This summer I have been working for a medical school in Center City Philadelphia as a research assistant on one of the qualitative projects in the emergency medicine department. I interview patients and providers to get their opinions of and experiences with telehealth services. I also observe the project’s principal investigator, Dr. K, as she treats patients in the emergency room.
These observations sessions were originally designed to get me up to speed on the happenings of medical world, but have proven to be more than just familiarizing myself with medical jargon and patient intake and discharge forms. Rather I am becoming more familiar with the hospital and the emergency room as linguistic anthropologist, Cheryl Mattingly, described it – the borderland of the sick and the well.
Anthropology in the Medical World:
In her ethnography, “The Paradox of Hope” (published in 2010) Mattingly describes the hospital as a space where individuals from different class, racial, linguistic, national, and social backgrounds interact in high risk situations. The willingness and ability of doctors and patients to communicate becomes essential for surviving a visit and living a life after being discharged.
Of course miscommunication often occurs when people come together under severely different circumstances. In some instances the old saying “forgive and forget” may seem appropriate, but other instances cannot be forgotten and may not be forgiven. Consider the story of Regina which begins one evening during my observation session in one of Philadelphia’s emergency rooms.
The Story of Regina:
Walking into the emergency room this evening I am engulfed by the sounds of televisions, cell phones, intercom calls, heart monitors, wheel chairs clanking, and automated doors opening and closing. Nurses, doctors, patients, EMTs, and custodial staff bustle about in constant motion. Just looking at the scene it feels like a fast paced hotel. People come in, are served, and go out. The flow continues from station to the next, from one doctor to the next, from one patient to the next.
This never ends as the bed capacity remains at nearly 100% shift after shift and hour after hour. Some things happen so fast it is hard to remember from one moment to the next, but some things happen that can never be forgotten or forgiven.
About four hours into the shift one of the residents, seeming slightly bothered, reports to Dr. K that a women, Regina, has come in and is “just on her period.” How dare she take up space for such a minor issue? Forty five minutes later, after seeing a few other patients Dr. K and I go to speak with Regina. She is 28 year old woman, described as “morbidly obese” by the resident, and characterized as, “a little slow” by Dr. K.
Dr. K is clear, firm, and compassionate with her questions as she assesses Regina’s medical and social situation. She came to the emergency room because she could not stop the heavy bleeding of her period; an alarming situation, but one that could have been easily resolved in a clinic. Unfortunately, when Regina went to the clinic she was refused treatment for not having her insurance card in hand. Dr. K asks her, “what are you using right now to stop the bleeding?” Regina says, “nothing.” She has no tampons, pads, or other products to keep her from bleeding on her herself .
Ask Dr. K continues to talk with Regina we find out that she was recently homeless, but is now living with a roommate and receives government aide to help pay rent. Regina has no other form of income, but does receive food stamps. However, with food stamps she cannot buy self-care products such as soap, menstrual products, or toothpaste. Regina goes without.
Seeing and hearing Dr. K. talk with Regina my mind begins turns everything over and over. I see myself in Regina. We are both women of about the same age. We have both experienced medical issues regarding our menstrual cycle. We have both been labeled “obese” by doctors. We have both been at the mercy of a doctor who we hoped could help us without laying out too much judgment.
Yet I see that we are so different. In this medical borderland I have been in her place on the side of the sick, but now I stand on the side of the well. How is it that Regina and I found ourselves together this night in such different positions? What events lead to this? Since, Dr. K and I left the room I have been unable to stop thinking of this woman. These brief moments with Regina will not be forgotten ad might never be forgiven. For I know not whom to forgive for the fact that Regina had no other option, but to come to the emergency room for help with a seemingly simple problem.
But, her problem is not so simple as Dr. K puts it her visit to the emergency room is, “a short-term fix for a long-term problem.” And she is not referring to Regina when she says “problem.” Instead Dr. K is calling out a system where people are left without advocates and unable to advocate for themselves. For many people with nowhere else to go and no one else to turn to, the emergency room becomes their only option and the people in that department their only advocates.
Dr. K gets Regina in touch with the emergency department’s social worker who gives her information about other women’s services she can access. They also make a pinky swear that next time Regina will carry her insurance card with her when she goes to the clinic. Regina leaves the emergency room with a goodie bag full of menstrual products, tooth paste, soap, shampoo, conditioner, and other personal care products.
Leaving the emergency room that night I know Regina’s story will continue on after tonight, but for I won’t forget my brief part in it. I still wonder who is to forgive and how to forgive them for what happen to Regina? How do you forgive the person who turned her away from the clinic? How do you forgive all the people involved in her life that played a part in her homelessness? How do you forgive the food stamps policy makers who continue to take away options for the poor? How do you forgive the resident in the emergency room who was quick to judge Regina? And, who will be forgiven for what happens to Regina after she leaves the emergency room?
Mattingly, Cheryl. 2010. The Paradox of Hope: Journeys through a Clinical Borderland. University of California Press.