Letters of resignation,
A cathartic overdue reflection. This is not a manual on how to quit. It’s a meditation on what happens when you get caught in the spin cycle of grief (Denial, Depression, Bargaining, Anger, Acceptance) and what happens after each stage of the tussle: a lovely mess.
As I (temporarily?) turn my back on a chapter that has defined me for over a third of my life (and my entire adult life), I’d like to not go quietly into that good night. I’d like to rage a little.
I, Ntoetse [middle names redacted] Lerotholi formally resign from the following, in no particular order (and under the guidance of the Desiderata):
I resign from clinical medicine.
“go placidly amidst the noise and haste and remember what peace there may be in silence… Speak your truth quietly and clearly”
The first is the most obvious one and a longtime coming and my reasons are many. I’ve called medicine a ‘bad boyfriend’ way too often. I love that thing with all my heart but it’s time to take a break and find out who I am without it. The Pandemic didn’t help (well, it sped up the decision some). Institutional betrayal is a painful experience and there’s no need to detail the dominoes that lined up before Covid-19 knocked them all down. But just this once: let’s talk about Bruno, I mean, COVID:
In the beginning, when we were still reading about our HCW colleagues’ terrifying experiences in distant lands on social media, South Africans were still in a joking mood. We gave the virus a series of cute nicknames because it was still our unwanted but expected guest from Italy (before nearly 100 000 people had died as of 20/03/2022) when we still thought <5% mortality was a reassuring number. The government eventually enacted the massive “21 day” shutdown and we were assured it was to help the health systems “get ready”. It took me a couple of go’s to realise that this wasn’t to stop COVID (we were learning in real time) and that the waves (plural!) were inevitable; that these measures were just aimed at slowing it down (remember: “flattening the curve”?). I’m going to be honest, I never felt ready. The first batch of masks were stolen from the hospital in the first week and the nurses had to hold them under lock and key like scheduled drugs. They were also sold out at any pharmacy that stocked them (along with toilet paper). We asked for PPE and public cooperation for the looming unknown (was it airborne or droplet spread? What was the difference between quarantine and isolation? What was the case definition anyway and in my case, wasn’t that definition every paediatric patient ever???). There was a lot of speed learning back then.
Instead, we got terrifying hero-worship/forced martyrdom: the people clapped. I never want to see another Angel-winged healthcare worker drawing again (well-meaning though they were). When state funds were mismanaged, went missing and were outright stolen, it was business as usual. And when the accusation turned on us: that there wasn’t enough PPE because we, the HCWs, were somehow misusing it or taking it home (what?!), we kept it pushing. When we asked you to stay at home: it was too much to ask. We, who were afraid to go home for our families safety. We who updated our wills, we who spent major milestones and holidays alone (if we could), we who never worked from home. We were asking for too much. So we baked banana bread and watched Tiger King. When we tried to tell people about the additional burden that alcohol-related trauma added to the system: I remember being told that it’s our job to hold the capacity for both. That it wasn’t the public’s responsibility to participate in Public Health measures. “you signed up for this”, they said, something about an oath…
We watched friends and family die. We watched Your friends and family die. No training on earth is preparation for that. I’ve forgotten what visiting hours sound like, I miss the Mageu and yoghurt, giving directions in the corridor and negotiating with spouses about discharge dates. The mothers stay alone, isolated in the neonatal unit without the option of physical comfort and support from family. Some fathers only meet their newborns as corpses, if at all. Dying in isolation must be one of the worst ways to die. COVID had many faces: an inconvenient passing breeze for many, a debilitating prolonged illness for some and a swift and vicious end for a few. But it didn’t feel like a few. 5% of the population is a huge number when you count it in human lives lost (95% recovery rate doesn’t sound so slick in that light). “a few” people on oxygen caused the 02 pressure to become so low that we couldn’t ventilate children on the top floor. Non-Covid deaths caused by Covid are the worst: the cancelled theatre lists, the lack of capacity for “regular” emergencies, the logistics of separating those awaiting Covid results and those which had already tested negative (deciding between doing the antigen and the antibody test), the referral delays because of Covid testing, the buckling under the all-consuming weight of it all. When our colleagues dying became a daily experience, a Hunger Games-esque cannon in the sky but on WhatsApp, I started uncharacteristically carrying cash to work because there were too many funerals to contribute to and I couldn’t keep track of which face I wasn’t seeing anymore (was it the masks, were they on leave or had they died?). We stopped knowing what our colleagues faces looked like. It wasn’t uncommon for most of the nursing staff to disappear for 5-10 minutes at noon most days to go honour a fallen Sister. We wore black that one Friday. There was no time to mourn. When science became one of many options (when science became an option!) and the conspiracy theories and WhatsApp aunty group chats held just as much weight as science we kept going. Shared info graphics, wrote threads. Tried to counter misinformation. Failed. Often. I’ve had the most baffling conversations and arguments with intelligent people I used to respect.
