When Professionalism Masks Survival
A Treatise on Quiet Culture and the Micro-Loyalty Economy in the Theater of Healthcare
Preface to the Tenth (and Likely Unread) Edition: Annotated from Personal Experience, Unfortunately
I found the original manuscript in a sealed manila envelope marked “STAFF DEVELOPMENT: MANDATORY READING,” which, if you've worked in a hospital, especially the kind with water-stained ceiling tiles, you’ll understand is less a choice than a curse. The envelope had been shoved into the space behind the microwave in the breakroom, which we weren’t supposed to eat in, but all did anyway. The one with the dead outlet and the sticky note that says, “Do NOT unplug the fridge!!!”
The document had been copied and recopied, margin-noted, coffee-ringed, possibly cried over, and passed around like underground media for the semi-licensed. Nobody claimed authorship, though rumors credited it to a night shift anesthetist, a surgical tech who now writes poetry in Vermont, or a cabal of circulators who developed a philosophy of resistance via eyebrow raises.
That was years ago. I should’ve thrown it out, but I didn’t. I photocopied it instead. I annotated it, and then I lived it, and then I forgot it existed, until I didn’t.
So now I present it here, marginalia and all, for those of you just entering the system and still under the delusion that professionalism is like a merit-based ladder rather than what it is: scaffolding stretched across silences, reinforced with fatigue, and held up entirely by a sense of belonging.
Let the record show that no one is expected to admit to reading this. Only to act as though they have.
Breakroom Cabinet of Unspoken Truths
It is a truth not universally acknowledged (because to acknowledge it out loud is to commit a kind of career mind game) that workplaces speak in silences far more fluently than in any orientation module, any PowerPoint slide on “Mission-Driven Excellence,” or any HR poster laminated and stapled to drywall with passive-aggressive force.
Not all cultures are announced. Some simply accumulate, like the crusted tea rim of a mug in the shared cabinet, the mug that no one cleans but everyone keeps returning to, like a ritual.
You don’t learn this culture in orientation. You absorb it through slow exposure. You pick it up in glances, and who's allowed to talk during rounds and who isn't. In jokes. In their timing. In who gets to laugh without consequence.
Eventually, you start to understand things no one explains:
Who really writes the schedule. (Hint: it’s not the manager. It’s “just the assistant” scheduler with a spreadsheet and a vendetta shaped like a smile.)
Who’s above correction, even when wrong.
Whose jokes land and why: trauma, timing, topology.
Who gets grace, and who gets watched.
Who eats alone.
Resonance Over Performance
This is not policy. It’s vibe-based gatekeeping. An unspoken calibration of who resonates. Not who performs well, but who refracts the shared dysfunction with the right frequency.
And then come the micro-loyalties, which sound like they should be small but are, in fact, the load-bearing beams of the entire operation. These are the sacred trades. The quiet deals were made in the hallway. The “I’ll chart your lunch if you chart mine” blood-pacts that hold the floor together when the system forgets it exists.
Examples, from my ledger:
I’ll take your late shift if you help me with that patient who throws suction canisters.
I didn’t see you crying in the locker room, and won’t ask why.
I’ll clean your OR and claim the mistake was mine.
I’ll warn you when the manager is prowling and the vibe has shifted from “team meeting” to “witch trial.”
These trades are undocumented, unrecorded, and crucial.
Break Room Epistemology
Conversation in the breakroom is not conversation. It’s ritual. A form of performative solidarity spoken in refrains so worn down they’ve lost the shape of language.
“It is what it is.”
“That’s how things roll around here.”
“Same shit, different day.”
These aren’t insights. They’re tray liners for the soul. They ward off the madness of pretending any of this makes sense. Their purpose isn’t to clarify but to recognize: yes, we’re all in the same leaky boat. No, we’re not patching it. Yes, we’re still clocking in tomorrow.
The Ones Who Eat Alone
Nobody eats alone by accident. That’s a myth peddled by HR to excuse exclusion.
Those who eat alone are not quirky, introverted, or “focused.”
They are the unprotected, the culturally unsponsored, the ones who either wouldn’t (or couldn’t) bend the right way when the team tested their pliability.
And yes, there is a test.
The work family is not a family. It is a battlefield alliance.
Its privileges include:
Joking about the surgeon with rage issues (but only once he’s off the floor).
Sharing memes in the group chat about burnout while everyone burns out.
Pretending not to talk about work at Applebee’s while exclusively talking about work at Applebee’s.
I tried rejoining this family, but you don’t rejoin a system like this. You hover around it. You try not to get reabsorbed. You perform gratitude while recalculating the odds of escape.
The Illness They Don’t Talk About (But Do)
My epilepsy, controlled, stable, quietly mine, was not discussed. Except when it was. Silently. Laterally. With the kind of non-verbal communication that makes you feel like you’ve left the room without standing up.
After the rumors (there are always rumors), I was reassigned for “reassessment.”
Let me explain what that word means:
Reassessment (n.): A bureaucracy’s polite way of saying, “We’re watching you now.” Usually framed as mentorship. Actually structured as surveillance.
My reassessor was a surgical tech I’d worked with before. Something about her had calcified. Her kindness had the soft, smiling edges of a resignation packet.
She never said “epilepsy.” She didn’t have to.
She corrected what wasn’t wrong.
Repeated what I’d already done.
Watched without acknowledgment.
Smiled like a memo.
The Comment
After a straightforward ORIF—nothing dramatic, 4-0 nylon, clean closure, low mess—I was wiping down the mayo stand when she left without a word. The nurse lingered. She was older. Kind, I think.
She said it casually, like offering gum.
“You really don’t look like you love your job. You should reconsider what you’re doing.”
I nodded. Not because I agreed. But because I understood. I understood completely.
You’ve been noticed.
You’ve fallen out of the loyalty web.
Reconsider leaving before someone makes that decision for you.
The Surveillance Layer
Here’s what they don’t print in clinical competencies: The burden is not to be well. It is to perform wellness with such unbroken consistency that even the performance is no longer legible.
Epilepsy only matters when it scares someone else. You’re allowed to have it. You’re not allowed to be seen having it.
To disclose is risky.
To conceal is a betrayal.
To perform it too well is lying.
To fail at performance is failure.
You live under conditional trust.
The team becomes a tribunal.
The Loyalty Economy
Don’t get me wrong, micro-loyalties are not evil. They’re efficient. They’re comforting. They’re how the real work gets done.
But they create a fragile market. And you, my friend, are a depreciating asset if:
You’re not someone’s favorite.
You miss the joke.
You hesitate on the wrong day.
You say the word epilepsy too close to a manager.
You become inconvenient.
There is no reentry protocol. No policy for reintegration.
Just the low hum of machines. The flick of a towel. And the knowledge that it was once meant for you.