Creative Work

October 23, 2020

Resuscitation fascination: Rubbing up against clinical responsibility

Renee van der Wiel

Turning blue

“Hey chaps, it’s getting a bit dark in here!”. According to Prof L this is what surgeons occasionally had to tell anaesthetists “back in the day”. This was before various equipment existed or was widely available to accurately and easily measure oxygen levels in a patient’s blood stream during surgery. A surgeon had an immediate view of “in here” – a surgical site with its viscera or muscle tissue. He (or occasionally she) would sometimes have to helpfully pipe up and tell the anaesthetist that the patient’s insides were starting to turn blue. More dark than healthier reddish hues.

Prof L mentioned this anecdote at a small faculty event while he was quietly regaling a group of registrars (qualified doctors training to become specialists, known in north America known as residents). A spritely, chatty emeritus professor in his seventies, he enjoyed striking up conversation and creating rapport with his younger medical colleagues. around how some aspects medicine were practiced “in his day”. He was just having fun, sharing humorous stories about how things were different “back then”. Being a specialist doctor required paying attention to life and death matters in ways that were different from the present.

When I heard Prof L’s account, my mind conjured up a slightly comical image of an anaesthetist saying “ooh!”, perhaps begrudgingly muttering a thanks to his colleague, and hurriedly cranking up a knob regulating oxygen flow. A near miss was part of a day’s work according to the professor. And, several bouts of fieldwork among healthcare practitioners indicated to me that while equipment may have improved and multiplied, oxygen-related close calls were certainly not only problems of yesteryear.

As an ethnographer of doctors’ institutional lives, I was an outsider, a layperson, in the clinical world. But it was exciting for me to rub up against the everyday work of medical responsibility, of being so close to the demise, or timely saving, of a human life. I was often intrigued by the nonchalant way in which my interlocutors would use words like “resus”, as in “resuscitation”. I’m not suggesting that resuscitation and oxygen-deprivation is something all doctors deal with every day, certainly not in all clinical fields. But this work is not unfamiliar, it is part of the job, they are required to develop technical expertise to deal with this. For most of us layfolk, the impairment or even cessation of breathing is a more exceptional event. (Or at least it was once.)

This illustrated essay brings together reflections on fieldwork with clinicians at Johannesburg’s public teaching hospitals. I mull over my peculiar fascination about, and even envy of, the responsibility and thrill of my interlocutors’ interventions in breathing and mortality.  Revisiting a set of artworks, pencil rubbings, provides a visual means to illustrate and contemplate the limitation of fieldworker’s insight, and the ability only to rub up against and imagine this kind of work. Describing frustration at my distance from the clinical world as the COVID crisis unfolded I simultaneously recalibrate my fascination during this period, which is distinctive from doctors’ more usual professional pressures and the tropes of crisis they traditionally use to describe the public healthcare system

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Renee van der Wiel

About Renee van der Wiel

Renée van der Wiel is a postdoctoral research fellow in the Department of Anthropology and Development Studies at the University of Johannesburg. Renée was awarded a Mellon Foundation Medical Humanities Doctoral Fellowship at the Wits Institute of Social and Economic Research (WISER). Her doctorate in anthropology was an ethnography of South African medical doctors who produce clinical research over and above their duties as healers and teachers. Prior to that Renee conducted research on breast cancer treatment at a public hospital in Johannesburg as well as international ova donation involving young South African women. She has held posts as a sessional lecturer, writing consultant, curriculum revisor, and undergraduate academic mentor, across University of the Witwatersrand, North-West University, Duke University (Organisation for Tropical Studies), and Varsity College. She has been a research assistant in the fields of sociology, medical history and surgery.