for my final assignment in medical school, i am instructed to write about my mission in medicine.

i’m going to just be totally disrepsectful to this whole institution. i’m going to write about how i think it’s fucked up the way people treat patients. i’m going to write about how fucked up this whole thing has been, and i’m going to just... i’m going to just, like... write some kind of something....

s▒▒ is talking about how if you pay all your loans for ten years, they wipe your balance after that. “you have to make your payments for one hundred twenty months,” she says, “and this is to incentivize people who have lots of debt to continue to pay it. [...] they said they’d comp fifteen hundred follars worth of the total loan amount. four hundred dollars for a hundred twenty months to save ffifteeen hundred and ten dollars at the end....”

that’s such ridiculous, penny-pinching bullshit. this whole institution is rotted to the core. everything about it is absolutely rotted.

i spent this whole afternoon talking to my friends about how they’re going to be in debt. one of them is considering moving in with her mom in the second year of residency.

it’s fucked up that “misssion in medicine” is even a thing they’re making us consider. there is no mission in medicine for people, bro. this shit is a scam. there’s nothing mission-driven about it anymore. the mission is to not be in debt.

s▒▒ says, “i’m gonna have to get good disability insurance.” p▒▒▒▒ already signed up for his.

“take the seven dollars out of my paycheck. i need that check to come if i can’t do my job.”

“what if i can’t afford the kind of disability insurance that would cover the situation i’m in?”

p▒▒▒▒ laughs.

if you couldn’t laugh, then you would cry.

the thing i’m saying here is that... this bird flying overhead, and all this nature... this natural world around us, the trees in the distance.... is higher education even worth it anymore? or is this shit just a scam, too? is there any way of being an american citizen that does not involve subjecting yourself to scams, fucking yourself financially, making yourself into an indentured servant, tying yourself up in debt so much so that there’s no way for you to go to greener pastures, no way to even imagine those greener pastures, because you’re stuck in environments that are so far removed from anything that is natural? it’s just concrete and metal and plastic everywhere you look. concrete, metal, plastic, wherever you look. there are no cell walls to be seen. there are only simularcra of those natural things. fake plants.

i can’t help but be disturbed by medicine itself. i hate to blame the institution of medicine for what is actually a problem with the institution of capitalism and the institution of america, but medicine has made itself so willingly blind to the follies of capitalism and america that it demands us all to ingratiate ourselves, fill out applications, get down on our knees....

s▒▒ says, “i guess this is why they want student loans to be high: so you have to participate. so you have to work eighty hours a week. you can’t borrow all this money and then... no wonder they’re so mad in that hospital. it makes more sense now. we’re sitting up there, hooting and hollering, while the residents are mad and stressed. they have to make a payment this month, and their [patient] list is not capped. they had to admit ten people today, and they can’t walk out.”

she laughs.

“ooh, it’s sick,” she continues. “ooh, it’s so sick. i’m starting to get it. they let you sign up so easily.”

“they really do,” p▒▒▒▒ says.

this really is a fucked up system, though, when you think about it. they make it so expensive and difficult that some people can’t get into medicine at all. but they make it so desirable. it’s so baked into our culture that medicine is such a noble profession. someone even said it to us in class last week: “just remember, doctoring is a noble profession.” they make us believe we’ll be heroes, and all this bullshit to get us to believe that this really is a good thing to do, that we really are alleviating suffering, that....

incidentally, that was my original “mission in medicine”: to alleviate sfuffering. in four years of med school, though, how much suffering did i really alleviate? i think most of the suffering that i alleviated was outside the walls of the hospital. while i was in there, it’s hard to say how much suffering i alleviated. but that’s not even the point anymore. i’ll just end that thought by saying that the suffering i alleviated that feels the most obvious and meaningful to me happened in environments like the theater, in friendships, in my family, in the jobs that i did over the summers, in things that were decidedly outside of the medical institution, outside of the hospital.

the hospital, for me, was always a place of heightened suffering. i always felt the suffering was at a max when i was in there. i was in the ICU listening to a woman let out dry sobs for forty-five minutes while we rounded on other patients and pretended not to hear her. i was in the OR watching a three-year-old get pinned to a table, screaming, for a tonsillectomy.

