A few weeks ago I commented to my wife that I needed to be careful at work, if I didn’t want to get in trouble. “I am not used to being nobody,” I said. “If I am not careful I will inadvertently step out of line.” The observation really struck me, and stuck with me.
Class and rank are deeply embedded in certain cultures. It is true–if overstated–that this is less prevalent in US culture. Here in proclaimed ethos we have the egalitarian way. But don’t look too close or you might see money and education gaining many unworthy people special privileges and advantages. Nonetheless, we don’t have the strict class of nobility so that is something.
The clash and tension between egalitarian ideals and the unspoken notion that some people are “a breed apart” manifest in the medical field of this country. This in some ways exists as a microcosm of US society as a whole with its tensions and contradictions, only more clearly drawn. Technically, anyone can enter this lofty ivory tower of the medical field, but those born into money and education have distinct advantages, both in entering and in rising through the ranks of this society. For the privileged this is their territory, their class. In essence, their home. Here they feel comfortable with the conventions and perspective which look out on the rest of the world. Any may enter, but you must prove yourself worthy of entering this class unto itself.
Somehow, I stumbled into the lowest ranks of this society, and as one not born into the guild I am not always sensitive to its conventions. This insensitivity is exacerbated by the fact that I was raised and educated as a homeschooler where typical authority structures of approved knowledge didn’t hold sway. Thinking critically for yourself was expected in ways and to degrees not seen in the average education. Questioning everything was expected, as well as valuing opinions and ideas for their own worth, not for who voiced them.
When I stepped out into the world of professional nursing it was within long term care, and this placed me fairly high in the localized authority of the organization. In the larger structure of the multi-state company I was a very small fish, but in the day to day I was in essence the boss of the floor. If someone had questions, I (or one of my peers) was the first place they came for answers. It was my underlings who had to be careful to not speak out of line. The smart bosses knew which underlings should be heeded, but they were officially the ignorant underlings.
Since I have moved to work within primary care my role has switched ends of the power structure. As a licensed practical nurse I am the lowest of all licensed health care professionals. I do the lesser work for those above me. Woe to me if I step outside my approved role or speak above my rank.
The atmosphere is not so severe as that. I have congenial coworkers. I am liked at my workplace, and I am respected for the work I do. The health care providers I serve are generally down to earth, and not the embodiment of aloof superiority sometimes imagined. Today one of them joked they were going to race me to the bathroom.
But that is the danger. For a naive man like myself, the good-natured surface masks the reality that there is a strata and we each have our own place. Don’t forget it, and don’t step outside your role. My personality and my background means I don’t naturally think about these things, and since I have no interest in writing medication scripts or referring patients for specialized testing I did not initially notice these bonds which constrain me.
That is, until I had an opinion.
In theory, the opinion and input of everyone on the health care team is supposed to be valued. They teach you that in school. In practice, your opinion is valued generally commensurate with your education and rank. In other words, within the class structures at work it is unthinkable for a doctor to consider my opinion. Such an act would violate all unspoken tenets of the social order. I do not have education sufficient to offer any worthwhile insight into any problem a doctor might face.
When facing a situation in which I feel I may have some worthwhile contribution, I have a hard time remembering that according to the structures in which I am operating I don’t have any valuable insight. I am to provide raw data for the insightful ones to process. I am not qualified to have insight. Mind you, I work with nice people so they would be discomfited if they were required to rebuke me in this manner. But I would be grossly out of line and due a rebuke if I started opining about a problem.
I almost got myself in trouble because there was a patient who was dealing with dementia issues. The patient and a family member had come in for the visit. My role was to see them first, ask the initial questions, and prepare them for the doctor. I have seen many different patients facing many different issues, but this struck very close to home. Having spent years as a caregiver for someone with dementia, having written a book about my experience, and having spoken around the country about the journey of those facing dementia, I felt I had some understanding about what these people faced.
When I left the patient and met the doctor to pass on report I began to offer my perspective on the issues they faced, and the doctor’s demeanor immediately became curt. I was told, “This person has been my patient for years. I know what is going on.”
It was then I realized I was nobody.
The doctor didn’t mean to be high-handed. It simply was that the operating class structures made plain it was not possible I had the qualifications for a useful opinion. If the situation was different–if I was standing at the podium of an Alzheimer’s Association event speaking–then what I said would have value. But here it did not. This is a quick lesson on class structure and caste.
It is good for me to be a nobody. I had my turn in the sun, to stand at the podium and tell everyone how things were, and to give advice. Sure, it felt good but that is only part of the world. And I had my turn to be in charge, and the person everyone on the floor came to for answers. That was stressful, and I don’t want to go back to those days. Now being small, and being nobody, is a new kind of learning. It isn’t always easy, and isn’t always comfortable, but from here I can look out at the world and consider .
There is much that can be learned from becoming small, and becoming nobody. But at the end of the day the roles and the strictures of this place also remind me that it isn’t my home. I am, and always will be, an interloper. Someday, I will be moving along.