occupation

preface

this post discusses the destruction of the self and also blood. it reflects on death as well. it's a little bit visceral. be warned thusly.

I worry that any of this will sound like hyperbole this particular time, that I am being poetic and loose with truth to cultivate a feeling. I think I'm worried about not being taken seriously when I say that some of the things I want to tell you in this post are hard for me. they are physically and psychologically difficult things. I worry that it'll seem as though I want sympathy. I just want understanding. I just want to spend a little time telling you about the things I scarcely talk about. it's not as though any of this is unusual for me, so I'll be okay. but part of sharing my eyes with you means sharing a couple things I normally reserve for my private experiences in life: work and bad impulses.

these things are embarrassing for me to talk about, but because of this, I must. otherwise, I lack completeness. I'm not as eager for everyone to read this one as I normally am with my more typical reflections, so I'll probably share it less widely. but if you choose to read this, thank you for taking the time to understand me.

occupation

there is a necessary death or stifling of empathy that must take place to sustainably perform this work. when the work is slow, it is easy and easier yet to ignore the truth of it and breeze through it without issue. I spend my downtime, when it is abundant, reading, learning new things, working on my website, and writing.

when it's busy, when it's overwhelming, it's harder to avoid. I push myself to go faster while maintaining precision. I am objectively good at my job. still, I feel the pressure. on days like these, when I talk to my coworkers, I'll remark that it feels like everyone's trying to die.

I don't mean it like that, but then, some of them literally are. yet another order for acetylcysteine comes through – an antidote for tylenol overdose. most are dying for other reasons. rocuronium, a paralytic drug, for an incredibly young ICU patient. epinephrine again and again and again for patients barely hanging in there, hardcore immunosuppressants, antibiotic after antibiotic.

I'm writing to you on one such day. to tell you the truth, it has taken me several hours and multiple sittings to get this far. I already know everything I want to say, and still I know I likely won't finish writing this until I'm on the bus home.

I work in an incredibly consequential yet largely invisible and opaque profession. the work culture is self-reinforcing in this. hospital pharmacy, especially as a technician, is not the profession for glory or accolade – these things belong to the nurses, certainly, and especially to the doctors, every last one of whom I've met has been astoundingly arrogant and operating on some other plane than that of reality. to even discuss my job in detail at all, let alone write about it, feels wrong. compartmentalization is an important factor in my professional life. when I get off work and my girlfriend asks how my day was, all I expect I'll tell her is, "hectic and busy, it was pretty stressful." she's very sweet and will likely offer to lend an ear so I can talk about it, and I'll always decline to go into detail about it.

I make the drugs that keep patients alive in a hospital cleanroom. the stakes are high. I must take great care with my movements inside the hood (whether LAFW or BSC) to prevent contamination in the preparation of sterile products. failure to do so could lead to an infection in a patient who is likely already in a critical or immunocompromised position, and it would not even be clear where it came from to the patient or the nurses or the doctors or even us.

everything is very carefully measured. failure to do so could underdose or overdose the patient. both can have catastrophic results. if I fuck up in my job, it could kill someone. it could kill someone in the emergency department or the victim of a horrific car accident or a cancer patient or a baby. this is why I have to compartmentalize. this is the job for meticulous checking and double checking and triple checking by someone else, and some days, it is unspeakably stressful.

it is nearly obsessive work. it has to be. there is a caricature of the pharmacists and the techs that lives in the minds of the nurses and MDs and surgeons and so on. one that paints us as the idiotic, incompetent, and stingy gatekeepers to lifesaving medication, always on the lookout for some kind of "gotcha" to keep them from saving lives.

what they don't see fuels their own arrogance. providers have rocks for brains and will try to place morphine orders for NICU patients that are four times the maximum allowable dose for newborns. this, even after all the safeguards in place that should prevent them from being able to submit an order like that in the first place. this is far from hyperbole. this kind of thing is an almost daily occurrence because, in their reasoning, "pharmacy will catch it." to them, we are stupid and pointless, and yet we are also miraculously diligent, capable, and responsible, an ultimately convenient scapegoat.

telling you this is cathartic. I am almost eager to erase this all because, even telling you the truth of the matter, it is heavily ingrained in the work culture that these are internal conversations. discussing the problems in pharmacy with outsiders feels cringe. I wish I had a more eloquent way to describe that emotion, but quite honestly, that seems to be the prevalent feeling in this field. it's embarrassing to discuss our struggles because enough of us have internalized what they think of us at least a little bit. we work tirelessly to be sure everything is correct, and still we feel that we are not entitled to recognition or something better than what we have.

