Notes from the end of the year/world, waiting for the next one

Happy New Year’s Eve Friends. Here are 5 notes of varying lengths.

(content warning: art with body parts)

1.     O winter solstice

            This long night, this longest night on the eve of empire. How are we? Is it strange to end the sun cycle in deep winter? Perhaps so everything may be reset from the deadest dead, including the post-Henry Kissinger era.

            This is the best of times and the worst of times and the same of times.

2.     New Year’s Resolutions

My toxic trait is that I am both an avid fan of get-rich quick schemes, ruthless ambition, productivity hacks, fad diets—and simultaneously an anarcho-socialist anticapitalist feminist immersed in critiques of the underlying insane individualistic capitalism that drives these cultural impulses.

Nailed Bread on display next to Philip Corner’s Piano Bed (1999) at the Museum of Contemporary Art, Zagreb, 2010. Photo: Goran Vranić From

3.     Reflecting on Writing and Not Writing

On NYE December 31, 2015 I was on call. I had gone out with friends. Staying up a little past midnight before work at 630am the next day seemed reasonable. I was paged every 90 minutes the whole night. There was a suspected meningococcal case in the ED. They couldn’t get the lumbar puncture. The ED attending was demanding I call the IR attending who refused to come in to do the lumbar puncture until the following morning. I felt bad for the ED attending who did not ask to manage a potential meningococcal outbreak crisis on NYE. But mostly I felt bad for myself because omg.

I was 33 years old. Five months beforehand, I had moved from Oakland, California to New Haven, Connecticut. By December, I was in a profound depression, probably because the sun was setting at 3pm, I worked 80+hour-weeks and uninterrupted sleep was rare.

On Jan 1, 2017, I had slept very little and had 25+ highly complex patients to round on. Instead of shoving lunch down my gullet in front of a nasty crumb-filled hospital computer in some gray workroom cave, I went to the sunny second floor of the North Tower of Yale New Haven Hospital, staring at the insane two story waterfall structure installed with donor money (likely contaminated with aspergillus, despite a tower full of patients with no immune systems).

Sacred anger: Giotto’s fresco cycle at the Scrovegni Chapel, completed 1305

Gulping black hospital coffee the consistency of crude oil, I scribbled ferociously a torrent of run-ons (grammar and spelling sic.):

“…exhorting myself to remember. Remember this feeling of violation, of perpetual beeping and buzzing thru the night for idiotic questions…This rage that a system would treat its workers so… that these mentors of mine I admired so much could not be benign forces to be complicit in such a system. And the little fearful piece of me that tells me to be a good soldier just follow orders until the next promotion until I am free don’t cause ripples just get your letter of rec and get out and oh the RAGE at this abusive relationship with medicine the sacrifice the diligence the years of disrespect and infantilization of feeling other and constrained of alienating my family… My body has de-structured, become misshapen, hunched up, with perpetual sinus drainage and distressing rashes Ratty and exhausted, my spirits depleted, chronically dysthymic with the somatizide body aches of anyone who is submissive and stolkhomed. Medicine owns me. It pays me but for what? I lost the romance long ago. This fractured capitalistic bullshit that devours everything. I thought ID would save me [?!] but all day I attend to the sequelae of iatrogenic mishaps.

“Today is the…first day of a New Year the half way point of this brutal 1^st year of fellowship. But I need to remember how terrible this feels. How angry I am how mistreated I feel. Is that right? Of course I will feel better after rest, sleep, travel. But is it ok? The last several years I have been deeply unhappy in medicine and in work. Doesn’t that mean something? Has it been worth it? …Surely if I have learned anything in this decade+ of medical training it is that death and disability lurk ever near. What is the meaning of my time here?”

Life did not get better after 2017. It got much worse, then got better, then I tried to make peace with life being waves until your particular wave ends. But as far as insane rants in one’s diary goes, that one did feel like a turning point, it felt resolved.

I would do what I want within the constraints I had. I could figure it out, it was a puzzle to solve, like any complicated diabetic foot infection treatment or the insane complex operation procedures of a breast pump. I unfortunatley didn’t know what I wanted, having systematically deadened my interior life to endure medical training. But I eventually knew I wanted to write more. I have since made this true, mostly. Initially writing was clinical research. It was not optimal, but served me well, sharpening my writing, analysis, and institutional navigation. By the time protests of George Floyd had come and gone, despite loving the people, I loathed academia qua institution and was out.

