{"id":4499,"date":"2021-10-28T22:56:54","date_gmt":"2021-10-29T02:56:54","guid":{"rendered":"https:\/\/www.tempestmag.org\/v01_2020\/staging\/?p=4499"},"modified":"2021-11-02T17:53:35","modified_gmt":"2021-11-02T21:53:35","slug":"commie-musings-from-the-bedside","status":"publish","type":"post","link":"https:\/\/tempestmag.org\/test02\/2021\/10\/commie-musings-from-the-bedside\/","title":{"rendered":"Commie musings from the bedside"},"content":{"rendered":"

T<\/span>he intelligentsia opted to redeploy me as a commie spy to a New Orleans hospital during the ongoing pandemic. Or at least that\u2019s how most days at work feel. In the movie version, however, I\u2019m not the strapping Bond villain conjured from stale Cold War fears, but Mr. Bean. The slapstick involving bedside commodes would all be based on true events.<\/p>\n

During the previous decade, I spent much of my time studying the works of Fanon and Foucault, often exploring their various methods in armchair-friendly settings. I admired the powerful effect of their work within hospitals on their subsequent theories and praxis, though I hadn\u2019t yet had such experiences myself. In addition to adjuncting online, I\u2019ve spent the last year and change working as a Patient Care Technician (PCT) on a Med\/Surg floor of a private, inner-city hospital. When not running down the halls, I now sometimes find myself in new reflective chairs\u2014listening to patients, answering call-lights, waiting for vastly improbable adverse vaccine reactions, monitoring cardiac telemetry, watching the same glucometer tutorial for the seventeenth time, and so forth. What follows are some thoughts from these new seats.<\/p>\n

A typical day on the floor begins at 6:45 AM with a short meeting known as the \u2018huddle,\u2019 a typical, abbreviated version of which runs something like the following.<\/p>\n

Scene: Bach\u2019s Fugue in D Minor resounds from the dialysis room to the dissonant accompaniment of screechy Sirens\u2014from the call bell to bed alarms to AvaSys cameras to completed IV infusions to DynaMaps to a host of their automated, attention-seeking kin.<\/p>\n

\u201cGood morning, Ladies and Dan. The Joint Commission has been cleared to come any day, any time. Clean, prepare, and reorganize accordingly by taking an ownership mentality rather than a renter\u2019s mentality of our floor. Our rooms are full of COVID-19 patients and we\u2019re short on nurses and PCTs. Everyone, including me (the charge nurse), will have to take one for the team, taking six patients. Ask for support from your designated buddy before coming to the charge nurse. Folks are still not charting enough on central lines and catheters! Remember: if you didn\u2019t chart it, it didn\u2019t happen. There were two falls last night. Make sure every bed alarm is on and consider setting up more AvaSys cameras. Please show empathy to each other and to your patients\u2014remember why you chose to become healers and heroes in the first place. There\u2019re lots of extra cookies and donuts in the breakroom, so please help yourselves. We\u2019re going to have a great day, y\u2019all.\u201d<\/em><\/p>\n

Like a carnival ride operator\u2019s repetition of rules before entry, huddle prepares us for our twelve-plus-hour ride in the funhouse where laughing, screaming, crying, and emesis are typical, daily occurrences. But like the visual perceptions of those who wear upside-down goggles for a period, hospital workers spend so much time in the funhouse that we\u2019ve adapted to its topsy-turvydom. We hardly notice, for example, how capitalist ideology suffuses even huddle, disfiguring our lives and livelihoods. Let\u2019s inspect a few of the different carnival mirrors and the overlapping distortions they reflect.<\/p>\n

First, modern hospitals oblige their workers to accept a peculiar first principle: \u201cIf you didn\u2019t chart it, it didn\u2019t happen.\u201d Since this proposition does not itself get charted, but instead governs the very process of charting, let\u2019s call it \u2018the charting principle.\u2019 The conditional, \u201cIf you didn\u2019t chart it, it didn\u2019t happen\u201d is logically equivalent to \u201cIf it happened, then you charted it.\u201d Upon a moment\u2019s reflection, all staff members would admit that such claims are absurd. We cannot really believe this statement that is parroted with nauseating seriousness. (Cue Mr. Bean pulling out a Foley catheter balloon then bunglingly uncharting it to undo his mistake).<\/p>\n

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Mr. Bean looking for the catheter; Photo<\/a> by By Metro Centric – Budapest<\/figcaption><\/figure>\n

If the charting principle is ludicrous, why do we accept it? We comply with a statement we nonetheless know to be false because we intuit the threat it harbors: \u201cChart\u2014or else you will face the consequences.\u201d The succeeding drive to have workers chart on more and more\u2014even on charting itself, which in some instances must, in turn, be charted on\u2014demonstrates the degree to which the norm holds sway. While infinite regresses are problems for the logician, they\u2019re solutions for the bureaucrat.<\/p>\n

Yet the charting principle says more than it intends. It does not only express a simple \u2018thou shalt\u2019 or \u2018thou shalt not.\u2019 The statement also belies the role of workers as both the subjects and objects of data-fication. In hospitals, this process serves as a primary means of bureaucratic oversight\u2014in the sense of \u2018the surveillance of oneself and others’ as well as in the sense of \u2018turning a blind eye to.\u2019 In addition to security cameras, telemetry, chart audits, noise monitors, teleconsultation, and rollerblading AvaSys drones, charting serves to give hospitals the upper edge in matters of liability. Since hospital workers have been conditioned to recall that \u201cIf you didn\u2019t chart it, it didn\u2019t happen,\u201d then ideally one need only peruse the online charting system to resolve some complaint of misconduct, and then to deny its occurrence or remove dysfunctional cogs from the proverbial wheel.<\/p>\n