a time afterwards too, in fact.

but i have a hard time with this particular piece.  "the honor and noble traditions," hey?  oh but those words hang heavy and limp on the lapel of medical history.  and by history i mean present, too.  what nobility drives the pharmaceutical race to gold; run on tracks made of vulnerable populations, hurdling laws and human-rights in a single bound?  what honor is in fear-based medicine that is more invested in avoiding litigation than in equitable access of all people to care?

how can i say that sentence with integrity?

and my brothers and sisters.  it's sweet to use inclusive language, but i don't think that way.  from where i sit, medicine is a brotherhood.  now, granted, women are allowed to join.  but as far as i can tell, that is more a result of their efforts to masculinize their thinking, discourse and demeanor rather than a true inclusion.  so what will i MEAN when i pledge siblingness to my profession?  an image of a roomful of docs bickering over which channel to set the television comes to mind :)

i think the most important bit for me?  is to keep present where i am and with whom i will recite my oath.  yes, medicine as an institution is RIDDLED with inequities and has an embarrassing legacy of abuses of power.  yes, it is a boys-club and will likely continue to be for many many more years.  but inside the machinery are people.  and inside those people there is Good.  i bet there is honor too.  and like diamonds in otherwise forgettable oar, there are shards of nobility.  i read their writing every day, right now.  and in my mind i see these individuals, privately and professionally both, striving to create healing... whether with bandaids or policy reforms... these are the big brothers and big sisters, the Older Cousins perhaps that i can look up to and hope to emulate some day.  ordinary dumb people, like all of us, who are doing their best.

and i think i may change a word in there, if no one minds.  "honor and noble visions" i can get behind.  i can cheer on and find inspiration in those.  the tradition, i dunno, man. 

i make no promises.

if the shoe fits?

i don't wear shoes at work.  i'm not sure when that started but it's kind of a thing.  it's ironic because i love to acquire footwear (the less sensible the better) yet am eager to kick it off at the first opportunity.  my favourite shoeless moment was in the coffee-corner at a bustling (dare i say frantic?) television production house.  my feet in the altogether, i nursed a mug of caffeine (which always was selected to subliminally coordinate with my outfit) only to be be asked if i kept my tootsies bare to "be closer to the earth" for creative purposes.  blink.  sip.  what?  "oh yeah.  totally.  how'd you guess?"  she beamed with the satisfaction of puzzle-solvery and i wondered fleetingly if she was stoned.

people are my favorite.  :D

working in television, one is afforded certain eccentricities.  i brought my cartoon of a wiener dog to work almost daily for a year.  she was an improvement on the neighboring director's shedtastic golden, who was a "sweet-of-heart if not -of-scent" allergy hazard of the first degree.  i had colleagues who worked almost exclusively at night in the spook and quiet of the sleeping building... the phantoms of the opera edita.  another who rigged an admittedly ingenious exhaust system out of CPU cooling fans to vent pot smoke from his office as he worked under the haze of his favorite herb.

even now, working in a philosophy department, i'm in a hotbed of unique-ity, though here the herbs are not consumed... but far more prolific.  even the bathroom stalls contain shrubbery.

but come august 23rd i will enlist in a nation of conformity.  a profession built upon sensible shoes and dress codes.  i have never worn a uniform in my life.   oh, and no one trucks around the ward with nude feet.

medicine simply is not the place to bare your soles.

eccentricity is limited to the colour of your stethoscope as far as i can gather (mine is green on principle but it's admittedly such a dark green it might as well be black.  they have pink but that's a little too Pepto-Barbie for me).  and sitting at the orientations, amid a sea of straightened hair, tall boots 'n' leggings, the appearance of a subspecies seemed to form.  the men almost all had the same kind of "precision-tousled" american eagle look to accessorize their staggering youth; the women were evenly tanned at the "lightly toasted" setting of their generation... and everyone had shoes on.  no exception.

mental note: don't shave your head again, heather.  you'll be fed to the crocodiles.

i have spent over a decade in the indulgent and playful world of entertainment.  i make bad jokes with a passion, employ cartoon voices on a regular basis, and do my best to make fun of myself whenever opportunities arise.   i say "no" to employers and defend my position (something i am sure has served me both well and quite poorly).  i'm not just 10+ years senior to my class-of-2015 contemporaries, i am an openly opinionated, do-my-own-thing, shoeless goofball with two kids and a mortgage!  demographic anomaly meets misfit in general.

i like to think of myself as anti-conformist, but that's as easily said as done in an environment that loves nothing more.  i like to think that i will successfully retain my sense of individuality as i climb aboard the U.S.S.Medschool... but i am a visitor to this foreign culture.  there is a degree of "when in rome" that is requisite to my residence there.  indeed the first vow of the hippocratic oath is one of fealty to the brotherhood of medicine (future blogs on THAT one forthcoming), and it is morally incumbent upon me to honour those words.

it all begins with the first step.

i will require a pair of sensible shoes.  and i'll have to wear them, too.




heavens, what what i done?

