STAY AMAZING
By ZOE LARIS-DJOKOVIC
They’ve instituted something called the Amazon One Palm Scanner at NYU Langone Health. Instead of asking your name and birthday the receptionist now beckons you to scan your palm on a miniature kiosk which uses your biometric data to automatically fill in those blank fields “for a faster check-in,” the receptionist told me. Naturally when I refused to scan she was forced to manually verify all the information my palm would have automatically revealed. When she told me my insurance was invalid and I’d have to pay for the appointment out of pocket I was distracted by her colleagues gossiping about a doctor in the department who never returns any of their friendly greetings.
The Amazon One kiosks scattered about the reception desk are surely representative of a final surrender to meaninglessness on the part of the receptionists, and a resignation of the facade of “personalized care” on the part of NYU Langone—an open admittance that, at the end of the day, The Hospital is a business, and it would be within their business interest to strike a deal with Amazon because nobody pretends anymore that The Hospital is first and foremost a place of healing as opposed to an investment and an industry and a franchise sustained by the illness of the populace; a site for QA testing new biometric software with an off-handed remark at a pitch meeting: “yeah, so we have them in hospitals now, and Whole Foods.”
“Your palm, your choice” it says on the Amazon One website, under which it says in bold: You are in control. I wonder who, if anyone, reads those words and chooses to believe them. As a civilian I’m tempted to be offended that Amazon, a multinational e-commerce empire entwined with the highest offices of political power, decided that simply telling me I have any control at all would be satisfactory enough. I’m tempted to be offended that they even use the personal “you” pronoun as if they’re speaking directly to me, which is only a matter of “public relations,” one of several professions whose contingency is deceit and whose realm has been almost entirely untethered from the true world—it does not matter whether I choose to believe them. It does not matter whether we choose to believe anything we’re told, i.e.: our menial bureaucratic jobs are essential, the primary interest of The Hospital is patient care—according to the presence of the Amazon One kiosks, we can hardly summon the strength to believe in any of the convictions we once comforted ourselves with, and collective morale dampens as technocrats unveil before our eyes the bitter gospel: your job can be easily usurped by a small robot. Meanwhile doctors, irreplaceable by desk kiosks, snobbishly refuse to greet some receptionists, and, in the evening, attend the same galas as the businessmen who sold the kiosks to their hospitals, the same galas as health insurance executives who’ve made their riches from denying the claims of anyone who had no choice but to go to the hospital to begin with.
That Amazon can simply declare “your choice,” and that these words, regardless of absurdity, are subsequently solidified as “truth” is additionally representative of the nature of “Rational” structures, such as the hospital and the insurance companies that finance them. Due to the sheer power of the medical apparatus, that the contradictory nature of its logic is blatant does not matter, and reveals that what is generally considered to be Rational is what is declared to be Rational by the most powerful, even if it is self-contradictory, even if the Rational conclusion of the hospital is different than that of the Rationally structured insurance company. The Truth, ultimately, does not require rational derivation so long as the proper signature is printed on its official declaration.
United Healthcare denied coverage of a $53,000 associated cost for a trip to the emergency room to remedy violent hemorrhaging in my uterus which, if left untreated, would have, according to the surgeon, resulted in my death. The reason for United Healthcare’s denial was that the visit was “not necessary.” New York Presbyterian Hospital made an appeal, United Healthcare denied the appeal, and New York Presbyterian sent a bill under the clause which essentially states: “Not Our Problem.” New York Presbyterian’s tagline is “Stay Amazing.”
It can hardly be logically contested that if the profits of the medical industry are accrued through its healing then the pretensions for its profit are illness, and if illness were to be eradicated there would be no need for healing, and therefore no profit for the medical industry.
