The Curmudgeon

"Me? Who am I?", asked the bearded older man, his arms crossed against his chest, half laid back in the chair as he replied with surprise and yet, fatigue. A moments pause, not that he was searching for the words, but a flicker of wit lit up his eyes as he amused himself with possible answers.

"I would imagine I am a curmudgeon," he chuckled at last, and glanced over to see how that landed. He continued, "I prefer to dislike a thing just because, rather than like it, for the same reason. It saves me energy, time, frustration, and money. And yet, people shake their heads and smile because, its just who I am. Take you for example, I don't like you." He smiled at his cleverness as he looked across the table.

Shocked, the other replied, "You don't even know me!"

"Checkmate."

Finding himself

Where was this supposed to be, this place where he found himself? Time might tell, but it seemed to be a thing he should know. His not knowing didn't just make him uncomfortable, it amused him. Not funny-ha-ha amusing, but amusing nonetheless. Looking up he saw the sky, blue, clear, cloud,less, like the sky everywhere else. Around him trees, the worn narrow path he found himself on, rocks, grass, dirt. Any where, and here. A deep breath, clean, fresh, cool air. The smell of the woods. He could see his breath... late fall. He had the sense he was late, for what he did not know, but he was late. He was pretty sure it didn't matter.

He had not moved. He realized he had not moved. He was tense, stiff, but not fixed in place. He made his shoulders relax, and took a deep breath. He turned around slowly taking it all in. He knew this place. It was where it all started. He felt a moment's angst: I do not want to live this again. He was suddenly anxious. Very anxious. Pulse quickened. Breathing quickened. He did not know what was next.  Another deep breath. A pause. He calmed. Now was not the time to panic. He was not the panicking type.

He took a step forward. He knew it was forward. This time it might be different, but he would need to remember.

And remember he would.

He started running, and he grew confident. He had no idea what was next, but he knew he was smarter, aware, and that he had done this before.

This time, he knew.

Dead Doctor Walking

Night passed; the day came. He awoke into that haze that narrows your world to what you can touch, giving way slowly to what you can see, and he lay there with a moment’s peace. Soon enough that haze lifted and the wider world intruded, slithering into awareness, bringing its anxieties and fears in a slow moving wave drowning him, the stress rising up within him squeezing his heart, taking his breath away. It was a matter of moments, but he was suddenly seized by the realization life was killing him, and inside he began to cry from the pain. He closed his eyes, rolled into a ball and stuttered a deep breath, slowly releasing it, washing some of the anger and fear away. The alarm softly began is crescendo chime, he reached out and silenced it, wishing it was that easy to silence these emotions that raged within him. He rolled back and stared unseeing at the ceiling, then stretched, hard, quelling the anxiety to the point of lightheadness, relaxed, and found a cat who was acutely annoyed at his having disturbed him. With a deep breath, a sob really, he sat up, stretched lightly, and looked sleepily around for his slippers. The cat had stirred, meowed and was now hugging him in that cat way, tail up, purring, head bopping him gently, as if encouraging him to get up, which he was, to compel him to feed him. He knew quite well that the only reason he was still alive was cowardice, the cats, and his family, probably in that order. Man, how he loves his cats. Or maybe it was love, and intense jealousy of the cats? As every cat owner knows, a cat’s life was the win.

He was nauseous. He tended to be in the mornings, in part nerves, in part medications. It waxed and waned, and would settle. He had taken to skipping breakfast because of this, and by the time he remembered he hadn’t eaten it would be well after noon because of the pace in the urgent care clinic. What happened to him really doesn’t matter. Work consumed him, and it was the poison that would kill him. Make no mistake, he loved his work, and those he worked with. It had taken a lifetime to find himself here. He loved his patients, almost all of them, especially the kids. But he hated the bubble that contained it all. He hated that piercing fear that seized him when a patient raised an eyebrow, or a voice, signaling something he asked or said, something he had done a thousand times before, annoyed this one, though his asking it was why they were there. His fear was not the confrontation, though that was certainly fueling the angst, it was that when they judged him, and they would be asked to judge him, their psychology would be the tool of measure, this moment of customer dissatisfaction, not his medical advice, would be the fault, and the bubble would squeeze him for failing to avoid the annoyance, for creating unhappiness.

