The Bug II
On burnout, emotional fatigue, and chitin in healthcare
The first medication which starts the process of a medication abortion is called mifepristone. The function of mifepristone is to stop your body from producing a growth hormone called progesterone. Once you take this medication the pregnancy stops getting bigger.
Do you ever imagine that you’re speaking into a mirror?
That is the bug clicking its mandibles together. The sensation makes my skin crawl.
The way you explain this– ten times a day, maybe more. Forty hours a week, maybe more. Have you thought of what you’d like to hear, if you were on the other side of the mirror? Why do you do this in the first place?
You know, Kafka was none too clever.1 I know what you are. You are no existential mirror to my inner self; you nasty hateful thing. Your pseudo-existence is a medical phenomenon called hallucination. I’m only tired. I type and delete a few words in the patient’s chart.
The mandibles and keyboard rise in a discordant cacophony, which causes the medical record to blur. My eyes grow dry, but the bug refuses to blink. It stares, horrid and pixelated through each hexagonal lens. Somatic delusion, the bug supplies unhelpfully. Compound eyes surely take some getting used to. The computer screen freezes, and I am left to tap the mouse impatiently while the woman before me clasps her hands.
I am not a bug. The second medication is a set of four pills called misoprostol. This medication will soften and open your cervix and cause your uterus to contract which will expel the pregnancy. In this way, a medication abortion is very similar to a miscarriage.
I see– you are speaking into a mirror. Clinical and efficient, I can appreciate that. But there is a flaw to this methodology– you have become desensitized to the topic. None of your patients are really a mirror, you know. You sound a little cold.
I dislike the bug’s puerile psychoanalysis. What, now you’re a Freudian slip too? Pick a metaphor, for Chrissake.
The bug ignores me and prattles on. Narcissus once stared into his own reflection until he fell in and drowned. You’re being incredibly selfish, actually, speaking to yourself through her. Luckily for you, I’ve developed superhydrophobicity. We won’t become waterlogged. Carry on, Narcissus!2
I rather think myself more akin to the Lady of Shalott,3 I say, disgruntled.
Poor you! The bugs trills, Tirra, lirra, tirra, lirra! in a mocking tone and wobbles to and fro at the periphery of the desk. Hah! Just as I thought. You won’t look beyond the mirror, will you? Lady Shalott is rolling in her grave– you’re either a coward, or a narcissist. Are you scared to look away from the reflection or do you simply not want to? Be honest now; there’s no use lying to yourself.
I don’t dignify the bug with an answer. Some women start experiencing bleeding and cramping within one hour of taking misoprostol. Most women are bleeding and cramping by the fourth hour. Most women pass the pregnancy between six to eight hours after taking misoprostol.
I’m beginning to understand you better, the bug says thoughtfully. Here, look at my pretty wings– how twitchy and delicate for fleeing before things get too close! And look at my pixelated eyes– so numerous and compact for seeing only what I need!
You are ugly, I sneer.
The lens of my eyes and the membrane of my wings are both made of chitin– which is translucent but not clear, like a smudged mirror. Chitin is generally impermeable to the usual solvents including tears.
You cannot cry, you heartless little beast.
No, we cannot, agrees the bug. You and I are chitinous all over. You won’t look beyond the mirror because you can’t. Plight of insects, I’m afraid.
I will squish you, I warn. The bug only stares. You will know you have passed the pregnancy by feel. Most women experience fifteen to thirty minutes of very intense cramping and bleeding, then sudden relief.
The bug sighs with longsuffering. ‘Who hasn’t ever wondered, am I a bug or is this what it means to be a person?’4
You are a Philistine, you wearisome little pest. Did you really think that your bastardization of Lispector would sway me?
I thought you might find it poetic, the bug crawls nauseatingly in an irregular shape, apparently with nothing better to do.
If it has been over twenty-four hours since you took misoprostol and you have not experienced any relief, that could mean the abortion was not completed, so please call us. If it has been over twenty-four hours since you took misoprostol and you have not experienced anything, little to no bleeding and cramping, that could mean it didn’t work, so please call us.
She’s nearly in tears, says the bug needlessly. Say something kind, now, go on. But quickly– so many more just like her, waiting for hours on plastic chairs.
I sit for hours in a plastic chair! My throat hurts and is dry from talking without cease. I know this may be overwhelming. Do you have any questions so far?
“Yeah will God hate me?”
Answer her question yourself. Why do I always have to vouch for you? But god doesn’t respond. He is off doing whatever it is that dads do when they leave us. I think god hates us the way the porch light hates the moths it smites– indiscriminately and with no understanding of how completely he destroys us.
The bug says, nonplussed, That’s an offensive analogy, given our state. It gestures to its distended thorax with a tarsus, which is spindly and crooked.
I look at the woman and say, Don’t you think he understands? And let her answer with her faith itself.
Glass houses, says the bug in a singsong voice. Do you know– Arachne was a perfect workaholic until she drew a god’s ire. She, too, was turned into a bug as punishment.5
Oh, I loathe the bug. Oh, you stupid insipid thing. Arachne was not turned into a bug but an arachnid; it’s literally in the name. Do you know what humans– like myself– call idiots– like you? Beetlebrained. I think you are a dumb brute.
The bug shuffles clumsily, shifting its gross exoskeleton, and I am sobered with the fear that it may lurch itself into the air menacingly and spread its grubby spurs, grasping and grabbing. God may hate me, having sent such a pestilence to torment me.
“Do you ever feel like God hates you?”
Oh, she’s perceptive.
I am unoffended. She is looking for solidarity, for some sign that she is not alone in her malaise of transgression, guilt, desperation and relief. I refuse to look at the bug, which is gleefully chittering away. Instead I wonder how to answer the question clinically, professionally– I consider sending her off to a social worker. Who am I to answer this sort of question? A worker bee of sorts– but, no, I am not a bug.
