On hierarchy

One of the things that really bothered me when I was working in the public hospital system is the pronounced (and revered) hierarchy of the medical industry. In short, it is what people call “top heavy”. If you’ve ever read ‘The House of God’ by Samuel Shem, even if you know nothing about it from personal experience, you’ll realise that this is a universal system of our industry. There’s an almighty, infallible boss at the top of the pyramid who ‘makes the big bucks’ and has his name attached to the patients “in his care” – even though he may not even be aware of these patient’s existence. Then there’s the half-bosses, charged with making all the hard decisions and often physically doing some of the too-hard things. He makes reasonable money, and you see him once or twice a day, but he also rarely sleeps. Then there’s the minions, working for scraps of money, working for almost every minute of every workday, being dealt all sorts of unpredictable tasks, and who is for the majority of the time a secretary with a medical degree.

If a scenario came up where the minion has just walked across a desert fighting off bullets and helping out injured civilians; he is met at the difficult battles by the half-boss who takes an armoured vehicle from one hard battle to the next (but driving by the lesser battles); and they are met at base camp in an air-conditioned shelter by their godly boss who has been driven in by chauffeured limousine from his 5-star hotel only seconds ago – who do you think will be offered a chair and a cold glass of water? Not the dehydrated, wounded minion with blisters on his feet. No. The boss will take the chair and the glass of water and not even thank anyone for it – he is the boss, apparently he deserves it more than the others.  And that’s life. That is not just the medical industry or the military, it is probably most industries! And that is why I had to get out of the public hospital system.

There’s also another story I don’t often tell about my experiences in the hospital system, and it is related to the above concept, but also about a certain type of discrimination. See, another thing about working in a hierarchy is that you have to respect and worship the hierarchy. You have to! Otherwise how are you ever going to make it to the top if you don’t play by the hierarchy’s rules, worshipping the people above you for their pity, grace, and reward? This is where I went wrong. My mistake was choosing to be honest, and choosing to be true to my own convictions. My mistake was also to be born flawed – but I’ll get to that later.

I was working in a team that was just like any other hierarchy I just described. I was a minion, of course. One day, through no fault of my own, I got sick and couldn’t come in to work. Oh my mistake! I received a reprimand from a (half) boss for staying home sick – how dare I?! But my mistake went even further than that. My mistake was that I refused to kiss ass, or to apologize for being human, to give an excuse or apology for being unwell that day. And I told the boss quite clearly that I would not apologize for being sick. So began my downfall. The next day when I arrived at work I was “kindly invited” to a surprise evaluation of my performance, a discussion led by my boss before a panel of hospital “Gods”. Oh, what a terrible worker I was! Late in the mornings, slow, lazy, absent on so MANY occasions, time-waster, friendly with too many other staff members, too well-like by administration and ward staff, etc. etc. I guess you can’t really say “she’s an insolent b*tch who won’t kiss my ass like she should” so you have to phrase it differently, even if slanderously.

I was then politely asked my opinion to his allegations. Needless to say, I was speechless. One day I am away sick at home, and the next - without warning – I am asked in a panel if I dare to contradict the guy who grades my assessment and who can end my career right then and there if he chooses to. Yep, seven years of university training, a $70,000 student debt, and a lifetime of passionate pursuit of this career on the balance. I kept quite. Even if I could speak, I’d had no time to prepare my defence (aka, stating the truth correctly). In my silence, the man hearing the case, summarised my case based on what was said about me. Clearly I was ALWAYS late to work. Clearly I had TOO MANY days off sick. Clearly I LACKED ENTHUSIASM for my job and my team. Clearly I was SLOW. Clearly I was LAZY. Clearly it meant I was WASTING TIME becoming friends with the people I worked with every day. Clearly I was guilty, because the boss who is higher up in the hierarchy than me said so. I then made only one comment; I said “it sounds like you’ve already made up your mind”. Yes, yes, the panel had. Never mind the fact that I had been working on this team for over 3-4 months with no complaint made about me, that no complaint had ever been made of my performance ever, and that these statements were great generalisations of that one time I was away sick. Was it a coincidence that all these allegations came to light from the man I had apparently disobeyed by being human and being sick, and that they came to light the day after I had refused to kiss his ass? Apparently so.

