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May 19, 2023·edited May 19, 2023Liked by R. G. Miga

My father and his wife are both teachers. Well, my dad is retired as of 2021--gritted his teeth through a year of distance learning and cashed out his PERS just in the nick of time, because by all accounts working conditions for educators are abysmal in 2023. On top of the perennial difficulties of low pay and crushing administrative pressure, the kids are completely checked out: oversexed and undersocialized and basically divorced from the idea of education as anything more than daytime childcare. The heavy egregore of "school" as an inevitability for all young people has been broken over the last couple of years; these kids have peeked through the veil to experience an unstructured adolescence in the 21st century, and they came back to report that it's all just Pornhub and the same four walls around you, all day, every single day, for weeks months years on end...

Another anecdote. In a small tourist town in New Hampshire, I worked at a coffee shop frequented every single day by one of the town's only EMTs. He'd been on the job for 20 years or more, and by the time I knew him he was a fascinating combination of truly dedicated to saving lives, and generally disdainful of the lives he was saving. Suppose that's what happens when every fifth call you respond to is from one of the same two dozen people, overdosing on heroin (again) or nursing bruises from their POS boyfriend (again). Craig could map entire family trees by dysfunction and saw the diseased roots popping up everywhere, locally and in the world at large. As far as he was concerned, most people are too stupid and self-destructive to deserve to live--and yet there he was nonetheless, sipping on a peppermint tea every afternoon, on call to attend to the worst day of someone else's life. I would call it inspirational, but there's something troubling about the idea that acts of altruism can be set atop such a deep bed of resentment.

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sounds familiar... my parents had some stories from the fire service. not them—they were unfailingly kind. but the lifers in the company would, for example, shout at the (granted, drunk) victim of a (self-inflicted) rollover who was pinned under the car in the mud (uninjured, thankfully) to "shut the fuck up" if they wanted to be rescued. seems like empathy is the first casualty of mechanized care: the people doing the work can't perform the technical parts of the job *and* stay emotionally invested in their patients, because too many can't be saved.

i wonder what the number of healers per capita is, on average, in traditional cultures that have resisted the incursions of Western medicine? i bet it's much higher, which means less grief carried by the same shoulders. probably also fewer opportunities to be physically or emotionally maimed in pre-industrial societies too.

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I see so often people referring to how far they live from a hospital and how quickly they can get care. Is this some sort of fear of death or something?

Like the closeness of a hospital dictates where they live.

I find it very curious

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i think it's a combination of learned helplessness plus overestimating how effective modern medicine is.

like so many other parts of our culture (art, science, religion, etc.) we've internalized the idea that regular people aren't capable of performing *any* healing or emergency care on their own—that it's only a job for credentialed experts. and so you get people who are completely incapable of self-diagnosing or performing even the most basic first aid, because (in their mind) they're not qualified. one of the reasons why the local EMTs are stretched so thin is because the college kids will call an ambulance for trifling stuff like a fever—and once they call, they can't be denied care, even if somebody else calls in a genuine emergency.

the other factor is thinking that modern medicine can perform miracles, and that's harder to let go of. i have two young kids; i'm fairly competent with first aid and home care, because my family is all medical professionals and first responders. if one of my kids breaks a bone or gets a bad cut, i have the skills and the tools to patch it up until we can get them to a doctor. but it will still take all my restraint not to blaze a burning path up to the emergency room because i know they can make the problem go away immediately: they've got the good drugs and the doctors and the stuff to help my kid stop crying RIGHT NOW.

even if the whole system is shoddy and unreliable—and occasionally outright harmful—as long as there's a chance that you might be the one to win that golden ticket, it's really, really hard to choose self-reliance over institutionalized dependence.

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That’s awesome that you’ve got all those medical skills, that’ll come in handy. But yeah it’s always hard to do it on your own screaming child!

When I came to the Philippines I was also surprised at how the ER was pretty much used for everything. Before that, I’d never been to an ER, even getting hit by a car I got taken to a doctors surgery and had to sit in the waiting room for my appointment time!!

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