A clinician and lecturer navigates two failing systems: one bound by rigid hierarchy and scarcity, the other overwhelmed by bureaucracy and performative equity initiatives.

From chained palliative patients and late-night pandemic guidance calls to endless appeals, grant rejections justified by "not enough clinician voice," and the quiet absurdities of academic life, the daily frictions reveal how institutions slowly reshape those inside them.

Institutional Rot is a sharp, unflinching autofiction ledger. No easy uplift. No tidy moral. Just precise, detached observation of how systems work and how they wear people down.

For readers who appreciate the clinical precision of Rachel Cusk, the institutional insight of Samuel Shem and Adam Kay, and unflinching looks at modern medicine and academia.