“In 2009, you kind of need to know some C++ just to talk about bands,” Brian Howe wrote in the Pitchfork review for Antlers’ breakthrough third album, Hospice, a bulwark of starlit indie rock against scuzzy gutter punks like Wavves, UUVVWWZ and Nodzz. The AV Club likewise leveraged Antlers’ earnest ambitions against shitgaze and chillwave and remarked that frontman Peter Silberman seemed, “unconcerned whether his work might be criticized as overcooked” by comparison. In Spin’s view, occasional Stereogum contributor Larry Fitzmaurice surmised that Antlers were out of step even in their hometown during the heyday of Hipster Runoff, adding, “this promising Brooklyn trio exist in an openhearted world far removed from their borough’s often too-cool posturing.” As Antlers spent 2009 as one of the buzziest indie rock bands in existence, all I kept hearing was how unfashionable they were.

The success of Hospice didn’t prove any of them wrong — these were all positive reviews, glowing even. Hospice was wide-released to the world 10 years ago this coming Sunday. It had initially been self-released by the band in March 2009; they celebrated that 10-year anniversary earlier this year with a reissue and a stripped-down acoustic tour that doubled as vocal rehab for Silberman. Either way, there were many future classics released in the following months of 2009, so Hospice can’t be considered the last great indie rock record of the 2000s. It is, however, the last great “2000s indie rock” record.

Hospice can certainly be seen as a triumph for a project that toiled away in obscurity until they were good enough to be noticed — it’s actually Silberman’s third record and not even Turn It Up, Faggot or the National’s pre-Alligator albums have been written out of a band’s history quite as definitively as Uprooted and In The Attic Of The Universe. But one thing Hospice had in common with every flash-in-the-pan indie act is a damn good narrative that played well in the still-thriving and still-influential mp3 blog circuit.

In fact, it’s something like an ultra-narrative, one that ties together every lingering thread from the decade like a series finale. There’s the “heartbroken man convalescing in seclusion” pitch — Silberman alluded to spending over a year and a half in near-total isolation in Brooklyn, which sounds far more harrowing than what Justin Vernon went through. People are supposed to go to a remote Wisconsin cabin to reevaluate the trajectory of their lives in complete solitude. When you do it in America’s biggest city, that’s sociopathic. Hospice’s porous boundaries between arena rock and post-rock ambience owed to early 2k bowl-passing staples like Sigur Rós and Godspeed You! Black Emperor, while its bombastic peaks were the byproduct of an “us against the world” propulsion that typified bands towards the middle of the decade like Wolf Parade, Okkervil River, the Decemberists, Bloc Party, the National and obviously, Arcade Fire. While “indie” as a whole was taking steps towards absorbing R&B, hip-hop and pure pop whole, Silberman’s influences were those of a cool RA — Boards Of Canada, Radiohead, Jeff Buckley, My Bloody Valentine. More pointedly, Antlers can feel like the last true beneficiary of the blog-to-Best New Music fast track, being thrust out of obscurity to immediate late-night appearances and enviable festival slots in the matter of months. I don’t think people necessary miss that kind of critical hegemony, just the idea that critics can possibly wield that level of influence.

Despite its long-tail success, Hospice is even more wildly out of step with the dominant modes of indie rock of 2019 — like many of those mentioned in the previous paragraph, Antlers’ influence manifests almost exclusively in more indie-leaning emo bands; I’ll argue Foxing’s “Five Cups” is pretty much the last three Antlers albums wrapped up in a nine-miute song. In fact, Hospice is worlds away from what Antlers themselves evolved into by Undersea and their presumptively final record Familiars in 2014 — songs regularly grooving out past six minutes with plenty of horns and only the faintest hint of song structure. If they were still around, an Antlers/American Football tour would make a lot of sense.

But what all of the above analysis missed is that Hospice would’ve been an outlier even if it had come out in 2005. Most of the definitive indie albums of this time had an inherent sweetness, and even superficially dark records like Funeral promised communal uplift and blasted a floodlight bright enough to guide your way out — listening to For Emma, Forever Ago is kind of a wish fulfillment for anyone who ever dreamed of being Thoreau or sublimating their breakup into something eternal, while “Wake Up” was used for a Super Bowl commercial.

