An excerpt from A Quiet Death.

Even as I lay perfectly still in the near-complete silence of my car, I could hear Dr. Tierney’s adenoidal voice in my mind. He always seized every opportunity to assure us that his diagnostic or therapeutic approach to patients was firmly supported by the literature. That, at least in the sense he intended it, was pure bullshit.

The medical literature had grown exponentially in the last twenty years. The vast machine responsible for conducting research and publishing it was too large, too complex, and too tainted by the competing self-interests of the parties involved. And physicians, including the few good ones I’d met over the years, were increasingly rushed trying to meet patient quotas due to ever decreasing reimbursement.

Sure, Dr. Tierney could rattle off studies that lent credibility to his preferred algorithm, but others could just as easily quote equally obtuse studies in support of a different approach. We were all engaged in a frenzied yet well-orchestrated dance of death choreographed by people with only remote interest in scientific truth, much less individual patients. And Dr. Tierney used the calculated chaos to his advantage, his approach to patients nothing more than greed and ambition thinly veiled by any studies that conveniently served his purpose.

At St. Gertrude’s our algorithms, and therefore a patient’s ultimate diagnosis, therapy, and length of stay, were more related to Dr. Tierney’s latest profit-driven vision for the hospital than they were the result of any universal medical truth. Our approach to patients was more finance and marketing than science. And physicians were low-level, stethoscope-wielding bureaucrats engaged in masking patients’ predetermined outcomes with meaningless physical exams and useless paperwork.

Thankfully, not all physicians were as determined as Dr. Tierney to banish empathy, individuality, and creativity from the hospital. Some, like Dr. Gelding, still tried to infuse at least a modicum of humanity and uniqueness into their day-to-day routine.

Dr. Kenneth Gelding was a new attending physician at St. Gertrude’s whose acquaintance I’d made only recently. I’d first met him a couple of months earlier, shortly after returning to the hospital’s harsh realities following a joy-filled weekend alone with my daughter down the shore.

He was a relatively short, portly man with wise brown eyes, a full head of distinguished gray hair, and a large, bespectacled nose prominently positioned above a full, well-kept beard. A confident demeanor, intelligent sense of humor, and calm, empathetic tone of voice conspired formidably to command significant respect despite his short stature. As a private physician, he wasn’t part of the faculty. And he seemed to prefer to simply tend to his patients, avoiding the political machinations that were such a large part of the lives of the academic physicians at the hospital.

“Do what’s necessary to make your patients well, Dr. Lipsom, and forget all the rest,” he’d said that first morning, casually jotting down notes in his patient’s chart at the nurses’ station. I was staring blankly at some lab results at the time, having just been reprimanded by an administrator for giving one of my elderly patients a cane to take home with her. I’d found it in the supply closet and had taken it without going through the appropriate channels. Gelding was certainly unique, and unfortunately so — he was one of the only physicians at the hospital that seemed to be both well-adjusted and in command of common sense.

As for the rest of them, they mostly seemed to follow Dr. Tierney’s lead, often being complacent to the point of indifference and simultaneously pompous to the point of callousness. They spent countless hours posturing and bickering amongst themselves. They argued endlessly, like schoolchildren, over whose approach was more strongly supported by the existing literature. And they did this despite knowing the literature and the system that yielded it were both fatally flawed. We quarreled in spite of common sense and despite the patients suffering quietly alongside our battlefields of fear and hypocrisy.

Rather than focusing on unity and creativity to bring change to a system that so frequently violated the very tenets we had once sworn by, we used our beloved algorithms as cudgels to beat down colleagues, patients, and anyone else who dared challenge our views on illness and healing. And perhaps rightly so, since tomes of poorly designed medical research were all that distinguished us from those quacks to the east with their unproven, alternative approaches to healing and their annoyingly long life expectancies.

So each day we armed ourselves for battle, our algorithms carefully concealed in our memories and the latest medical literature securely holstered in the pockets of our white coats, while vultures dismantled our profession piece by piece —

I lunged forward in my seat after hearing a … rolling sound I suppose would be the most accurate description — the sort of circular, high-pitched creaking that reminded me of the wheels on the broken-down wheelbarrow my father had pushed me around the backyard in when I was a kid. I checked my immediate surroundings, but again there was nothing. My ears, and mind for that matter, were never reliable on such little sleep.

I glanced at my watch and found I still had twenty minutes before I needed to go in. I was tired, exhausted. And I wasn’t feeling well again. My mind had started to race. Cold sweat covered my head; a fine tremor subtly vibrated my hands as I loosely gripped the steering wheel. I tightened my grip, and the tremor disappeared.

I closed my eyes again and tried to relax. I knew I was too tired to stay in the car any longer without risking sleep, yet I didn’t want to move. I was alone and shrouded in darkness there in the visitor parking lot furthest from the hospital’s entrance. I’d recently started parking as far from the hospital as possible to ensure privacy should I decide to eat lunch alone in my car — I’d been avoiding the cafeteria as of late.

I’ll get out of the car in a couple of minutes, I thought, staring blankly at the glowing cross suspended above the hospital’s entrance. It was Friday, and I knew if I could just make it through that day’s shift, I’d be rewarded with my first full weekend off in almost two months. The thought offered hope — at least I could put off the inevitable for a few more days.

A faint smile brightened my countenance for a few fleeting moments before the tortured, screaming faces that so frequently haunted me, each morbidly draped in badly torn skin and drenched in perpetually flowing blood, forced their way into my mind. I’d learned any attempts at casting them off were futile, so I embraced their agony, and my own, as I drifted off …

Luis Collar is a physician who blogs at Sapphire Equinox. He is the author of A Quiet Death, and you can follow him on Twitter @HippocratesNow.