Not whether to respond, but how
While this scenario of a baby with clinically significant bronchiolitis
is fictional, situations like it are very similar to the rooms I (BS)
have walked into many times, both in this hospital and others like it,
spaces that are, after fifteen years of training and practice, home for
me. Like many of my healthcare colleagues in moments like these, I am
exhausted, worn down by the fulfilling but emotionally charged work of
looking after children and their caregivers when the former are sick and
the latter are often afraid, frustrated, and exhausted themselves.
Despite that, when on call, there is no choice of whether to
respond or not. The only choice is how to respond to those
seeking help at our doors at this late hour, a choice that may be
informed by drawing upon an ethic of hospitality.
My ability to offer hospitality in this scenario is contingent upon
people seeking it out in the dark hours of the night. When on call, I
await the arrival of people who may never come, yet despite the above
pressures and demands on time laid out above, I must be at my best if
they happen to appear. Even if I create space in anticipation of
receiving someone, I cannot know what that space will look like and how
it will be enacted until the person arrives. I have looked after
over a hundred children presenting with bronchiolitis throughout
residency and now independent practice, yet what the illness experience
looks like for this family at this time in thislocation will call me into being in a unique way. Further, I might
recognize the biomedical condition, but I really have no way of knowing
what sort of requests or demands this family
living this illness will make of me. So, space is made and the
lights are left on, but the future is totally unwritten, the ambiguity
of what could happen inexplicable until a specific person arrives,
asking for hospitality.
Given the frequency of clinically significant bronchiolitis in infants,
combined with the late hour and the bonecrushing fatigue that
accumulates after years of training and practice, I suppose that I could
be forgiven for being somewhat disinterested in this specific clinical
encounter and for trying to get through things as quickly as possible.
As such, diagnosis could solely exist as the means to structure
biomedical treatment and fix the problem at hand. My challenge is to
remember that health care encounters, while sought out, almost always
involve people not really wanting to be there. There are undoubtedly
countless other places that caregivers would rather be than in an
emergency department with a sick baby in the middle of the night. That
they are indeed here indexes a sense of being bereft of options, cast
out of the familiarity of their lives, at a loss to name what is
happening, and feeling uncertain as to how to help their baby.
Brought to bear on this scenario, then, an ethic of hospitality
illustrates three key aspects. One, my presence in health care
encounters is not a given; rather, I am called into presence as a
paediatrician each time anew by patients asking for help. Certainly, I
can draw on the somewhat standardized affordances that a correct
diagnosis offers for biomedical aspects of this encounter – among
others, oxygen, suctioning, and ensuring appropriate monitoring and
nutrition. Yet an ethic of hospitality also invites me into the unique
lived experience of this clinical encounter, one in which
clinically significant bronchiolitis in this infant’s life is
likely to be extremely rare, one in which we attend to the other, less
clinical and more existential function of diagnosis: “to symbolize the
source of suffering, to find an image around which a narrative can take
shape. To name the origin…is to seize power to alleviate
it…and is also a critical step in the remaking of the world, in
the authoring of an integrated self”.13
Second, it compels us to acknowledge the sharp edges of thisfamily’s double vulnerability – the precarity that comes with the
“unhomelikeness” of illness18 and the strangeness of
the acute care centre world in which they now find themselves. That
parents, experts in their child, come seeking answers and support from
complete strangers – albeit those in socially legitimated roles like
the ones physicians embody – is testament to the ruptures in everyday
life that significant illness brings. Adding to this vulnerability is
the common perception of the acute care hospital context as both
unfamiliar and daunting to caregivers and children, particularly when
under the duress that significant illness brings. Movements from triage
to exam room to in-patient bed, contact with myriad health care
professionals, and the indiscriminate blaring of monitors that may
indicate low oxygen saturations but may also simply be reacting to the
normal movements of a four-month old all confront people with a massive
amount of information, often when they are already exhausted. Further,
even “well-educated” caregivers, unlike the health care professionals
they may be meeting for the first time, are not typically immersed in a
biomedical worldview, fluent in the sociolect of professional medicine,
or familiar with the logic of questioning and examination that are part
and parcel of clinical encounters.
Third, then, an ethic of hospitality also lays bare that a health care
professional’s expertise and experience are ways by which we may
“unlock” the unintelligible aspects of this world.30While it is unlikely that anything I do will make the hospital a place
where patients and caregivers will ever desire to be, I can focus my
efforts upon making it less unwelcoming , acclimatizing them to
this novel context and recognizing their need to incorporate this time
of unfamiliarity into their broader life narrative.