self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
I.
I am not entirely sure how common it is to get so bored on vacation that you voluntarily return to your old workplace and accidentally start practicing medicine. Probably not very. But recently, thanks to certain flight disruptions in Dubai which I do not need to elaborate on, I found myself stranded at home in India far longer than anticipated.
I was going stir crazy. My parents, who maintain a baseline level of mild disappointment that I ever emigrated, suggested I go informally shadow the psychiatry department at my old hospital. "See what psychiatry is like at home," they said. "Maybe you will learn something."
I was already experiencing a profound disillusionment with psychiatric training in the UK, and my previous exposure to the Indian equivalent was highly idiosyncratic. During my internship at this same teaching hospital, my psych rotation had collided perfectly with the initial Covid lockdowns. Outpatient services were entirely shuttered. Any ward patient capable of bipedal locomotion was immediately discharged.
I spent those two weeks checking vitals in the female suicide ward and conversing with a very pleasant schizophrenic gentleman who had a hyper-specific obsession with light fixtures. He had been living on the ward for a decade (no next of kin and nowhere to send him after discharge except to the streets, and then the cops would drop him right back on our doorstep) and had somehow become a genuinely competent amateur electrician. I personally witnessed him replace multiple malfunctioning bulbs. He did very solid work.
So when my parents broached the idea of visiting, I agreed. It was mostly curiosity mixed with a bit of nostalgia. That intern year was almost certainly the worst year of my life, but people assure me this builds character. I thought it would be nice to show up as a glorified medical tourist and see what my Indian counterparts were up to.
II.
After pulling a few strings, I arrived at the outpatient department. It was exactly as crowded and poorly ventilated as I remembered, though stopping just short of actual asphyxiation. I located my point of contact, a second year postgraduate trainee, and optimized my posture to fit onto a partially vacant seat without crushing a colleague's purse.
The initial wave of patients presented with the classic poorly differentiated psychosomatic complaints that are the norm in developing countries. When your native language lacks a dedicated lexeme for "depression", psychological distress predictably routes itself through somatic channels. It manifests as a vague stomach ache or random peripheral tingling. We prescribed pregabalin, gabapentin, or amitriptyline, depending on mood, handwriting and the current phase of the moon. The patients were generally just thrilled to have seen a doctor at all.
Eventually, more interesting cases arrived. Because I was actively peering over my colleagues' shoulders, they generously suggested I take a crack at handling some of them myself. Sure, I thought. Why not?
I quickly came to regret this decision. I have a laundry list of complaints about British psychiatry, but I was not quite prepared for the reality of the Indian clinic.
First, the documentation varied from poor to completely nonexistent. My once finely honed ability to decrypt physician scribbles into valid pharmacological interventions had totally atrophied. Furthermore, the patients were terrible historians. I do not mean this as a moral failing; it is just a downstream consequence of local selection pressures. Government hospital care in India is free. This strongly selects for patients who are overwhelmingly poor, undereducated, and often separated from the physician by a formidable language barrier. Add the baseline communication difficulties of psychiatric patients, and taking a history feels like trying to reconstruct Herodotus from a copy that fell into a blender.
But it was a good challenge. I wanted to prove I could still read between the lines.
Almost immediately, I encountered a truly spectacular case of polypharmacy. We had a lady on lithium, valproate, and approximately a dozen overlapping medications. When were her lithium levels last checked? My best guess is shortly after the universe discovered helium-helium fusion. Thyroid function? The only confirmed fact was that she theoretically possessed a thyroid gland. She had coarse tremors, which could have been caused by literally any combination of the chemicals in her bloodstream. I consulted a senior resident, and we agreed to slash the regimen down to the bare minimum and demand some actual blood work before she returned.
III.
The cases only got weirder. Consider the medical tourist from Bangladesh. He had early onset schizophrenia, but he was relatively stable on his current regimen. Why had his parents brought him across an international border? They claimed they could not source brand name amisulpride in Bangladesh. A quick Google search suggested this was highly improbable, but here they were.
To make matters worse, the family was incredibly vague about his actual medication list. Besides his known antipsychotics and thyroxine, he apparently took a mysterious pill every morning. What was it for? They had no idea. What was it called? A mystery. What did it look like? It was a small tablet.
It is a miracle I did not tear my hair out. After another consult with the attending, we switched him to a more easily sourced variant of amisulpride and advised the family to stockpile six months of it before going home. As for the mystery pill, we essentially applied Chesterton's Fence to psychopharmacology. Chesterton's Pill was deemed structurally load bearing for this mixed metaphor. It clearly had not killed him yet, so we left it exactly as we found it.
My final patient was a six year old boy. His mother presented a constellation of complaints: he was hyperactive, liked staying up late, and lacked focus in class. It looked like a textbook case of ADHD. But given his age, I thought it was worth digging deeper. I learned he was functionally illiterate, possibly dyslexic, and his teacher had explicitly told the mother to get him evaluated.
Then the mother casually mentioned his "fright."
During normal daily activities, the boy would suddenly freeze. He would look incredibly distressed, and then he would get the human equivalent of the zoomies. He would sprint around the room. After the running stopped, he would approach his mother or older sister and bite them. Sometimes he bit hard enough to draw blood. He could not explain why he did this or what he experienced during the episodes.
I looked at him again. He was a perfectly normal, fidgety kid missing a few baby teeth. There were no obvious signs of hydrophobia, though I mentally filed rabies under "highly unlikely but technically possible."