and yet, myself and everyone I know with the same license is at least a little passionate about it and will eagerly explain at length all the horrible ways the materials we handle could grievously harm you. it's derived from the precise midpoint between professional interest, suspected or confirmed neurodivergence, and a sick sense of humor. I have a tremendous depth of specialized knowledge about this line of work that I never allow myself to share with others because we just... don't talk about it. a favorite pastime of mine in my field is when we'll regale each other with scary stories about the chemotherapy drugs we handle, like cytotoxic doxorubicin burns or the apparently routine nightmare of accidental intrathecal vincristine administration and its resulting ascending paralysis until death.

anyway, today was busy. it wore through me until a hole opened up in my head, which continued to spread down my neck to my heart, and after a detour to the right side of my body, continued to my stomach and legs until every last bit of me was burned up like sacrificial paper. I'm trying not to think about our patients because once you do – once you acknowledge what's happening to them, how you and your attention to detail is personally responsible for saving lives from illness and medical malpractice, how even after all that, there is still a chance that the patient will die from the severity of their sickness or wounds or from negligence in the nursing unit or from something else entirely – you can't come back from that.

not in a day, anyway. skip this paragraph if you can't handle thinking about sick kids. some of my coworkers have expressed this sentiment about the NICU, especially. how their heart breaks for sick babies. here, "sick baby" means something else. all babies in the NICU are sick. but the ones we call sick are at a point where they are receiving very many drugs to keep them alive every hour of the day. fentanyl, gentamicin, heparin, hypertonic saline, sodium and potassium acetate, vecuronium (another paralytic) - more and more and more. the same patient names come in day after day until one day they don't, and sometimes you hear about when it's gone wrong, but you never really know what happens to anyone unless they get so sick they need hospitalization again. it's true of the kids and the adults alike.

there are some things you shoulder and don't complain about. they're so full of barbs that it'll just hurt the ones around you, and they'll look at you with big sad eyes and tell you that you can cry if you need to. on days like today, sometimes I will. I'll break down inside the cleanroom, and I'll cry while making the third high dose of epinephrine in an hour for a patient that they're desperately trying to keep alive. just long enough for their family to arrive from out of state so they can say goodbye.

on days like these, I just say work was hard. what else can I say? my loved ones, if I were to tell them that's my work life, would be worried. by the time I'm home, I'm just tired. I'll let it be my occupation, but I don't let it occupy my heart. I simply have too many other things to do.

you have the bag

an account from work on code response

You have The Bag.

Inside The Bag are lifesaving medications. You are the only one who has it. The bell sounds. They may not need it. They probably do. 11th floor. You are in the basement. The consequences of sauntering are that the patient may die a frightening death being crowded by twenty people frantically doing whatever they can to revive them. There is no room or time to consider these kinds of things. There is only your capability.

You have The Bag. The emergency pager guides you to the floor and room number. There is no room for other thoughts. Run a city block through the underground tunnels. 11th floor. You are in the basement. The elevators are not in service. This again. You've done this before, and the 9th floor almost killed you. You arrived triumphant, set the bag down, and collapsed.

You have The Bag. You have willpower. You won't let it happen like that again. Your legs become weak at floor 3. You are pushing yourself if you continue to run up stairs two at a time. You look up again. Floor 5. You briefly consider how much farther there is to go, but there is no room for this thought. One stair at a time, it's straining you and you're already forgetting. It's less of a run and more of a march.

Floor 7. There is no running left in your body. This is where your body began to give out last time. You fought so desperately last time. You cannot afford to stand still for a moment, the weakness begins to overtake your legs if you do. If you do not maintain forward momentum, you will slow down fast. With an oil leak, the engine will continue to run for an unpredictable amount of time before it seizes. You consider trying to get an elevator here, but if everyone else is running up stairs, they probably can't get one either.

Somewhere between 7 and 8 and 9, as you slide up the handrail, rounding corner after corner after corner, up and up and up, you begin to notice it. Other than the continued weakness, the noise. Not the noise above you that you've heard since floor 5, the thundering footsteps of countless others scrambling upstairs from higher floors.

None are as determined as you. It's demoralizing, how much more energy they seem to have. Thunder overhead. Not that noise. The inaudible whine in the background. That one. Something's coming, something's rising. It's terrible, whatever it is. You have to get there before it gets too loud. It pulses with your breaths.

Floor 9. You understand what the term "ragged breathing" means. The beat of your heart is the beat of the world. Bam bam bam bam. The whine in the background, rising and rising. 9. 10. Fuck. 11.

You are on flat ground now. Solid ground. You cannot stop. You won't make it if you do. You arrive and drop the bag. You fiddle with your mask but you dropped the attempt at staying masked somewhere around floor 2 or 3.

Gasp. Gasp. Gasp. Whine. Gasp. It's not enough.

The patient is unresponsive. They cart him down the hall to take him to the neuro ICU.

It's not enough. If you'd been faster, would it have been enough? Did I commit the sin of arrogance? Is someone dying because I wouldn't let someone else do this? You can't think about it. You cannot think about that. You can't start thinking like that.

