Awesome news guys! I just found out that I was accepted as a presenter at this year's White Privilege Conference. Thanks to Dr. Eddie Moore, Jr and the folks at WPC. Special shout out to Danae, one of the blog readers for the hook up! Y'all should swing by if you happen to be in Kansas City. Or... even better, plan to be in Kansas City for the conference. It's an awesome program and I can't wait to soak up everything folks there have to share.
It’s the weekend after Thanksgiving and for once, I’m not scheduled to work at the hospital. Yet, on Friday evening I found myself fastening my badge to my clothes and walking into the Intensive Care Unit.
One of my most beloved patients, Ms. Chhem is passing away. I’ve come to say goodbye. It’s not a complete surprise as she’s had serious chronic medical issues for years, but after being part of her care team for a countless number of prior hospitalizations, it’s hard to believe that this will be her last.
When I first met her five years ago, I was shocked at the number of hospitalizations she had survived. Her chart identified her as a refugee from Cambodia with significant psychological trauma, two kinds of hepatitis from poor healthcare, and end-stage kidney disease requiring dialysis three times a week. She had low health literacy, few resources and didn’t speak English. I was terrified to be the young doctor in charge of coordinating her care and keeping track of all the pieces that inevitably get lost in our complex medical system.
Of course, in real life, she was nothing like the chronically ill patient her chart suggested. Despite the physical and emotional trauma her life had brought, she was always upbeat, laughing, and ready to experience life’s next moment. Or perhaps it was because of that trauma that she learned that this was the only way to cope.
During our visits her delightful pragmatism grounded me in what otherwise seemed like an impossibly chaotic healthcare plan. Our last visit had only been only 72 hours ago. As I walked into the exam room she had erupted into laughter, jumped up, and grabbed my hands with both of hers in greeting. It was a relaxed visit. Ironically, for once I was feeling good about her medical care. All of the loose ends I had been trying to resolve had recently been tied up.
So despite being familiar with intubated patients, it was jarring to see Ms. Chhem, the same woman who just a few days ago was relating to me the hilarity of coping with recently misplaced dentures, as a patient, intubated, sedated, and surrounded by machines and IV drips. Death doesn’t impact me the way it used to when I first became a doctor, but I still choked up as I held her hand and said goodbye.
Media coverage of the Standing Rock protests against the Dakota Access Pipeline has been hopelessly myopic. Certainly environmental justice, police brutality and the violation of sacred burial grounds are important topics, but no one has addressed the larger systemic issues at play: Native American treaty rights and how their handling portends dismally for the everyone else. Even the most self-centered and politically apathetic must realize Pastor Martin Niemöller’s warning that it’s only a matter of time before even the most mainstream of society are persecuted.
To truly appreciate the full significance of the face-off at Standng Rock, one has to understand understand the historical context of this struggle, which has seen supporters from 300 Indian tribes lining up to back the Sioux People.
Every person in the United States has the right to clean water, but for Native Americans, that right is two-fold. The treaties that set up Indian reservations were not simply land ownership agreements. The terms actually dictated a broader set of terms. This includes not just land, but also the obligation to protect tribal property and assets; in other words, natural resources such as clean water.
Furthermore, the Snyder Act of 1921 delineated that the federal government is also obligated to provide health care to federally recognized tribes. While this typically takes the form of providing clinics and health insurance through Indian Health Services, ensuring clean water is obviously a basic tenant to providing basic public health care.
So when the Sioux who live on the Standing Rock Indian Reservation demand that their source of clean water is protected, it’s not simply a matter of basic human rights, but also a contractual financial obligation.
But the bigger concept at play here is that the 56.2 million acres of land that are identified as reservation land (at totally of only about 2% of the United States), are actually held “in trust.”
