A New Direction

I’ve had this blog for 14 years since my third year of med school. Back then, and even still I find writing in long format a great way to reflect on life, process events and generally make sense of the world. It’s been four years since I’ve written a real blog however, and it’s taken me some time to reflect on why that is. I think a large part of my unwillingness to reengage was my confidence of what I would find in my own depths that I preferred to ignore.

Since 2016 until recently I have been working full time in Federal Corrections for the Bureau of Prisons and part time in the Oregon Air National Guard as a flight surgeon. I knew I wanted to practice primary care in an underserved community and also needed a position that allowed me the flexibility to pursue my military obligations with the Air National Guard. The federal prison system seemed to be the perfect fit.

I’ve always had a fascination with corrections and so I was incredibly fortunate that a position at the complex in Florence, Colorado was open. Florence is often seen as one of the flagship institutions in the Bureau of Prisons. They have every level of security across the four compounds from a low security working camp to the only federal level ‘Supermax’ in the country, housing such characters as El Chapo and the Unabomber.

The medicine in prison is as full spectrum for an adult male population as I could possibly imagine. I’ve managed everything from acute psychosis to penetrating chest wounds to simple toenail fungus. The robust clinical practice is only half of what makes corrections fascinating however. Even as a medical officer I was a correctional officer first and foremost. This meant having familiarization with every aspect of prison culture from how to restrain an inmate or defend myself to understanding the politics of prison gangs.

Over the course of four years I thrived. There was hardly ever a boring day and I was lucky enough to rotate between the various facilities at Florence experiencing a wide variety of the correctional environment. The innermost levels of a high security prison taught me lessons about the human condition that I would have never learned from the outside world. The growth I experienced both professionally and personally was tremendous. Looking back on it I fully believe and still do that corrections is the best fit for me in clinical medicine. After the first year or so I felt a strong sense of professional satisfaction from my day to day work, I felt like I had finally arrived at something I had been seeking.

Something however was not right. Everyday was a different adventure, but everyday was also the same. As the years ticked on I started to feel like I was playing on an endless loop. My daily routine and clinical practice had all become blandly enjoyable and comfortable. Everyday seemed to be a repeat of the last, and it wasn’t all that bad. Everyone I worked with seemed to also be equally complacent with the not so bad, not so great 20-year hamster wheel that ended at the mysterious and somewhat mystical destination known as retirement. I was also aware of the fact that my time was no longer my own. Most days I had around maybe two hours that was truly my own to do with as I wished, the rest of my time I was subservient to the system I had been trained to show near zealot devotion to.

Somewhere deep in my mind I knew I had reached an impasse. This wasn’t how I wanted to live out my years, yet I was also aware of how content I was to do just that. I saw how every measure of training and expectation society had of me as a physician was designed to put me in exactly the place I was in. This was something I couldn’t escape, couldn’t reconcile, and certainly couldn’t face myself to write about it. I also didn't want to leave as I knew there was nothing more I would rather be doing as a physician.

A heavy guilt weighed on me that I even felt this way to begin with. I made good money, the hours were fantastic and I didn’t have to deal with hardly any of the bullshit that providers on the outside struggle with. So many docs I know in revenue based models of care are burning out from the constant pressure to see more patients, generate more profit, or fight insurance companies for various preauthorizations. I had none of that to worry about. As a primary care physician I had a great gig, and that knowledge became a trap.

After a while it simply felt like there was no longer a carrot at the end of my stick. Various accolades were dangled in front of me, I was offered a Clinical Director role in various prisons, but I wasn't interested, the pay was the same and the incentive was one of prestige. I suppose the allure of filling up my resume or plastering certificates on my wall had faded.

I struggled to understand what my problem was. It was only when I started to question the very nature of how we approach work and employment in modern day society that things started to reframe and make sense. I understand I come at this from a place of privilege in so much that I have a decent income potential, no debt or children, and minimal monthly expenses. What I observe however is a cultural standard in which so many of us will routinely and without question pour the majority of our waking hours into a job that we only minimally find satisfaction with, or worse, just tolerate. Surly a vast amount of people do this out of necessity with very few perceived options to do anything else, however I think just as many do it because it’s safe and comfortable.

I didn't know exactly how to fix this, but I knew what I wanted. I really had three major criteria moving forward. I wanted more of my time back, I wanted to stay in corrections, and I felt I should be be adequately compensated for the value I brought from my years of experience in the field. So like an inmate with a rusty spoon I spent the better part of a year planning my escape. I wasn't interested in jumping anywhere without at least a theoretical parachute.

After almost a year of research and planning I chose to resign my position as a federal employee and start working as a physician contractor for the prison system. I designed a contract that was part time, fairly compensated and found a company I could work with to make it all happen. I then found a prison in rural Illinois that was interested in bringing me on for one week per month. It was obviously going to be a big pay cut, and I would lose my benefits, but in my mind the freedom gained would more than make up for that.

In July of 2020 I made the leap. Since then I’ve been commuting to a federal prison in Illinois every month for a week at a time. There have been a ton of logistical moving parts to make everything happen, and it was complicated by the myriad of restrictions and slowdowns from the pandemic. In the end with some luck, and a lot planning everything has fallen into place.

People often wonder what I’m planning to do with a free three weeks a month. I’m trying to dabble with some tele-health work on the side and spending more time with my online fellowship in Integrative Medicine through the University of Arizona. We also purchased an off-grid travel trailer and are hoping to have a new chapter of adventures. The reality however is that I’m making a deliberate effort at the moment to just do less.

Parkinson’s law generally describes the idea that any available capacity in a system will eventually be used. Basically this means that with enough down time work will eventually fill the gaps. Just look at anyone that retires and how quickly they fill their plate back up with all sorts of trivial projects. In fact there is a saying in the retirement community for the importance of having a plan to transition into, and the danger if you don’t— when you retire, you expire.

I’m not immune to this pressure, the first thing I did with more time was to think about all the ways I could fill it, but this is just another trap. My theory is that if we are always either working or filling in the gaps then there is never any room in our life if something really extraordinary comes along. We either don’t notice it, or we are too task saturated to engage with it.

My goal right now is to experiment with various projects, but to also hold a large amount of empty space vacant and to protect the emptiness of that space. The natural cliche would be to say that I am waiting for the perfect opportunity to fill my time with. The reality however is that for the time being I am just interested in learning more about what this new void is. It feels foreign and different and full of potential, and I just want to sit with that for a moment.

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