The Omelas Accord

Content warning: mention of birth injury

Iris my darling,

If you are reading this, then the rule of law hasn’t come for me - but death has.

As your grandma, I have given you many things that may burden or empower you, whatever your opinion on them: thin hair, myopia, a preference for savoury over sweet. What this letter means to you, my love, is yours alone to trial.

Don’t read this letter in company. I loved you with intention, patiently and methodologically, as only a professor of science could (and I have to speak in the past tense because, being dead, that is very much where I live, and always have), but this doesn’t exist as a sentimental keepsake. What’s in this letter contravenes this country’s laws to protect its darkest secrets, which I’m afraid may make your decision much more difficult - if you choose to read on.

When I was a child, my mum used to douse me in talcum powder. Clouds of it. By the time it was discovered to be a possible carcinogen I'd joyfully gulped in billowing lungfuls of it. When it was my turn to become a parent, talcum powder was an artefact, yet still, I found my own way to impose toxicity on my unsuspecting child. Ambition. Every professor worth their salt must be able to admit when they are wrong, and so I did what I could not just to face up to my mistakes, but to scrutinise them.

Another generation, another chance. For you, I had no ambition.

You gurgled into life; a soothing, bubbling up of an emergence. Love, which at that time was crystalline within my chest, scratching from the depths of my thorax, dissolved: immersing your mum and me, renewing us all. You are, and always have been, a bringer of solutions.

Still, I saw nothing in your future; I resisted every urge to indulge in hypothesis or storytelling. While your mum bit her fingernails, as you arranged rather than repeated your flash cards, I felt calm in your wide-eyed silence.

This is all to say that you, at each turn, reminded me that I shouldn’t underestimate you. I have had moments when it’s appeared so clear to me that you can carry this burden. But don't read on because your gaze carries you, habitually, down the page. Do it in the full knowledge that what awaits you will be indelible.

I’ve been spared the tiresome choreography of managing your place in my shadow. Your pride in me disentangles all complication. Iris, this was such unexpected and blissful relief. I haven’t always followed society’s unwritten rules, but it comes compounded by plain common sense: my professional standing provides partitions and hazards in what should be my closest of relationships - my tribe. But to acknowledge that? Gauche. As the lifter of Eve’s Curse, it’s not as if I haven’t had other tribes, but I delighted in the unencumbered way you might exclaim to the uninitiated, “My grandma is Professor Victoria Harrow - Professor Victoria Harrow! - she’s the reason birth is pain and injury free”.

For you to get your place in Medicine at University College London, the institution which birthed me, and my lifelong intellectual home, caught me unprepared. I should have recognised your potential far earlier. I watched a video of you playing with the flashcards and unlike on previous viewings, this time I could quite clearly see you creating taxonomies. I realised that those childhood silences were subterranean springs, from which you only gave intermittent, controlled explosions. How much hadn’t I seen, and how much had you kept from me? You’d never given me reason to think that your admiration extended to, in some way, emulation. You were possibly quite fed up of my UCL reminiscences, and are quite glad to finish your studies without them - but I hoped at the very least they might offer you one or two passable anecdotes at faculty dinners.

Your success in your studies is why I wrote you this letter. I suspect you might be fearsomely good at what you do, as I was. The fact that will be before you - and there’s still time to avert that course - will in some way empower you. I feel as though you’ll know what to do with it better than I ever did.

You already know the catalyst.

I spent the winter of 2021 in a small flat in Holloway, in the midst of a national coronavirus lockdown, nurturing a newborn, body and mind irreparably damaged by a perfectly routine birth. Antiseptically described as “natural” and “normal”, the violence was so systematised I’d quite literally signed consent forms to surgical interventions with the salient and willing autonomy of a torture victim.

I’d been working as a postdoc. In the weeks before being ripped in two, I’d indicated to my Head of Department I might be able to return before Christmas. In my current condition I was coming to regret that. He’d been keen to remind me how tight my funding deadline was, without of course overtly acknowledging the precariousness of my position. He regarded me like a sixteen year-old who just about managed to keep the baby in until they’d left secondary school.