No one asks to be colonized… do they?

So here’s the sitch.  Big Pharma (the catchall phrase to indicate all of the major pharmaceutical companies like Pfizer, Unilever, etc) has the most powerful lobby mechanisms in history.  Our government is so enamoured of BP (pun intended) that it smacks of an episode of the Bachelor – one swanky dude swarmed by a fleet of preening fans, each desperate to bat her eyelashes most prettily.  However, the BP privilege is far greater than its vote-swaying ways.  To explain my point, I suggest we call it something other than a collection of corporations.

Big Pharma is a nation state.  It has an ever expanding populous, a specific and defined culture, system of laws and independent governance.  This last point is of particular import – as evidenced by CETA and other trade agreements, the patent system and its myriad of revisions to protect BP, this nation is not answerable to any other government outside of influences from the UN or World Bank… like any other country.

Now, Canada is home to 34 million residents.  These residents have a wide range of health care needs.  Canadians also consider the tending of such needs to be a basic human right.  We contribute our tax dollars willingly to the common good of medical access for all citizens.

When BP first arrived on our shores, in its pillbottle Mayflower, it brought promise of treasures we’d not known before.  Penicillin, polio vaccines… Viagra.  Our distinctly Canadian culture created the socialized distribution of these drugs, grateful for the explorers who had come to elevate us from our ignorance.  Over the years, like any good colonist would do, BP constructed an increasingly dependant relationship with the savages they found on our land.  Each promising new drug that our public money saw through preliminary trials was scooped up by our landholding visitors – very good, little farmer, we’ll take that.  Don’t you worry your pretty little heads about completing the final stages now that you’ve invested so much time and money already!  Here’s a shiny nickel… run along.  Take some potatoes with you.

Today the nation of Big Pharma controls almost all of Canadian access to life-saving medications and interventions.  They also control almost all of Canadian access to agricultural products that allow us to compete in the food production markets, upon which our ecosystems are now dependant; products with health hazards sometimes requiring drugs from the BP States.  If the BPs were to withdraw their presence in Canada for only one month, thousands of people would die – starved of insulin, heart medications, antibiotics – and others would go mad – suddenly bereft of antipsychotic regimens – while our chemically dependant crops would fail miserably.  Sure, BP would suffer losses in the millions, but with profit margins in the billions they can afford the inevitably unwavering deference that such an act would purchase.

Like the Spanish invasion of South America and the Philippines, the Dutch and French in Africa, the British in India and Native America, the BPs have gained economic control over our ability to sustain our most basic survival, cloaked in the paternalistic guise of working in “our best interest” with technology we don’t have, and wealth we didn’t imagine.  It wasn’t as obvious, of course.  There weren’t red coats and rifles.  The colonization was political and economic.  The lobbies are their tanks, rolling over our self-determination, flatting it to the ground.   Committee canons blow holes in policies intended to uplift the less fortunate, while the firing squads shoot pink slips at MPs who resist.   Local culture (altruism, peacekeeping) is undermined by increasing privatization of health care, in an effort to impose the colonist’s profiteering values.  Evasive maneuvers (closed-doors) drew in the powerful members of the World Bank and UN to skew the law. CETA is part of the growing worship of a foreign god, as BP is not only mainstreamed but revered.

Canada has been colonized.  Only, unlike the Mayans, Pakistanis, Congalese … we asked for it.

But we can still learn from our international sisters and brothers.  India did not find independence in a day.  Like any revolution, we need to start grassroots.  Small steps to build an infrastructure that can bear the medical burden that will collapse upon us when BP is overthrown.  We need to construct pharmaceutical self-governance, making increasingly public that which is privately held unjustly.  Publicly funded research needs to hang onto its patents.  We need public entities to produce and distribute medicines (employing Canadians instead of making American stockholders more wealthy).  They may offer us treaties, but we will know better.   We know that “trickledown economics” is more trick than economical, that the disparities between the rich and poor grow as nations like BP gain international power.   That our economy is not dependent on this particular arrangement any more than the US was to Britain – economy is fluid, elastic, stretching and snapping as values pull it in different directions.  It will adapt.  Instead of feeding the insatiable appetite of the BP elite, we can nurture the visionaries of our future, like Martin Luther turning over the Bible to the masses, repealing patent-sanctity and making medical access as public as it should be!

History, as it tends, has repeated itself.  But if we take care, take notice, and take action, the story of colonization will cycle through to the coup we require.  Our health is too valuable to leave in the hands of a nation that, like other BPs before it, will be all to ready to make an irreparable mess, say oops, and cash in early retirement while those whose lives have been tarred struggle to clean up the spill.