After the unnervingly quiet “Prologue” and “Kettering,” the chorus of “Sylvia” hits like a pressure hose full of glittery revreb and it’s pretty much the only reason Hospice can get compared to Arcade Fire. But at no point do Antlers actually sound like a band who wants that chorus sung back to them by thousands of festival goers — the production is brittle and tinny, arena rock played during soundcheck. Nearly all of Hospice is coated in electronic chatter, like a hospital or inpatient clinic littered with noise machines and whirring LEDs — it’s almost like “Kettering” or “Wake” are Wilco’s “Less Than You Think” in reverse, predicting Silberman’s eventual, debilitating hearing loss rather than replicating it.

But more to the point, Hospice isn’t an uncool album, but one that’s really not cool — it’s absolutely brutal, even ugly, providing no catharsis, no likeable characters and not even a hint of redemption. The two main characters on Hospice are a put-upon, codependent, and delusional hospice worker and his muse, who mostly just wants to die and throws phones at him until she gets her way. There’s maybe one moment that sounds even remotely joyous, and that’s “Bear,” which shifts from twinkly, almost twee-pop to a hearty soul rave-up similar to “Wake Up.” And it is clearly about getting an abortion — not only that, but after the narrators make the quick decision to go about that nasty business, they get drunk and play charades in a hotel like they just finished law school finals or a Q4 accounting presentation or something.

When I saw the acoustic Hospice performance earlier this year, “Two” got the loudest response and it’s about getting so deep in a toxic relationship that the rest of the world ceases to exist. In this context, Hospice was probably emo all along. It’s a record I turned to for the same reasons as the phenomenally demoralizing likes of Cursive’s Domestica, Pedro The Lion’s Control, or pre-cancellation Brand New — it’s a safe space to lean into the shittiest possible feelings, have them validated and resurface an hour later, going about the business of trying to be a decent person.

Silberman was wisely cagey about what he chose to reveal about Hospice — yes, he spent some time visiting a children’s cancer ward, hence the unnerving “Kettering,” named after New York City’s cancer treatment center. Yes, this album is inspired by the disintegration of a relationship with an emotionally abusive partner — a theme it shares with the early work of Sharon Van Etten, who incidentally provided lead vocals on “Thirteen” and elsewhere throughout Hospice. “Sylvia” is directly inspired by Sylvia Plath (“get your head out of the oven!”), but also Leonard Michaels’ Sylvia, a fictionalized account of the author’s turbulent relationship with his wife and her eventual suicide. This is all stuff I found out after the fact, and so for a while, it all jumbled together to become an album about a guy who gets into a romantic relationship with a terminal cancer patient who might also be a child. It was … a lot when Neon Indian and Washed Out beckoned.

But if Hospice were simply a record about an overeager hospital worker who gets into a doomed romantic relationship with a patient in their care … that’s basically the whole Denny subplot of Grey’s Anatomy. Today, the album it most reminds me of is the Hotelier’s Home Like No Place Is There — in both cases, I wasn’t really able to fully get what they were about until I actually worked in hospitals and mental-health treatment as a professional.

During my residency at a VA hospital in Kentucky, I had a two-week rotation in hospice — they called it “long term care,” which is somehow both euphemistic and cruelly ironic, since people are only placed there if they don’t have much longer to live. Working in long term care is an emotionally powerful and unique experience on a human level, but also the most unchallenging rotation I did in my entire five months — dietitians are essentially waiters in this role, with the Hippocratic Oath as the only guiding medical principle. You’re basically there to give them whatever they want to eat, as long as they’re not allergic to it, or it doesn’t interfere with their medications, or it doesn’t make them choke due to a compromised ability to chew or swallow — they call the shots as long as what they want doesn’t actively make them die faster.

And sometimes, they just wanted somebody to yell at. These times were rare, however. This hospital is filled with veterans after all, people who chose a career path where they’ve likely seen their friends die right in front of them or have been responsible for causing death themselves. At their advanced age, mortality no longer catches them by surprise. These are the sort of hospice situations commemorated on albums like Touche Amore’s Stage Four or Eels’ electro-shock blues, where the narrator preemptively mourns for a blameless victim of circumstance who goes about their final days with dignity and grace. Every now and again, they were like the character on Hospice. Their physical and mental decline has stripped them of nearly all of their dignity and the one way they can feel powerful again is to wrest control over the one thing over which they have dominion: what they choose to eat. Enduring verbal abuse in this setting is not pleasant, but it’s easy not to personalize any of it.