But before the panel “discussion” was over, one final point was raised. Was it not true that I suffered what is commonly called depression? After all, this can lead to increased work absenteeism, to tardiness, to lack of enthusiasm, to general slowing down… Oh, this is when I lost it! Talk about discrimination – and coming from the same profession that should be advocating against this type of prejudice. It didn’t matter that the things that I was accused of in an act of spite, of revenge, to put me in my place, to hurt me, were false; what mattered was that I had a condition which obviously must apparently make the allegations true. And I lost it because you can’t wash these things off. Did I not suffer depression? Yes. ‘Well, then that must mean that you are slow and lazy and unenthusiastic and take a lot of days off work…’ The only thing getting in the way of that theory was that these allegations weren’t true in the first place. And I was completely symptom-free at the time this all happened. But I couldn’t say no; that would be a lie. It was to me like being asked “isn’t is true that your skin is brown?” or “isn’t it true that you’re Latin?” or “isn’t it true that your native language is Spanish?” But I won’t be ashamed of my skin or my culture or my language, I wouldn’t deny them. It seemed to me at that point that in this world it is politically incorrect to be racist, but not so to discriminate against those with a history of mental illness.

I must admit I have had times where I wish my defect was in my skin or in a spot I could just have surgically repaired and then be on my way. It’s not that easy. If you have a mole on your face that everyone stares at when they look at you, it makes you uneasy. But at least you can have that removed and be more appeasing to those that are superficial and judgemental. What so many people wouldn’t give for a solution that easy.

On being sad

I’ve been reading Fyodor Dostoevsky’s ‘The Brother Karamazov’, and having read a few others of his works I came to question the moods often associated with depression. You see, in his books I’ve always found a character that is just simply a miserable man, a man that is also spiteful despite the fact he is also often the protagonist.

“I am a spiteful man”, one story begins. Here we meet a man that is sad, miserable, unhappy. He wants for nothing because he has already accepted he is a miserable man. He has a job, he knows people, he does ‘things’. He’s not an outcast or necessarily a strange man. In fact there are probably a lot of people who feel just like him. He was sad, yes. But why? I always wondered why, but I now am starting to realise ‘how could he not be?’ I think the answer to this question lies not in looking at what he had (a job, friends, etc.), but what he didn’t have. Where was his purpose? Where was his passion? Where was his love? Where was his self-pride and self-efficacy? And who if not himself could he blame for lacking these things? You have to hate the man who deprives you of these things – and so comes the self-loathing.

In one of my most recent episodes of “depressive” thoughts I was asked why did I not seek adequate treatment once and for all. And pondering this question, I had to remember the spiteful man of Dostoevsky’s stories. Why was his misery untreatable? Because it was a matter of the human condition, not of an illness, per se. (Note, I am not making a general statement about the existence of the illness we call depression, but rather about a personal reflection based on my own experience.) And so what is a man like Dostoevsky’s protagonist to seek treatment for? “Depression”? Or the fact that so many aspects of his life are not yet in place? I remember a quote from ‘The Manual of The Warrior of Light’ by Paulo Coelho: “By now, millions of people will have given up. They don't get angry, they don't weep, they don't do anything; they merely wait for time to pass. They have lost the ability to react. You, however, are sad. That proves that your soul is still alive”. Sometimes I think a bigger sin than being sad is to not be sad at lacking that which enriches life: love, company, passion, freedom, activity, purpose, peace…

Why am I sad? Because I have a mental illness, or because my life is not yet like it should be? Don’t get me wrong, I have many things in my Iife I am very grateful for and I have had many achievements… But instead of telling you what I am lacking, let me tell you of what I am now achieving, how I am “curing” my state. I have found the love of my life and I am planning a family with children. I work a job that I don’t hate. My passion is writing, even this humble blog. And I have finally stopped being afraid of being judged for being myself. I am learning resilience, building my self-efficacy, and I take the responsibility for my own emotions. What I still lack IS worthy of my dissatisfaction. But what I have is worthy of so much joy.