(“loan deferment for economic hardship or unemployment may no longer be available,” s▒▒ says. “forebearance is capped at nine months over a two-year period. i’m not going to fellowship. this is as far as i go. fuck that. nope.”)

tonsils the little girl was screaming as the anesthesia hit her. in the PACU, she was couldn’t cry, but you could tell it’s all she wanted to do.

i don’t give a fuck about how much suffering was alleviated by her tonsillectomy. i don’t give a fuck if you think holding people in a psych ward against their will is actually somehow better for them in the short-term, and it’s preventing them from killing themselves or harming others. i really, at this point in my medical training, don’t give a fuck about that, to be honest with you. i really just don’t care.

there is so much iatrogenic suffering we impose upon people. we, weapons of the system.

i was in the psych ward when the man dropped his vape, and i told the nurse manager—because duh, because i’m a good little boy who doesn’t want to get in trouble—and he activated every possible alarm, and he made the man strip naked and take everything out of his room, and the man started beating his head against the wall, and then security came, and a nurse injected him with thorazine, and he just had to go through it. i don’t buy it at all.

and i thank god that i didn’t go into debt to get here, that my dad made enough money selling heart catheters to get me through school, that i don’t have to become an indentured servant and give more of the best years of my life to an institution that is actively wielding its power wrongly, that is making people suffer, that is doing harm even when it says that it will do no harm.

to anyone out there who is in medicine and thinks i don’t get it or is offended by my saying these things: i’m sorry, but i don’t give a fuck. your field is trash, at least the way it is now.

why do we care so much about saving humans lives in the first place? we go to such lengths to preserve human life, polluting the earth with tons and tons of plastic waste in the process, as if we’ve all settled on the fact that human life is the best thing there is. meanwhile, there’s an ant crawling around on this fake monstera plant, likely with no idea that there’s nothing there of use to it, except maybe some of the biological materials that may have accumulated on the plastic leaf over the years.

why is medicine so noble? why do we try so hard to save these lives? does the body not have an agenda of its own that will obey or disobey the doctors according to its own whims? is it not wasteful to spend all these resources doing surgeries that we are going to have to correct in a few days? doing hernia surgery that’s going to cause adhesions inside this person’s peritoneum that are going to stick to each other and require more surgery down the line? many of the solutions we’ve come up with are so shoddy, so barbaric, so ineffectual, so full of hubris, so nonsensical.

i’m sure that i’m glad to have gotten this education, if only for a better understanding of science. since i’m going to be living in a human body among other humans whom i love, it’s nice to have a better understanding of the things that happen to humans. i’m sure that i have a better understanding and appreciation for human biology which will somehow serve me in the future in ways that i can’t predict right now. i’m sure i’m grateful for it....

but i’m not grateful to medicine in how it makes me feel bad about myself. i’m not grateful to steven canfield who would send me emails telling me i “unfortunately did not pass the hematology exam.” i told him i was depressed and had to go on an ssri, and he told me that i should actually consider studying more, because maybe that would lead to a reduction in my depression symptoms. i’m not grateful to him, at all. i’m not grateful to him, and i’m not grateful to anyone who might have suggested to me that i’m somehow the one in the wrong. i’m not grateful to mary sciutto for asking me whether i had made this decision to not do residency while in a depression. i’m not grateful to her at all for that implication. i’m actually quite resentful.

i’m also pretty resentful toward anyone who’s ever told me or implied to me that i ought to really, seriously reconsider my decision, anyone who’s ever seemed concerned and asked me, “what are you doing after med school, then?” bitch, i don’t know. i’m getting the fuck out of here.

i’m going to keep doing medicine. i still want to alleviate suffering, and i still want to do medicine, but i don’t want to do it in this fucking system that you have come up with. i don’t want to be an indentured servant to you any longer. i don’t want to give you any more of my time. i don’t want to give you antyhing the fuck else. you have already taken so much from me, and yes, i’ve freely given it to you, and yes, i’ve chosen this over and over for years, and i could’ve dropped out at any time, but you sure didn’t make it seem like a reasonable decision to leave.