But that’s not what we’re talking about with Hospice. At times, I wonder whether Silberman’s metaphorical conflation could’ve withstood modern sensibilities — equating a mentally ill partner with a terminal cancer patient in a narrative where he gets to play the victim. But with time, I’ve found that Silberman hasn’t sensationalized so much as made Hospice more accessible to anyone who’s found themselves dedicating their lives to a lost cause, any situation where it’s your job to help people who might not necessarily want it.

There’s actually a section in the Big Book Of Alcoholics Anonymous that describes the difference between the actual hospice songs on Hospice and the metaphorical ones where Silberman’s subject is suffering from an undisclosed mental illness — “if a person has cancer all are sorry for him and no one feels angry or hurt,” whereas the addict “engulfs all whose lives touch the sufferers.” This includes friends, family, coworkers, and also the people who dedicate their lives to fighting the battle against oblivion along with them.

Whenever I tell people I work in eating disorder recovery, the general response is “wow, that’s intense” — whether or not they know it’s the deadliest mental illness in existence. The intensity is inflamed by the circumstances of the job itself — contrary to the visions inspired by Betty Ford or Celebrity Rehab or Kendall Roy stepping out from a glimmering blue Icelandic spa on the season premiere of Succession, most people who work in addiction and mental health are paid astoundingly incommensurate with the education requirements, the difficulty of the job, and the emotional investment required to do this day after day. There are plenty of reasons for it — American healthcare’s dim view of mental health services and the still pervasive societal message that depression or addiction or eating disorders are something people can just “snap out of” if they could just exhibit some damn discipline. But as I’ve been told many times by my colleagues, it’s a wage deflation reflective of how most people who work in this field are women.

It should go without saying that, while working in mental health is on a somewhat altruistic plane, we get something out of it that an easier, better-paying position (i.e., most of them) wouldn’t provide. Anyone who doesn’t want to do this kind of work and this kind of work alone doesn’t last very long. Everyone meets a client hoping they can break through where society and birth family have failed. And because most of us have so much emotional equity at stake, it’s much more difficult to disengage during the times when our clients or patients strike back the way people do on Hospice — they’ll tell you they can’t be saved and and “you only care because you’re paid to.” The cruelest insult of all — you dedicated your life to this, and does it even really work?

When I listen to Hospice now, I don’t really think of it as a “breakup” album. It is one that holds a space for the sort of things that my colleagues don’t like to admit they feel, the resentment that bubbles up when people don’t seem to want to get better as much as you want them to get better: the impatience, the burnout, the fatigue in restraining from use of the “righting reflex” which is basically the pre-chorus of “Sylvia” — “please let me do my job.” And the times where you wonder “why won’t they just listen?” and feel like you’re no better than the people on the outside. Worth noting that everyone who works in the field is recommended to get their own therapist.

But these feelings aren’t exclusive to my line of work — anyone who toils in the service industry or really any creative field where you’re subject to the unpredictable whims of something you can’t control can probably relate. Sometimes the saddest thing about Hospice is that the narrator isn’t a surgeon or a doctor — those are the people who have to give him the tough talk on “Kettering” and “Shiva,” which could either signify the Jewish ritual of mourning or the Hindu destroyer of all worlds. He’s just a guy in the hospital who thinks maybe he has access to something beyond our synthetic knowledge that can protect and even save this poor kid.

If he actually died along with her, that might’ve been romantic in some macabre way — the reverie that closes “Epilogue” uses the lyrics of Neutral Milk Hotel’s “Two Headed Boy, Pt. 2″ for tracework. But there’s a different line on “Epilogue” that breaks my heart every fucking time — “I don’t work there in the hospital/ they had to let me go,” Silberman sings, bringing the story back to a matter-of-fact reality. He’s some dude who got fired because he became too attached to a patient, too engulfed by his purpose and now he’s gotta figure out what else to do with his life. Imagine being there for that conversation. Imagine trying to sleep that night. I owe Hospice this debt of gratitude — I can imagine those things and never have to experience it firsthand.