This pressure was changing him, from being a good clinician, to being the vending machine, a provider, an awareness that made his colleagues happier for having accepted it. HE need not be there. The customer asked, demanded, directly or through the subtleties of the dance, and his was not to judge the appropriateness, the safety, but to find what they wanted and provide it. He wasn’t to be a clinician, but a provider. The bubble even made it a point to call him that to remind him of his place, and to criticize his lack of wokeness for suggesting he was, in fact, a clinician, not a provider. Maybe that was what they meant by “moral injury” that was literally killing his brethren, the struggle between working all your life to be a strong clinician, to learn how to compassionately and professionally make medical decisions, and only to learn that was not respected, not desired, in fact, it endangered you. In these times he only needed to know what the customer wanted. It was coming to terms with understanding you are a placeholder, the least among you is equal to you, their ignorance was better than your knowledge in these transactions. None of your decades of preparation, your struggle, really matters. The uneducated customer had become superior to your years of education, experience and knowledge, and all that mattered was what that customer wanted. You are not measured by any tool for the quality of your medicine, your ability to weigh the evidence and solutions, picking the most suitable one, but solely on the happiness you gave to customers, your ability not to displease.

This, the bubble was coming to realize, was why you could be replaced by someone with far less qualification and experience, that they would be called your equal, because the medicine doesn’t matter, the cost does. And if you found this offensive, you are not woke. It was the fragility of it all, that a “customer complaint” for not making the customer happy could destroy him, his medicine would not be relevant, and he would be chastised, punished, with no one to defend him, no voice. No one held the accuser accountable, they are the customer, and when profit is the goal, that is the superior role. He failed to create happiness. The bubble made it clear, his was to accept the bullying, both from the customer, who short of shooting him was never wrong (perhaps not even then), and then from the bubble, for making the bully bully him. He wondered, who apologized to him?

It was not at all why he had done this, any of this. He did it to take care of people, and to tell them what they needed to know, give them what they needed, not necessarily what they wanted. He did it to protect people from mythology and snake oil, to make things better for everyone. That was all upside down. He was a provider, a means to profit, not a clinician, a practitioner of medicine. He had to strip all of that away. His job was to be another invisible cog, and stay employed. Every part of his character, integrity, and being, all that had made him an exceptional man and clinician, rebelled this need to ignore all of that to survive. All that he did, from the encounter, the testing, the EHR record typing, to the prescribing, and finally, the piece de resistance, the coding, in minimal time, was all about profit. He was not here to do medicine in the traditional sense, that was just the theater of it all. “Entertain the patient while the body heals itself!”, Voltaire had revealed. The price of survival was decaying all that he was.

Most of his days passed well, he succeeded somehow finding a balance, and he would enjoy those days making a difference for those receptive to learning and understanding he cared about them, hoping to relieve their suffering, even if only a bit. But all it would take is one customer who knew more than he, who wanted what they wanted, for whom it was his duty to provide, and he failed them, despite himself. There was that moment when the abuse was too much, and he, bubble forbid, pushed back against the bullying. He raised his voice. The complaint would be dramatic, histrionic even, and the more so, the more “egregious the allegations”, the more injury upon him. The accuser had met the enemy, head on, and was holding him accountable. Its basis in reality doesn’t matter, there was likely a kernel of truth, but the goal wasn’t to create awareness, it was to damage him, to punish him, and only strong, dramatic, pious re-creation would do. He had committed the ultimate provider crime: he created unhappiness. For that, he could lose everything, and be cast out, the years he had dedicated to being here would become instantly valueless, and his life would be over. He would be formally labeled, “A Maker of Unhappiness”. A provider who created such customer unhappiness was not welcome anywhere. His medical acumen has no power here. He had no value anymore.

That is why so many of us physicians chose to end our lives. That pain, the daily deep seated fear and corrosive anxiety, that abandonment, that powerlessness, that lack of representation, leverage, that having nowhere else to go, that inability to take care of our families, the humiliation, the confusion for it all being wrong… that is the pain that could only end by taking our lives. No one sees this, because everyone averts their eyes when they see the smoke, lest they be next, be tainted by it, be an accessory, or be seen by the bubble as conspirators, and because we are never sure until we are there ourselves, at that last breath. Stay employed. Lose your job, lose your life. Hung by our Golden Handcuffs, literally. This dumbs down the medicine, and they get away with it, it costs the bubble no profit to lose another one, we are fungible. It creates victims, survivors, out of amazing people. As a result, there are fewer and fewer physician clinicians, the gaps filled with providers, but even they are becoming sparse. One day there will be no clinicians left, and maybe no one will notice. But the money in Ferengi Medicine is good, and that is the point of it all.