When the vaccine became a reality, we enrolled in the Sisonke Trial and became among the first to get vaccinated (usually proof of belief is volunteering). When we tried to tell you that the burden wasn’t just the COVID but what COVID did to everything else: outpatient visits, elective theatre lists, cancer treatment, non-COVID emergencies, bed capacity, ICU space, training medical students, staff morale. It didn’t matter. Everyone was a vaccine expert suddenly. Booster shots (which have been around for decades) became a fresh conspiracy. We had to hear about your cousin’s friend’s insights. We were now liars, sellouts and brainwashed servants of Big Pharma or (imagine) the government. What we actually were (and are) is Exhausted. Discourse started about how HCW’s who were doctors weren’t actually real doctors as the degree amounted to an honours qualification at best. As if we were arguing the superiority of the qualification as opposed to the subject matter it covered. That you didn’t even need to be that smart to get one anyway. That a medical degree of any kind did not make you an expert: during a global health pandemic. That our degree allowed and enabled us to cut you open, care for your children but you drew the line at advice on viruses and vaccines. In the first few months I remember saying this a lot: I’m not an expert on [insert: virology, epidemiology, public health] but I’m listening to those who are and you should too. I have not read everything but I’ve seen plenty and I still don’t understand why anyone would choose to belive we’d lie. Collectively.
I stopped watching the news in April 2020 for my sanity (I was terrified), I stopped actively following the stats because all they did was piss me off (and they were showing up on my WhatsApp statuses daily anyway) and besides, it didn’t change anything that was happening day-to-day anyway. At least not for me. I tried very hard not to talk about the Pandemic in my creative life. I didn’t want to whine or complain because I feared that I would never stop if I started. And again, what was the point? What would it change?
When my one of my best friends and I had Beta-wave COVID for Christmas and made daily jokes willing the other not to die, I wasn’t at the end of my rope, I was long past it. When I lost my sense of smell, I couldn’t cry about it (I, lover of flowers and food, regular Human me) there were bigger fish to fry. When I huffed and puffed and uncharacteristically sweat throughout my first day back on day 10 of isolation doing a 24 hour call (and huffed and puffed for months after) I didn’t say a word. I’m not special, my story isn’t even unique. But hear this: Healthcare workers aren’t soldiers. We’re not canon-fodder, we’re not martyrs. This is what we do. Taking care of sick people? it’s our job, but not like this guys. There has been a violation of the unspoken social contract: the human contract. The one where we’re supposed to look after each other. We’re all humans first right?
