misery is confusing

victim-blaming vs. system-blaming at the "local" "non-profit" obstetric hospital.

whatsup my fellow healthcare serfs

i’m back at the obstetrics hospital for my OB anesthesia rotation this month, and it would be weird if you didn't already know that because of how frequently I lament my current situation at this hell-on-earth place

so I’ve been thinking a lot about why I hate it so much and pray on its downfall any 15 second opening I get.

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what I've realized over almost 4 years of residency is that it's sometimes really hard to understand what you're actually feeling about certain things:

“Do I hate medicine, or do I hate being a resident?”

“Do I hate being a resident, or do I hate waking up at 5am and working 60 hours a week?”

“Do I hate anesthesia, or do I hate the manner in which it's commonly practiced?”

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Nothing in my 4 years has exhibited more clearly the nature of what I call "factory medicine" than this obstetrics hospital. 15 triage bays, 22 labor & delivery (L&D) rooms, 6 ICU beds, a massive antepartum unit, and 5 operating rooms with 4-8 scheduled C-sections/ECVs every weekday – not to mention (among other things) all the regular ORs one floor upstairs, the numerous unplanned emergency C-sections that throw off the rest of the day, and the endless “difficult” IV access consults from people who quite frankly as trained healthcare professionals should know how to do this by now.¹

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Before this month started, I was absolutely dreading being back here; I had already done 2 months here as a PGY-2, which to this day involved some of the worst days at work i’d ever had. non-stop exhausting 12 hour shifts, difficult patients and family situations, flipping back-and-forth between days and nights multiple times during the week, never knowing the date or day of the week (although it really didn’t matter), trying not to fall asleep at the wheel on the drive home after an overnight (this actually happened once), eating a lot of shitty mcdonalds breakfast before crawling in bed at 7am praying that a lawnmower, my neighbor’s bitch-ass mf dog, or a thundering city bus wouldn’t wake me up 2 hours later… you get the idea.

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but being back here as a senior resident with a little more wisdom and experience allowed me to better compartmentalize and identify the actual reasons why I despise being at this place – because although it's a wildly busy service where some days I don't get to sit down for nearly 7 or 8 consecutive hours, or i don’t get to eat lunch, or a difficult patient says an extremely hurtful thing in the heat of a tenuous period, there are also a lot of moments i find myself feeling rewarded for hard work and genuine effort.

and what i realized is very simple:

the reason i don’t like the OB hospital is not because i work longer hours than anywhere else; not because of the ridiculous shift changes that render me a zombified, robotic entity; not because of the chaotic nature and sometimes difficult patient population of obstetric anesthesia.

the reason is because almost everyone that works at this place is 100% grade-A certified M I S E R A B L E.

the triage/L&D nurses? miserable.

the OB residents and attendings? miserable.

the scrub techs? miserable.

the support staff? miserable.

environmental services workers? miserable.

this is not meant to place blame on these workers - it’s meant to paint an accurate picture of this place as a lifeless shell devoid of hope, autonomy, or solidarity. the degree of alienation of these workers displays the blatant joyless, mechanical nature of healthcare labor (ha ha OB, labor, lol it’s a medical joke lmao haha) at this hospital, and it sickens me to my core. everyone is an overworked and underpaid automaton, a master of emotional labor, a husk of a human expected to work at a speed and efficiency of 12/10 at all times with minimal support.

and to top it all off, it’s all steered by the capitalist logic of socialized production and privatized accumulation (which i’ve previously referred to as the Administrative-Executive Apparatus, or “AEA”) that…

• refuses to appropriately staff the L&D floor;

• prefers hyperexploitation of chronically burnt out/morally injured healthcare workers with an absolutely insane turnover rate;

• and chooses untenable staffing ratios which disallows healthcare workers from actually having the time to connect with patients;

…over a safe, healthy working environment where decisions are made not by the faceless names in top-level executive suites who prioritize profits, but by the people who actually perform the labor involved in taking care of patients and prioritize good healthcare outcomes.

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i’ve said this a lot, but i think it’d be appropriate to repeat it here:

it’s okay to be annoyed with the people you work with. you’re not expected to like everyone you interact with.

this is the difference between friends and comrades. not all friends are your comrades, and not all comrades are your friends.

• friends are people you like, people you bond with, people you choose to spend time and create memories with. this is a relationship called, well, friendship.

• comrades are people with overlapping interests that you unite with against common enemies. this is a relationship called solidarity.

• friendship with your fellow workers isn’t necessary. solidarity with your fellow workers, however, is.

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so considering all this, i realized that hey - i actually don’t hate OB anesthesia. in fact, being back reminded me how much i enjoy doing epidurals and spinals, how much i really like talking to patients and easing their anxieties during a stat C-section for prolonged decels, how much satisfaction i get out of a CSE that sets up beautifully and quickly relieves the patient’s pain who’s 9.5cm dilated and about ready to start pushing…

what i do hate is the philosophy of medical practice in the united states that has been almost entirely molded by the hegemonic structures of racial capitalism, the “professionalism” inherent in academia in the context of the rise of the professional-managerial (sub)class, and the shadowy march of internal colonialism and domestic imperialism that overwhelmingly targets BIPOC, neurodiversity, gender and sexual minorities, the undocumented, and the disabled. what i hate is a healthcare system that has been commodified to an unrecognizable degree vis-a-vis healthcare provision and finance in other countries, while still being more expensive and producing worse outcomes. what i hate is a care-work sector that has created a depressed, anxious, alienated, and indebted workforce that has forgotten why they pursued a career in caring for people in the first place. and what i hate is healthcare, an essential human need, that has been transformed into a money-making racket to the benefit of a small group of shareholders, investors, executives, private equity psychopaths, and landowners, and to the detriment of healthcare workers and patients everywhere.

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so the next time you want to blame your coworkers for the horrifying material conditions that are outside of both your and their control - imposed on us all by a powerful ruling class of wealthy owners and the politicians they’ve captured - consider the following:

all workers deserve respect at the place where they spend most of their time and make their living.

all workers deserve proper remuneration for the effort they give.

all workers deserve an adequate amount of rest, leisure, and idleness for the time they sacrifice.

all workers deserve the ability to make decisions democratically and feel like a co-creator, not a cog.

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people are probably going through similar things you are.

people are almost always just doing their best despite their circumstances.

and people don’t deserve to work at a place like this.

it can be different.

healthcare can be different.

let’s make it different.

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solidarity.

-fidel

1. this is not one of those “that’s not my job” sentiments, which i truly can’t stand - i still love putting in IVs, and i enjoy making my coworkers’ days a little less hectic. it’s just that it’s another time-burden on our already incredibly busy service, and if the designated “IV team” is allowed to just give up and call anesthesia after routinely and daily failing to place IVs multiple times on multiple patients who oftentimes have what we in the business call “PIPES” all along their BL upper extremities, then something is wrong and should be reevaluated.