Dealing with messed-up-ness of medical system as a healthcare provider?

Lately I have been thinking about, or feeling like I need to think more about, becoming a healthcare provider in such a messed up system. Messed up in a lot of ways, including the lack of access and profit-driven system in the U.S. (call your congresspeople about single-payer universal healthcare, expanded/improved medicare for all, now!!), but that's a whole other post. I'm thinking about more the ways in which medicine has such a history AND present of being rooted in systems of domination and oppression such as ableism, classism, homophobia, racism, sexism, and transphobia.

How do I bring into conversation the idea that medicine is inherently a project of domination (an idea I take from discussions I've had with friends - theoretical and personal, and people I've read and heard in activist and academic contexts) with:
-the left-wing but not queer or radical in the same way doctor-activists and nurse-activists that see "good medicine" as a force for change (with whom I sometimes vehemently disagree, but sometimes think have done really good, important work)
-the objectified and rude-ranging-to-abusive way I frequently see patients get treated by providers at the free clinic where I volunteer
-the idea that even if this field is inherently fucked up and untrustworthy, there are still many things people need to get from it (sometimes because it is expertise or a skill specific to medicine, sometimes because medicine and/or government has control and acts as a gatekeeper)
-my own privileged experiences of being a patient (on the object side of the patient/doctor equation, but in a very privileged class, and racial context and a not-visibly-marked body in terms of gender variance and disability)?

What do I need to do when I am a nurse practitioner to make sure I serve the needs of the patients and/or disrupt the messed up patterns and practices of healthcare? What do I need to do now when I am interpreting or facilitating classes at the clinic? To not EVER lose sight of treating people respectfully, like people, instead of like objects to be touched (with or without consent). Or like interesting ideas to be bounced around later with colleagues (a greater danger for me, as I have noticed myself doing this)?

I have decided to go to school to be a nurse practitioner instead of a doctor. I think not entering into the old-white-boys-club (which now some women and people of color can be a part of if they play their cards right and/or have enough class privilege) of medicine, will position me a little bit differently. And when it is problematic, I will not have to have 110% of my time and energy devoted to it, so I will have time to seek out other worlds/people and take care of myself enough to not become a total pompous stressed out asshole that thinks I'm more important than everyone else, especially patients. But it still is part of a messed up, disciplining field, and it would be ridiculous to think being a nurse would escape that. Also, I am going to the top of a very hierarchical nursing field (hierarchies with strong racial and class components), and in programs that skip a lot of the grunt work and go straight to the masters or doctoral level position. Programs that are in some ways designed to position us just like primary care doctors (and that is part of what appeals to me about them).

Some of this is the mind vomit that will be irritating to look back on (and maybe for others to read). But I needed a place to work on processing, and also to be held accountable or discuss ideas if anyone has any.

Further reading (an extremely incomplete list):
Mississippi appendectomy - forced sterilizations on women of color
Ashley X petition
FRIDA on Katie Thorpe's womb to be removed
Interview with Harriet Washington, author of Medical Apartheid
Medical Apartheid book
Bad Blood book (on Tuskegee Syphilis experiments)

Before and After.

Ok, so this is what I meant to post about when I wrote the last one.

So maybe it sucks that this kid's body is getting displayed everywhere, but here's a before and after picture, courtesy of the awesome "Broken & Fabulous" zine. It's a type 1 diabetic kid in the 1920's, before and after insulin was discovered (and she was one of the lucky ones to get access to it in time). I'm sure some of you fellow diabetics have seen it before:
The above is just one of many reasons I don't respond well to pictures like this:
or this:

or people telling me how I look great after I've lost some weight (which this time, is largely due to high blood sugars, since I have definitely been exercising less and eating either similarly or more food and less healthy foods). So it is definitely not from being "healthier" this time, it's from being less healthy.

I have several issues with the prevalent "weight loss is always positive" idea, but this is just a part of why it's more complicated (medically/physically and emotionally/psychologically), and what it means to disappear or not disappear part of your body, what starvation means, etc. to me.

follow-up on my fat runner soapbox

I got a response to my letter to the guy who wrote the stupid column about fat marathon runners = unprepared marathon runners:

When you note that you limit yourself to shorter races, you underline my point. You have wisely decided that the marathon is a challenge that requires intense preparation and may at this point be too much for you.