I would pay my HPCSA registration fee again just to find out what they’ve been up to (oh wait, I did pay them; twice in 2021). Especially when that the AHA guidelines changed during (not after) the delta wave, precluding the requirement of donning PPE before administratering CPR. I have never felt so betrayed, incensed, defeated. The national guidelines had changed at that time too, implying in no uncertain terms that HCWs getting sick is first and foremost a resource strain. Screw Benificence, Non-maleficnce (popularly known as “first do no harm”), forget “Hazards, Hello, Help”. These guiding principles that we were taught to live and work by somehow did not apply to us apparently. Fuck that. Fuck this pandemic and fuck any and everyone that made it harder than it had to be. Screw everyone involved in drafting us into a war and sending us in without protection and worse still, gradually stripping away what little protection we had and have, whatever illusions of safety and humanity we clung to. “I pledge to serve humanity”: but this time that human is me. Organisational betrayal of the highest order (I cried when I listened to Brene Brown discuss betrayal here). I don’t apologise for my anger, it needed to be said: A resignation.
No Kind Regards this one time,
Early retirement: Let’s talk about what we lost. I’m retiring my old life and who I thought I wanted to and was supposed to be. Mourning is a good word to use here. This one is complicated and tied to self worth and several tightly-held paradigms. I think it’s finally time to say goodbye to the version of life we were raised to play out because as Millenials we were screwed out of that “natural” path a long time ago. 2008 happened when we were in or leaving high school and university. We didn’t stand a chance as the world we were preparing for our entire young lives crashed and burned around us. Google 2008. I swear you don’t remember it as well as you think you do. I was taught to specialise quickly, be the youngest whatever. To know immediately and write the necessary exams. I still can’t believe I did all those things and came to a screeching halt just before the finish line (or the starting line depending on who you ask). I took a left turn and switched tracks with the momentum of my former goal still propelling me. While my friends got reg posts, had children, got married and bought 2nd houses: I took a pay cut and moved back into my mother’s house for the first time since I was 9 years old. I’m happy for all of us but the mental hurdle of not going with “the plan” nearly tripped me up. But this season is called surrender: I’m not going to fight the current (I’m switching metaphors now, just go with it😂).
I’m going to repair my boat in the shallows and take a good look: am I seafaring galley? A fearsome warship that belongs in an armada (I don’t know why I love the word armada so much!), am I a rowboat, am I meant to catch fish? For so long I’ve pushed myself into the deep sea never asking myself if I was built for it? Crashed against waves, crashed against rocks, lost sight of the lighthouse all in an effort to prove that I’m a sailor but never taking the time to ask if I was (I am, I’ve found ), more importantly if I should be one and most importantly if I want to be. So yeah, I’m retiring from blind sailing, that shit’s dangerous! Even if I have to stay ashore a while to build my lighthouse for my next trip out, I’ll do it. And maybe the light will guide other lost ships and weary sailors safely home.
The shortest one of all: I resign from the position of Strong Friend. I emotionally autoregulate and think about most things deeply but that doesn’t qualify me to do life without a community. I know I allowed it to happen: stuck in a vicious cycle of not asking for help, becoming shocked when help wasn’t offered and then not feeling safe to ask. That’s over now. I have told all of my favourite people that I am a marshmallow and would like to be able to share that soft sticky part of myself more freely. I’ve asked for the space to do so, to be checked up on. I’m not good at being taken care of but it can be learned: I can’t wait to be my softest self safe in the knowledge that I can be. It’s going to take a while to recalibrate on both sides but not leaning on my friends and growing resentful was not the system.
Collective retirement: Strong is wonderful and necessary to get through this cruel world but as Strong Black Women everywhere retire the moniker and abandon the post in search of something softer, I gladly join the exodus. Strong Black Woman Out!
Kind regards (actually the softest regards possible)
I formally resign from the fairytale and the fast line. Nothing has to happen before I turn 30 except getting me and my people there safely. My mentor said something delightful the first time we met: am I interested in a love story or a life story?
“beyond a wholesome discipline, be gentle with yourself. You are a child of the universe, no less than the trees and the r stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should”.