i am grateful to henry weil, who told me that he would support my dropping out, and that it might be the best thing for me, and that i should just do it if that’s what i think is best for me. that’s one thing i’m grateful for.

i’m grateful to all the civilians i’ve met recently who did not respond with anything other than unerstanding when i told them that i don’t want to do medicine anymore. i have to tell you guys that all of you in the field of medicine are really disproportionately negatively impacted by my telling you that i’m not doing residency. the civilians out there really don’t give a fuck, and when they do give a fuck, it’s most often that they’re happy for me. one of my friends told her friend i’m not doing it, and she responded, "good for him."

i told a patient that i’m not doing residency. a few weeks later, when we were saying goodbye, he told me that i might be anxious, but for his part, he sees no reason for me to be so, because he believes in me, and thinks that i will do good things wherever i go.

it’s funny how i can feel so seen by indivdiuals who don’t know much about me at all, but my own classmates and mentors could find me so totally incoherent.

but as incoherent as i am to all of you, you will be as incoherent to the people outside of medicine the longer you stay in it.

i want you to keep an ear to the ground. i want you to stay among the people. i don’t want them to quiet down around you because they find you too out of reach, too far above their heads to be able to have a conversation with you in which they tell you the full and real truth. but to tell the truth, i’m not sure if there’s a way around it. i’m not sure if there’s a way for you guys to remain part of civilian life. you might be too far gone.

but me, i’m getting the fuck out of here. my mission in medicine is to get out of it and start actually doing medicine. i’m going to figure out how to do it. don’t worry about me. the main thing is don’t worry about me. don’t worry about me. i’m going to figure it out. i’m going to figure it out.

i believe in my peers, and i love you all, and i want better for you, and i trust that you’re going to be good people. i don’t know, though, if medicine is a good career. i warn you that it’s going to be really hard, and i know you know this, but i warn you that it’s going to be hard for reasons that you haven’t predicted yet. you’re going to lose access to the real world, the civilian world. people in your life are going to see you less, and they’re going to share less with you, consciously and unconsciously, if only simply because you won’t be around as much. you’re going to lose some access to the people you love.

you’re also going to lose access to your patients. a key to medicine is taking a good history, but you’re going to find that it’s impossible to get a good history from some people, and you’re going to say it’s because they’re a bad historian, but for many of them, it’s going to be because they don’t trust you, because they don’t feel that they can share anything with you, because you’re too far out of their way, because they take one look at you, and they see your nice scrubs, your chanel sneakers, your expensive watch, that glazed-over, tired look in your eyes, and they see that you’re not someone who can take their full truth. you’ll look like someone who can’t understand what they’re going through.

the ant on the fake plant is still walking around like it’s its first day on earth, which is actually not entirely unlikely. this thing is exploring this plant as if it has anything to offer it, anything at all, but i tell you what, ant, you are, right now, enrolled in a kind of samsaric hell. you’re bound in this concrete jungle, this outside back patio of these two restaurants which are merged together. you’re not going anywhere. there’s nowhere for you to go. where would you go? where could you go?

we were talking just now about how some jails have a pay-to-stay model where you have to pay upwards of sixty dollars per day for room and board. you accumulate a lot of debt while you’re in jail, cuz you can’t pay it back. sometimes they collect the money from your family. when you get out of jail, and you can’t pay it, they’ll put you in jail again for failing to pay.

the system is modeled on itself, and everything is everything. med school is jail, and then so is medicine. i wonder how many people stay in medicine not because they have a missison in it, but because their overarching mission, which has been thrust upon them, is to pay their debts.

the mission of american culture is to be financially independent, to make enough money. we’re all told that we just have to make money. that’s the primary thing we all have to do. we all have to make money. we have to!!! we have to. there’s no other choice. they give us no other choice than to make money. you have to make money. it beigns and ends with making money. no way to make money means no life in the united states.