This is more of a basic fact than a critique. The reason for the existence of most industries stems from necessity: natural law accounts for the inevitability of sickness. Life on earth and the human body are not without their flaws, and medicine has developed such that it has become a discipline, because it must be. From chaos and pandemic inevitably emerges the distinctly human capacity for the interruption of natural order and the rejection of the Darwinian notion that only the fittest shall survive; “the fittest” now supplanted by “the richest,” a shift so apparent it hardly requires stating. Of this, we are all aware: money blunts the progression of illness. Money wards illness off. Illness will likely always be an element of human life, just as it is likely that we will choose to fund elective procedures which genetically tailor the offspring of the wealthy to their preferences long before we commit to curing disease on Earth. It is even more likely that illness will persist as a symptom of poverty, even once a cure has been manufactured for whichever disease due to lack of access, while Silicon Valley billionaires swim in excess plasma which they use to life-max.
Louis Althusser’s discourse on Ideological State Apparatuses—those institutions and practices that sustain social order, enforce control, and perpetuate, in Marxist terms, the relations of production—makes no mention of Medical Apparatuses. Medicine, by design, is meant to stand outside ideology and politics as a neutral and rational force concerned only with health. It is not the Church, shaping belief. It is not the Police, wielding force. It does not claim to govern or dictate ideologically or authoritatively. It exists because illness exists, and will exist so long as bodies falter.
In this era of post-Enlightenment, which began when Wise Men effectively usurped God and replaced Him with Science in the 17th century, it would be myopic to claim that medical institutions, i.e. the hospital, the medical school, or the healthcare network, are not Ideological State Apparatuses, and that the doctor or the surgeon are not figureheads of the medical apparatus whose authority extends well into the broader social and political stratification of societal structure. And if medical apparatuses truly were independent institutions, untainted by power, guided only by the quiet work of healing, they would still buckle under the weight of their own machinery. Institutionalization demands bureaucracy, and bureaucracy breeds a class of professionals who believe themselves rational to the extent that they have access to The Truth. But more than this, medicine requires money, whether from the state or from the privately wealthy themselves.
If, generally speaking, amount of power is directly correlated to amount of money, every state apparatus, including the medical apparatus, is in a struggle for power by struggling for funding. And if truth, according to Foucault, is now nothing more than a discourse of power, the injection of profit into medicine means the truth can be bought, and so those at the top of the hierarchy of the medical system, the highest-salaried, are the most truthful. And if being truthful is good; if being truthful is moral, acting in the image and will of God, those medics are the best. Following this train of logic leads us to the ultimate conclusion that the commercialization of medicine is the deification of established order.
This deification is what I want to emphasize as the central point of the essay. But as I write this I am distracted by the pulsing absence of something, which could very well be the absence of—or at least the absence of the expression of—passion, which is diffused when there is an absence of an object towards which to direct that passion. Notably uncanny to anyone who has dealt directly with The Hospital is the detached manner by which the medical system strips the patient of the comfort of a responsible party in the matter of their own life. There is not one, but a whole network of people who make up the infrastructure of the hospital, who levy responsibility based on fairness regarding skill and salary and working hours, interchangeable between each other and consistently reintroducing themselves. In this way, they also levy blame. The bureaucratic-pathos-of-distance, taking the form of possibility-of-lawsuit, wedges itself between question and answer, deflecting accountability, which, in the business of life and death, signifies the absolute absence of justice. And as I write this, I struggle to summon the rage I mean to convey, its force already diffused among too many half-guilty hands and further diffused by the sieve of written language. Anger is unruly, irrational, at odds with the architecture of argumentative essay, but that it should be excluded and dismissed as logical fallacy, as misplaced concreteness, as ad hominem, is at odds with the nature of passionate argument.
Matters of life and death are the primary concerns of doctoral sciences, onto which the detaching serum of objective rationality is applied in order to effectively address them. But matters of life and death are inextricably tied with the sensuous realm, even though the hospital would not show it. There is no fanfare in the hospital. There is indeed the same quiet maneuvering as in any office, the same hierarchies, the same sterile hallways indistinguishable from any other bureaucratic maze except for what lay at the end of them, paperwork in ceaseless cycles, backed up waiting rooms—all which signify not a place of healing but a place where Things Happen. It would be pointless, like in any bureaucracy, to channel one’s justified rage at the low level bureaucrats sitting at the front desks shaking their salads behind their computers and sipping their over-iced drinks out of their Stanley Cups because, like in any bureaucracy, they are the dispensable pawns who make up the regenerating blockade at the base of the chain of command; before you can get to any responsible party, you have to get through them.
