In times of stress we revert to old habits so it's not surprising that a few days ago I found myself tallying the race if each resident in every program that I was considering. As a medical student on the verge of graduation, the deadline for submitting our rank lists is just around the corner.

Unlike applying for college, medical school, or even most jobs, the residency application process is a mutual one. Nobody is accepted and nobody is rejected.  Each residency program makes a rank list of the applicants they want with their favorite at the top.  Each applicant does the same with residency programs. The lists are submitted and computer magic spits out the optimized combination.  On “match day” the results are released and each applicant is given a slip of paper with the name of the program that they’ve been assigned.

The process is similar to dating. It’s a complicated social dance of desperately trying to get a program to like you while at the same time trying to figure out which program will make you the happiest. The process is only intensified by everyone around telling you that it's the most defining decision of your career. 

As I reduced each smiling face into a hashmark on my paper, I thought about the email that had prompted this undertaking.  It was from my friend and fellow Family Medicine applicant. In it she ruminated about the ranking process. She noted that most of the programs that we were applying to were dominated by white faces. Was that an appropriate thing to be concerned about? How much weight should diversity carry in the ranking process?

I realized that I had only been taking vague notice of resident diversity so I decided to be more objective.  I decided to count. Any person I was unsure about, I counted as "person of color - not otherwise specified."  Of the programs that I was applying to, the percentage of white residents ranged from 31% to 79%.

Sitting in front of all the numbers, I pondered their actual significance.

Most of the time becoming a resident simply feels like plodding along to the next predetermined step in the path to becoming a doctor.  The vast majority of my life has been this way: preparatory. When I applied to medical school, there weren't any life considerations. It didn't matter if I didn't have any family nearby, and it didn't matter where I wanted to live after I graduated. It wasn’t real life yet, just school.

But there are also moments when I think, “This will be my first job as a doctor.  This is, like, LIFE!” Professional networks in medicine are regional. The network you form is important because that’s where your mentors come from. It’s no wonder that two thirds of residents end up practicing where they train.  This time it’s not just about getting into a good residency; the specific program matters.

Medical school in the midwest has been moderately traumatic.  I'm sick to death of only white people.  I'm also tired of feeling like I'm one of the few people who understands the difference between charity and empowerment.  And even more importantly, I want to be in an environment where everyone around me challenges me and pushes me to be my best. It has to be a diverse.

Racial diversity is an indicator of not only diversity of thought, but also a dedication to justice.  I routinely calculate racial diversity in a room because it means something. At the same time, it doesn’t mean everything. Like most things in life, it’s complicated.

It would be stupid to miss out on a fantastic opportunity simply because it’s mostly white people. In fact, generations of folks have died fighting for exactly that right.  Besides, most of my life has been spent with white folks who have taught me so many important things, including about race.

Furthermore, given my educational and financial privilege, I have a lot in common with liberal white folks.  Maybe that’s where I belong - mucking about with other folks of privilege, together trying to find the best way to improve the world. Responsibly leveraging the privilege that one has is difficult. I can always use some more good ideas.

Ultimately my ideal residency program would have a focus on care for the underserved, a culture of social justice activism, academic rigor, and a diverse community. It’d like it to be somewhere I could see myself living for awhile. In the end weighing all these things turns out to be more gut instinct than anything else, just like dating.  Sometimes one thing is worth compromising on for another, sometimes it’s not.  And funnily enough, every once in awhile, upon meeting each other, requirements that were once “deal breakers” suddenly are not as crucial as you once thought they were.

The mainstream media likes to claim that Occupy Movement is comprised of aimless activists without concrete goals. They should go ask Martha and Lorena Reyes, two recently fired Hyatt housekeepers who know exactly why the 1% who run everything need to be occupied and what the 99% is demanding.

Until recently, the two sisters worked for the Hyatt Regency in Santa Clara, CA. On October 14th, after 30 years of combined service, they were abruptly fired.

According to the Hyatt, they were terminated for “stealing company time.” The hotel alleges that they took ten minutes too long on their lunch breaks.  The Reyes sisters explain that housekeepers are assigned so much work that they frequently do not have time to take their legally-mandated, 10-minute break in the morning. It is routine and long-accepted by management for them and their coworkers to take an extra ten minutes during lunch to replace their missed break.

The Reyes sisters believe that they were actually fired for a different reason. 

Their story begins in September during “Housekeeping Appreciation Week.” On arrival to work, Martha was greeted with a collage of her and her coworkers’ faces digitally altered onto the bodies of women in bikinis. She was horrified and took down the picture of herself and her sister, Lorena.