Most of us don’t know what that means. In life experience of the average American, you either own something or you don’t, but a “trust” is something in between. Some rich children have an idea. It’s similar to the “trust funds” that wealthy people set up for their children. The money is named to them and for their use, but with active management and significant restrictions on its use. Only at least with rich kids, at a certain age, the trust money usually is given to them outright and they can spend it however they see fit. That will never happen for the lands held in trust for Native Americans.
What that means on a practical level is that even if a specific tribe has rights to the land of reservation, it’s only in the setting of the high regulation from the Bureau of Indian Affairs.
Jan Bianchi was one of the co-authors of the Washington State’s Initiative 120 that was passed in 1991 by popular vote and created the most liberal abortion legislation in the country. Washington is also the only state that legalized abortion through popular vote rather than through legislators.
In an age of internet dating and profile writing, it seems like everyone is a "foodie" these days. I was filling out one of these for work when my colleague looked over my shoulder and said, "I'm surprised you didn't write 'foodie' on yours." I am obsessed with food. But I'm not a foodie because my relationship with food goes so far beyond a hobby. Really, it's a matter of identity.
I won't deny that there's a cultural disposition. My parents are from Taiwan. It only takes a few days of wandering around Taiwan to realize that food is a creative outlet in Taiwan. Food here is an evolving organism. It's constantly reinventing and perfecting classics. It's constantly experimenting with techniques and recipes from other cultures. It's so far outside of the box that the box is a piece of dust that Wu Pao-chun swept off his kitchen counter as he got ready to beat the French at the international Bakery Masters competition.
Even CNN recognizes how much Taiwan loves its food.
Members of my family have been known to bring an empty suitcase with them when they go back to Taiwan, just so they can fill it with food to bring back to the US. But for me, it's not just about getting to eat food that we can't get in the United States. My bond with food goes deeper than a cultural indoctrination. It's also about finally being in a place where things that I love are not seen as weird and I'm not seen as strange.
Like many children of immigrants, food, something that was so important at home, became a source of alienation outside of the home. I have a vivid memory of bringing in some lychee jellies to school one day to share with my friends. They were not only delicious, but also a rare commodity. The local Asian market only carried an inferior kind of lychee jelly that didn't have a piece of firmer fruit in the center. I excitedly passed them around at the lunch table and was crestfallen to hear everyone's responses. "Why does it have this thing in the middle?" "This doesn't taste like anything." "This is weird." "I don't like it."
My friends weren't trying to hurt me, but it's certainly one of the most vivid memories I have of learning the power of microaggressions. How does one explain to another person that their seemingly small and personal comment about a food made me feel weird, alone, isolated, and foreign? Unlike the need that many second generation children feel to fit in, I felt the need to be understood. I wanted my identity to be seen and celebrated in the same way that everyone else's was. I wanted to be recognized as a person regardless of how different I may have been.
Additionally, like many cultures, giving food is a way to show love in Chinese culture.
To this day, it's really hard for me to not interpret the dislike of food that I try to share with others as a rejection of my love. And despite knowing that taste is also a matter of personal preference, it's impossible for me to see the rejection of Chinese food as a manifestation of a self-centered system of evaluating the world. When my friend told me that my lychee jellies had no taste, it was clear to me that it wasn't the lychee jelly that was bland. The issue was that she was judging it based on a Western palate and simply assuming that her way of viewing the world and judging food was the accepted norm.
So while there are incredible non-edible experiences in Taiwan, food and family are my primary concerns when I come to Taiwan.
As you might expect, such a vibrant food culture means that you can't always expect the same restaurants or food carts to be where you last saw them. It's sad to discover that a place that you discovered has closed or moved on. As a vegetarian, this can be particularly heartbreaking. It might have been the only place that made a vegetarian version of a special dish.
