Psychologically Surviving Working in the Managerial State 2019-now

As a doc who has worked for many years in a highly government regulated medical institution I feel I am in a good position to comment on this

Something changed over the last five years of my nearly 20 years on the job.

Beforehand, working at a large hospital system, I had normally just left my politics at the door, and while my leftist colleagues could more freely and publicly indulge in occasional mild displays of political mania over LGBTQ stuff, racial stuff, etc., I figured that was just the way things were - mostly these highly performative, self-indulgent displays of virtue were brief, bounded around holiday observances (e.g., MLK Day, Harvey Milk Day, Cesar Chavez, etc.), so they were pretty harmless. Occasionally rolled my eyes at but didn’t really think about it much. Such is living and working in a bland, center-left managerialist bureaucracy, right?

Prior to 2019, I could mostly just focus on working alongside my local team of folks (nursing, allied health professionals, etc.) whom I at times regarded like a bit of an informal extended family, a ragtag group of clinical geriatrics problem solvers. Sure, the regulatory strictures of working in a nursing home are always annoying and ponderous, we have topheavy administration, the documentation headaches are always bad and getting worse, etc. - it’s all a pain but the cost of doing business.

I have always had my own politics. Socially liberal in the classical sense of the term, philosophically for much smaller government, high respect for individual rights, freedom of speech, equality under the law, government out of our bedrooms and etc. - and fiscally conservative.

My modus opporandi prior to 2019 - as a libertarianish, conservative-ish white, straight male professional working in a politically dark blue area I simply survived by being a political cypher at work and in social gatherings. I largely didn’t talk politics except to occasionally mouth token agreement when my views occasionally overlapped those of my progressive colleagues or supervisors.

Mask Off Moment in 2019

Then 2019 happened - what I like to call The Coropanic - when the whole world turned upside down and was encouraged to go utterly insane, and as far as my nursing home, my workplace was concerned - it functioned like a neutron bomb. My workplace - the sanctuary for me, the nursing and interprofessional staff I work with, and most importantly, my residents - was utterly savaged. It was no longer safe.

This was horrific for families, residents, and caregivers - the “window visits” forced on demented, dying residents. This went on for months.

Cruel window visits, mandated masks, banning families, banning congregate dining, the push to turn staff into psychological torture specialists, all for the aim of “defeating a virus,” or, when that clearly turned out to be an absurd goal, for the aim of “getting everyone vaccinated.” Of course this turned out to be a cruel lie, a savage joke - after our residents got vaccinated, these absurd restrictions continued on for a year or more, and some even persist now.

2020 “Mostly Peaceful” Summer of Floyd

Right alongside Coronapanic, the COVID mania - there is the “diversity, equity and inclusion” (DEI) mania which pushed into medicine and medical care that was catalyzed by the massive, NGO-swarm¹ funded street riots during the “Summer of Floyd” in 2020.

I’ve noticed my students, my trainees are increasingly indoctrinated into woke ideology. Clinicians are now to be on the lookout for “trauma” caused by “microaggressions” or "unconscious bias,” and even “white supremacy” and “capitalism.” We’ve being encouraged to be on the lookout for “cisheteronormativity” in our elderly nursing home patients and my colleagues have been pressured for the last several years to engage in strange, off-putting rituals like pronouns in email signatures. I’m considering not having trainees anymore. They seem almost dangerous to have around.

Even CMS (Centers for Medicare and Medicaid Services) has gotten on board, signalling they have had plans to rejigger their payment and “quality metrics” to favor “equity.”

Yes, it is bad - just read this fact sheet, it is full of all of the awful buzzwords like “birthing people,” “gender identity,” and is overall appears to be a blueprint for how to refashion the gargantuan CMS monetary spigot into a gigantic woke indentarian medical patronage system.²

How have I Kept my Sanity?

going crazy person holding head yelling with eyes closed

It’s crazy making for many to be put in this position. So what do other people do?

Some people accommodate living in an insane society by becoming insane themselves.

floyd riots looting burning

I will be honest, when the George Floyd racialized moral panic of 2020 - engineered by a rare moment of unified, top-down narrative coordination via social media censorship, legacy journalistic monomania, and terrified into being via mass violence, looting, and burning in the streets occurred, and the lexicon and strange illogic of DEI, “systemic racism,” “white privilege” and “white supremacy” became the zeitgeist, I found myself briefly, successfully cowed into a moment of questioning my basic powers of rational thought and even sanity.³ This option - of becoming insane to accommodate insanity - is by far the worst option.

What I have learned is that I am now a “stealthy infiltrator.” It’s not something I wanted to be, or intended to be. I just want to be left alone to do my work, to take care of residents and patients. To solve clinical problems. That’s it.

I recommend you all hop over to

John Carter

’s Substack and read his essay titled “The Blitzkrieg Through the Institutions,” which touches on what it’s like to be, well, me (and perhaps you, or someone you love). A great quote that really spoke to me:

The psychological demands of stealthy infiltration are spiritually toxic. Anyone attempting this path finds himself embedded in a social context in which all of his friends and colleagues adhere to values which he privately despises, and moreover, he knows that the instant they discover his true beliefs he will be not only fired, but ostracized and isolated. Worse, he’s constantly placed in the position of betraying his own convictions, of going along with and even actively supporting things he knows are wrong, because failing to do so would be immediately suspicious. Since the left is a hive mind, he must ‘pretend’ to give up his agency ... and insofar as you are what you do, there is very little difference between pretending to give up your agency, and actually doing giving it up. Living like this is miserable. It requires iron discipline, and there is very little reward. Some of you doubtless have direct experience of this.

As a coping mechanism, as you all know, I’ve developed my online persona of “GeroDoc,” where I engage in lengthy philosophical expositions here on Substack (and simply just vent and rant on Elon Musks X). Then I put my generic mask of bland, white guy professional at work, put my head down, and blend in as a “stealthy infiltrator.”

It’s a very schizophrenic existence. Not, obviously, in the sense of psychosis - as in hearing voices or seeing things - but literally as in “split minded.”

I look forward to the day when I can simply be me at work - and when work stops being a place for ideological manias of any kind.

When I’m not required to wear a mask and simply sit blankly through institutionally-sanctioned ideological struggle sessions and tolerate open ideologically-polluted, performative screeds from fellow colleagues about white privilege, cisheteronormativity, DEI, and anti-capitalism.

Or to tolerate in silence the irrational, scientifically illiterate, panicked ritual nonsense that passed for public health during the Coronpanic.

It’s going to take time. It’s going take work. It’s going to be a long fight.

Let’s do it.

1. USAID

2. I’m assuming this absurd and monstrous looking “health equity” CMS blueprint is largely on ice for now due to the incoming Trump administration. But it’s horrible, & it’s scary to see how close we got to having this all become permanent.

3. I am proud to say I have never for a second thought in any serious way that “trans women are women,” or that morbidly obese people can be “healthy at any size.”