So, I’m retiring from timelines entirely and while this starts with the “by 30” to do list, it also includes:
3.1. Scheduled Feelings: most of the time I’m really OK and happy. And sometimes I’ll remember that that man really hurt me. I’ll be walking to my car or flirting with someone new and midway through my smile I’ll remember what he did and how he did it while deliberately making me no promises. You’re allowed to mourn who you were while building anew. You’re allowed to be sad about what you lost for as long as you need to be because you’re still moving past it, shaking it off. I say this because when my healing wasn’t moving at my preferred speed, I found myself laughing (see: cackling) whenever he crossed my mind. But it was cruel and derisive laughter and I gasped when I realised that it was directed at myself: the fool who wasn’t over it yet. And I asked what right I had to be so unkind to myself. I wasn’t even being unkind because I wasn’t over it, I was being unkind to myself because I wasn’t over it yet. I was not meeting some obscure self-imposed deadline of healing. I remember I stopped bringing him up around friends, I promised a friend that January would be the last time I spoke his name. I lied. I don’t want to lie anymore. I’m mostly fine and beyond the worst of the pain and barely think about him but that man hurt me and like any injury it lives with me now. My recovery encorporates the injury: I move differently now and while I’m no longer wounded I will never be the same. My baseline has moved but so am I: I’m still moving 😊. I’m also learning to take my time and be gentle with good feelings too: what does it mean if I’m not head over heels in love with someone by the end of the second date? Why don’t boundaries feel good immediately when you enforce them? Why hasn’t the scale tipped after my first workout? Why didn’t I orgasm immediately or during the first round? Patience is a wonderful form of grace and I’m extending that towards myself now. So yeah, I try not to romanticise melancholy but what I will not do is set timelines for pain and pleasure anymore. I will be gentle.
“be yourself. Especially do not feign affection…Take kindly the counsel of the years, gracefully surrendering the things of youth”.
3.2. No Expectations: I don’t have to know where and what everything is immediately. Expectations are lovely and I try to have them as often as possible. Pretending not to have expectations is a response to having been hurt but its a lie. Expectations are what goals and dreams are made of. It’s the root of accountability and I refuse to live without them. Will they be met immediately? No. Will they be met exactly? Also no. Can I rise to meet them (with the occasional stumble and falling short while rising)? Absolutely. I will be firm in my expectations and flexible about timeline of meeting them.
3.3. Perfectionism: no thank you. Perfection is a myth, oftentimes a crutch disguised as virtue. You can’t start because its not perfect (PS: finished beats perfect 9/10). I fully plan to continue trying, failing and succeeding. Perfectionism doesn’t require bravery. I’m now happy to build and break beautiful things with kind and willing people who will dissapoint me just as I will disappoint them. I will extend them the same imperfect grace I extend myself as I judge them on who they prove to be instead of how they seem.
“Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time”
Acceptance: A New contract:
I’m not rebuilding the wheel here. I now and forevermore reserve the right to change my mind and extend the timeline on anything I wish during this one precious life I’ve been given. I reserve the right to have hobbies and jobs as well as a career and vocation. I promise to never need to combine the above but will be utterly delighted if they overlap. I reserve the right to risk delight. For: “We must risk delight. We can do without pleasure,
but not delight. Not enjoyment. We must have the stubbornness to accept our gladness in the ruthless furnace of this world” – Jack Gilbert, A Brief for the Defense
I reserve the right to be a walking contradiction, to do hard things and have great expectations of myself and others while being graceful, gentle and surrendering to the current. We are not who we used to be and clinging to that idea is hindering who we could be. I am resigned to my new life. Changing the plan is hard, resigning is hard and you can (and will have to) do hard things. But remember this: betrayal is a special transgression and what you do not want to be responsible for is a betrayal of self . Good luck and give yourself gentle gentle grace.
“and whatever your labour’s and aspirations, in the noisy confusion of life, keep peace with your soul. With all its sham drudgery and broken dreams, it is still a beautiful world”