That’s when the coffee kicked in. He suddenly was aware he had arrived, not quite sure how he got there, walked into the clinic, and felt the warmth of those he worked with, those in HIS bubble within the bubble. They could not protect him, they probably wouldn’t even if they knew his suffering; they had their own issues inside the bubble. His disappearing would meet with a moment’s sadness, a momentary ripple where the finger left the bucket, and then it would be like he was never there. Some words of sadness and regret on his behalf. No injury to the bubble, so it didn’t really happen, it didn’t matter, really. Only the bubble matters. Another day in the machine, another day making someone else’s dream and desires happen on his back with no awareness nor concern of the cost to him, the actual value to the bubble he is. We are just employees, to be bouyed by corporate “vision statements” of inclusion and caring, smiling at the cheerleading as team players, all the while being excluded and ignored. The “successful” had come to terms with this, and were “happier”, but at what cost, to them, to us, to society? At this point, he just wanted to weather another day without a complaint, without scrutiny of his ability to provide happiness, to stay employed. And in that, being a good clinician really didn’t matter, in fact, it was a character flaw. He was becoming a provider, with all its damaged ambiguity, mediocrity, and isolation.

And maybe, today he didn’t kill himself, you know, for his cats.

Me and Zaphod, Zaphod and me.

Shame makes dragons of snakes.

         

Feed the Yang

I had begun to think of my life as something to avoid. It wasn’t that I was, or am, depressed; it’s just that I have tired so much of all the competition, everything is a struggle of everyone trying to win over someone else. Yet, every morning I would wake up and there it was. Unavoidable. There is, of course, the illusion of escape found in the depths of a good book, the tunnel of a good movie or TV show, my moments alone. But each and every time I would emerge and there was my life, waiting like the cool kid, leaning on the wall, sipping a soda looking at me over the top of its sunglasses as if to ask, “Wuzzup?” I sigh, shake my head at the “ineffable plan” and carry on. The kid isn’t bad, really, it just is. But with all its kind as a whole, that is where the ugliness thrives.

We imagine that life was once better. It wasn’t. It just… wasn’t. Our history is one of dark cognitive dissonance, of nonsensical juxtapositions of what we claim to be, and what we actually are. We, more specifically, are Americans, that special breed of exceptionalism in all things human, but in reality as a whole we are ugly and sordid. We are the ultimate social experiment, the wannabe melting pot that turns out to be a salad bowl with some weird fruit thrown in and something sticky at the bottom. We are the incarnation of humanity, all of its foibles, its sweetness and its rot. The magic was supposed to be that we were the ones who were going to make that okay, the beacon of humanity’s future. Despite ourselves we would agree to be better to and for one another, for all. We had a shining path illuminated for us provided by our revered Constitution and the ideals it represents, arguably the most ambitious and profound of human inventions, and though we stumbled, the Law, Justice, Equality of all peoples, no matter who or what, that was what gave us and the world faith in our better selves. But those struggles to be who we claimed to be, those terrible travesties and internecine battles, our dark and monstrous, shamefully hidden-in-the-closet history on human rights, these were the signs that we were no better than the earliest of our kind who functioned on base instincts trying to walk upright in physique and psyche. We failed to overcome our human nature. Our knuckles are calloused and abrased.

We break into two tribes, we Americans, but I imagine worldwide, one moving forward, excited, one looking back, afraid. We call these tribes Progressives and Conservatives. They are as real as mom’s apple pie. While other tribes have claimed exception, really they were and are variations of the same aria. They are not new tribes; our human nature has always been Yin and Yang, always dichotomous. Since the days of fire, stone, and caves, we have been those who felt safety was the thing, that staying in the cave, staying within our comfort zones, being afraid of what lie out there, feeling overwhelmingly powerless against our nature, and nature, taking succor in what was known, rather than what could be, and we have been those who sought to walk in the open, to walk to the other side through some darkness, to challenge the fear of claw and tooth, seeking better ways to live, love and become. These are literally Yin, and Yang.