However, with a large population of buddhists and a focus on health in the past decade that includes eating vegetarian, you can always count on finding new vegetarian favorites. Here's the highlight for the past week:
SEATTLE, WA -- Ever since moving to Seattle it’s become clear to me that though most of its inhabitants identify as liberals, the dominating white culture enables a culture of armchair liberals. When it comes to LGBT rights, Seattle will stand up, but when it comes to addressing issues that actually threaten the comfortable, largely white and privileged population of the Seattle, it’s another story.
In 2015, the Washington State Supreme Court started fining the state government $100,000 a day for continuing to underfund K-12 public education. In 2011, after a 9 month investigation, the Civil Rights Division of the United States Department of Justice sued the Seattle Police Department for a "pattern of excessive force” that violates the US Constitution and federal law.
This year, Washington has a second chance to address police brutality and in compliance with international human rights laws.
As it currently stands, Washington has some of the most feudal police use of force laws in the country. It is essentially impossible to prosecute a police officer for murder. As it is currently written, Washington law states that if a police officer kills someone, as long as they acted “without malice and with a good faith belief that such act is justifiable,” they are immune to prosecution. King County Prosecutor Dan Satterberg stated, “This almost perfect defense to a mistaken use of force has kept police officers out of court as defendants."
In fact, according to an analysis done by the SeattleTimes, from 2005 to 2014, 213 and thirteen people were killed by police officers in Washington and only 1 has been prosecuted.
Earlier this year, House Bill 2907 was considered which would have struck the “malice” clause from the state law, but it wasn’t even voted on. Frustrated with the lack of action from politicians, an activist group called Washington for Good Policing have proposed Initiative-873, which if passed, will strike the “without malice and with a good faith belief” from state law. The initiative will need over 250,000 signatures to get placed on the ballot for general voting.
Ironically, the legislation uses the term “peace officers” to denote law enforcement officers.
While the Black Lives Matter movement has drawn attention to the racism that continues to lead the murdering of innocent black citizens in this country and the destructive American system of mass incarceration of Black Americans, it’s worthwhile to note that the Washington police officers have targeted more than Black Americans. In 2015, Antoni Zambrano-Montes, an unarmed, Mexican man was shot at 17 times by police officers while running away with his arms raised in the air. He was dead at the scene.
It's been difficult to know how to cope with the mass murder in Orlando. It's an amalgamation of emotion:
Personal safety as a queer person. Heartbreaking loss of human life. Frustration and anger around the politicking and continued lack of gun control. I go to conferences all over the country all the time. I go to a gay club in every city. I was just in Orlando! It triggers all the emotions that surface when abortion clinics, another issue close to my heart, are targeted with violence.
As I imagined the victims, other queer people of color, I reflect on the compounding difficulties of being a minority within a minority.
Today I've found some comfort by celebrating the amazing QPOC culture. What straight people don't understand is how important gay clubs are. Movies and TV portray it as a social gathering place at best and sex craved debauchery at worst - but it's so much more than that. The community that is formed; the self-actualization and validation that is often found nowhere else; the political organizing. When I think of gay clubs I think of empowering warmth (except when it's dominated by all white people, then sometimes I feel angry). And so naturally I could not help but think about Voguing.
This, of course, triggered a whole new group of cascading emotions. I felt proud of the culture that Voguing created. But I also felt sadness that such a vibrant community come under attack. I felt anger at the way that Voguing has been appropriated.
Straight folks just don't get it. Even wikipedia, my trusted source and salvation during medical school, doesn't capture the emotional and communal importance of Voguing in their article. Nor does it discuss how artists like Madonna and documentary artist, Jennie Livingston, have benefited from Voguing as its not clear what trickle down benefits the original communities experienced.
That being said, overall, as I watch some of my favorite Voguing videos on YouTube, I feel inspired and somehow calmed. It reminds me of the strength of our community and that even in the bleakest of times, we will rise again and celebrate ourselves. And mostly I feel gratitude that the generations, specifically in this case black and latino POCs, that have come before me (who have faced so much more than I have personally as a QPOC) have role-modeled such courage and beauty.
