Miscellaneous Thoughts on Living In an Enormous City

Mexico City is a very modern city...skyscrapers, an underground metro, wifi everywhere. But the process for residential recycling is this:

1) recycling truck stops in the middle of the street, blocking all traffic

2) a man gets out and rings a bell while walking up and down the street

3) neighbors carry out bundled cardboard and glass and so forth, or sometimes just bags of mixed recycling. 

4) the rest of the garbage men collect and sort the trash in the street and load it onto the truck

There are so many jobs here, or at least when you go to a business there are a lot of employees. Restaurants are staffed up. Stores have multiple people inside to offer assistance the second you walk in. Security guards stand at every door. Workers are employed by the city to sweep the park sidewalks every single morning. A man mops the stairs outside of our apartment every single morning. All five flights. On Monday mornings the whole city smells like Fabuloso. And if you aren't employed, you sell stuff.  I was sitting at a cafe with my Spanish tutor and was offered candy (typical), pumpkin laser pointers (not typical but it was Halloween), finger puppets, and tiny potted cactuses! There was a man selling some gorgeous MCM tables on the sidewalk. Two ladies open up a stand with second hand clothing every morning at the end of our block. It's really expensive here, so even people with college degrees and professional jobs, have side hustles. Maybe Uber, maybe running tours for tacos or Lucha Libre, or teaching Spanish, or teaching art to kids, or they're in a band. 

A lot of people wear uniforms to work. The nannies wear scrubs. The guy that opens the door in the apartment building wears a security uniform. The people that work in the pharmacies wear white coats. There are people that walk around with public health information and they have special vests on emblazoned with their political party (Morena! Currently in control so it's everywhere.) 

The background noise is constant. A solo trumpet player circling the block, a man shouting about fruit for sale from the back of a truck, the amplified recordings of the junk buyers looking for scrap metal, the horns honking when gridlock happens, the whistle of cyclists and police officers, someone singing while washing dishes. 

I do not worry about my kids being too loud, at all. 

Bots and Docs

I recently spent a few days playing around with a variety of AI bots to get help with analyzing my blood work and imaging from the last year. There's a lot of research and development going on with pharmaceutical treatments and cures for my condition. The FDA actually just approved a drug regimen that could halt the progress entirely, before it breaks my bones or trashes my kidneys. My condition involves frequent monitoring of a dozen or so blood markers, and it can be kind of dizzying to scroll through MyChart screens and try to figure out if the changes I'm looking at are noteworthy. Those little red exclamation points can be unnerving!! But they don't always indicate an emergency. I also have two other benign conditions that can impact how my disease markers could be interpreted. I have spent a lot of time trying to explain them, and they aren't always documented in a useful way.  ChatGBT ended up being very helpful. It generated easy to view charts of how my labs are changing, concise paragraphs I can paste into MyChart to alert each new doctor of my benign, but relevant, conditions, and a list of lifestyle and diet choices I should prioritize right now. 

In the United States it is imperative that you communicate relevant information to your doctor in the first 1-2 minutes of an appointment. I have learned a lot about asking for documentation, and the doctors themselves now use AI notetaking apps which actually really improve the quality of my records, and hopefully save them a lot of time charting! 

Risks include sharing all of this personal data with a profit driven corporation, of course. And the AIs got some things wrong. They corrected them when I pointed it out, but I wouldn't just load your results in and say what's wrong with me? The bots will tell you clearly that they are not doctors. However with targeted requests, it gave me exactly what I was looking for, saving a lot of time combing through research papers.

Another important factor about choosing when to start treatment and which treatment to choose is cost. The patient advocacy groups for my disease run monthly financial seminars and AI bots can really help to synthesize this information. (Healthcare for All! Someday, hopefully, but until then the reality is that finances do influence what you can access.)  Unfortunately the myeloma specialist in my city retired and has not been replaced. I could travel to another National Cancer Institute, wait for them to hire someone new here in Pittsburgh, or continue to receive care at the community hospital.

I've been really diligent about educating myself on my medical issues. For the first year, every doctor said it was IBS or perimenopause, a rheumatological issue or...the vast majority of time....stress. I knew there was something else going on. I can literally feel it in my bones! So, as much as it sucked to get a diagnosis, it was also sort of affirming. I think the only reason I have weathered the last five years and remain in relatively good overall health is that I am pretty devoted to all the recommended lifestyle choices that fend off chronic diseases. Eat fiber, chew a lot, sleep enough, move your body. Hydrate. Get some sun. Read poetry. Laugh with your kids. Hold your husband's hand and linger over coffee in bed every morning. Prescriptions for good living. 

So my verdict on AI is that it is a very useful tool for both doctors and patients,  but that the lack of regulation around it definitely means your data is not secure or private. Use it with caution.