This gets notes every time it drifts into leftist circles. But here’s the thing: I am a doctor. I have cared for children in hospitals. Vast, intricate supply chains that rely on functioning world governments with trade agreements are necessary to the provision of modern medical care. There is no way to work it so those kids can win if electricity, water, food, or medical supplies like sterile intravenous fluid bags or EKG stickers get interrupted. Forget even permanent disruption, a temporary disruption of the sterile tubing necessary for surgery would mean a lot of kids die of appendicitis. The generators we have as back-up are meant to last minutes, not weeks. And you can say “under my new system, the total violence done would ultimately be less than the violence done by the state,” but it’s easier to say that about a hypothetical kid than one lying on a gurney in front of you. When you’ve been responsible for a life—when you’ve lost a patient, when you’ve been through a Code Blue for a one-year-old—there is nothing you would not do in order to protect that life. I think all the time about what Devil’s bargains I would make for various situations; it’s one of the fucked up things I do. I can tell you that I would kill anyone who tried to cut power to my hospital, or I would die trying. There is no alternative.
The world is too interconnected to allow one part of it to go down. When Puerto Rico got slammed by hurricanes and the US did fuck all about it, we had a nationwide shortage of bagged IV fluids. I was working in hospitals through that. Things we normally do as part of routine medical care, like giving the puking kid with the migraine IV Zofran and Reglan, got a whole lot harder. I was working inpatient during COVID, when there were sudden shortages of pain and anxiety medications we relied on, like opioids and benzodiazepines. There was a nationwide shortage of lidocaine last year and we had to save it for biopsies of suspect cancers. Surgery requires not only a surgeon but an entire team of people and complex equipment to safely sterilize tools, most of which are now based around laparoscopic surgery that requires camera tools instead of the old-school open surgeries. You could not even say “but the surgeons can still operate” because no. They can’t. Not safely. Not with ether instead of succinate and fentanyl. I could deliver your baby after the apocalypse, but who’s staffing the blood banks when you have a post-partum hemorrhage and I don’t have three trained nurses with a kit of specialty meds to slow the bleeding? I still remember the time during the worst of COVID when I couldn’t fly a patient from our rural hospital to an urban hospital that could have done the operation he needed, because the hospitals were completely full. I had to buy time with heavy-duty IV antibiotics (the one and only time I’ve been allowed to use a -penem) while he lay there in agony for 12 hours until a bed came open and we could transfer him. If we couldn’t treat the pain and keep the infection from killing him long enough to operate, he would have died then and there, in front of us, while we stood there helplessly.
So how many kids are you OK with watching die from a ruptured appendix? That’s what comes in to the ED at two in the morning and within half an hour if you’re lucky has an ultrasound proving the diagnosis and a surgeon getting scrubbed in. If there isn’t ultrasound, ultrasound techs, pain medication, anesthesiologists, ventilation machine for when you’re under, light-up scopes with blades to allow for intubation bc then there’s direct visualization of the vocal cords, paralytic medications to keep you still, medications to keep you asleep, monitoring machines that read your blood pressure ans CO2 levels and pulse oximetry while you’re under, computer scheduling for OR time, post-op recovery nurses, gurneys, autoclaves, specialized small metal tools for the surgery—if there are interruptions in training or production of any of these and a whole lot more, anyone could die of a surgical problem, but it hurts worse when it’s a kid. Watch breast cancer come back into vogue, as we lose mammograms. You ever treated a woman who’s ignored breast cancer so long it’s now a fungating mass? Go Google what that looks like. Two cases have walked into my office and they are both dead now. One was schizophrenic. Without modern global supply chains, we don’t have lorazepam or morphine for humane death, let alone psych meds. How many people would deteriorate? Get specific. Which friends would you be willing to watch die? Which of their kids are expendable?
What kind of violent revolution are you planning where you are able to look a patient in the eye and tell them, “Your death is necessary to my vision,” and not understand that you are the villain?
You get to decide whether you want to end your own life for this glorious future. You do not get to decide to end my life or my patients’ lives or anyone else’s. You are not God and you do not get to make plans as if you are, as if you have the One Correct Vision and the rest of us just need to fall in line and follow the prophet. Fuck you. You think the Black kid whose treatment team I was on while he writhed in pain on a hospital bed because he had a kidney transplant and it was rejecting wouldn’t tell you to go fuck yourself about your violent revolution? Our society is no longer able to tolerate large-scale disruptions. We have built too much and we would lose too much. We are too big to fail, and although it’s easy to see that as a bad thing, what I keep seeing, over and over, is that transplant team. How the nephrologist and the resident and the nurses and techs and pharmacists and therapists were working together to keep that kid alive. The scientists who did the research, relying on impossibly complex systems that have taken hundreds of years to build. Collaboration is how we survive.
We cannot allow the vulnerable to die and call that progress. We cannot turn the lights out on any hospitals, because the people in the ICU on ventilators will stop breathing and die within minutes. Would you want that to happen if it’s your mother in that ICU? Would you tell your mother the answer to that? What if it was your child? What about your favorite sibling? How many of other people’s families are you willing to sacrifice for the sake of something that stands a virtually 100% chance of going up in flames immediately, when we look at prior attempts at creating a new government out of war and chaos? The massive impacts of even “small” shortages on patients is not theoretical and has killed patients since I’ve been an attending, starting three years ago.
You do not own the right to anyone else’s life.
And if you think you want a violent revolution, see how you do with your next toothache without pain meds, lidocaine, dental expertise, and composite that lets you keep the tooth and keep chewing. How long would you have to suffer to crack?