So the puzzle continued. Money, time, attention, a room of one’s own; turned over and over in an endless midlife crisis Rubiks cube. However done I felt with medicine, its loans were not done with me (lol). I am now stranded in the Midwest in some bizarre bourgeois finger trap of academic job market and the economics of California real estate. It is a guilded finger trap, but I’m still ready for the out.

Writing more generally presented dangerous similar traps as academia and medicine. Literary writing and journalism unfold like any other bourgeois career: ever accumulating gold stars, counting the coin of the prestige apparatus, maneuvering the institutions of traditional media and writing-academia. Except even more competitive and less material coin. It has been a long road undoing the trauma-driven immigrant striver mentality. There are finite and infinite games. Art is an infinite game: there is no winning, there is only finding a way to keep playing.

It is a perpetual experiment. In 2023 I am deeply grateful for progress. I have foremost built writing community. This has meant guidance from art coach Beth Pickens and writing coach and editor David O’Neill (both are amazing). I took an amazing monsters in writing class from Chloe N. Clark. I love my writing group (shout out Friday Night Writes!) and my St. Louis fellow ID doctor writers Jason Burnham and Uchenna Ikediobi; the astonishing School of the Alternative community (now accepting applications!); my truly astounding and gorgeous Kenyon Review nonfiction cohort and Grace Talusan who led us. Thanks to my brilliant and talented sister, sister-in-law, friends and cousins who patiently listened to my schemes. And fine, also my also brilliant cousin and brother for making fun of the schemes (yes I am starting a podcast, shut up).

There was output too. This year I got three bylines and 1 research paper published. I second authorered with the amazing Joy Liu on HCW flow at Medscape Today. I wrote a piece about the electronic health record, Obama and tech bureaucracy for Logic(s) (it is a worthy subscription, but unpaywalled article here). The third small piece is technically not out yet, but forthcoming in the next issue of Drift. I read 16 books and countless journals, magazines, articles and tweets. I posted some tiktoks (ugh). I completed my first television pilot which was very hard to write and was kind of bad (lol). I wrote and submitted a book proposal, which was also kind of bad, but has potential to be good. I attempted to get 50 rejections: 37 attempts, 24 rejections, 8 acceptances, the rest floating in the ether of possibility.

I wanted more more more, but that doesn’t always make sense. I am still really mad a lot of the time. I still have several weeks of overnight call this year. I am grateful to my past self for telling my future self to remember what it felt like and to claw back an inner life.

4.     Reflections on medicine and work

            In the last 5 years I have worked as fellow then faculty in prestigious academic medical centers; a flourishing private practice run by savvy business-women of color; a locums agency; and now a queer HIV primary care/STI prevention nonprofit. I have interviewed for clinical trial units of major pharmaceutical companies, psychedelic medicine start-ups, CVS corporate, and niche medical education tech firms; these I have turned down, or was turned down by, or we walked away with mutual distaste. I have been a paid speaker, writer, and consultant. I have developed curricula, taught classes, published research papers and ephemera for little to no pay. I have tried to get rich quick but it has gone slowly. I launched a business for which the revenue source and business model are still—an open question, let’s say. It has been a wild ride.

            I don’t like this uncertainty. My career goal has long not been medicine or research or writing or even getting rich. It has been finding a stable niche in middle class America so I could just live my life. Hustle and chaos is for first generation immigrant life, my assignment was to ground that shit and have weekends off. That has not been working out.

            My sense of betrayal by the dream of the middle class is shared widely. My rage about it is also targeted widely, but especially honed at academia/medicine, because that is where my formative adulthood was incubated, and where I regretfully poured my secular spiritual dedication. It isn’t that hypocrisy was not always apparent, it’s just that accumulating events (motherhood, pandemic, unrelenting colonial crisis, the complete dystopic breakdown of the healthcare industry) made it so nakedly undeniable, until the fracture was complete.  

            And yet. Despite my cynicism and rage at this dysfunctional hellscape of American healthcare industry, constantly rubbing my nose in its callousness as both a worker and a patient—I don’t hate it?