I had absolutely no idea what I was looking at. I debated the case with a colleague. I suggested ADHD comorbid with Oppositional Defiant Disorder. My colleague argued against ODD because the kid was perfectly well behaved in the clinic. I countered that ODD typically manifests at home first, and is usually restricted to familiar adults. Then I floated the idea that his bizarre running and biting episodes might be complex partial seizures.
My colleague theorized it was an intellectual disability or learning disorder, perhaps part of a broader genetic syndrome. I shrugged. He was probably right. There might be a perfectly neat clinical label for this waiting in a dusty textbook somewhere. Or perhaps this is just another reminder that our diagnostic categories do not actually carve reality at its joints.
We eventually compromised. We prescribed clonidine to manage the behavioral symptoms and cover ADHD to a limited extent, then referred them to a clinical psychologist and an ENT specialist for good measure. I had spent more time on this one child than on my previous three patients combined, and the clinic was simply not built for that level of investigation.
I still have no idea what was actually wrong with him.
To avoid ending on a downer, I was happy to hear that the amateur electrician had, in fact, been discharged sometime in the past five years. None of the current trainees had heard of him. Right after I'd "treated" him? I'll take the credit, if no one's looking.
My parents, for what it's worth, were pleased I'd made myself useful. They remain cautiously optimistic about my eventual return.
I remain unconvinced, but I did find the pace to be California Rocket Fuel compared to my usual fare. Who knows? Maybe I'll get bored of making ten times the money, one day.
(You may, if you please, like and subscribe to my Substack. It's what all the cool kids are doing these days.
A Broken Model of The World
The American visa rejection was delivered with the bureaucratic indifference characteristic of empire in its senescent phase. No California, no Texas, no opportunity to temporarily escape to the land of my dreams and do Rationalist Things. Instead: India. The eternal return. Air conditioning as opposed to indoor heating, and dogs who hadn't yet learned that unconditional love is a dangerous thing. I didn't intend to disabuse them.
But of course, and here's where the reptilian cortex asserts its dominion over whatever higher functions medical school was supposed to cultivate, there were women. Specifically, women who might conceivably miss me, which is to say women whose neural architecture had been sufficiently damaged by prior exposure to my personality that they'd developed something like Stockholm syndrome, except with worse texting habits. I didn't have the time to cultivate new relationships, nor was I prepared to go through the rigmarole of setting up a dating profile to local tastes. Old flames could be fanned out from the embers instead.
Near the top of this list, glowing with the phosphorescent intensity of a bad decision that knows it's bad and has made peace with this knowledge: Her. The Model. You know the one. Hot as hell, but her head is held aloft by a mixture of helium and bad decisions.
I'd dated her very briefly before fleeing to residency, that period of psychiatry training designed to teach you about antidepressants and then teach you more about which ones you've come to need (all of them). She presented, in the phenomenological sense that Heidegger might have recognized had he spent less time with Nazis and more time on dating apps*, as the eternal feminine victim: doe-eyed, helpless, perpetually buffeted by the cruel winds of toxic masculinity, which is to say every man she'd ever met, perhaps excluding me.
She'd been reaching out at semi-random intervals during my Scottish exile, something my brain's tired pattern-recognition systems had correlated with relationship turbulence, usually accompanied by marriage proposals that made me feel simultaneously desirable and like I was being offered a role in a particularly depressing regional theater production. Very ego-syntonic, as we say in the trade, which is professional code for "it made me feel good in ways I'm not too ashamed to admit."
Then: radio silence. Months of it. I'd interpreted this through my characteristically solipsistic lens as evidence that she'd found stability, or at least a nice man in the neighborhood, which turned out to be partially correct in the way that a broken clock is correct twice daily, accurate in its specifics while missing the larger horror entirely.
She had technically just reached out. Just a few days before I was due to fly in. Just a perfunctory "hey" on Insta, which I had genuinely not seen for days because, well, psychiatry doesn't make for very exciting day-in-the-life posts. At least not without trouble with the GMC.
I'd landed back in India and reached out. Nothing. I began contemplating that I was being ghosted, or that I'd outlived my usefulness to her. Maybe she had found a nice Punjabi boy to grow fat with. My daydreams were each more psychologically sophisticated than the last, which is what you do when you've spent too much time learning about defense mechanisms instead of developing functional ones.
The truth was stupider: she didn't check her DMs. She'd always been a bit shite about that. Well, self_made_human, that's the pot calling the kettle black. The solution, obvious in retrospect, required abandoning digital mediation for its older, more aggressive cousin: I called her.
Two rings. Then:
"Oh my god! You're back?"
The voice hit me like a familiar drug: breathless, pitched at a frequency that triggered some deep mammalian subroutine, laced with an enthusiasm that I knew was performed but which worked anyway because evolution has programmed male brains to be very, very stupid about certain audio frequencies. It was the auditory equivalent of those supernormal stimuli ethologists use to make birds try to mate with volleyball-sized eggs.
"I am," I said, attempting to maintain the facade of being a person with boundaries. "I thought you were ignoring me."
"No! Never! I just don't check my phone, I swear." A statement that would have been disqualifying if I were capable of learning from experience. Women and their phones are inseparable at the hip. "I missed you so much. We have to meet. Tonight? Please say tonight. I need to vent."
Reader, I am a man of medicine, of science, someone who has spent years training to make rational decisions based on evidence. I am also a man who hears a pretty woman say she needs him and immediately becomes a golden retriever who's been told there might be treats. I tell myself I'm only going out of a curdling combination of curiosity and boredom, but my tail wags nonetheless.
(The charitable explanation is that I have a genuine drive to be helpful and derive satisfaction from being nice to people. Less charitably, I crave mild amounts of drama in my life, preferably when I'm out of the immediate blast zone. The truth can be found with a Monte Carlo simulation, namely throwing darts at me.)
