The other day, the front page of my city’s local newspaper had an article in it called Big Brother Is Watching. The hospital that I work at featured prominently. The communications people there (and there’s a misnomer for you) are monitoring our communications, and if we say unfavourable things about them, we are to be disciplined.
I read this thing once that said the only way you can write something approximating the real truth is by writing fiction. I read memoirs, and the only ones that are any good are brutally honest, and the only ones that are brutally honest are when the narrator is the sole survivor of some horrific thing. Everyone else is dead, or it’s a scandal of epic proportions and the person has been stripped of all dignity. She has nothing at all to lose since everyone knows the public details of the shame right down to the brand of stain remover she used to try to remove the semen stain from her dress.
The heroes in these memoirs are divorced, widowed, fired or wrongfully imprisoned. Most importantly they are usually unemployed, if not unemployable. Horrific things make for gripping reading, but that’s not the only reason these memoirs grip you. It’s because they are free to be true. It is the pure raw truth of it that holds you in its thrall. You could make someone’s ordinary life a best seller too, if only you had some way of making it that truthful. But you can’t, because you need the witnesses dead, so you can speak ill of them. If they aren’t actually dead they will soon be dead to you if you are writing anything awful about them. And you will be writing awful things because it’s the truth. Everyone has an awful side to them. They don’t call it the awful truth for nothing.
I like to read mom memoirs too. But there’s a reason why all those mommy blogs are about toddlers. They have to stop writing as soon as their kids can read. There’s this huge gap in the momoir genre. Unless something horrific happens, like, say your kid is in one of those schools for criminally insane children in Utah, and even then, you don’t dare write a word, because they might get out one day. You hope they will. If, say, they are trafficked out into a polygamous cult and meet a tragic and sticky end, well, then you can write away. You don’t hope for that. So, you can’t write about your own real life.
The main barriers to writing the truth come in the form of witnesses. If the writer-to-be is the actual perpetrator, they, of course, have almost no incentive to reveal themselves. If the writer-to-be is a victim, they are often afraid of retaliation. So a great many awful things carry on happening in plain sight of many people. It is The Emperor Has No Clothes On and He is Now in Charge of the Maternity System. No one can speak of it, unless you want to be divorced, exiled or never employed by anyone ever.
In his book Feral, author George Monbiot writes that we have been conditioned to have a benign view of farming because of the stories and rhymes of our childhood. Remember those story book farms with exactly one pig, one horse, one cow and one duckie swimming in a little pond? The horrors of the slaughterhouse, the cruelty of factory farming; those things were never depicted in those books. Later, we put two and two together: Farmer Brown’s friends were in those the meat packs in the supermarket. The farmers in turn, point their finger of shut-the-hell-up shame at us to distract us from the pile of entrails in the corner over there. They don’t want us to be vegans.
We’ve probably been conditioned to have a kinder regard of medicine than it deserves too. A similar set of circumstances conspires to shape our early views of it. The play doctor kits, storybooks and soap operas are practically developmentally staged favourable views of the medical profession. Later, it’s self-interest and self-preservation that keeps you from examining things too closely. We give up the best years of our lives for medicine and to find out it is based on any word of a lie is painful.
There’s something else that prevents us from truthfulness. People can get hurt by lies but they can also be hurt by the truth. Mothers know this. They have fed a great many mother’s day breakfasts, lovingly prepared, to the family dog. I read this thing about how people with Asperger’s do actually read the things that you write on the internet about people with Asperger’s. Patients read what we write and I like my patients. Colleagues read what we write and I like my colleagues. Flawed and twisted they may be, I like them a lot. They are a pain in the neck to work with just like people with Asperger’s are a pain to live with. But then, people, in general, are a pain to live with. It makes sense that they are a pain to work with too. And a pain to look after as patients. Life is a pain.
You can take painkillers, or antidepressants, alcohol, and, if you can get it, a smidgen of cocaine, for that. But life in general has no medical cure. We all know how it ends. Palliative care for life comes in the form of reading poetry and literature and in writing things down. I have done this almost my whole life but I only found out recently that this is a thing. There are actual prescription books, “novel cures”, and emergency poetry….things you read for the treatment of actual conditions. You can have bibliotherapy, which is exactly like chemotherapy, without the side effects.
If I was talented enough to write fiction, I’d write about a middle aged obstetrician, who has a disabled son. She’d have hair greying in an attractive way, which she wouldn’t dye because she’s paradoxically quite crunchy. Just to be clear, she’s not me, you can tell because she weighs five kilograms less, she’s a little taller, and has better teeth. She would have more energy than I have too. In the night, when not on call, instead of lying in a state of sweaty anxious exhaustion, she’d be doing research, at the university, trying to find help for her son, which is to say, help for herself, which is to say, the meaning of life.
She is failing on every count. It is ever thus, half-finished projects litter her life. She needs to pick one cause but there are too many things of too much importance and she is paralyzed. In addition to the above mentioned tasks, she wants to dismantle the system that conspires against mothers, but she finds that it’s snowballing out of control from its own weight. It has scooped her up, surrounding her in deep swathes of snow, her arms and legs are soon the only things sticking out as it rolls down, down, down, dead leaves and twigs stick to the surface like medicalization and iatrogenisis stick to the practice of obstetrics.
Like so many problems, the trouble is in the naming. The trouble is that good people stand by and say nothing, while so many emperors remain unclothed. In obstetrics, in workplaces everywhere, it’s no wonder. Have you ever tried to speak with your mouth stuffed with snow? We are trapped and silenced. We cannot speak the truth. She, our hero, especially, cannot.
She can’t lose her job because her disabled son will depend on her for his whole life.
I am a first year resident. My job is to assist, to write the post op orders, and to dictate the notes. Today, I am assisting one of the staff doctors at a caesarean section for breech presentation. The surgeon makes the first cut, parting the skin over the fat and underlying fibrous rectus sheath and so he begins the decent down to the uterus from the abdominal wall. He reflects the bladder, and cuts into the uterine muscle. But what’s this? We are supposed to be seeing the baby’s bottom, this is what they call the “indication” for surgery, as if it’s a signal, a sign, a pointing finger, the marching orders to the operating room. You draw that breech card and you are not passing go. You are not collecting 200 dollars. The baby is head first. The surgery has been done for nothing. The doctor swears, just loudly enough for me to hear. The rest of the surgery proceeds in silence. At the end of the case, he says “I’ll dictate this”. I wonder what he is going to say.
I read the note later.
Pre op diagnosis: Unstable lie tending to breech
At least the lying part was true.