Ooh hoo hoo, the bug rubs its legs together. The stridulation creates a shrill tinnitus, a most grating violin. This ought to be good.
I suppose… I must, finally, flick the bug backwards onto its exoskeleton. The awful little legs flail about the air as it bobbles, futilely, like a clownish and Kafkaesque Playskool Weeble toy. It cannot hurl itself right ways up, and instead takes to making an incessant buzzing.
You’ve got to answer her sometime today! Thirty more patients waiting, it’s only just past ten. The session’s been twenty minutes yet and you’ve not even got halfway through! She’s got to know your answer. Your computer is frozen, you’ve vomit on your shoes, you’ll definitely stay late today and– and– Ohh, hee hee hee! The bug waggles its legs some more, helplessly, which it knows I hate.
I say to the woman, I suppose sometimes I feel god hates me. It always feels like something more personal than what I do for work, though.
The woman nods, and the bug wriggles on its back to observe her. Clever, clever. You’re good at this– deflection is like a second skin on you.
I maintain eye contact with the patient. I find, in talking with women considering abortion, that it may sometimes bring up preexisting feelings of guilt or uncertainty. It can be a vulnerable process that makes ignoring those feelings very difficult. It can also be a good thing to address those feelings. Have you felt this way before, or are these feelings new?
The patient nods again, and seems content to leave the question semi-answered. She says that she has needed a therapist for some time now. So agile! So withholding! So chitinous! Your defenses are so admirable, so pretty and gleaming in the fluorescent light. You really have gotten quite good at being a bug, you know. Mandibles clack in a chirping sort of laughter as I type a note in the patient’s chart. The bug reads from upside down on the table:
Patient has expressed some religious guilt pertaining but not limited to abortion. This user offered compassionate understanding and normalization of negative emotions; suggested alternative framing of broader feelings of guilt. Patient was receptive. Post-abortion counseling resources needed, patient is also amenable to transitioning to long term therapy for extenuating life circumstances. Request social work consult for resources.
The bug presses its gangling appendages to its armored breast before spasming out again. Ooh hoo hoo, how brilliant! So concise and impersonal! What a treat. What shall we do to put this out of your head before the next one? Will it roll around in there all day?
Shut up, I say irritably. I won’t have you piling up my thoughts like dung.
Be selective, says the bug sagely. We’ve got a tiny brain after all; only so much I can help compartmentalize. Who will you decide to care about most? Who are you keeping with you today? Anybody at all?
I hate the bug passionately. I care, my jaw clicks as I work it back and forth, about all of them. I can do that because I am not a goddamned bug.
The bug clearly begs to differ, but resigns itself to look back toward the patient. It has finally heaved its rotund body back up. Its voice is harsh and hoarse from repeating the same words over and over all day, its great dull eyes unfocused. It drones on, There are two ways to take misoprostol…
Author’s note:
I was reluctant to write this piece, and even more reluctant to share it. At a time when discussion on abortion seems hopelessly polarized between emotional appeals, metaphysical posturing on what life is, and stark absolutism in anecdotal experience either for or against women’s choice in reproductive freedom, the complex experience of the healthcare worker may be easily misunderstood, misused, and misconstrued. Add to this the personhood which a healthcare worker must, despite their best efforts towards objectivity, inevitably bring into their work– here you have the true makings of a horrible misinterpretation. I suspect this may be why many dedicated abortion care workers do not write existential treatises on their experiences. Or, perhaps the urge to do so is my own neurosis. Either way, there is a dearth of creative work from this particular perspective. Put very simply: there isn’t much room in the discussion for the complicated feelings and creative impulses of the abortion healthcare worker.
As much as I would like to trust the reader, I feel I must clarify: abortion work does not cause hallucinations, the development of Hemipteran features, nor any perpetual sense of guilt in either healthcare professionals or our patients. Alarmists needn’t take this all too literally: it is magical realism and an enduring love for existentialism, a vestige of my unfinished philosophy degree. Please understand when I speak of the abortion healthcare worker’s “complicated” feelings I do not refer to some ubiquitous ethical dilemma felt regarding abortion– as far as I can tell, most of us find the work itself to be personally and morally fulfilling. I use “complicated” here simply to mean that, frankly, this job (like much of healthcare) is as much pleasant and fulfilling as it is unpleasant and frustrating. The daily exposure to other people’s trauma, fears and pain, the occasional abuse received from patients, the physically demanding nature of the work, the constant proximity to other human beings’ strongest emotions, the necessity of buttoning your own emotions down– when combined with underpaying, understaffing, overworking, and the individual history and circumstance of each person doing healthcare, the result is a phenomena called burnout. The healthcare worker, once burnt out, begins to realize that the slightest effort beyond muscle memory and perfunctory completion of tasks is Herculean. Burn out makes an exposed nerve of the healthcare worker: stimuli stab and stab, until a protective layer must be formed. Imperviousness, in these circumstances, seems a requisite for the longevity of one’s career. This is what we might call emotional fatigue. Grappling with burnout and emotional fatigue is its own tight spiral of shame and exhaustion— Why can’t I maintain my passion and optimism? I should be able to empathize; these are real human beings I am treating! They are just like me, aren’t they! This is the plight of the bug: how can I do this job that I love when I scarcely feel anything anymore?
This entire story is, obviously, inspired by The Metamorphosis by Franz Kafka
From Ovid’s Metamorphoses, Book III
From The Hour of the Star by Clarice Lispector
From Ovid’s Metamorphoses, Book VI
this is truly so good. I want to see it published in print i feel like i should be holding it in my hands
read this twice and still have no words. you’re the coolest and most brilliant and most awe-some writer on here, I suspect. wow