Though it’s commonplace to see images of scantily clad women in the media, Lorena explains, “In my culture I was raised to be conservative with my body. I don’t like bikinis…  I felt very uncomfortable knowing my male coworkers were looking at that.”

Shortly afterwards, both women were fired.

On November 18th, the Reyes sisters filed retaliation charges with the U.S. Equal Employment Opportunity Commission.  Their lawyer, Adam Zapala, states, “[The Hyatt is] retaliating for [Martha and Lorena’s] opposition to their pictures. You have two long-term employees, with sterling work records, and then all of the sudden, they’re terminated. And they’re sisters. And then you go talk to other workers and they say they do this too [if they miss their morning break] and they’re not disciplined.”

Martha and Lorena allege they were fired for standing up for themselves.  And it has cost them. Because her husband has been laid off, Lorena is the sole supporter of her husband and three children. Martha has five children as well as legal custody of three grandchildren. Like many Americans, without this job, she is also worried she will lose her home.

Victoria Guillen, a worker at the Grand Hyatt San Francisco, recognizes the pain that the Reyes sisters are experiencing.  In February of 2010, Guillen was fired because she was unable to meet the Hyatt’s demand that she return to work only four days after having a medically required caesarean section because of her high-risk pregnancy.

Though these two stories involve different people and circumstances, the heart of the matter is the same: power.  Martha explains, “I go to work and I’m very serious at my work. When managers ask us to participate in various activities I participate. But I feel in this case, management is abusing its power.”

Hotel management frequently relies on disrespect, humiliation, and fear to maintain power over their employees, power over wages, and power over benefits.  Firing the Reyes sisters and Guillen sends a message not only to them, but also to their co-workers. If people can be fired for preventing inappropriately sexualized pictures to be displayed or for simply having a baby, surely behavior such as taking a sick day, demanding safe working conditions, or a living wage, would be punished with even worse.

What’s notable is that both hotels that the Reyes sisters and Guillen worked for are on the list of 17 Hyatt properties that workers, clergy, unions, and community members have been boycotting because of poor labor practices.

Additionally, separate from the Reyes sisters incident, the Hyatt Regency Santa Clara, is one of seven Hyatt properties where workers are fighting for a fair process for the workers to decide if they want to form a union.  While other large hotel chains such as Hilton and Sheraton have already agreed to nationwide card-check neutrality agreements, where workers are able to win union certification by simply getting a majority of workers to sign cards saying they want a union, instead of having to go through a lengthy Labor Board certified election, the Hyatt refuses.

When workers in Santa Clara announced their desire for a fair process in 2008, reports of worker intimidation surfaced immediately.  One worker recalls having a manager close the door so that the two were alone and theninform her that she could get fired if she signed card in favor of a union—an action that is a clear violation of labor law.

Huy Tran, a former Hyatt bellman, describes how management “used a combination of things to scare people and bribe people.” He said when one of his coworkers expressed ambivalence about the union, “Suddenly he was assigned all the good jobs. Whenever Mr. Rice, the general manager, needed something personally, it was [him]. It was like an informal promotion.” Conversely, Tran, who was vocally supportive of a fair process and a union, found that “they stopped talking to me.” He says, “Whenever they did have to talk to me, it was terse and cold.

Nationwide, they Hyatt Corporation has had a less a history of than stellar labor practices:

In the fall of 2009, 100 housekeepers at three Hyatt properties in Boston, now referred to as “The Boston 100,” were fired on the same day and replaced with out-sourced workers.  The incident was so egregious that even the Governor of Massachusetts threatened a boycott and the Harvard Business Review ridiculed the move.

A 2010 article published in the American Journal of Industrial Medicinereported that out of the four hotel companies that they analyzed, the Hyatt had the highest injury rate of 10.36 injuries/100 person years.  That was nearly twice the baseline injury rate of 5.2.

To date, the Occupational Safety and Health Administration (OSHA) or its state counterparts have issued 15 citations at 10 different Hyatt hotels and 3 citations against one of the housekeeping subcontractors that the Hyatt uses. They allege violations of safety regulations and have proposed fines totaling $95,405.

Slowly, other Hyatt workers are speaking out as well.  A recent Youtube video, “Joey Quits,” about a hotel employee quitting with the help of a marching band, went viral and has galvanized abused workers across the country.  That employe has begun to collect testimonials in hopes of raising awareness of the “unjust working conditions in the hotel industry.” At the time of this writing, over one third of the contributions were from Hyatt employees.