my friends are in debt, and their beautiful human minds, which have been honed over thousands of years of evolution, are being put to the tasks of kafkaesque, bureaucratic systems which are destroying them, which have beeen created within the last century.

this is why i say that medicine is biologically disrespectful: it does not respect our biologies. it purports to tell us what is good and bad for our biologies, and then it tells us that we have to go against all these things in order to practice it. oh, it’s good to be outside? well, we pratcice medicine indoors, where you will spend most of your waking hours under fluorescent lights. oh, it’s good to sleep eight hours a day? good luck doing that in residency. there are going to be long nights. it’s what residency is famous for.

it’s good, also, to have normal, human relationships in the real world, but they become harder in medicine. there’s no time for them. and the relationships you form with patients and colleagues have rigid boundaries. there is no freedom in those relationships. you are inside a container all the time: the container of professionalism.

my mission in medicine is to keep doing medicine, but to do it outside the institution of medicine. i can’t take it anymore. medicine almost killed me. medicine made me think that suicide was a logical thing to do.

and p▒▒▒▒ just told s▒▒ that suicide is a logical answer to her debt. “if you’re not alive, you’re not in debt, and the problem goes away.”

we had a good laugh about it, but it’s not funny. it’s not funny, and it’s not acceptable that medicine, that this thing that we’re supposed to be passionate about, should put us in such dire straits that we would carefully consider suicide as a logical option. that suicide even crosses our minds while in medicine is fucking insane.

part of the reason why i decided not to do residency was because i foresaw a high risk of suicide if i were to do it. i really, genuinely believe that if i were to do residency, i would come to the conclusion, the logical conclusion, that suicide is an appropriate way out of the situation. or, if not appropriate, then at least highly logcical. because it’s true: the problems you have will go away if you are not alive.

to be so very alive, to have these brains and bodies which have been honed by thousands of years of evoltution, and to even consider the idea of suicide, is a terrible thing. i do worry about my colleagues who will be in these biologically disrespectful indentured servitude jobs for at least three years. and i’ve heard being an attending isn’t much better.

but we heard from some attendings that medicine is so meaningful to them, and they have these meaningful careers, but how much of that is just copium? how much of that is them finally being free from debt, finally being paid the big bucks at big fancy institutions, and them now being so far removed from any sense of poverty that they are now the ones who are not able to be heard or seen by their patients? they can just go on living these fancy lives, and they forget all the strife that they had to go through to get to this point, because who would want to remember something like that?

but i remember. i do remember, in this moment, here, as i approach the final day of med school. i remember the moments when i looked at the black kitchen knife in the apartment that i shared with two other classmates, and i would imagine drawing it along the length of my forearms, and i would sit on the floor of my bathroom with the shower running, trying to fill up the air with water vapor and drive out all the oxygen, and i would imagine the life escaping me.

i was so close to suicide. it seemed like a logical thing to do. it’s something i never want to consider again. so i’m getting the fuck out.

and no, i don’t know what i’m going to do instead of medicine. it will be a good start to be in a situation in life where i actually want to be alive. i think it’s a fine place to begin to make decisions.

but my mission in medicine is still the same. i am still in it for alleviateing suffering. but now i’m also in it for the destruction of the powers that be. i want to destroy this system in any way possible.

one attending asked me whether i had considered becoming a psychiatrist and changing the things that i don’t like about it from the inside. wow, what a fucking great idea, you absolute dickhead. i’m surprised i never thought of that. how could i not think of that? how did not think of it myself? you’re a genius, sir, truly. you’re an absolute genius. wow. really good job, dude. really awesome idea that i never thought of. you fucking stupid ass fucking loser. are you kidding me. i hate you. shut the fuck up, you prick. get the fuck out of my face, you fucking spineless, weak-sauce-having-ass, motherfucking bitch. shut up, dude.