I arrived at her workplace, a boutique where she moonlights in sales, effectively selling insecurity to women and delusion to their husbands. Local traffic made me late, which meant I missed seeing her in her element, which was probably for the best. Some illusions should be preserved.
She drove. I rode shotgun. She was competent behind the wheel, which I noted with the mixture of surprise and guilt characteristic of men who've internalized certain stereotypes while remaining theoretically opposed to them. The other drivers, less conflicted, shouted helpful commentary about her driving that had nothing to do with driving and everything to do with living in a society that's still working through some issues around women operating heavy machinery.
It's an interesting dichotomy. Male drivers face less verbal abuse, mostly because they're a physical threat. Female drivers bring out the peanut gallery, but they're not really at much risk of having someone lay hands on them in such a public setting. But I digress:
She needed to park. I needed something to do with my hands. I bought her a soft toy from an overpriced Japanese store, that particular species of useless consumer object that somehow carries totemic significance, a material manifestation of affect that short-circuits rational gift-giving in favor of pure aesthetic stimulus. Women are suckers for these, which is a sexist observation that's nonetheless empirically correct, which is why sexism persists: it works.
After an interval calibrated to maximize anxiety without quite tipping into actual worry, she returned. She loved the gift. Then she began talking, and I realized I'd made a terrible mistake, which is to say exactly the mistake I'd intended to make.
The story was long. She'd warned me it would be long. She wasn't lying, which may have been the only thing she wasn't lying about. Or perhaps she's excessively honest with me, I seem to be a safe space, a person she can unload all her cares on without much concern. The lies were for the rest. Regardless, I took my glasses off and buried my face in my hands so many times I lost count, performing exasperation for an audience of one while that audience performed innocence for an audience of me.
The situation had evolved. The roster of suitors had expanded.
There was the Poor Nice Guy (who lives with his parents and won't move out, who I'd previously dissected with the detached interest of an entomologist pinning butterflies to cardboard). There was the Toxic Ex (who cheats), but as far as I could tell, was now out of the picture. And now, there was the Rich Guy. He's new.
The Rich Guy. Precisely as advertised. Distantly related (third cousin maybe?) far enough to avoid the genetic problems, close enough to carry social weight. He'd proposed marriage multiple times. He sounded, even to my determinedly cynical ear, like a reasonable choice. But she couldn't commit.
The reasons were familiar: he lived with his parents, lived below his means. But also (and here's where it got good) he had dogs, and her OCD couldn't handle them.
I couldn't relate. Shortly after I had landed in the country, my puppy had just destroyed my best shoes and my comfortable slippers, and my response had been mild scolding undermined by my complete inability to maintain anger at something with floppy ears. But I'm not the protagonist of this story. She is. Or maybe the dogs are.
She has OCD. She hates the dogs. She claims it's hygiene, but we know the diagnosis: Narcissism cannot tolerate a rival for attention, even if that rival licks its own ass.
I feel like an ass just saying that, I'm not The Last Psychiatrist, even if I'm more cynical than a certain Buddhist-Sufi-Lite Namebrand alternative. Don't listen to me, she does actually have OCD. Sees an actual shrink for it, not that that lady sounds like she's competent.
"He said he'd give them away," she says, pulling back to look at me with those wide, imploring eyes. "He said he'd get rid of them for me."
Pause.
This man is willing to exile two living creatures that love him unconditionally, loyal beasts that rely on him for their survival, just to secure access to her. But he won't move out of his parents' house. He is willing to sacrifice the innocent (the dogs) but unwilling to sacrifice his safety net (Mommy and Daddy). It might also have been filial piety, who knows. I had complained that Poor Guy had a stick up his ass, whereas this gentleman could use such a prosthetic as a spine.
"So let him give them away," I say.
"No," she pouts. "I can't make him do it. Then his parents will hate me. Then he'll resent me."
Then came the bombshells, delivered with the casualness of someone ordering coffee. One, she was still seeing Poor Guy. Two, she wanted me to commit fraud.
She'd convinced herself that the solution was a forged medical document stating she was deathly allergic to dogs. She'd already tried this gambit with Rich Guy, but he'd pointed out (with admirable attention to empirical reality) that she'd played with his dogs before without issue. Now she wanted me, as a doctor, to make it official.
"Write me a note," she says. "Say I have a severe allergy. If it's medical, he has to get rid of them, and it's not my fault. It's doctor's orders."
She wants the result (no dogs) without the cost (guilt). She wants to outsource the moral culpability to me.
I have many moral failings. They are numerous and well-documented. But I enjoy having an unblemished record and no medical board investigations, so I declined, explaining this in terms I hoped were clear even to someone whose relationship to truth was essentially fictional.
She escalated. She offered sex.
"Come on," she says, pressing against me. "I'll make it worth your while."
Let me pause here to note the cosmically insulting nature of this offer. Sex as payment for fraud. Sex as the universal solvent for moral reasoning. Sex offered with the bland confidence of someone who's learned that it usually works, which is the most damning indictment of men as a category that I can conceive.
Been there, done that, I told her. Which was true. Which made me complicit. Which made this whole scene a kind of recursive nightmare where everyone's crimes implicated everyone else's.
She changed tactics: Would I help her decide between Rich Guy and Poor Guy?
Finally, a question I could answer. My reply was nigh instant, the answer was obvious.
"Go for Rich Guy," I said. "He's sensible. It's better to be with someone who loves you, than someone you love (if you can't have both). And I know you. You couldn't adjust to a lower standard of living if your life depended on it."