Ultimately, the Hyatt Corporation is a concrete example of what the Occupy Movement is fighting.  Before the Hyatt became a publically traded company in 2009, it was owned by the Pritzker family, members of which still own controlling shares.  Eleven members of the Pritzker family were listed in the Forbes 2011 list of “The Richest People in America.”

And though Hyatt has claimed that firing “The Boston 100” was financially necessary, just the month before, the CEO, Mark Hoplamazian, had been given $1,662,500 worth of company stock as a bonus.  Three months later, he was given another 105,00 shares which were worth approximately $3.16 million.

The Hyatt, Hoplamazian, and the Pritzkers are the “1%.” And though Martha, Lorena, Victoria, Huy, Joey, and the 100 housekeepers in Boston might not be camping out every night, they are the “99%” and they are fighting.

With the help and support of her coworkers, Victoria Guillen protested her termination and her job has since been reinstated.  But to Victoria, even though she might have her job back, the fight is far from over.  As long as workers are treated unjustly, she will continue to fight with them through delegations, protests, and petitions such as the one Martha and Lorena started demanding that their jobs be reinstated.

Victoria recalls a famous saying from Tupac Amaru II, the famous leader in Peru’s fight for independence.  She states, “We will fight until we relieve the last man on the ground. I will fight and I will triumph until the last bullet is done.”

Lorena summed it up best, “I think [the Occupy Movement] is great. They are fighting corporations to stop abusing workers and to give them their fair share.” 

When it comes to workers like these who are fighting back against the abuse of bosses, it is clearly appropriate to declare, “This is what Occupy looks like!”

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This article was cross-posted on Thiscantbehappening.net.

The year 1984 is probably most well known because of George Orwell. More relevant to me, it was the year I was born.  More relevant to researchers desperate to publish before they proverbially "perish," 1984 was the year that Helicobacter pylori was discovered.  With a brand new bacteria that nobody knew anything about, it was low hanging fruit for publishable data.  There's even a whole journal that is soley dedicated to H. pylori and it has a new issue every two months!  More recently, it's become clear that H. pylori is highly correlated to the development of gastric cancer and most experts believe that it's causative due to the chronic inflammation that can result from infection. However, it's important to note that only a minority of people infected with H. pylori will go on to develop gastric cancer.

In the medical student world, though critical and diagnostic thinking are highly emphasized, rote pattern recognition is just as important.  During our internal medicine rotation and board exam studying common scenarios are pounded into our brains.  Young African American woman with difficulty breathing? Sarcoidosis. Diabetic with an unhealing ulcer? Osteomyeolitis.  The list goes on and on. The Asian claim to fame? The Japanese man who eats lots of preserved foods.  He has gastric cancer.

But that's all I've been told. Basically, I can bubble in the right answer on a multiple choice test question. Nobody ever told me that gastric cancer used to be the second most deadly cancer in the world.  Nobody ever mentioned that though the incidence of gastric cancer has drastically decreased worldwide, it's happened disproportionately.  The incidence of gastric cancer in rich countries continues to drop, but even in the United States, according to SEER data, Asian Americans, Latin Americans, Black Americans, and Native American's have a much higher rate than other races.  And absolutely nobody ever told me that the 5 year survival rate is only 25%.

Earlier this year I did a rotation at Asian Health Services (AHS) in Oakland, CA. AHS is a non-profit primary care healthcare system that provides services to low-income, linguistically-isolated Asian Americans in Alameda County.  Part of my time there was spent reviewing the current research on screening for H. pyolori, gastric cancer, and Asian Americans. I could only find one study that actually studied gastric cancer in Asian Americans. It was an epidemiological study that found that rates of gastric cancer in Japanese families decrease in each subsequent generation after immigration.  One other study used Japanese Americans as a subset for analysis.  It was a cost-effectiveness analysis and they simply took data on white men in the United States and multiplied their risk by four.  I'm not sure that counts.
 
It's not surprising that though gastric cancer in Asians is common enough to warrant a board's question, there's been little research done on it in the United States.  Asian American's are nearly invisible when it comes to health research. The US Department of Health and Human Service's Healthy People, in their 2010 Asian Americans/Pacific Islanders: Defining a Baseline, reported that only 0.1% of published medical research articles even mention API populations. This, in combination with the model minority myth, only perpetuates and contributes to the false notion that the API population does not suffer from any health inequities. Despite this having been recognized for years, little has changed in medical research and issues in data collection and analysis still remain. 

