Never talk politics and religion...

Fourth year medical students are warned at my school to avoid the topics of politics and religion when applying for residency programs. We are taught in the preceding years that this applies to clinical encounters with patients and to professionalism in medicine.

The fundamentally flawed assumption in all this is that the practice and discourse of medicine are scientific and therefore fundamentally non-political.

This is, of course, entirely untrue. The provision of allopathic medical care at wealthy academic medical centers is absolutely political, based on access to the accruing benefits of power and violence that permit capital accumulation.

I wish I could say, however, that the political practices of biomedicine are limited to such insidious phenomena. In that case, one could say that at least physicians, nurses and everyone else is just doing their best. Any instances of collusion in regnant economies of inequality and harvests of violence are unfortunate and unintended. If politics is implicated in medicine, it must be working behind the backs of those teams of sleep-deprived people in white coats who congregate every morning before most other people are awake.

Fine. If that is so, then why is it acceptable on the in-patient wards to complain about Medicare physician payment cuts, and about Obama's "socialist" healthcare plan?

If it is so damn hard to pay taxes out of a six-digit physician's salary, then why not complain about the "hard-earned tax dollars" that go to the military budget every year without fail? That is, ~$500 billion per year, depending on how you do the math. Comparing this figure to Obama's stimulus package CBO and to the healthcare budget, we are faced with the gut-wrenching realization that people (who happen to be physicians) can be bitterly opposed to "government-sponsored" healthcare while having little problem with government-perpetrated violence.

Physicians can be as self-serving and reactionary as anyone else who benefits from the way things are. Unfortunately, the contemporary industries of medical education and healthcare provision reward these qualities.

Lest this sound like an angry rant, I should say that I am deeply, deeply saddened by all of this. I have had the luxury of persisting, albeit in little ways, in those brands of radical idealism that call for lived and pragmatic solidarity with the poorest and most marginalized.

And it is horribly, devastatingly disappointing to witness such countervailing ideologies and ways of being-in-the-world in people with whom I share something so presumably sacrosanct as the mandate to alleviate suffering.

So now I tried to bring it up...

During moments of downtime, I introduced the topic of high neonatal and infant mortality in communities in Guatemala where I have friends and patients.

The most I've gotten as a response? "Yeah, that makes sense. I mean its not like some places in Africa..."

What?

In the Neurosurgical Intensive Care Unit

the anthropologist in me (or is it just the same old suspicious world-systemist in me?) is making comparisons between the energy that is quite readily and appropriately expended on prolonging the life of critically ill and injured in chicago (electricity and materials for manufacturing and operating the mechanical ventilators) vs. the energy that is so violently taken away from indigenous children in rural guatemala (food scarcity, absence of government-run sewage treatment+disposal --> diarrhea, all of which manifests as chronic malnutrition).

here, suffering patients warrant fancy machines.

in socorro, suffering children get contaminated wells, juan's 5-foot-deep holes on the footpaths (for sanitation...eventually...labor paid in kCal's by adult male beneficiaries...); energy sapped by malnutrition enteropathy and bellies pregnant with worms; jun ti way rik'in jub'a ri atzan; fewer and smaller red blood cells and inches off children's linear growth potential.

i imagine accusations, eg from critical care docs, that this comparison amounts to a rationalization of euthanasia. but that is a provocatively empty, reflex reaction. i'm trying to be provocative, sure, but simply to call for even more care for more sick people.

...

sadly, it feels dicey when i broach this topic with my teammates in the ICU. if only they knew: i'd be overjoyed if they did what they do everyday in the ICU for a patient in guatemala.