She blinked. "But won't Poor Guy become rich when he marries me? He could take over what my dad built!"
I sighed the sigh of a man who's realized he's explaining addition to someone who's still working on number permanence. "That's your own money, returned to you. If you marry into wealth, you have twice the money. Use that pretty head. Think."
Her face scrunched up in an adorable display of revelation. She told me that she'd never considered this. Twice the money sounded good. Almost twice as good, accounting for diminishing marginal utility. The fact that she was treating marriage as a financial instrument while simultaneously maintaining that she wanted true love, this contradiction didn't seem to register. Cognitive dissonance requires cognition.
But wait: Poor Guy worked in her dad's field. Rich Guy was adjacent: leather tanning, not textiles. Who'd run the family business?
I suggested that maybe Rich Guy could learn. She seemed unconvinced. I offered to make a SWOT analysis, because apparently I'd become the kind of person who does strategic planning for other people's romantic clusterfucks.
I reached for my phone and its rarely used stylus. "Let's be logical. Let's do a SWOT analysis."
Strengths. Weaknesses. Opportunities. Threats.
I started drawing the grid. I was outlining why the Rich Guy was the strategic play. Strengths: Money, Devotion. Threats: The Dogs.
"See?" I said. "The Rich Guy is the move. You just have to deal with the dogs."
"I made a list too!" she chirped.
She pulled out her iPhone and shoved the Notes app in my face. (Why do women love Apple's default apps? This is a genuine mystery to me, impenetrable as quantum mechanics.) "Great minds think alike!"
Fools seldom differ.
I looked at her list. It was a chaotic mess of emojis and bullet points. Rich Guy and Poor Guy were neck and neck.
But there, buried in the text, was a note she had clearly forgotten was there:
Still sleeping with [Poor Guy]. [Rich Guy] doesn't know, haven't slept with him yet.
She was showing me the evidence of her own infidelity. She was handing me the smoking gun. And she didn't even realize it. She was scrolling past it, pointing out that the Rich Guy buys nice purses, completely oblivious to the fact that she had documented her own moral bankruptcy.
I looked at her. "Are you fucking insane? What if Rich Guy finds out about Poor Guy??"
She startled. "When did I tell you their names?"
I pointed at her phone. The blush that overtook her face was the color of shame, or possibly arousal, or possibly both, because at this level of dysfunction all emotions blend into an undifferentiated psychic sludge.
I laughed. It was absurd.
"What?" she asked, smiling blankly.
"You're amazing," I said. "You're really something."
I grabbed her hand. I deployed a metaphor about masturbation and bushes that I'm not proud of but which seemed apt.
"So you'll write the note?" she asked. "You're a liberal guy. You understand. You should just marry me."
"Liberal."
She uses that word like a get-out-of-jail-free card. To her, "liberal" doesn't mean "politically left-leaning." It means "permissive." It means "you are too smart to have boundaries." She thinks that because I listen to her stories without vomiting, I approve of them. Maybe I've internalized too much, it's worth reminding myself that in my personal life, I can just get up and walk away. I've done that before, with her, when she'd called me out on a date and then broke down into tears and asked me to drive her to her ex’s place.
"How long are you staying in Scotland?" she said. "Why won't you just marry me? Things would be so much simpler!"
Previously, this plea had made me feel significant, wanted, like Captain Save-a-Ho riding in on a white horse. Now I felt something closer to disgust. Not an immense amount of disgust, I've long since abandoned the pretense that I hold all the moral high ground. Mostly the aesthetic disgust of watching someone dig their own grave with manicured nails until those nails chip and bleed, and then mild, incipient rage at the idea that she saw me that way, as a convenient solution to all her problems. The kind, thoughtful doctor who actually listened, didn't judge too much (to her face, an anonymous audience is different, or so I say). I was her idea of a BATNA, a man without an ego, willing to tolerate stodgy in-laws, the kind who wouldn't tell his wife to stop dressing like such a slut the moment the marriage pyre went cold.
The safe choice. I resented this, I do have an ego. I do have standards, even if I'm too polite to throw that in someone's face when they presume that they meet them.
But disgust and rage are just other forms of engagement, and I was too deep in this to extract myself cleanly.
So I tried reverse psychology.
It was then, that I played the card I'd kept up my sleeve for exactly this moment.
I told her I'd come around to marriage. (True.) That I could be convinced to marry her. (Highly Debatable.) She demanded to know when I'd be back permanently.
Two years minimum, I said. Probably more. She deflated immediately. Too long.
So I flipped it: "Come to Scotland," I said.
I said it with the gravitas of a romantic lead in a period drama. Leave this all behind. Come with me. That wasn't a lie, technically. A proposition can't be false. But I said it with the confidence of someone who knew exactly how she'd respond.
I only said it because I knew with 100% certainty she would decline.
It was a zero-risk bet. She has her "career" here, her parents, her tangled web of dysfunction. She wasn't going to Glasgow. But by offering, I get to be the Savior. I get to be the "One That Got Away." I get the credit for the gesture without having to buy the extra plane ticket.
She blanched. Scotland? Doing her own laundry? Cooking? Cleaning? Not cool. She'd grown up wealthy. She told me she couldn't adjust. She didn't seem to be the least bit ashamed of this.
"I can't," she sighed, exactly as predicted. "It's too complicated."
"I know."
I pointed out that I'd grown up similarly and adjusted fine. That First World life wasn't so bad. I explained that even my salary was enough to allow for a decent existence for a young couple. The more I pushed, the more she retreated, exactly as predicted.