With respect to H. pylori and gastric cancer, the vast majority of the data comes from research done in high risk populations in East Asian countries.  While we can use this data to estimate what might be true in the Asian American population, it's only a crudIn the end, there's convincing data that screening asymptomatic individuals for H. pylori and treating them before they progress to chronic inflammation can reduce the rate of gastric cancer.  And because testing for H. pylori is a simple blood test as opposed to the more invasive tests that are used for screening for gastric cancer itself, it's an appealing and possibly more cost-effective alternative.

Unfortunately, we've only known about H. pylori since 1984 and the amount of research that has been done, especially related to gastric cancer, is still in its early stages.  While we have data to suggest that a screening program would be helpful, there isn't enough data to flush out what the exact details should be.  In order for a screening program to be effective, one has to target the proper population at the right time with the right test. We just don't have the answers to those questions to create a formal screening program.

Ultimately we concluded that high-risk patients (immigrants from China, Korea, or Japan; men; smokers; and positive family history) be screened for H. pylori based on clinical judgment with the understanding that the evidence suggests that it should be done no later than 40 years old. Additionally, though serum pepsinogen was recognized as a promising screening tool for gastric mucosal changes, there was also not enough evidence to recommend a formal screening program.  Asymptomatic high-risk patients should be screened based on clinical judgment. The evidence and epidemiology suggest that this should be done between the ages of 40 and 50 years old.
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For a more comprehensive review of the data and an analysis of a key research study, the document I put together for my presentation can be found here.

This week is National Coming Out Week. And though we'll focus on celebrating the queer community, it's not a holiday.  And despite the fact that its whole existence is due to prejudice and hate, it's not a memorial.  When I was in high school, I started a Gay and Straight Alliance and I remember how big a deal National Coming Out Week was (though back then I think it was only a day). This was our chance to establish our presence. In an environment where any queer aspects of the curriculum were laundered and the social scene was assumed to be heterosexual, it was also our chance to challenge the norm.  With our pins prominently displayed and posters strategically hung, I remember feeling like we were walking into battle.  Long before "fierce" was campy, it was butch; and we were fierce.

As my aspirations to effect change have grown, so has the scale of my efforts.  The cynic in me says that efforts targeted at "small numbers of people" have no significant results.  The egoist in me says that my time is better spent elsewhere.  And yet I continue to advocate for grassroots change.  It turns out my hypocrisy is not only limited to telling my patients to exercise regularly.

A fellow activist and organizer once counseled me when I was complaining about how tired and burned out I was. "You need some inspiration," he said.

Last year, the business school gave out rainbow pins during National Coming Out week. By the end of the week, nearly every business student had one.  I didn't think much of it until a desperately closeted friend of mine said, "You know, seeing all these people walking around with pins -- even, like, the big footbally guys -- makes me feel like I could really come out and it would be ok."  Talk about warm and fuzzy.  Inspired by that, this year all of the queer organizations on campus came together for a button campaign targeted at the entire undergraduate and graduate student population. (See an interview with the organizer here!)

In high school things were pretty black and white for me: you either take a stand for justice or you don't. These days I feel overwhelmed by the complexities of everything. Now I'm concerned about unintentional consequences, participating in programs that are more colonial than empowering, marketing my message so that it can be heard, taking leadership without taking power, and building smart alliances without selling out.  But this button campaign... it builds a sense of community, it creates a sense of safety, and it establishes a presence. It's simple and it pleases me.

If for some reason you stop getting deliveries please let me know!

I've been quiet lately. Recently it feels like writing is more of a hobby rather than a necessity.  I'm not totally sure why, but when I reflect on how I've felt the past few months, I can't recall having those episodes of acute dispair and anger that used to be so common.  These days, it's almost as if the injustices of the world roll off my back.  It's not even anger fatigue -- it's a true lightheartedness.

In some ways, it's a bit of a relief. Life feels easier and is less of a burden. I'm happier. I'm probably also more pleasant to be around. (Just the other night I had a dream where all my classmates rated each other from most to least liked. I was somewhere in the bottom ten percent.)

There are reasons in my life to be happy. I've completed my third year of medical school and fourth year has been much less intense; I took a vacation and traveled all over Taiwan; I've been playing more ultimate and I even flew to Seattle to play on my college reunion team and with my sister; I've been cooking more.  I've been having so much fun that my usual porcelin complexion has been replaced with one that can actually be accurately described as "of color." In fact, the other day I experienced the distinct pleasure of some old white guy aggressively yelling at me from across the street, "MABUHAY!"

And while I'm sure that there are folks in my life that probably think this is a change for the better, I'm not sure.  Without much motivating emotion, I've been less active.

