(P07)
Anxious hope: life and death in hospital ethnography
Location Chancellery Building, A1-014
Date and Start Time 05 Dec, 2018 at 11:15
Sessions 2

Convenors

  • Debbi Long (RMIT University) email
  • Narelle Warren (Monash University) email

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Short abstract

As places of high drama and everyday embodiment, hospitals are sites of both the sacred and profane, where life-and-death are intimately intertwined. This panel presents contributions on death-and-life from hospital ethnographers.

Long abstract

Hospitals are places of life, death and the everyday: soaring hope, deep hopelessness, enforced routine, heartfelt compassion, and impersonal managerialism. Hospital ethnography documents intimate moments of embodiment, formalised procedures and protocols, biomedical rituals, and deeply complex human, technological, material, spatial and temporal relationships. This panel presents papers from hospital ethnographers on the ordinariness and/or the extraordinariness of death-and-life in hospital environments.

This panel is closed to new paper proposals.

Papers

The role of intersectionality and reflexivity in community health clinic research

Author: David Colon-Cabrera (Monash Health) email
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Short abstract

Community clinics provide quality services to low income populations. This paper will discuss an ethnographic project conducted in three community clinics serving uninsured populations, and how a reflexive approach led me to use an intersectional approach which shaped the research and its analysis.

Long abstract

Community health centres in the US provide low-income populations with much needed coverage given the expensive nature of healthcare in the US. These centers continue providing services to low-income communities despite the heavily politicised discourse around health care costs in the last 10 years. The clinics balance scarce resources while providing quality services regardless of their patients' ability to afford insurance. In this paper I will recount my ethnographic research project in three community health centres that provide prenatal care to low-income and immigrant Latina women. Using an intersectional approach, I study the ways in which the clinics strive to serve their populations while managing their own limited resources. Part of my work meant reflecting on my role and presence as a male cisgender Latino researcher in that setting. That personal reflection had a profound effect on my research, since it changed the way I interacted with the participants. Even more so, my research priorities changed; the focus of my ethnography shifted from studying the way in which research can influence policies and clinical guidelines, to understanding how these guidelines are (or are not) carried out in everyday practice. It also shifted the focus of my research analysis. The research benefited since this approach contextualised the omnipresent tension that comes from providing quality services while having limited resources.

Uses of hope at the ends of life

Author: Mythily Meher (University of Melbourne) email
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Short abstract

Set at an Indian nursing home where the healthy often evoked a hopeful outlook to comfort the suffering, this paper shows hope as best understood in terms of its intricate, fraught relationships with hopelessness and helplessness in this institution's non-normative and circular temporal frame.

Long abstract

The linking of positivity to health, in which hope is characterised as healing, is more and more a mainstay in medical contexts. My paper asks after hope's uses in end-of-life care by drawing ethnographies of hope in oncology and physical rehabilitation together with fieldwork at an Indian nursing home, where a hopeful outlook was evoked by the healthy to comfort the suffering (especially the suffering who voiced their desire to die so that suffering might end). These conversations—awkward but inevitable—point to the jarring sensibilities between classical understandings of hope as agentive and effective, and the orientation of residents who embodied pain, and even boredom. Nearing the end of life, after all, ordinary senses of future fall away. Yet, I attend to more subtle hope-like attitudes evoked by pained and restless residents to carry themselves from one moment to the next amidst future-less orientations—like realism and acceptance—that seemed like hope's antithesis. I show hope as a quality best understood in terms of its intricate, fraught relationships with hopelessness and helplessness in the stream of time, where time, in this institutional setting, is circular and predictable. At this nursing home, time, action and hope are demonstrably intertwined in unusual, non-linear ways, broadening hope's potential as a category of analysis.

First deaths: doctors experiences of their first patient who died

Author: Debbi Long (RMIT University) email
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Short abstract

This paper explores the trope among doctors of "my first death", that is, the first patient who dies while under their care.

Long abstract

Health workers are trained to save lives. On a day to day basis, many clinicians work in circumstances in which lives are hanging by a thread. For them, death is an everyday reality. As the people in health systems who hold professional, legal and moral responsibility for patient survival, the impact of patient deaths on doctors holds very particular meanings. Based on fieldwork from a number of hospital fieldsites, and explored further in interviews with doctors, this paper examines the trope of "first deaths" among medical doctors.

Experiential tensions: language, trauma and amputation

Author: Narelle Warren (Monash University) email
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Short abstract

Amputee rehabilitation decisions are often made on the basis of etiology. In this paper, I draw upon an ethnographic study of four Victorian amputee clinics to interrogate the tensions that are brought about through the language which is used to describe the etiology of amputation.

Long abstract

Within amputee rehabilitation, decisions about formal support are often made on the basis of etiology. People who undergo amputation for reasons related to trauma (usually road traffic injury, workplace injury or misadventure) are classified as 'traumatic amputees' and receive psychological support, as well as assistance from social work services. Yet, for the vast majority of amputees, limb loss occurs in the context of a chronic condition, and is thus considered 'non-traumatic'. They receive limited - if any - psychological support, with most formal psychosocial services delivered by prosthetists, physiotherapists, occupational therapists, and social workers. Despite what this language suggests, the amputation itself often represents a violation of the body's organic boundaries, of losses which are embodied by the prosthesis and in the rehabilitation clinic. In this paper, I draw upon an ethnographic study of four Victorian amputee clinics to interrogate the tensions that are brought about through the language which is used to describe the etiology of amputation. Through this lens, I attend to the relational and affective implications of the changed material body, and highlight that the relationship between etiology and nomenclature undermines the distress associated with limb loss itself, regardless of why. In doing so, I highlight the blurring boundaries of lifestyle-related amputation between distress and depression, traumatic and non-traumatic, and the material and immaterial.

Rehabilitation socialities

Author: Joanna Shorland (Caulfield Hospital) email
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Short abstract

This paper examines rehabilitation inpatient experiences, and argues that the social life of the clinic is central to understandings of recovery.

Long abstract

Rehabilitation following serious and disabling health events is often positioned as an individual journey, in which the inpatient, guided by health professionals, actively works towards a sense of recovery. Yet this understanding only captures part of the rehabilitation experience, and recovery draws on not only the practical activities of the amputee gym, but also through the shared experiences within and between inpatients, and during encounters with health professionals and hospital staff. Drawing upon our current study of (predominantly neurological) rehabilitation inpatients, we draw upon interviews and observational data to consider the social life of the rehabilitation clinic and argue that, for many, the socialities of rehabilitation make an equally significant contribution not only to recovery but to long-term wellbeing.

This panel is closed to new paper proposals.