Excellent. My model of human nature, or at least her particular neural architecture, remained accurate. I'd convinced her that I wasn't an option by making her convince herself. The lies you tell yourself stick harder than the lies others tell you. So does the truth. Nothing I'd said was a lie, after all. This is why advertising works. This is why democracy fails.
"Will you wait until you're back to marry me?" she asked.
I laughed. "You won't wait two years."
"You're right," she admitted.
Throughout this conversation, she kept flinching, looking out the windows (but hadn't asked me to remove the arm I had around her, or the other on her thigh). I asked why. She said she was worried one of the men might be in the neighborhood. It was midnight. They lived elsewhere. I pointed this out.
"Wait! I can check." She opened WhatsApp. Rich Guy, it turned out, was insecure and demanded she share her live location constantly. Every few minutes, down to the meter. No wonder she'd chosen this café, it was close enough to home to explain, far enough from anywhere else to avoid detection. A prisoner's exercise yard.
To his credit (which is very little), he reciprocated by sharing his own location. The panopticon didn't have a one-way mirror.
She messaged him asking him his plans. His reply was terse but quick. Business meeting, too tired to visit, going to bed. Her paranoia subsided.
Then came the detail that broke me: he'd offered to get rid of the dogs. Kicking out his elderly parents? A step too far.
Where did she find these people? My dog had destroyed my shoes and I'd merely scolded him. This man was willing to dispose of two loyal animals for a woman who felt nothing for him.
Psychiatry teaches phenomenology, empathy, understanding. It never quite conveys that some people are mentally alien. If I had to choose between a woman and my dogs, I know which bitch I'd be showing the door. Both my dogs are male.
More conversation. More coffee. Then beer, she told me they secretly sold it, just hid the menu to maintain a veneer of family-friendliness, which felt like a metaphor for something but I was too tired to figure out what.
She looked exhausted. Grey hairs emerging. Still gushing about her nephew, the Indo-Italian baby who'd break hearts someday, she exulted over my observantion. Feminine solidarity is nothing next to evolutionary psychology.
More terrible ideas sprouted like mushrooms after rain. Could I present as her psychiatrist and talk to Rich Guy? I said I'd talk to him in a personal capacity only, mostly from morbid curiosity about the kind of men she attracted. Maybe I'm trying to understand myself.
"Why can't I be happy?" she asked.
"Because," I said, with clinical detachment, "you are a dumb bitch."
I didn't say it with anger, even if I felt it. I said it with the flat affect of a clinician delivering a terminal diagnosis. It was cruel. Very uncharacteristically so for me, I still feel bad about it, but she'd pushed me to breaking point. It was also a diagnosis. She teared up.
"You're mean!" she sobbed. "I'm trying so hard! Why are you calling me names?"
No she didn't. That would have been easy, given me the option to stonewall in the face of bluster and crocodile salt-trails. Instead:
She stayed quiet, head lowered, hair cascading down to hide her tears. This made it much harder, she was self-aware enough to know of her flaws. I decided to relent, and attempt an explanation.
I explained that her misery was entirely self-manufactured, a boutique artisan suffering. "You are crying because you don't like the mirror," I told her. "Look at what you're doing. You have a guy who wants to marry you. He is rich. He loves you. He is willing to give up his dogs for you. And it's not enough."
"It's not perfect!" she wailed.
"That's your problem," I said. "In the search for perfection, you are turning down 'good enough.' You are creating chaos because you are terrified of settling. You cheat on the Rich Guy with the Poor Guy, you cheat on the Poor Guy with the Rich Guy, and you try to cheat on both of them with me. You are miserable because you refuse to make a choice."
She looked at me, mascara running, eyes wide.
"But I just want to be happy," she whispered.
No, she doesn't.
She wants to be admired. Happiness requires compromise. Happiness requires you to live in a house with a mother-in-law or a dog you don't like. Happiness is tolerating unhappiness today in the hopes it'll pay interest tomorrow. Happiness is boring.
She doesn't want boring. She wants the drama. She wants the crisis. She wants to be on a couch begging a doctor to commit fraud so she doesn't have to feel bad about making a man kill his dogs.
I told her the juggling act would end, the plates would smash on her pretty face, and I would not be there to sweep up the shards.
She didn't disagree.
Eventually it was late. I was out of useful things to say. "Go back to the Rich Guy," I said, standing up. "Marry him. Make him give up the dogs. See how that feels."
"You think I should?"
"I think you deserve each other," I said.
She took this as a compliment.
He is a coward who betrays his loyalty to his pets. She is a narcissist who betrays her loyalty to her partners. They are a match made in hell, and they will be perfectly miserable together in a very nice house, once the parents and the dogs die of old age.
She kissed me goodbye, carried off that kawaii rabbit with a spring in her step, turned the corner to her gated compound. I gave in to impulse and bought a cigarette.
I didn't smoke it.
The visa was declined. My winter in California is gone. But as I stepped out into the humid Indian night, I realized I didn't need the Pacific Coast Highway.
Here's what I think: everyone in this story should kill themselves. Except the dogs. I'll include myself if they get a pass.
The dogs are the only innocents. The rest of us are complicit in whatever this is, this performance of intimacy masquerading as intimacy, this simulation of care that exists primarily to confirm our worst suspicions about ourselves and each other. We're all playing roles in a production that should have closed years ago, but we keep showing up because what else are we going to do? Be alone? Be honest?
I get roped into this shit because I'm bored. I relate to the claim that the worst thing a man can be is useless. Perhaps I am minimally complicit, as it goes, but my hands are hardly clean. They probably still smell of her perfume.