            Let me try to say it from a differently. Sometimes I am so mad at myself for failing to have the imagination to have dedicated myself to something I truly loved – philosophy, writing, art, science, some life of the mind full of interiority and creativity. Or! Some easy sell-out job so I could have hobbies! Sometimes I excoriate myself for relenting to parental pressure, class anxiety, material anxiety, feminine acculturation to pleasing, not being born into the ruling class, being foolishly misled by nonprofits and academia who extracted my labor and passion for so cheap.

            But then. When I am deep in intellectual work trying to make sense of what is around me, I am so crushed by the cruelty of empire, of the nonsensical destructive frenzy of our civilization, the blood and bones that underly the western intellectual tradition in which was immersed…I was never going to be able to be only an intellectual, never the artifice of the “art monster.” Most people can’t! Most people give and receive love and care work. I have dreamt and desired my children, but still bemoan how they consume all my energy and how isolated I feel in the work of motherhood. And yet: the daily work of their care was the deeply grounding thing in all the social chaos. Unlike the institution, they loved me back; not in an ego feeding way, but in that we were connected, bidirectionally. The solidarity of parenting has deepened my connection to my partner, friends, family and strangers.

Art Monster, unknown source

And medicine: I love healthcare workers. The nature of the work requires a concreteness, a different kind of problem solving from research or literary writing. And sometimes you need concreteness! You need to show up somewhere with people who are recognize things need to be done and we will do them, even if it’s weird and hard. Sometimes you need to chop wood and carry water, dress wounds, hold sorrow, and cure some gonorrhea. I’m not saying we the HCW are not sometimes incompetent nor as cruel as the system in which we work. But HCW are also often competent and reliable. My colleagues call-out bullshit. They say they will do a thing; then they do the thing! When shit is scary and horrific, not only will they stand their ground and face the scary shit, they will develop a protocol for it. When institutional America abandoned everyone in the pandemic, workers had each other’s backs. I do not know if I would have had the courage of the healthcare workers in Gaza, but I know those people, they are by my side all the time. These are people who run towards fires, probably for reasons we should address in therapy, but they also know what they are doing! The intellectual work is necessary to understand how this impulse is exploited, but the concrete work of care and maintenance: sometimes you need to just do something useful for someone else (and know they will do the same for you).

Engraving from Anatomia Uteri Humani Gravidi Tabulis Illustrata (The Anatomy of the Human Gravid Uterus Exhibited in Figures), 1774, William Hunter (author) and Jan van Riemsdyk (artist)

This is not unique to health care workers. In Solnit’s book about Hurricane Katrina and the flooding of New Orleans, she makes an argument that fundamentally, people are actually helpful, especially in crisis. She documents how hundreds of boats from all over the gulf showed up for rescue, but were stopped. She describes extensive evidence that people were sharing food, electricity, care, but the only narrative the media repeated was about looting, which was rare and (retrospectively) extensively fabricated. But cooperation is threatening to the status quo of the ruling class. Why buy a lawn mower for each house if a neighborhood shares one? How to justify building a highly militarized police without convincing people they must be protected from each other, instead of protecting ruling class’s hoarded property from the rightfully angry people?  

Healthcare remains one of the few spaces in the US where such work, solidarity, pragmatism and rigor is for care (vs the military) and in which some workers can hope for at least middle class salary (as opposed to parenting, caring for elders, childcare, teaching, social work). And so: it has been devastating to watch our literal colleagues in Gaza, who have worked by our side in American hospitals and universities, get bombed, disappeared and tortured. They bombed and tortured the journalists, writers, poets and scholars too. And: I have hope because is is also healthcare workers (and the writers, artists, jouranlists) who organized in solidarity. My colleagues, the doctors, nurses, social workers, have all been organizing, teleconferencing, meeting, advocating, sending supplies, marching. Hell, my own representative Cori Bush, one of the first to say the right thing, is one of us, a nurse.

            It is only possible for me to do everything: to do, think, feel, connect. That’s most people!

From exhibit, Of Care and Destruction link

5.     I have a new planner.

This is critical. Let’s exert control on the uncontrollable.

Happy New Year! Long live doing our best in imagining a better future while surviving the present! Long live navigating joy and abundance outside of the current regime’s learned helplessness! Long live facing history and future with clarity and courage! Long live us—not just in survival, but in defiance and flourishing.