My state of disbelief, following the birth, sent me into several weeks of paralysis which felt physical, although it wasn’t. I couldn’t move past the stark revelation, unavoidably looping in my conscious mind, that what happened to me was unremarkable. Four in ten people go through this at some point in their life, and we don’t have uprisings - in fact, so many willingly do it again?

At a breastfeeding clinic a midwife took me aside after I mentioned my stitches, which seemed to be healing poorly. ‘Don’t take no for an answer,’ she said, putting a hand on my arm. ‘Too many people suffer in silence.’ Unfortunately, I already well understood the need to be conspiratorial about basic medical care.

I had been suffering from migraines throughout pregnancy. The only effective medication, of course, was deemed off-limits until I was no longer breastfeeding. ‘It isn’t proven to be dangerous for the baby,’ the doctor had advised, ‘but we don’t know it’s safe. I’m sorry, there just isn’t enough evidence.’

As a researcher, I knew the architecture of that uncertainty. It can never be ethical to disadvantage or cause harm to a trial participant, born or unborn. We have codified this, from Nuremberg onwards. For the first time, I considered this principle, and shifted my focus - away from the harm, and onto the never. I followed this thought’s logic, and the impossibilities it presented. Was I supposed to accept that these are things I might never know?

You know much of this, so please forgive me covering old ground - I suppose I include it mindful that one day this letter may become public, and also perhaps to prepare favourable ground for forgiveness. Amongst what you are aware of, what I have never shared is that at this point, medical ethics began to feel increasingly like convenient and uninspired orthodoxy.

While I sat immobilised in domesticity, in the world I had left, pioneering scientific progress accelerated at a pace not seen in twenty-first century history. With the development of the Oxford-AstraZeneca vaccine, a ten-to-fifteen year process was condensed into less than a year. They announced the first vaccinations with a televised jabbing of a friendly old biddy, such as I vowed never to be, on BBC Breakfast. Collectively, the world sighed in relief.

I cried longer and more bitterly than my baby, your infant mum, that morning. It didn’t matter to me that I knew I was living in exceptional times. I was undone by the fact it wasn’t just Oxford - there were multiple vaccinations on the horizon. When history called for it, we could meet the challenge, several times the world over. When we wanted to it could be done.

I have never heard as much as a whisper from God, but this crushing injustice could only be damnation.

In those days, women in the UK were twice as likely to die of a heart attack as men - not due to any physiological reason, but thanks to underdiagnosis and delays in treatment. Crash test dummies were designed on male anatomy, and as a result of this defaulting indifference, women were nearly fifty percent more likely to be seriously injured in a car crash. Seventeen percent more likely to die. Pain medication, sleep medication, statins - these trials were all modelled on the molecular structures of men and the drugs were overprescribed in women. Imagine dying of being an afterthought.

So the story goes, it was then that I began researching in my own time. Looking into retrospective studies, and using data science to build a predictive algorithm. After years of refining, this would turn into my first groundbreaking piece of research: the algorithm which could predict with near-total certainty the danger of a drug in pregnancy. No more equivocation, no more medical professionals drawing your hard-won appointment to a close with a shrug of their shoulders and telling you, in far more anodyne language, that the world hadn’t cared enough to ease your suffering.

That breakthrough alone was enough to win a Nobel. The youngest ever winner for the prize for Medicine. Funding was immediate and abundant, and with it I'd create bionic injectables which strengthened and restored elasticity to the pelvic floor. We cut through years of nonsense about convenient and discreet squeezing to end that form of birth injury, many types of incontinence, and the expectation that sufferers should spend what little time they do not have reconditioning like a gym bro.

Finally, I would lead the team which defeated the archetype of agony itself. We pioneered pain relief without sedative effects, and elegantly engineered to target only where and when it was needed.

Eve's curse was lifted.

So the story goes.