i’m not going to change anything from the inside. i don’t believe in that. how can you change something like this? first of all, i don’t believe in changing it, i believe in destroying it. second of all, how can i destroy something while i’m inside of it? i would actually really like to evacuate as many people as i can... everyone, if possible... before this thing gets destroyed. and let’s be clear: this house ought to be condemned, because look at it. look at how the foundation is sinking, how the walls are threatening to cave in if the roof doesn’t do it first, how all the people inside are going to get crushed under its weight anyway, whether i do anything or not. the signs are there, right? the death rattle has started, hasn’t it? you hear it, right? i hear it. maybe i’ve got bad ears. maybe i’m having auditory hallucinations. maybe i need to get locked up, or maybe i need a cochlear implant. but i’m pretty sure that’s the death rattle i hear.

it has to get destroyed, and you can’t do it from the inside, so i’m not going to stay inside.

my mission in medicine is to get out of it. my mission in medicine is to alleviate suffering. my mission in medicine is to find ways of practicing it that don’t involve indentured servitude, that don’t involve participating in manmade horrrors beyond compreshension, that don’t involve pinning little girls to operating tables and forcing them to be unconscious, that don’t involve injecting thorazine into a guy who dropped his vape because he needed some nicotine to get through his stay in a psych ward where they don’t let you go outside.

there’s nothing about the institution of medicine as it stands now that compels me to practice in it. all you freaks have thwarted my plans to be a doctor, to use medicine as we know it to alleviate suffering.

but there is medicine in the arts. there is medicine in relationships. there is medicine in nature. there is medicine in space. there is medicine in attention. there is medicine everywhere. there is medicine in the hospital, too, but that is not the only place. and i’m not just talking about the clinic. i’m talking about the woods. i’m talking about the theater. i’m talking about the fucking coffee shop. i’m talking about playgrounds. i’m talking about the ocean, about outer space, about laboratories. i’m talking about all kinds of places, dude. i’m talking about all kinds of places.

my mission in medicine is to get to those places. my mission in medicine is to leave, because y’all are fucking sick, and this is a prison, and you gotta destroy the house from the outside.

my mission in medicine is to practice it somewhere else, somewhere people actually see me, respect me, don’t find me so incoherent, somewhere i am coherent, somewhere my coherence can be healing, somewhere that is not so much like a jail, somewhere that is not trying to scam people, somewhere that is not so very subject to the whims of capitalism and the surveillance state and professionalism and occupational psychosis.

i’m gong to the woods. that seems like a good place to start. you won’t find me, probably. but if you do, i wouldn’t mind. we can talk. but if you have any complaints about medicine and how you’re not sleeping and how the attending was mean to you and how your patient died and how you can’t do what you want to do and how blah blah blah medicine is flaweded, i will only smile and say “that must be really hard. i can imagine what you’re going through.” i won’t say i told you so.

please don’t kill yourselves, though... be patient, you will die. and i love you all. i really love all my medicine homies. but be careful, becuase this shit is a whirlpool, and it’s trying to suck you in. i wish i could tell you how many times it’s tried to suck me back in, how many times good-natured and good-intentioned people tired to convince me that i was making some mistake by getting out. i wish you knew how hard they’ve tried to hold onto me at various points in various ways, some sublte and some not at all subtle. i wish you knew how hard it was to get out at this seemingly natural stopping point so that you could imagine how difficult it’ll be to get out if you realize later that this place is the pits, if you realize that it’s as unethical and prisonlike and war-torn and disastrous and unconducive to healing as it is.

and maybe i just don’t understand. med school is hard for everyone, and it gets so much better in residency when you can actually make decisions, when you actually have responsibility, blah blah blah blah blah—i don’t buy it. i don’t buy it at all. i don’t buy that it’s going to get better.

maybe i’m naive and acting rashly. but no, this is a decision that was made far from impulsively. it was made many, many times over the course of the past two years at least. i think it’s almsot a miracle that i’ve made it this far, but ultimately i’m glad that i did make it this far, so i could say these things with my chest and not get insecure and think, “i just couldn’t handle it. med school was just too hard for me, and it’s not for everybody.”

it’s not for me, and i still was able to finish. you can’t take my fucking degree away now, bitches.