Paper short abstract:

This paper explores how ESKD patients underscore chronic dimensions of their lives, frame COVID-19 as “just one more thing,” and orient to God to silence contemplations of an imminent death and embrace dependence on kin and medical technologies to reject rupturing their social networks and routines.

Paper long abstract:

End-stage kidney disease (ESKD) patients are expected to die within weeks in the absence of either a kidney transplant and dependence on lifelong immunosuppressant medications, or dialysis, an arduous process that binds sufferers to machines three times weekly and leaves them drained (Crowley-Matoka 2005; Kaufman 2005). Even without a typical slew of comorbidities, such patients’ health-compromised state renders them epidemiologically vulnerable to COVID-19 (Pakhchanian et al. 2021). Anxiety over their precarious existence and looming end of life would thus seem overdetermined among patients. Yet, in ethnographic interviews with twenty poor and racialized Boston Medical Center ESKD patients and five clinicians enrolled in a study investigating the syndemic effects of the pandemic and associated stigmas, orientations to illness, time, and care differed. Drawing on these interviews, I explore how patients underscore the chronic dimensions of their lives and frame COVID-19 as “just one more thing,” while clinicians use a “grammar of crisis” (Giordano 2020) to characterize their patients’ worsened situations. Narrating themselves as haunted by the anger and hurt they felt in response to White racism, patients come close to articulating a political etiology of their illness (Hamdy 2008), yet nonetheless affiliate with prevailing American biomedical ideologies of health that privilege individual agency and control over one’s life (Martin 1992) to embrace their chronicity. Concurrently and perhaps paradoxically, they frame life as in the hands of God to silence contemplations of an imminent death and embrace dependence on kin and medical technologies to reject rupturing their social networks and routines.