That the best that can be done in channeling the rage of needless death, at disease repurposed for profit, at careers sustained by illness, is to blame the established order, to accuse the systemic structure or the lowest level bureaucrat of depravity and wickedness is, ultimately, castrating. To be advised to re-channel that vindictive rage from the personally involved to the system-at-large leads one to reimagine The Count of Monte Cristo so that he is not seeking revenge but seeking to reform the justice system through small acts of grassroots organizing, or that Inigo Montoya does not say to the six-fingered-man “you killed my father, prepare to die” but “you’re only a high-level administrator in this repressive royal ministry, so I can’t personally blame you for the death of my father because it is actually the fault of the established order." Although scientified order has assumed the conceptual bodily form of a deity whose lifeblood is money, it cannot be blamed as a singular entity because it is still composed of individuals who are signified by the titles of their occupations. The individuals who compile the deified order, in dealing with medicine, deal directly with matters of life and death, but through its dispersed operations, the entity at large deals with life and death in the indirect and distant way which symptomizes bureaucracy.
To have no single villain, no name to curse—what Hannah Arendt called “the tyranny without a tyrant,” the etymological rule of nobody—is its own kind of defeat which robs us even of the bitter comfort of blame, of a fist shaken at the one who undid us. This, perhaps, is one of the most demoralizing elements of the medical apparatus: its harm without a face. We are left railing against an abstraction—an all-encompassing force that funnels us through its channels. Every human face of its power is blameless, shielded by another office, another bureaucrat not at liberty to speak, another referral to someone else, somewhere else, who charges us hundreds of thousands of dollars for our afflictions.
I’ve been trying for some time to conjure a way to wave my own fist. It seems that, whenever I try, the general response to any accusation is that behind every failure of the medical system is a doctor who is just trying his best. For the sake of the injection of passion, I refuse to accept this. To reorient one’s rage, to make it rational, to step back in the face of suffering—a loved one’s illness left to fester for lack of money, an undocumented person denied care for lack of visa, a routine procedure gone wrong and morphing into a financial and physical noose—then to say, I am not mad at anyone; I am merely frustrated with the system adds an extra and uncanny step to the processing of personal grief, files down its edges before it has even been fully felt.
It is without a doubt the system that bears the weight of the blame. Yet just as David Graeber once called the police “bureaucrats with batons”—the “baton” a symbol of the police officer’s specialized enforcing power necessary for their role in the established order—doctors, then, are bureaucrats with stethoscopes. The presumption is then that the specialized knowledge of the inner workings of the human body symbolized by a stethoscope is used for the altruistic act of “healing.” However, true altruism can not involve personal profit, which is the fundamental paradox of the profession: the fact that doctors make money at all, and the distance manufactured by the eroding injection of policy between doctor and patient. And that manufactured distance is the same in any apparatus, for example, again, the police: a police officer murders someone and then retroactively applies paperwork with legal justification and procedural evidence to detach themselves from the act of the murder, wedging the established order between them and their actions, reifying the absence of justice and accountability. Doctors and insurance companies do this paperwork proactively, but it remains: the unnecessary illness or death of any individual person can not be separated from the medical professionals and insurance agents who had a role in it.
I actively support the assassination of Brian Thompson, and I actively support the assassination of any insurance agent or broker who has ever denied a claim. Finally—the act of vengeance, the re-personalization of murder, of injustice, the presentation of the rage that countless can recognize in their own thoughts but fail to piece together from an abstracted “enemy,” the proclamation: you did this to me. I know where this train of logic leads me, so before you say it: I do not believe anyone who pays their taxes and is therefore inadvertently responsible for unnecessary death deserves to be assassinated, but I stand behind the point in specified declaration. I do not plan to justify Luigi’s execution of Brian Thompson through the use of logic or reason because to inject any act of rage with the dampening serum of rationality is exactly the issue. And I will not feign Socratic ignorance through the posing of the question: if we can’t all agree that murder is wrong, then what can we agree on? The answer: nothing. Or, Socratically, the answer might be another question: well, what about being indirectly responsible for but directly profiting from the sickness and death of millions? Indirectness: another element of banal evil. The indirectness of damage and injury, unremarkable in its commonality. When the doctor or treatment fails with a patient, they drift back into the general abstraction of “the ill.”