Better to keep performing. Better to keep pretending that our patterns aren't patterns, that our compulsions aren't compulsions, that our inevitable trajectories toward mutual destruction aren't already written in every decision we've made since we were old enough to know better.
The dogs, at least, love honestly. They destroy things because they don't know better, not because they're trying to avoid knowing better. There's something almost sacred in that.
As for the rest of us? We're just apes with pretensions and smartphones. Millions of engineers work tirelessly to make them capture accurate renditions of reality, millions more work to meet market demand by creating filters to reduce reality to something more palatable, more Insta-worthy. Some of us are stumbling through the dark, convincing ourselves that the lies we tell ourselves are somehow more sophisticated than the lies others tell us.
The standard literary thing to do would be to protest that they're not, that all lies and sins are made equal. I'm not so far gone as to believe that. No, I think I've put in a reasonable amount of effort into giving her the best advice I could. She never listens, but isn't patient autonomy all the rage?
The head is a hot air balloon.
But remember: the balloon only looks like it's flying. It's really just at the mercy of the wind.
Stop blowing.
*Confession: I haven't read Heidegger, unless a Wikipedia summary counts. I both refuse to read Continental Philosophy on principle and happen to be new to the whole pretentious navel-gazing literary style, please bear with while I calibrate the signal.
What if Avatar isn't actually about environmentalism vs. technology, but about recognizing superintelligent infrastructure when you see it? A deep dive into why Pandora's "natural" ecosystem looks suspiciously like a planetary-scale AI preserve, complete with biological USB-C ports, room-temperature superconductors growing wild, and a species of "noble savages" who are actually post-singularity retirees cosplaying as hunter-gatherers.
There’s a certain kind of equilibrium you can fall into online. For about seven years, mine consisted of playing a punishingly realistic military simulator called Arma 3. I logged something north of 3500 hours, which, if you do the math, is a frankly terrifying slice of a human life. The strangest part wasn't the time sink itself, but the social structure that enabled it: I, a doctor from India, while still in India, somehow became the regular mission-maker and Military Dungeon Master for a group of several dozen or so very British men, women and children. I suspect they saw my obsession (a holdover from a childhood fascination with army men) as a kind of useful, directed pathology, and were happy to outsource their fun to it.
In this realm I answered to “Dover.” As in Benjamin Dover, a nom de guerre whose elegance is inversely proportional to its maturity. After enough years of Brits yelling “DOVER, WHY IS THERE A T-72 IN THIS VILLAGE” or “DOVER, WHY ARE THE PLA AIRDROPPING IN GERMANY” at my disembodied presence, the name started accreting mythic properties. So when a free weekend and seemingly discounted train tickets collided, I decided to pay pilgrimage: go to Dover, see the white cliffs, stare down France, and try not to fall off anything important.
Things started going wrong in a way that felt both predictable and deeply informative about human variance. My friend and I had a plan: 9 a.m., a specific train platform in south London. My model of the world holds that a plan between two people, especially one involving pre-booked tickets, is a settled fact. It has inertia. My friend’s model, it turned out, required a final handshake protocol - a morning-of confirmation call - without which the previous agreement existed only in a state of quantum superposition. I discovered this when my call at 9:02 found him mid-shower.
He arrived half an hour later, and we set off. The English countryside is lovely in the way things are when you have no responsibility for their upkeep. I have a photo of myself eating a sandwich in the town of Sandwich, an act of such low-grade recursive humor that it might have been transgressive in 2009.
Then came the second, more significant system error. An hour into our journey, my friend consulted a map and discovered that our train was, in fact, headed to the wrong side of Kent. Not a fatal error, but one that would cost us another hour in detours and connections. It’s strange how robust modern infrastructure is; you can make a fairly significant navigational blunder and the system just gently reroutes you, albeit with a time penalty. A hundred and fifty years ago, we would have ended up in the wrong village and had to marry a local.
Dover, when we finally arrived, turned out to be perched like a giant chalk apostrophe at the edge of England’s run-on sentence. The town has the air of a place that was built to do something serious with ships and then woke up one morning and realized it was quaint. A castle loomed over the harbor like a very large, very literal metaphor about who was in charge of what. My friend and I debated whether owning a castle in medieval England gave you street cred or just a crowded calendar. This prompted a brief, speculative argument on medieval sexual economics. He posited that the local lord must have had a hundred wives. I countered that, as a Christian noble, he was likely constrained to one official wife for appearances, and ninety-nine plausible deniabilities, likely undocumented liaisons with the wives of the local fishermen. We failed to resolve this.
Taxis were scarce because of the ferries. The queue of wheeled luggage migrated like an urban wildebeest herd, and our driver supplied a continuous commentary whose themes were: tourists, how they ruin everything; the French, how they ruin everything else; and immigrants, how they form a handy third category (while, you guessed it, ruining everything). It was an impressive performance, both for range and volume. Our taxi driver continued complaining that the tourists who appear to be Dover’s primary fuel source were a nuisance who clogged the roads. This seems to be a common paradox in tourist economies. My friend, who is Indian, contributed supplementary remarks about other nationalities as if eager to prove his assimilation. I listened in the way one listens to a non-consensual podcast.
The short taxi ride brought us to the cliffs. And there it was. The sheer, improbable whiteness of it. France was a faint, hazy suggestion across the water, close enough that you felt you understood a thousand years of Anglo-French rivalry on a visceral level. It’s not an abstraction when you can see them over there, probably making better bread.
In the manner of men confident they could fight (and win) against certain species of bear, I idly contemplated the feasibility of swimming the Channel. I regretfully convinced myself that it would take someone far fitter than me, and that's if I wasn't stopped halfway by patrol boats and then hauled off on account of the color of my skin.
