Exit Interview

Last year, I left my job at a major hospital system, where I worked as a research editor. I'd spent nearly nine years there, most of my thirties. The managing editor in the office, a veteran of the Federal Reserve research division at a time when they laid out pages on poster board and photographed them, taught me the art of editing. She shepherded me through projects that tested the limits of my stamina and patience---nights, weekends, early mornings with the sun blasting off the white and chrome favored by the campus architects. I became a professional. On breaks, we watched YouTubes of Monty Python and discussed our lives, mine anxious and matrimonial, hers filled with boomer intrigue. We laughed over the headers on random pages of the enormous American Heritage Dictionary she kept on her windowsill.

For as long as I knew him, my colleague's husband was either recovering from or experiencing heart ailments. In 2015, I watched his health decline, plateau, then decline again until he died in 2016. His chest was studded with implantable devices designed to pump, prop, pace, or shock, all of which failed at one point or another. He was alive in his bed in the intensive care unit, talking about home repair and answering my paranoid questions about asbestos removal, then he was dead in the middle of the night after a last meal of chicken wings, his heart galloping past the silent devices to the finish line.  

His healthcare at the same institution that employed us was expensive, risky, and at times inexplicably cruel and misleading. Each week brought a new doctor, a new promise, hope buoyed, then another procedure and another failure. The sediment of this anguish settled in me. His gray hair parted down the middle and combed. His cough freighted with the fluid they took off him in gallons. The boat he bought when he knew he was going to die. A honeycomb of smells. A struggling body smells honest and human and unavoidable. It's a miasma of prescriptions and altered diet and interrupted sleep, of bed baths instead of showers. His skin grew mottled, but he was still tall and mighty. His commanding voice was burnished by years of cigars and Scotch. Take her out to dinner, he said one grim afternoon in his hospital room. He flashed his credit card around the room at his adult sons, at me. 

He lived, then he died. 

In that year, my colleague lived 60. She ricocheted from promise to promise. She had no choice but to rely on a system that quickly showed itself to be indifferent to the personal and captivated by money. She drove him to the emergency room in the middle of the night. In vain, she wondered what happened in care team meetings and procedure rooms. When she asked, she got half-answers, or contradictory answers, or no answers. 

It's one thing to know academically that people get sick and die as a matter of course, as an imperative of nature or fate or otherworldly prerogative. It's another to watch it. It's another to watch a person mow his grass and grill vegetable sandwiches and drink Scotch, then walk out of a hospital freighted and hobbled, then wheel in and stay, again and again, all in a great mystery that everyone seemed prepared to prolong, but no one seemed prepared to solve. 

It's another thing to watch a system work.  

My colleague and I sat in adjoining offices and produced drafts, submissions, proofs, second proofs. The race was on to produce more papers than the hospitals that were ahead of our employer in national rankings. She taught me about column balance and bad breaks. We debated hyphen versus en. In a sweater set and scarf, black dress pants, silver jewelry he'd made, and fresh lipstick, she visited her husband. She brought him homemade meals in an insulated lunch bag. She brought him his war medals. When he was sedated, she sat with him.

I'd never thought about my jobs in any moral or political way. As someone who'd lived on her own since age 18, and had worked since age 14, I had no qualms and no shame about earning money and receiving benefits, no matter the job or what it asked of me. Jobs resulted in money and the ability to live. Once I had one, I tended to stay for years. I'd thought all a job ever asked of me was the work itself, contained at a desk or restaurant table. It certainly didn't ask me for anything insidious, such as belief or endorsement. I applied to myself the capitalist corrective that I was producing something or contributing something, even when the something was difficult to define.

I was 32, 34, then 39. I clung to a salary 5K less than I asked for and 20K less than my peers. My employer, which was also my health insurer and provider, sent me letters informing me that I was obese and needed to lose weight to receive a reasonable rate on my health insurance. A surgeon groped me in a stairwell. It was suggested the grope was something a father would do to a daughter. Any disciplinary action would have to be initiated by me.  

The MeToo movement, which hasn't yet reached high-profile medicine, reintroduced to a national audience the concept of the whisper network. But women in the workplace know about the whisper network. My former department's whisper network was broad and deep. We talked about the surgeon who threw a scalpel across an operating room. We talked about the secretary who was hounded for a date by a surgeon until she complained and was transferred across campus. We talked salary, which is the most important conversation one can have with colleagues. It is also the most verboten, violating an honor code enforced by people whose job it is to figure out how to pay the least and extract the most. 

We talked about the right-sizers who arrived in our department ready to make cuts, whose cluelessness was matched only by their eagerness. We talked about how the department head, one of the most famous and respected researchers in the world, refused to participate in the ill-conceived takeover. When the dust settled and the middle managers were hired, he was removed from the organizational chart and stripped of important responsibilities. We talked about the cheap pens that broke off in our hands and the cheap forks that broke off in our food and the cheap sutures that broke off in surgical wounds. Every Friday, we carried our office trashcans to the hallway and emptied them into an overflowing main can. Women colleagues cleaned the office kitchen and vacuumed the office floors. They also brought in their own tools and tried to fix the bathroom sink so the department wouldn't be charged for a service call. One afternoon, we wrote on the kitchen cleaning sign-up sheet, "Waiting for a man to sign up!"

Revenues lifted into the billions. Patient volume was high, with plans to double it in five years. Traffic snarled around the main entrance. Elevators were full. People clutched sacks of pill bottles. They trailed catheters and cannulae, and smelled of cigarettes and alcohol and sickness and death. It's one thing to know, academically, about sickness and death. It's another to experience it and smell its brutal odor. 

Experience erodes naivete and ignorance. It can make us radical, if radical means facing the fact that sacred systems are perversely incentivized and corrupt, and in need of overhaul. It shows us the pressure of systems on people. Experience shows us how years of conventions and niceties and compliance accumulate into a plaque. It casts a long, cold shadow over the thousands of private cowardices we've indulged and the bargains we've made. It gives us the gifts of doubt and skepticism. It may show us the way out.

First, we talk. By talking, we divest from shame and other conspiracies. We become acquainted with others like us, so we don't feel so atomized and powerless. We also become acquainted with the kinds of people for whom the talking, not the wrong itself, is the wrong. The kinds who privilege allegiance or non-disclosure, which are ultimately about power. By talking, we glimpse real and subversive freedom. 

Last March, I came back from California and turned in my resignation. My new boss reacted with alarm, speculating that I'd been recruited to a rival hospital system. On my last day, I came home to a gift basket from him and a note thanking me and wishing me the best. I wrote him back, but I didn't say what I wanted to say.