• JAS

All the dangerous things we do with our hands

Wielding pens. Waving swords. Stopping traffic.

I’ve believed that for a long time, not just in the old adage that “the pen is mightier than the sword.” As a writer and a doctor, one of my greatest hopes and exultations in earning my MD was the power and respect the degree bestows, for better or for worse, deserved or not, to be a spoken/outspoken advocate, and to be published for it.

I use writer in the sense of “someone for whom the act of writing is not an option; someone for whom writing is as necessary to existence as is oxygen.” I use doctor in the sense of not just the traditional physician and caretaker for a body and a person, but in the Latin derivation of “doceo, docere – to teach.”

Almost every sentence and every paragraph here starts with I. There is, too, now, “Je suis Charlie/ I am Charlie,” for what it’s worth, for belief in and disbelief against the recent attacks in Paris of freedom of speech.

I have recently felt ill, paralyzed, galvanized by moment and by turn by the deaths of Ebola, inequalities in Africa and health systems in Africa, prejudice, hatred, and fear of those of African descent living in the United States, focus on a few individuals sick in a country where they can be taken care of versus thousands upon thousands in countries whose fragile infrastructures are being destroyed; by injustices perpetrated by institutional racism across the country and most poignantly, most close to home in New York, a system in which I, physicians in general, anyone in a hierarchical position of power is complicit, where I weakly, as a primary care physician, offer flu shots and preventative measures to my patients who, in the South Bronx, are more likely to go to prison than to college, who could be stopped and frisked on the basis of nothing, who fear and are injustly feared on a daily basis.

Lannion, my hometown - where 5000 people is a large percentage of the population

There is the public health.

There is fear, worry, and helplessness because my friends in Africa have a higher chance of dying because, well, they have a higher chance of dying, and in two and a half years I went to exponentially more funerals, including those of children, than I have ever attended in the United States.

There is anger, outrage, need for telling when one of my patients almost died because of his insurance company and the lack of single payer health care, the lack of a generalized belief in health care as a human right in this country (article in progress, submission of said article to be done). He’s the first patient I asked if I could write a story about, a patient I know well, and he wanted me to publicize his story, to let others know, to try to help this not happen to anyone else. It was one of the best medical visits we’ve ever had.

I often end up watching the news, being part of the world, in patients’ rooms. We talk about it. It’s where I’m near TVs. In the intensive care units, these patients might be comatose, sedated, intubated, and as I try to remember and still speak to them as people, I become more part of the world.

I watched the events in Paris, some of, unfold in such a room. The patient was maybe-dying; a patient we’d had arrive last week in a similar condition did die. Because the hospital does not have the capacity it should for patients of this acuity of illness, because systems and overcrowding and a Bronx that has one of the highest burdens of illness of anywhere I’ve worked, he had not received an adequate level of care for the two days since his heart stopped and was restarted. I know little more about him that what the scant notes told me. I know he immigrated at some point, I know he mostly speaks Spanish, and I can imagine that due to a paucity of translators (though the phones are available everywhere), minimal time, and sometimes a lack of value placed on communication with patients and families in languages that they fully understand, he had likely not received the highest level of care or explanation of his condition. He apparently has a primary care doctor, that’s somewhat lucky. He was able to have a procedure to open the clogged vessels in his heart, that’s lucky too --- though it shouldn’t be.

So I was standing behind the head of his bed, increasing his level of sedation as he started to resist us placing a line in the largest vein in his neck, to give him the medications he needed to increase his blood pressure to the point of getting sufficient oxygen to his brain and to the rest of his body. It’s not just because Paris is partly home (true), or because I was there two months ago (also true), or because so many people I care about so much are there (true), but I felt more sick and focused on this, the fear minimally of death compared to the fear and horror of violence against writing and writers, than by the pain I was inflicting on a human being for “his own good,” necessity, for his illness that was contributed to by societal inequalities.

All of the above would be silent, unknown, if they could not be written of. There is TV now, internet, social media and the Arab spring, There is the movie held from theaters for political threats. But first, foremost, and still (yes, a picture may be worth a thousand words), there are writers, there are pens, there is finding the exact expression of something that is not for and by one but that is for and by a collective.

Plato banned poets from the Republic. They were too dangerous.

It’s not just that they were writers and artists. It’s that an editorial board meeting was targeted (and what, more than that, proves the power of words?) In France, political satire is an integral part of the culture. The political cartoonists were, are famous, before their violent deaths for writing. Not every country would hold a national day of mourning for writers. In few countries are major streets and squares, and so, so many other public and critical things, named for writers and philosophers. Writers are venerated. Artists are venerated. There are TV shows, many, solely of political cartoons and sketches. There are more newspapers than this one. Growing up in the United States, spending much but far too little time in my native country, in my first language, even I knew their names.

With everything wrong and injust and indignifying and terrifying and almost to be believed in the world (what else makes the news?), the largest piece of meaning, what I personally (and everyone is making this personal. Freedom of speech, freedom of expression is not just a societal but a personal human right granted to every individual – or should be—Je suis Charlie, I am Charlie) want to make a major part of my life is to write about it. There is arrogance in that too, in the need and want for publication. But it is tapping into a collective conscience, conscious and unconscious, Poetry is, anyway. Many of the writers in Paris wrote under assumed names, partly because that, too, in political satire there, is part of the culture. They were still known as people. Any attack on writers is not just an attack on writers but on everyone with a mouth, a tongue, a hand, an ear.

In Cameroon, I know people afraid to speak of politics in taxi cabs. On presidential election day in 2007, my friends didn’t want me to leave my house for fear of what I would see and what could, potentially, happen to me. The same year, I spent six months trying to master the bureaucracy of the French embassy in order to register to vote as a citizen abroad, I traveled (four times) one hundred miles in fourteen hours in order to vote. In the United States, I have campaigned in every presidential election since 2000. And I have been grateful for the accident of birth that gave me two passports in two countries that honor, that promote the right to speak and write freely. This shouldn’t happen in my first, my native country and language or in the country I am also from and where I’ve spent most of my life.

There is nothing left to say, there is nothing left to write but to speak. And to write.

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