-I used to think I was cyclothymic. Turns out I may just be human.

On skin

I was sitting in with a dermatologist one day learning about skin conditions of the type that are severe enough to make it into hospital. Before I went in to sit with him (as an observer) I had to wait out in the waiting room with his patients. I noticed a red man there with lots of fine scale on his blue work shirt and around his chair. There was also an older lady who I could not discern anything of note from where I was sitting. Then I went in to the dermatologist’s room to sit in the corner as any good medical student.

The man I had seen in the waiting room came in. He was quite animated and greeted both me and the specialist with a handshake and a big smile on his face. He was having another flare up of his psoriasis because he had been working out on a roof (he was a painter, I believe) and didn’t wear his usual long-sleeve shirt that in the Brisbane summer is only best described as torture. He was bright red (beyond what I had learnt the word erythema meant) and was shedding layers of skin everywhere, even as he talked and sat. He had come in his work clothes and he offered to remove it so that I, the medical student, could see and learn just how bad psoriasis can get. He was not a bit embarrassed, and he thought he owed to show me at least the worst spots of the disease, which extended literally from his feet to his face. After his treatment was sorted out and different work strategies were discussed to prevent such frequent exacerbations, he left with a smile even bigger than the one he came in with. The dermatologist explained to me afterwards that he was an extreme example, that he was the worst even he had seen, and that the man was remarkable to continue on with his employment and in such great spirits. I must admit, until that day, I had never even seen any psoriasis at all except in books – and that was not ‘typical’.

The second patient we saw was the other lady I had seen out in the waiting room. She came in, sat down, pulled her skirt up above her knees, and started crying. There were two small psoriatic plaques on her knees, about 4cm long by 1cm wide. The plaques were raised and had some scaly skin on top. There was no redness. This was devastating to her because this was the second or so time this had happened to her in the last four years. One knee, two small spots, and not inflamed. She apologized for having to show us such “disgusting” things that were on her knees; she was clearly embarrassed. The dermatologist treated her as if he had not just seen actually bad psoriasis and tried to dissipate her concerns and offer medical therapy for her skin. I was stunned to see how incredibly emotional she was and how humiliated she seemed to be!

One day I was out walking with a friend and she was telling me how she had always struggled to feel comfortable in her skin because she had a skin condition since she was very young. I had of course noted her skin appearance, but it had never occurred to me that she felt self-conscious about it. She told me how she imagined people thought of her because of her skin. They might think she is unhygienic and her skin is disgusting, that she is ugly and possibly ‘retarded’ or suffering some greater disorder. She said she imagined people would speak of her and comment on how ugly and disgusting she looked, and they would laugh and make fun of her. Just then a group of adolescents with skateboards went past us and were laughing amongst themselves. She said episodes like that made her think it was her they were laughing at. I felt at that moment not pity for her for having a skin condition, but rather offended as a human being not of what she thought people said of her, but what she thought of us, us people other than her.

I had one question to ask her: what did she think when she saw a person with a skin condition like hers? Did she think they were ugly and disgusting? Would she laugh and mock them? She responded no, of course not! I asked her then if she was special, was there something about her that meant she was a good person and the rest of humanity were judgemental, spiteful human beings? She said no, she wasn’t special. Of course she would never think she was special, her problem was one of low self-esteem not a heightened arrogant one! Well, I said, if she is not special and she would never think that way of anyone, what made her think anyone else would think that of her? Here she was accusing strangers, others, of being spiteful, judgmental, arrogant people with vicious mocking thoughts in their minds. Freud called it projecting, the act of ascribing to other attitudes and feelings you personally have. I believe no medical condition, handicap, special ability, money, or other advantage or disadvantage entitles you to cast judgement on other human beings!