Many years ago, I trained my butt off to run a marathon: 12 weeks at 60 miles per week average, with some 7-day stretches over 100 miles. That is how I viewed the challenge of the event - something to be respected and taken very seriously.

The result? A 3:33 marathon for someone who had been 40 pounds overweight - 12 years earlier. I got myself in shape well before I tackled 26.2 miles. The training was a diet by itself.

For a variety of reasons, I never was able to put in that training time again. That is why my marathon career ended at 1.

Thanks for writing / PH

What irritates me the most about this most is the patronizing and wrong assumption that I have "wisely decided" a marathon is too much for me at this point, presumably related to my fatness.
As if:
a) He knew why i wasn't running a marathon. He doesn't - my reasons include being busy with school/work, diabetes struggles right now (which aren't caused by my fatness, thankyouverymuch), and not really wanting to. My knee pain is about #4 or 5 on that list, and if I lost weight I may or may not still have it.
b) I must be on this path (or at least be trying to be on it) of fat to skinny - I'm not.
c) The destination of the fat to skinny path is a marathon, you can't just do one while you're fat.

Also note his use of "in shape" to not only mean in shape, but also skinny as if they mean the same thing (my whole beef with his original column).

gettin' up on my fat runner soapbox

I had to get up on my fat runner soapbox again today. It's interesting because I actually feel like I've been passing as "not fat" a lot more this year, between getting a little thinner and moving from a residential college campus full of rich young northeastern disproportionately white people back to Chicago and the work world that has a lot more body size diversity (and frankly, people are just fatter on average) which I think has something to do with the region, class, and age make-up of people I am around. However, I think I still definitely count as fat among runners. Heck, I'm slower with the same or more effort sometimes (I could probably leave those skinny people in the dust if they had another 50 pounds strapped on them), and I'm in the largest of 4 Clydesdale (bigger runners circuit, which is an awesome idea) categories for females.

I wanted to re-write this to make it more in my own voice and ass-kicking rather than what I tailored so that this columnist might be able to hear me and I might have a chance of getting printed. But I really need to get to studying or sleeping, and I think that kind of perfectionism prevents me from posting as much as I'd like to (ahem, see the last 2 months), especially when I'm busy. So here goes:

Regarding Phillip Hersh's comments (October 9, "A Saner, Safer Race) I agree with your point that a marathon is strenuous and runners should be well-prepared (although this does not absolve race organizers of the mismanagement that resulted in stations running out of water and Gatorade on a dangerously hot day). However, your comments about who "looks" like they can run a marathon were inaccurate and disrespectful. You cannot see by looking at someone how many training runs they have done.

I have never done a marathon, but I have done many shorter races, and despite training adequately and eating healthy food, I was still fat. I'm only running a few miles a week now, but I bike 50-60 miles a week, and yep, I'm still weighing in with a fat BMI of 29. The only way for me to become a skinny person that "looks" like a runner would be to go on a strict diet for years, and I actually enjoy my body and don't have enough self-loathing to want to do that. I'd rather put my energy into exercising, enjoying my life and taking care of my health.
EDIT FOR BLOG ENTRY: Screw that, I'd literally have to get myself a full-fledged eating disorder (for both physical ability for that to be possible and the attitude I'd have to have to dislike my body enough/be driven enough to have that kind of discipline) to be able to do that! I'm never going to "look" like a runner with that definition. Nor do I want to.


There are lots of us fat runners out there that "deserve" to be racing. I'm sure some of the fat runners trained adequately and were well-prepared at the starting line last Sunday, and some weren't. Just like the skinny people - some were prepared, and some of them weren't. Being skinny does not mean you are in shape to run a marathon. Being bigger does mean that you probably won't be able to run as fast as skinny people, but it absolutely does not automatically mean you are unprepared and should not be running. The Clydesdale circuits (the Chicago Area Runners' Association includes the Chicago Marathon) for bigger runners recognize this, and provide a forum for bigger runners to compete. See http://cararuns.org/cara_info/clydesdales.html

Additionally, if being heavier puts a runner at risk for anything, it is joint problems, not dehydration. Anyone who pushes their body too hard on an 88-degree day puts their health at risk.

Sincereley,
me

el embarazo milagroso, or, get in my BELLY!

Starting, especially creating, things is usually overwhelming for me and I procrastinate. And then I don't do things that I wanted or needed to do. So I'm going to start with something that seems easier to write, a story about what happened today.