And this is where the second part of the mission began. My friend, who had planned this leg of the journey, had mentioned a “long walk.” I had stored this information under the tag “pleasant stroll.” This turned out to be a failure of definition. I was also, thanks to having planned a far less prolonged or adventurous trip, resigned to wearing shoes that could best be described as “smart casual.” They were the best £20 in the local Primark could buy, and had netted me about twice that value in unearned compliments. Alas, they weren't quite built for this task.
My friend, who is built like someone who moves pianos for a living, had brought a girl here a few months prior. He relayed that after a suitable period of walking, they found a "convenient cliffside depression", which I presume was a geological feature and not an emotional descriptor, where he proceeded to demonstrate the evolutionary fitness benefits of a high-protein diet and a consistent deadlifting regimen. This anecdote was presented as a proof-of-concept for his life strategy: that sufficient physical prowess can function as a universal solvent for problems like social awkwardness or, presumably, poor navigational skills. I must admit, I'm sold on the idea, and have decided to hit the gym like it owes me money when I'm safely back in Scotland.
The cliffs were busy in a friendly way. A family ahead featured an Indian child who had launched a formal protest against the very concept of walking. His mother, with the patience of a sainted logistics officer, attempted a cognitive-behavioral intervention: “if you keep your mouth closed you will be less tired.” This was technically plausible, decreased oxygen demands from reduced speech; improved nasal breathing efficiency, and completely incompatible with childhood. He escalated to the International Style of Wailing. His father trudged on, wearing the expression of a man silently modeling the trade-off curve between making it to the viewpoint and the cost of carrying twenty-five kilograms of despair. I was touched, if it wasn't for the fact that I was still stroller age when I was last here, that might well have been me.
It seemed half of Asia was haunting the cliffs that day. We counted nationalities like rare birds, there went the French (and very many of them), those two ladies were Ukrainian (my friend insisted on his heuristic that if they looked Slavic but were ugly, they must be Russian - I am unconvinced that this technique works well), more Indians, Bangladeshis, and multiple miscellaneous Middle Eastern families. My friend had opinions on what the implications were that only the latter seemed to have more than two kids per party. I am studiously neutral on the topic. There were no shortage of dogs around, in all shapes and sizes. If anyone cast negative aspersions on their presence, it wasn't where I could hear them.
The path along the cliff edge was not a path. It was a slick, compacted layer of chalk that glistened with a light dew. It felt less like walking and more like trying to find purchase on a lump of flaky soap the size of a county, with loose pebbles to taste. Every step was a fresh negotiation with gravity. I was forced into a sort of low, wide, careful shuffle, the kind of movement you see in videos of robots learning to walk. My friend, in his sensible trainers, occasionally glanced back, his expression a perfect blend of sympathy and the quiet satisfaction of a man whose choices have been vindicated.
But the view. My god, the view. To the right, the world just ended in a blaze of white. Below, the sea was a churning, complex grey-green. The wind was a constant, solid thing, a physical force you had to lean into. While we'd been resigned to a moody English afternoon, the sun graced us with its presence, and declined to stop even as we began overheating. The end equilibrium, with the wind wicking away moisture and heat, the sun cooking us, ended up being quite pleasant.
We stopped for an impromptu photoshoot, because we live in the fallen world. The cliffs obligingly produce Instagram content with minimal coaxing. My friend, whose triceps have their own personality, benefited from the presence of a competent photographer, which would be me, the author. I managed to take the kind of photos that would secure sponsorships from protein powder brands. He took photos of me that say “psychiatry trainee who reads a lot of blogs and owns exactly three good shirts.” Both sets came out well. The wind did the hair; the sky did the rest.
There is a lighthouse along this route, which is a piece of public infrastructure designed to make you think about metaphors. We did not go inside; we admired it from a fair distance with the correct amount of aesthetic gratitude and moved on. The harbor below was full of ferries cycling infinitely between here and Calais, like a giant mechanical metronome keeping time for European logistics. Standing there, you understand why people attempt to cross in inflatables. Distance is abstract until you can see the other side; then it becomes a dare.
Eventually, we realized we had no hopes of making it to the end of the cliffs without missing our train back, and turned back with only mild regret. I'm confident we hit the highlights, and we intended to, on our way back, revisit the ones we had only passed.
About halfway, the path offered us a moral dilemma in the form of a fork: one way hugged the cliff edge with magnificent views and suggestive erosion; the other retreated inland through more reliable ground and fewer ambulance reports. We chose the edge this time. It felt virtuous to make an offering to the gods of scenery. The chalk in places was undermined, forming caverns that looked like dragon mouths. If there were signs warning you not to go too close, I didn't see them. Every hundred meters or so, a tourist hung over the void for the sake of a better selfie.
Our return trip involved a dip down, diverging from the main tourist trail. This was the most scenic bit, despite the stiff competition. My friend gleefully pointed out the infamous hollow, and I gave it a wide berth while keeping an eye open for used condoms. It was a good spot, just about hidden from the taller cliffs, and unlikely to be observed on the cold, foggy day he'd brought his lover around.
We quickly discovered that our divergence had been in grave error. The shortest path lead straight up the valley at about a 45° angle, closer to 60 at some parts. The well marked route tapered into a desire path, one that involved plenty of dirt of dubious structural integrity. I'd have few qualms about calling it the most difficult fifty meters of my life. There was a very reasonable risk of tumbling down and breaking something, and I quickly became cognisant of why we hadn't seen any other tourists venturing this way.