It makes me reflect on how my values have changed over time. When I was in college, I was a peace-loving, vegetarian, coop, communal-living being.  I preached that a movement born out of love, not anger, was the only way to make sustainable change.  After all, how could anger beget respect? After college, when I was working, I was a militant, rage-inspired being who rallied with my coworkers.  It was then that I realized the power of anger.  Love might sustain movements, but it's anger that motivates and overcomes fear.

And it's not that this joyful lifestyle means that I've grown and swung over to a more "love, forgiveness, compassion" side of activism. I may not be as angry, but I still struggle with having disgust for fellow human beings.  I still have to remind myself not to judge those that I perceive to have privilege too harshly.  I'm not as angry as I have been in the past and yet I still lack compassion.

I hear Audre Lorde's "Uses of Anger" in my mind and I am reminded of the distinction that she makes between "anger" and "hatred." It occurs to me that much of this is about striking what seem to be impossible balances.  One must be angry, but not hateful; compassionate, but not enabling; and critical, yet forgiving.  The balance that I'm currently grappling with is one that is associated with privilege: how to emotionally "zen" injustices without turning a blind eye.  It's a difficulty that we dare only whisper.

If I'm honest with myself, I have to admit that lately I've taken advantage of the fact that I have enough privilege to simply coast through life.  It began with my third year of medical school. "I'm so busy!" I told myself and keeping myself current with the news and society slipped away. (Nobody panic, I still electronically signed the petitions that got sent to my email.  A sad confession: part of me felt that signing petitions so consistently, even if that was all that I did, was quite admirable.)  Then I got used to keeping my mouth shut because medicine is incredibly hierarchical and traditional institution. If I wanted to get the skills that I need to be a good doctor, I needed to duck my head and plod along.  But constantly supressing my indignation wore on me and before I knew it, I had learned to ignore it.

I remember in college we organized a big anti-armament protest against Lockheed Martin and I was astounded to discover that a significant portion of people who worked there not only adamently believed that they were NOT contributing to a destructive force in the world, but also that they were, in fact, a peaceful force.  "The best defense is a good offense," they told me with sage nods. Recently, I heard an interview on the radio with the politician who is working to reinstate prop 2 in MI. He solemnly declared that he was fighting for true equality and to end racism.  It occurs to me that this is how people do terrible things but still sleep at night -- convince themselves that what they're doing is actually noble.

I think I've been lieing to myself as well.  I've been patting myself on the back for getting along so well with folks.  I've hobnobbed with rich business folks and conservative medical professionals and our interactions have been quite pleasant.  I've even been invited back.  I thought I was growing and becoming more open-minded.  In reality I haven't been less critical, I've just been ignoring the things about them that I don't like. I don't let myself think about it. Even worse, because sometimes it's just easier to be friends with people, I justify or somehow make an exception for them in my mind.

Somewhere in between rejecting someone because of their flaws and denying the existent of them is the ability to care for someone while being fully conscious of all their shortcomings.  I'm flawed. The people around me that I care about the most are flawed.  I think about the number of relationships in my life that actually reflect this balance and they are quite few and, in a way, forced to that balance.  For example, when it comes to family, it's much harder to break up.  Even if there are times when you truly dislike a family member, they don't go away and over time you learn to not just ignore their shortcomings but confront them honestly. While the idea of "unconditional love" always seemed a bit puzzling to me, I finally understand what it means.

But I've been selling myself an even larger untruth: I am not happier because I have learned to emotionally "zen" the injustices of the world.  I have been happier because I have been escaping from the injustices of the world through my own privilege.  My girlfriend likes to use quote a particular analogy when it comes to anger. It goes, "Anger is like a torch.  You want to hold it closely enough to help light the way, but not so close that it burns you."  I guess in the past I've always struggled with getting burned so I've been working on holding it further away.  These past few months I thought I finally had a balance, but in reality I had just joined the light-bulb powered party in the room next door:

"The first [Kunta] had taken the massa to one of these "high-falutin' to-dos," as Bell called them, [he] had been all but overwhelmed by conflicting emotions: awe, indignation, envy, contempt, fascination, revulsion - but most of all a deep loneliness and melancholy from which it took him almost a week to recover.  He couldn't believe that such incredible wealth actually existed, that people really lived that way.  It took him a long time, and a great many more parties, to realize that they didn't live that way, that it was all strangely unreal, a kind of beautiful dream the white folks were having, a lie they were telling themselves: that goodness can come from badness, that it's possible to be civilized with one another without treating as human beings those whose blood, sweat, and mother's milk made possible the life of privilege they led."     --Roots