I could talk about the sanctity of queer nightclubs. Queer nightclubs are to queer civil rights as black southern churches are to black civil rights.
I could point out that Donald Trump’s asinine statements about Muslims and a radicalizing second generation are exactly the kind of ignorant bigotry that spurs these sorts of hate crimes to begin with.
I won’t though, because we all know that this has already been done and will continue to be done until this devastating event’s emotional significance is reduced to meaningless babble on repeat.
However, what has yet to come is the inevitable discussion about the mental state of Omar Mateen and the role that might have played in the shooting. Already, there is foreshadowing of this discussion as journalists report those around him describing him as “bipolar” or “erratic.”
I’m nipping it in the bud. We cannot go down that path. It’s distracting and unproductive because mass shootings are not just about mental health. Of course, mental health plays a role, but guess what plays an even larger role? GUNS.
Liberal and conservative politicians alike focus on mental health as a strategy to avoid discussing the true heart of the gun control debate.
Democrats use it to avoid risk. These so-called liberals like to focus on the mental health of the shooters in these high-profile tragedies. By advocating for improved mental health services and preventing the mentally ill from getting guns, they get to seem like they care about gun control without having to actually advocate for any meaningful change.
I’m the main doctor at a primary care clinic based out of an organization that provides psychiatric care and case management for patients with severe mental illness. It’s a population that is very close to my heart. I’ve had patients tell me that they would shoot me given the right circumstances. I understand both the critical shortage of resources for mental health as well as the increased risk that patients that suffer from mental illness have to behave violently.
At the same time, as a family physician I have treated an uncountable number of victims of gun violence. The vast, vast, vast majority of these patients were shot by people who either do not carry a psychiatric diagnosis or whose most serious psychiatric diagnosis is depression.
Addressing gun violence solely through the lens of mental health will never solve the problem. While I’ll be the first to tell you that the woefully underfunded state of mental healthcare is devastating to society on every level, I also believe that it is only a small part of the gun violence issue.
Hey y'all. As we all know, access to the healthcare system only impacts the health of our patients by, like, 20%, if that. What really impacts health outcomes are education, housing, food security, and, well, not getting shot. If you care about health, you need to care about politics.
One of my favorite parts of being a family med doc is talking with kids. During the routine preventative visits I ask them what they want to be when they grow up, not just as a way to get to know them better, but also to be another small voice telling them that they are worth believing in.
Yesterday, the most astonishing thing happened. I asked QiLing, a 7-year-old with bright eyes, that very question and she responded, “I want to teach ignorant people about race so the world will be better for my children.”
I told her that she should consider the field of medicine instead because it would be more relaxing and pay more.
Right. No one believes that happened.
It didn’t happen. Why? Because nobody grows up wanting to be a race educator. Sometimes a child might say they want to fight “bad guys” when they grow up, but not once have I heard any child dream about addressing race inequities.
So it’s shocking to me that some white folks see people of color who do race work as self-promotional. It’s not self-promotion; it’s self-preservation. We’re forced into this work because we see no other course of action when racism is thrown up in our face constantly. Back thousands of years ago children did not say to themselves, “I want to be a gatherer!” They just needed food so that’s what they did.
But that self-preservation, attempting to address injustice can simultaneously be self-destructive.
What I've been reading:
by Viet Thanh Nguyen
about this blog
A place where I can write my thoughts on race, on privilege, on class, on being a doctor. Part of the endless struggle to become a little bit more enlightened and feel a little less alienated.
Agree with me. Call me out. Pass it on.
I post once or twice a month with smaller comments on mini-blog.
My name is Jess. In the interest of full disclosure: I'm a 30-something-year-old Chinese American and believer that the quest for social justice and equity must be an intentional and active one. I'm a Family Medicine physician. I'm queer. I'm a radical. I grew up in a mostly white suburb and my parents are white-collar workers. And I don't eat meat, but I miss it sometimes.
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