"I Am Determined to Prove A Villain" is Great Theater and Bad Health Care Policy

Richard III, Act I, Scene I is my favorite Shakespearean Moment

“Now is the winter of our discontent…made glorious summer, by this Son of york…and all the clouds that have lour'd upon our house, in the deep blossom of the Ocean, buried.”

Thus begins what I consider to be among the more underrated plays in the entire canon of Bill Shakespeare.

The soon-to-be King of England was a real historical king, and he was physically deformed from the bones we can see now. He may have had scoliosis. Here are his bones.

In the very opening scene of this play, our anti-atlas chooses to let the audience know what he’s about. And it’s pissed off. He is filled with grim regret that war has come to an end:

 Grim-visaged war hath smoothed his wrinkled front;
And now, instead of mounting barbèd steeds
 To fright the souls of fearful adversaries,
 He capers nimbly in a lady’s chamber
 To the lascivious pleasing of a lute.

For a nasty man, this is a grim state of affairs. He lays out the details for us:

 I, that am rudely stamped and want love’s majesty
 To strut before a wanton ambling nymph;
 I, that am curtailed of this fair proportion,
 Cheated of feature by dissembling nature,
Deformed, unfinished, sent before my time
 Into this breathing world scarce half made up,
 And that so lamely and unfashionable
 That dogs bark at me as I halt by them

He is not pleased with his options as a deformed villain. So, he decides to lean into his anti-heroism.

since I cannot prove a lover
To entertain these fair well-spoken days,
I am determinèd to prove a villain
And hate the idle pleasures of these days.
Plots have I laid, inductions dangerous,
By drunken prophecies, libels, and dreams,
To set my brother Clarence and the King
In deadly hate, the one against the other;

Or, he could have become an internet 💩poster if it were today. None of us are supposed to like him; it’s not the reaction from audiences he was written to achieve. I always did, a little, anyway. Not because he was nice— I admired his lack of ambiguity. And he wasn’t a hero and wouldn’t deign to be one. He couldn’t be one.

This clear-eyed acceptance of one’s self appealed to me in my youth. I saw this play for the very first time in Hartford, CT. Hartford Stage did a production inspired by Nine Inch Nails. It was all leather Kilts, Rust, and Grimness. This was shortly after the downward spiral had been released. I love that record, too.

Some days, being a physician feels like that. We have asked doctors—nurses!— and other health professionals to carry the world's weight for all of us. We have not protected them. A recent kerfuffle on Twitter about documenting patient behavior in medical records: being a nurse is among the more dangerous jobs. Being a psychiatric nurse is more dangerous still. Being a Psychiatrist or other physician means you're going to get stalked at a shockingly high rate, as I've documented before.

We subsequently decided to allow private equity to buy much of emergency medicine and run it into the ground. No applicants do not want to be an emergency medicine doctor—can you blame them? Vertically integrated major healthcare companies, which I will not mention specifically, employ thousands of physicians directly. We're not jumping up and down about the state of excellent care in the United States. We have crisis after crisis. We have massive strikes of healthcare workers.

You can expect people to leave when you make a line of work miserable. The problem, of course, is that it's really hard to restock this particular lake with trout for fishin’….every doctor who burns out, every completed suicide, every nurse who does something else, that's millions of dollars of training, hundreds and thousands and tens of thousands of hours experience, and that doesn't get replaced overnight. It doesn't get replaced in a decade. Every doctor who retires at the end of a career a little earlier than they could have otherwise? It robs us of thousands of hours of clinical experience with patients. This is the knowledge of what to do in a crisis. We are pushing out the people who know what to do.

Being a physician often sucks. It has robbed me of quite a bit—I certainly can’t complain as freely as I might like! I have some sense of restraint! I started life thinking I’d never go to medical school, and I tried to prevent myself. Was I right? I should have kept at it, perhaps.

The bulwark against suicidal hopelessness for those suffering? It is to realize that we are only as trapped as we imagine. We can survive without psychiatrists. Some of us can, anyway. But nobody wants to survive without an intact medical, nursing, and care corps who take their call to service seriously. We don't want “no doctors.” We don't want “no nurses.” We don't want burned-out nurses who feel harmed by their work helping our families. That is what we've got. The more people escape, the more escape becomes an option in the minds of those who feel trapped. The more we push, the more people will run for the exits. Just like a great show in a theater, the house of medicine is “no re-entry.”

Physicians, nurses, and other health professionals were smart enough to get to where they are. They have other options. All of us are just sitting around hoping and praying for the brilliant doctors and nurses we need to survive—in the case of gallstones, pneumonia, cancer, or the next pandemic— not to quit.

Recently, 70,000 nurses have gone on strike in the Kaiser system. Doctors have gone on strike in the UK. This pattern goes poorly for all of us. We will all survive without private equity investors. Very few of us will survive the kinds of predictable causes of early death that will commonly befall us if we let all the doctors and nurses quit. Appendicitis. An accident. A complicated infection. A psychiatric emergency. How often has medical care intervened in a way that saved your life? How many times did you take that for granted? It only needs not to be there one time to end the life of any of us.

That is it. That is the update.