There’s an early movie by Pedro Almodóvar called ‘Dark Habits’ in which a group of nuns take on the names such as Sister Manure, Sister Rat, Sister Damned, and Sister Snake. The aim is to humiliate themselves and remind people how even the “good” ones of us are despicable; they believe that “man will not be saved until he realizes he is the most despicable being ever created”. By the end of the film all the nuns have become either prostitutes, drug addicts, drug dealers, and other such “sinners” befitting of their adopted names. At the end, a higher-order cleric visits them to shut their order down and reminds them that sometimes “humility” can be the worst kind of arrogance when you wear it for a badge. Nothing that attracts pity entitles you to act carelessly or exonerates you from being responsible for what you say or do.

On the rules

One day I told someone that I was struggling because there was something that I really wanted to do but that I didn’t do simply because it goes against my religious beliefs. And it wasn’t a fleeting desire, either; no, it was actually a very deeply-seated desire that penetrated and marked me to the core of my being. But, yes, I had a system that I lived my life by and it is religion. People often quote this feature of religion as being one of the “bad” things about it. It’s so restrictive. It rules people’s lives and is a great evil. But everyone lives their lives with at least some rules. Some are there to protect the ego, others to protect our survival, others to keep us out of jail, others to protect our conscience, etc. But every rule serves to protect something – and we all, even the most free-spirited ones of us, obey some sort of rule or rule system. My rule system is basically Christianity.

The friend I told how I was struggling with this feeling I had but had to hide because of my religious system gave me some advice: change or leave my religion. Of course! Why didn’t I think of that?! In fact I had thought of that, but before I tell you about that, let me tell you about something else I really really wanted to do one day.

I was at a restaurant once and this woman pushed me as she walked past. I was furious! I wanted to pull this lady back and pull her hair, punch her in the face, and kick her in the guts. I felt an energy surge through me, it was so strong. My expression changed to one of absolute spite for this woman, so much so that the people around me noticed my anger. They told me to let it go and move on. Someone moved in between me and the woman so I wouldn’t make a sudden lunge towards her. I thought to myself, “Move on?! Let it go? But I feel this feeling so intensely, so deeply, so in my core.” I let it go, though. Do you know why? Because there are rules in society, and even if I don't agree with them, they still apply to me as a member of society. Of course one can always break the rules and accept the consequences of doing so.

This incident is not the only time I've really wanted to hurt someone, nor am I the only human being who has ever had this desire. We have all wanted to hurt someone for even minor spites like being cut off by another car while you’re driving, being spoken to in a rude and impolite way, seeing someone purposely abuse an animal or someone who is weaker than them, etc. All these things can irritate a person and the human instinct may kick in to react with violence to serve our own ‘justice’. Now, should you? It's something you want so why should you have to resist? Because it's against the law? Because it's against social norms? Because it would be morally “bad”? Because it’s against your religion? But none of these norms and rules were devised by yourself, so why should you comply? Do you see what I’m getting at?

I rejected my friend’s suggestion that I change religions because I don't think everything in life should be solved this way. I think this attitude of always having things your way, if not changing your environment (the physical environment/religion/political party/professional membership, etc.) comes from our society's new rules of the self as deity. Our religions, the object of our worship, have become ourselves. We worship by seeking to maximize our personal pleasure and meeting all our desires – often at the expense of... ‘whatever it takes’. And what is wrong with that religion? Nothing. But our religions are not the only rules we face in our lives. Sure you can punch that guy who pushed in front of you in line at the cinema, or you can steal that item you really want from the shop, etc. but you’ll still have to face the consequences of doing so. That’s just how life is, with every rule comes a consequence.

I’ll tell you now how I overcame my struggle. No, I didn’t change religions just so I could obey my desires. I still believe in everything I ever did about Christianity. I didn’t suddenly lose the burning desires I once had. No. The only thing I changed was I accepted the consequences. There are some things that are worth the consequences.

Only God can judge me.

J