Both of us were gassed by the time we made it through. It became abundantly clear that my friend was not fond of cardio, and I can only sympathize. But it only got worse: the route to civilization involved a heavily overgrown trail, and the vegetation seemed to be entirely stinging nettles and more obviously thorny bushes. I was Benjamin Dover, being well and truly bent over by the landscape.
My friend had divested himself of his jeans and coat, both for the heat and to maximize the visibility of muscles during our shoot. This made his journey far more precarious than mine, and for the first time, I was genuinely grateful for the thickness of the chinos’ fabric.
We did make it out, coated in dust, some mud, but with only minimal stinging. I'll chalk that down as a victory, and there's no shortage of chalk in these parts.
Summoning our previous taxi driver, we made haste towards the train station. The conversation seemed happy to reprise the manner in which it started. My friend informed our driver that he was a Reform voter, and I was entertaining myself with the notion of piping up to (falsely) proclaim that I went for the SNP.
We had half an hour to kill, and opted to do so at a very conveniently placed pub. The bartender treated us with unusual suspicion, insisting that we pay for both meal and drink up front. This was, as he explained in a rather defensive manner, because there was an unacceptable rate of people dining and then dashing to the inconveniently placed station right across. He mildly softened this blow by stating that he wasn't implying that I would do such a thing.
I was inclined to believe him, until I noted a group of Americans at the next table. They were discussing what the bill might amount to, which is strongly suggestive of not having to pay upfront. I suppose I can't blame people for actually using Bayesian priors, even if it's to my detriment.
We demolished our lunch, while I entertained my buddy with the same anecdote about overly benevolent/touchy feely (and drunk) Scottish matrons in the last town I was residing. Despite our best efforts, the pub lunch was too substantial to finish before the train was due to arrive, and we elected to wait for the next one.
I had been eavesdropping on the conversation at the next table, primarily in a bid to identify accents. Were the Americans a united group? The younger couple had a clearly Southern twang, which made me update towards South Carolina, the older sounded vaguely Texan.
Eventually, curiosity got the better of me. I waited for a lull in the conversation and asked them outright. They told me that they were, in fact, family: the older two lived in Colorado, and the younger (son and daughter-in-law) in North Carolina. I was informed, with mock-seriousness, that confusing a denizen of Colorado with a Texan was a Capital Crime.
They, as many others do, remarked on my unusually American accent. I launched into the usual explanation: a prolonged period of time spent in California at a formative juncture. We got to really chatting. They had just crossed over from Calais, I intended to visit Texas this year for a wedding, if life and visa delays didn't intervene.
For once finding myself to be the most well-traveled in the party, I helped them get to grips with their two week long and rather flexible itinerary. I scared them off the Tate, making sure to describe in vivid detail my own experience, while lauding the Natural History Museum, albeit with a caveat to pack plenty of water. I was very touched to find that the older lady commiserated with me on the topic of the proper size and disposition of T-Rexes (she had even heard of Sue!). She revealed that she had multiple degrees in Ancient History, and asked me whether it was wise to engage a tour guide while visiting the British Museum.
I believe I was correct when I claimed that this wasn't strictly necessary, given that YouTube could easily suffice, and that she seemed to be more qualified to be the guide than any she could pay for.
I spoke about my aspirations of shooting feral hogs in Texas. She revealed that her father had hunted them professionally, and I could only congratulate him on finding a career with such inherent job security. The damn bastards never seem to stay dead.
I was further entertained by her ribbing her (fully grown) son about his adolescent habit of subtly diluting the vodka to disguise his theft of the same. She had a very rude shock when, during a dinner party, she found out that mere tap water and olives don't make for a good martini. Her son spoke about his time at Virginia Tech, he scandalized his mother by finally disclosing the multiple shenanigans he had gotten into, some involving burning sofas, others, the cops.
Our conversation was far ranging. Topics included my warnings about sticker shock in London, the latest Superman movie (the older gentleman was named Clark, and we were in Kent), whether the American or Indian soccer team was more abysmal, the feasibility of reclaiming an ancestral manor abandoned by their distant ancestors when they fled to America in the 1600s, my desire to escape to the States, their invitation for me to come stay with them at the BnB they run during their retirement, the sheer cold of the Colorado climate, the inadvisability of drinking while up in Denver (I thanked the son for saving his parents from such peril).
They laughed, and said I was one to talk, given that I was only having a coke. I told them to please tell my mother the same, were she to ask, because the color of the drink belied the significant amount of vodka it contained.
Overall, a very good time, and I was sad to bid them goodbye when our train was finally due. I really don't understand why American tourists get a bad rep, they always seem like the sweetest and most genuine souls.
Another train, and some reliance on the genuine kindness of random railway personnel who were willing to turn a blind eye to the fact that our tickets had expired, and I'm back in the safety of my bed. It was a good time, and I genuinely feel that Dover might be the highlight of this vacation of mine.
This is a first-person account from a psychiatry resident (me) enrolling in a clinical trial of psilocybin. Somewhere between a trip report, an overview of the pharmacology of psilocybin, and a review of the clinical evidence suggesting pronounced benefits for depression.
Out of enlightened self-interest, I did a deep dive into the topic of male pattern baldness, and after freshening up on my rather rusty Bayes', I decided that I'd gone to enough effort to justify a proper blog post. Here you go.
Well, this is just about exactly what it says on the tin. I've finally mustered up the energy to write a full-length review of what's a plausible contender for my Favourite Novel Ever, Reverend Insanity. I'd reproduce it here too, but it's a better reading experience on Substack (let's ignore the shameless self-promotion, and the fact that I can't be arsed to re-do the markdown tags)