Gasp. Gasp. Gasp. Gasp.

annihilation

in romance, I will love you with my entire heart. and I could be the most comfortable and secure I've ever felt in my life, and I will still want to destroy myself.

you can tell me about the horrors of your past and I tell mine, and we'll fiddle with dry autumn leaves while affirming that it doesn't have to be terrible anymore. but the feeling grows, something that makes me imagine about how nice it would be to recreate every awful thing that has happened to us both. don't you want to feel it again? don't you take comfort in knowing I could destroy you too? that I could watch you break yourself down, and that you could see me at the very worst I've ever been myself as well? don't you want to understand it viscerally?

I don't really want that. but I dream about it. it calls out to me like the smell of nicotine. if I ever started smoking, I would instantly become addicted and I know this with absolute certainty because I love the smell and the taste and it doesn't get old. I weakly told my ex that I didn't like when it smoked, and not with my usual conviction because I selfishly wanted to taste nicotine in its mouth every time I kissed it. I want you when you're destroying yourself. I want to destroy myself too.

I feel guilty that I didn't push harder against it, as though whether it smoked or not was my choice to make anyway. if I saw you giving into old bad habits you've worked so hard to break, my heart would shatter and I'd do anything to keep you from it. a part of me is learning how to surrender to your helping hand when you see me begin to slip, rather than pushing it away and accelerating headfirst into a brick wall. this all feels so natural, so comfortable, so right... don't you want to ruin it with me and prove that the world is cold and suffocating, and that strength through brute force of will must be the only answer to the struggles of the world? don't you want to keep each other from getting better?

goodness. in any lifetime, I want nothing but the very best for you. regardless of where it leaves me, I want to see you grow and improve and be your best self. it pains and distresses me to imagine a world where you're still suffering.

I am driven by a selfish curiosity, one that is productive towards this idea I have for myself of completeness of being. I want to experience everything. I have suffered and loved so much. there are many things I do that are ill-advised and dangerous, but very few I have ever done unintentionally. I want pleasure, I want pain, I want boredom and overstimulation and satisfaction and certainty and confusion and ambivalence.

I am so thoroughly in love with life that even if I hate something, I will very likely love it a little. I crave novelty and am willing to go to extreme lengths for it. so long as it does not violate my morals or values or seem too boring for me, I want it. in an instant, I'll romanticize your fingers tracing shapes in the palm of my hand just as much as I will slipping on ice and stunning myself on the cold, winter asphalt. every single thing reminds me I'm alive. when you read my observations, how I love every piece of the world, that's why.

some things, like cooking for others, I return to again and again. I'd do it every day of my life in the right conditions. I tell myself I'll try most things twice, and some things I can tell I don't want again after experiencing only once. even still, I'll dream about experiencing it again in a different light.

this can mean some pretty extreme things. as a teenager, myself and other curious boys would simulate kidnapping and torture because we were curious about what it would be like. it resulted in some mild post traumatic stress that has since subsided. I am thankful that I experienced a horrific car accident where I narrowly avoided a certain death alone off the side of a cliff. it was a terrible experience I never wish to repeat and I think it makes me more complete as a person. one of the most painful things I ever experienced was scarification via skin removal and I'd do it again in a heartbeat.

I will never say that I explore anything through kink, even if that's what some of them could be perceived as being - breathplay, impact, restraints, blood, whatever. I don't find any of these things physically pleasurable and I do not delight in getting hurt in the typical masochist experience. I'm not doing kink. I'm doing something else.

what it is, exactly, does not have a convenient name, but one of its significant constituent parts is curiosity. don't you want to know what drowning feels like? don't you want to know what it's like to have your face covered in blood? don't you want to know what going to this nice restaurant is like? with and without an embarrassing piece of clothing?

this is an abnormal experience of the world, if only slightly. most people don't want these things and would be surprised to hear them. some psychology freak would probably attempt to categorize these things as resulting from my trauma or a maladaptation to my mental illnesses, but the truth is, I've always been like this. I can rightly see its origins in my drive to satisfy my curiosity.

however, there is a parallel drive intertwined – its sister, my drive for annihilation. it's not exactly a drive to destroy myself, but it's close. it's there because I've been through such terrible and extreme things that I know that I can take it. I was able to do it once (or more), often outside of my control – what else can this body do? how far can it be pushed?

it is not an easy thing to categorize as a poison thought and dismiss. it is the upper bound of one of the things that is so recognizable to who I am as a person. it's my curiosity taken to its extreme and is inextricable from it, hedged in only by my morals and the guilt that would result from causing harm to come to others around me. aren't you curious about what it would be like if you destroyed yourself, growing more and more distant until you're alone again?

I'm not. not anymore. I don't want annihilation. I'm tired of it, and honestly, now I'm more curious about the other boundaries of the human experience.