The Yin function in environments of structure, control, dominance, and flowing through it all, fear. Fear is The Force. They operate on basal instinct, basal needs, fundamental and predictable, controllable. It’s as if the cortex never need be, notions are not tested by reason, in fact, reason jeopardizes belief, faith in dogma, order and control; it’s all brainstem, all the time. Throughout our entire history these have been the fear mongers, the Witch hunters, the Inquisitors, the controllers, the persuaders through emotion. Fear is their succor and gaslighting themselves and others maintains it. Fear gives them purpose, they exist to control their fears while, not ironically, stoking them, justifying them, and to make sure others share those fears. Safety is in group fear. They create monsters, reasons not to change, reasons not to leave the cave, or let anyone else in. They create magic and stories to assuage their fears, as they need to control their nature and the nature that surrounds them. They are afraid not just of nature out there, but of their own nature, often needing to make even their own body and its functions frightening, evil things. Their leaders are those who, for power and control, best sell the fear, uniting under shared fear. Life is staying alive. Since reason is not used to measure their world, they do not understand it, they fear it. Reason is to be feared as it illuminates fear, and without fear, the Yin is lost, and more afraid. The Dogma, the Mantra, that is where safety lived and fear held at bay. Fear is the Yin, the Yin is fear. Fear explains everything. Stay in the cave, don’t let anything in, repeat and never question the Dogma.

The Yang are the troublemakers. They are the wanderers. As toddlers they were found beyond the opening of the cave in wonder, only to be snatched back by a Yin. Always the Yin with the snatching... New is exciting, fear is a challenge, everything is a wondrous experience and the more the better. The Yang doesn’t need to understand, that may come and they seek it, but it does not slow them. They need to experience and enjoy. They die young, and often, but travel far and know much. They welcome the unknown and the unknowable, and seek to use reason, study and humanity to be better at exploring their ever better selves. Their leaders are thoughtful, reasoned, worldly, inclusive and as diverse as they are. They know the self is myriad, and that this is okay. Lack of understanding is not a reason to fear. They celebrate diversity no matter how uncomfortable because that leads to discovery and understanding, a better, more forward moving humanity. To move beyond the self they must be compassionate as they need compassion themselves to thrive, and that is the reason for life, to thrive. They appreciate the different for they recognize and revel in being different themselves. They seek chaos for its wonder, not its darkness, they find succor in letting go of what they “know” for what they can understand. These are our explorers, inventors, thinkers, writers, artists, our ruffians and scoundrels, all of the things that paint the better us! They are not fearless, but they are not fools. Reason enlightens, it propels, it empowers, it changes its mind, its way of thinking as it learns. Thought is their Force, an ever changing, ever wandering Diogenes.

But the Yin are not all joyless, the Yang not all happiness. Like all things, all is variation on the theme. But nevertheless, these paradigms serve, and they illuminate what, who and why we are today. We are, if nothing else, creatures of habit. Always, we struggle to leave the ways of the cave, and move into the light, all the while fighting off those who would snatch us back. World history, American history, Yin versus Yang. While certainly simplistic, it illuminates why we are who we are, and not who we want to be. Humanity’s base nature is Yin, our better nature is Yang. Yin keeps us alive, Yang give us reason to live.

The competition between our natures is destroying the beacon we could be to the world. From the moment we are born, Yin and Yang fight for our very souls, and these two wolves turmoil within tearing at the fabric of our psyche. Everything becomes a competition. Power and Control, in every single thing we do, say or act. Every relationship is governed by Power and Control, the Yin want it, the Yang are aggrieved of it.  As the Native American lore mythically shared, “The wolf who lives is the one you feed.”  Today, sadly, we are feeding the angry, hateful, Yin Wolf, and instead of keeping us alive, it will kill us all.

So I am tired, tired of reading, hearing, seeing the Yin versus the Yang. Tired of being snatched by the Yin, for I am Yang and I abhor their world of fear. I am tired of fear creating loathing, more fear, and death. I want fear to unite us, not to destroy it, but to explore and embrace it, to become a better us because with it. I want us to all understand we are all afraid, but that we should not be of one another. That will not always end well for us, but reason can protect. What we do with the fear differs if we feed the Yin or the Yang. Our better selves, our humanity, lies within leaving the Yin behind and making the Yang the human nature. Seek understanding rather than protection, seek progress rather than regression. Be willing to make mistakes when making someone else’s life better. Its not pie… there is more when we share. Feed the Yang.

An end to a means

The General spoke with kindness and concern to the young Captain.

"You manage with power, and control. Discipline and loyalty are fragile things, especially in times of war. You might want to explore leading and inspiring, lifting up instead of forcing down. Fear is no way to bring out the best in anyone. For in the end, if you continue in this way, you will have many wars, external, and internal, but few useful soldiers, and when you have lost, it will be for naught, for a people who do not deserve it, and you will have made it that way."

                                                                                ~  Hijikata

Practice who you want to be

Practice everyday, being the person you want to be. That is who shows up when you are most needed.

                                                                             ~ Hijikata