I recall an evening several years ago when a good friend’s well-connected father returned from a kind of fundraising benefit hosted by and for high-profile wealthy philanthropists, and when I asked him how it went he advised me that I should, at all costs, avoid ever finding myself, like he found himself that evening, trapped in a conversation with a pediatric oncologist.
The reasoning for this pronouncement seemed apparent enough that I asked no follow-up questions. The pediatric oncologist: the definitive Noble Man. The savior of the weakest, of the most vulnerable. A hero in his profession to the effect that calling him a hero isn’t even meant to pacify his conditions, like the “Essential Worker,” nor is it disputable, subject to strong polarized debate like the Police Officer. He is Good, a title of nobility which he has earned, and therefore he is deserving of his riches, and of the right to boast.
“We don’t react to our fears, but instead, we respond with common sense and skill and courage,” President Obama said of the American way. Maintaining level-headedness in situations of crisis does, in many ways, define a true Hero. I wonder how this mandatory neutrality is sustainable in the context of a lifelong profession. How doctors, who deal perpetually with illness and mortality, clock out at the end of their work day. Through what lens they view the illness and mortality of those closest to them when they’re required to be utterly detached and rational in the instance of the lives of others. How their apparent desensitization grants them the capacity for neutrality when dealing with a patient on the surgery table, but through what channels it enters their unconscious, and how it reemerges. In Killing of a Sacred Deer (2017), heart surgeon Colin Farrel goes home to his wife, Nicole Kidman, who pretends to be unconscious under general anaesthesia as he has sex with her. Surely this cannot be such a fabrication of the reality of the paradoxical nature of the profession. Surely, even if the surgeon is capable of conquering the libido for the duration of his shift, his unconscious can not be so impenetrable by the traumatic events of his work day, every day. And even to be inhibited by the hospital system, to lack the bandwidth to leap through loopholes for every patient, they must then objectify themselves into ideological neutrality within a system built on suffering, or else they would not be able to do anything at all. And this again requires viewing the “the ill” as an abstract beast as opposed to a series of suffering individuals. Of course a doctor will offer specialized care to those who he loves, will prioritize his children or families before any of the millions of indiscernible faces sprouting out of the Lernaean Hydra of sickness. This is the main deviation between the pediatric oncologist and Jesus, who offers nondiscriminatory salvation to all of his children. Otherwise, the wisest thing a doctor and any bureaucrat can do to comfort themselves is believe the fateful assertion: the system is correct so I am correct.
The general supercilious nature of Doctors and the air of idolatry which surrounds them free with their MD license plates and their title (demonstrated satirically for example in Eyes Wide Shut (1999) by Tom Cruise’s recurrent flashing of his medical license as if it were a police badge, as proof of his authority) is symbolic, in large part, of their self-awareness. That they are self-aware is demonstrative of the fact that, whereas successful doctors (those who open people up and become responsible for their life; who watch people die and hold beating hearts in their hands all while resisting the natural human inclination that would send a regular person into hysteria) must conquer the ego in order to be as Rational as they are required to be, it is impossible to separate oneself from the ego entirely, to be purely Rational and not at all empirical. On Earth there are hierarchies, there is money, there are objects, there are families and obligations and responsibilities, there are rules which are established as the bedrock of a mechanically constructed rational system, separate from the empirical realm, that are inherently contradictory to the inner world. The result of the injection of the neutralizing serum of rationality into a human being in order to achieve that cool attitude, what Ernest Hemingway in A Farewell to Arms calls “that beautiful detachment and devotion to stern justice of men dealing in death without being in any danger of it,” are Doctors as we know them: a class of sociopaths with God-complexes.