It’s important to remember - back in the 2020s, the UK was a waning world power. Many economies outside of the West were soaring, whilst the UK relied on service industries, seriously under threat from the inexorable advancement of AI. Its voice was becoming increasingly impotent in international circles. At home, the majority of its population, my esteemed compatriots, seemed determined to vote us into insular insignificance. With populists insisting we expel every immigrant from Albion’s shores, life was becoming increasingly difficult for all institutions in higher education - looking desperately to the future, clinging onto relevance with fingers enfeebled by port and prevarication. There had been success with the Oxford-AstraZeneca vaccine. Perhaps world-leading medical research might offer a steadier foothold in a new world.

I am a medical researcher of some considerable talent, but I’m also a strategist.

When those vaccines were developed, my rage helped me see the arc of progress bending towards me. I seized the opportunity.

There are ways and means in academia to cover up a tainted methodology. Very few will scrutinise what you do, truly, and especially not when you’ve worked hard to cover up the trail of crumbs. Who peered into Pandora’s box after it had been flung open? Retrospective cohort studies, simulation-based modeling, compassionate use and emergency exemption trials - all offerings for the wishful thinkers who wanted to know how we made this groundbreaking progress within the strictures of “avoiding all unnecessary physical and mental suffering and injury”. None of these methods are lies.

All are a smokescreen.

It’s not possible to do the things I did without administering profane fingers to human flesh.

There are millions of people in refugee camps across the world. Millions of pregnancies and births. There are even more displaced and desperate, living outside of camps. More than enough for a good sample size.

I was the instigator, but I did not do this alone.

You won’t find any information about The Omelas Accord in any of your medical history modules. Don’t Google it - don’t leave a trace. It took many years before it was formalised and agreed between University College London and the establishment. At first we were a little experiment they turned a blind eye to - a shadow which could disappear should it be cast into light. Left alone, without limit, we discovered the tremendous secrets of the human frame. When they knew we would find success, it was then that this most clandestine of groups was formed, to press forward, unrestrained by ethical codes which fail to speak to the great span of humanity past and future, and only to our zeitgeist: the cult of the individual.

More than once, I wanted to tell you. When you showed interest in my work and your questions cut directly to the heart of my experiences, it was hard to lie to you. Yet, those moments were always held at bay by your weekly calls, in which you’d tell me about your wanderings in London, some fascination of anatomy you’d discovered, the peculiarities of your teachers, or your wry take on student life. If you are reading this letter, it means I couldn’t find it in myself to contaminate those memories while I was alive. To the end, I wanted the simple warmth of your “hello, grandma”.

I know what I’ve done. In those early days, I was there too - in the camps, on the front line - and I despised what I witnessed. As time passed, others took up the work, reporting their data back to me. Not all were sacrificed - we had many successes. Science has always been this way, before we removed its teeth. Today, do we forego the pill, reconstructive surgery, or syphilis treatment, because they originate from abject and unfair suffering?

I wanted your mum, and you, and every woman who I don’t know, to no longer be victim to righteous democracy. Ethics are weaponised by those who do not care about our continued suffering. I did care. In fact I was the only one who cared enough to drive this era-defining progress. Perhaps I’m from a different, less tender, age. Not ahead of my time, but far, far behind it.

While I was alive you loved joyfully in my shadow, yet now I choose to cast a shadow upon your life so that you know the truth. I know you will have read this far, and I hope that it doesn’t cause you too much pain. But we know that pain relief is overproscribed anyway - I sheltered you selfishly, not for your sake. You deserve to have knowledge which carries the sting of empowerment. My legacy is fuelled by formidable forces. You now see who you travel alongside: but the next steps are yours.

I trust that if not now, then sometime not far from now, you will know what to do. In my mind’s eye, you sit in silence, reckoning with the hand I’ve laid before you. You consider the permutations, organising these truths with care into their various taxonomies. Perhaps you will move with the flow of the establishment; perhaps you will rain disruption upon them; perhaps you will be the great flood. I can’t pretend to guess the movements of those subterranean springs.

My girl, my luminary, my Iris: I know you will find a way.

All my love,

Professor Victoria Harrow,

Grandma.