Today, I was wearing an outfit that shows my belly when it's been more than 3 seconds since I adjusted it (too big skirt + too small short-style shirt + big belly = lots of hiking up & down), probably inappropriate for my second day of work in an office. Oh well. Anyways, after waiting too long for the train, I get on, and am standing with about 15 other seat-less people in the car. A woman looked at me and quickly offered me her seat. I told her I was fine, but she was already standing up. So I sat down, thinking that my feet were tired and she probably was just positioning herself to get off the crowded train at the next stop. But she doesn't get off, several more stops go by, and as soon as another seat opens up she rushes for it. I think she thinks I'm pregnant. I'm young, my disproportionate belly is hanging out (and I think my pump was hidden), and why else would she be so insistent?
Then I start to think... on this crowded train, do I now have to play the part? Slash would it be fun to do so and mess with people? I start thinking about the conversations that would happen when somehow someone asks and I either lie and say that I am or come clean that I'm not, it's just a big belly and now I'm enjoying this seat, HA jokes on you. And I was thinking why I might want or not want to say that to someone, or tell this story in general. I would not be afraid to say it because I am embarassed that my belly was fat/round/disproportionate enough to be mistaken for a pregnancy. On good days, I actively like my shape. How it looks aesthetically/beautywise and the idea that I can take up space and mess with ingrained values of thinness and other related issues. On pretty bad days, I might not feel those ways, but I wouldn't feel actively embarassed either.

I would hesitate to say it to someone because I would be worried/mad about them feeling sorry for me, bad, or embarassed for the situation (or that I was trying to elicit that reaction and some pity or reassurance for it). This would imply that I was either making a negative comment about myself or trying to mitigate an insult that had been thrown at me. That I did not want to look pregnant or fat. This runs on the basic common assumption that looking fat = bad. That it's something to avoid. Even if you disagree with that assumption, it's hard to break out of it, or even to see that it is there, because its so a part of the way we think that it seems natural.

This might lead a compassionate listener to be uncomfortable if they thought I was telling a story that was painful to me or that I was being self-deprecating by assuming that someone thought I was pregnant. It might also lead them to deny that my belly looked pregnant as a consolation that the supposed insult was not accurate, so therefore not hurtful.

I wanted to avoid bringing up exclusive to certain people/classes theory, but this really makes me think of the Butler essay on speech and some other stuff we read in critical race theory. The idea that it can be useful/powerful to not automatically assume injury from phrases that have historically been hurtful. If you don't automatically take it as an insult, it gives you room to step back and question why it's harmful - like that assumption that fat=bad, and then possibly not take it as harmful. reclaim it. if you don't believe in the anti-fat idea that its based on, then it might not hurt if someone class you that. also, another related point that is that making this insult into a big deal puts emphasis on the harm this one individual is doing to another; the problem is a mean/rude person rather than a larger system of power and ideas in society that is the problem.

however... it's also really important to consider the current situation. and that it can be tiring or impossible to fight things and go against the grain all the time. one person can't just undo all the societal stuff because you want to, it still is in you and affects you. so, you might not always want to try to deal with rethinking all of these things that have a hurtful social meaning. the compassionate listener trying to make you feel better according to the rules/assumptions of the current social reality might be just want you want or need.

(and people that I talked to about this, I promise I'm not talking about you! or annoyed with at all! I was thinking about this before and also the way we're socialized I think its hard not to act in certain ways).

Either way, for some reason the idea is in my head and I shift my notebook so that it's not squashed against my body. I also became aware of carrying myself carefully walking off the train.

Enough rambling. I am way too long-winded. This is partly why I worry about blogging - maybe this is just stupid and unthoughtful self-centered stuff. I didn't go into class, gender, race, and sexuality assumptions that are a lot of the reasons that made this a more interesting/funny story to me because it's based on it being strange or funny that I would be pregnant.

I wanted to start this to encourage myself to think critially and write, or to keep thinking critically and practicing writing. I also want to get feedback from, dialogue with, but especially be challenged by friends and other people reading this. I think I'm wanting this partly because I had a lot of these things in school and I feel like I've had a lot less since I graduated. I want to keep doing it for my own sake, and to not lose sight of my politics/goals/ideals while having less directed time to think about it and possibly working in jobs not entirely in line with them.
I'll figure out more/write more later about what I want this blog to be. Actually, maybe I won't. Just writing would be better.