Just as God created the world in seven days by divine design, modern administrators have constructed a new world order according to bureaucratic logic. We follow the prescriptions of established order just as we would have once followed the Ten Commandments, measure our own correctness in relation to adherence to systemic order, aspire to be proper administrators “whose first virtue,” according to Ludwig von Mises, “is to abide by the codes and decrees,” just as a Godly citizen adheres closely to His word. The main incongruity in the deification of the administrator is that they are just that: administrators, playing God. God made the world in His image, and wise men renovated the world in the image of perceived correctness. The “wise men” today are defined not by their capacity for abstraction or even their curiosity about the world of ideas, but quite the opposite—their wisdom is measured in relation to their correctness, which is measurable by Rational standards, requiring the most wise to have conquered their libido in order to be like God, the only true Rational being, the only perfect being, the only truthful being, the only being without contradiction.
A habitable society cannot balance precariously on hypothesis alone; some foundational truths must be accepted to avoid the collapse of order, as Plato warned. Truth as foundation is truth as consensus: we are unified by the proclamation that there “is” truth so there are a set of virtues we can all agree on. That there “is” truth, simply in saying it, prompts mention of St. Anselm’s Ontological Proof of God, which predicates God’s existence on the word “is”: “Perfect beings exist; God is a perfect being; God exists;” a syllogism which Immanual Kant disputes on the basis that being is not a real predicate. A proof which rests on the “is” is illogical, as “is” is empirical, and logic can have no empirical part. Being, dislogic, the idea that truth simply is, that truth is logical and these structures are apparatuses of truth is the counterintuitive consensus that predicates the established order.
The first lesson we are taught in science or natural history class: the definition of hypothesis, of a theory. Gravity, they told us, is the theory that something you throw in the air will fall back down, that when you jump you land, that there are forces which transcend our physical senses and keep things operating in a certain way. I know gravity is real because when I jump I land, when I throw something in the air it falls back down. I can see how powerless I am against its force. I believe gravity is real because if I don’t, I will understand nothing. Newton declared gravity was law, it was universal law, and everyone sighed in relief that something in this world, in this universe, can be certain and true. And then someone asks you why gravity is real, and you can tell them the basic formulas you’ve retained from high school physics. You can quote Newton’s laws of motion. But if they ask you too many questions, you’ve run out of answers. You don’t know. Gravity, then, is real because—come on, look around. It just is. When you jump you land, when you throw something in the air it falls back down, you are powerless against the forces which transcend your physical nature, and Newton declared it was law. Gravity is real because I don’t understand why I’m stuck to the ground in the same way that God is real because I don’t understand what was there before the universe began or by what order the world was arranged. To accept even the most established theorem as fact goes against the very nature of theory and the genuine pursuit of understanding the world. And that we accept it as fact because scientists, who are the noble wise men that supplanted God, presented it as explanation for the things we can all already see, is the illogical blind faith in institutionalized science in the same way there was once general adherence to religious virtue. Our structure is not logical, the medical apparatus is not Rational, this bureaucracy is not divinely arranged—it was man-made. And that it lacks divinity is partially due to its ugliness, but more so the fact that we created it and can therefore understand it.
And it is not one God or one noble man, but a whole system of individuals arranged in the image of a perfect being with money coursing through its veins. And these individuals, who make up the apparatuses which uphold social order and the relations of production, together congregate and produce the established order. And as long as the money flows, it is functional, sustained, and real. Which all leads back into the initial and central point: those at the top of the deified hierarchy are those who, like God, deal most directly with matters of life and death and are, in the new system of truth, the most handsomely compensated, the most truthful. Like God, we require that doctors be unwavering pinnacles of so-called logic in a heretic and changing culture. But being is not a real predicate: they are simply there, sitting atop the simulated structure of reason. Instead of Nietzsche’s famous assertion that we’ve killed God and built a church, we can now more accurately say we’ve killed God and built a medical school.
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