As Emily Yates-Doerr observes, the “field” of care is variously situated, ever-contextual, and overall, expansive. It follows, then, that care manifests in ways both obvious and not, clinical and otherwise, as a complexity that can be codified in the simple act of “a doctor gently wiggling the big toe of a patient in farewell” (as Ruth Fitzgerald notes), and even extending out to “soil and seeds” (as Yates-Doerr suggests). Care might surface in any relational field.
These tendencies inspire attention to what Livingston calls “the intersubjective phenomenology of care” (2012:112). They also resonate with Ingold’s more general contention that the “world we inhabit” is a relational field, a “meshwork of entangled lines of life, growth and movement” (2011:63, emphasis in original). The “texture of the lifeworld” is comprised of strands woven together – the trails “along which life is lived” (2011:69-70). Building on Ingold’s insights, we are “wayfarers” whose paths indeed do enmesh with “the clinic” and the seeds.
This finding of care in any number of conceivable domains is a large part of what makes it a provocative field to explore. But in light of such ubiquity, how might we account for care as anything in particular? I approach this question via considering acts of care – like Ingoldian paths of movement – as orientations toward maintenance and a [hoped-for] course. This is the nexus at which I engage more directly with my assigned keyword of “deviation”…
What happens when we look at care as a way of deviating from one path, or, on the other hand, as a way of avoiding deviation? And for that matter, deviation from what?
In my work with organ transplant candidates and recipients1 and their kin in the Midwestern United States (from 2007-2010), I came to find that, even beyond the transfer of organs, for transplant hopefuls and recipients, living had an awful lot to do with care, and care involved maintenance. Daily existence could look very clinical at times, even among non-clinicians, with patients and caregiving family or friends managing complicated appointment schedules, pre-transplant interventions ranging from dialysis to dental work, post-surgical wound care, and a confounding and ever-evolving medication regimen. Gravely ill persons might seek a transplant out of a hope (see Good 2007) to diverge from one path – tangled in a meshwork of illness, decline, and likely death – and back toward another more in line with received wisdoms about living as a parent, a daughter, a spouse, a grandparent (also see Kaufman et al 2006). Patients, too, often were caregivers to others; the very pursuit of transplantation might become an act of care in itself (Heinemann 2013). For many, this was not a simple matter of living longer, but rather of emancipating both themselves and loved ones from the snarl of medical treatments surrounding organ failure.
If all goes well, life for transplant recipients mostly is not lived in the clinic. From a medical perspective, though, post-transplant living is utterly dependent on a recipient’s ability to consistently and perpetually ingest a concoction of pharmaceuticals meant to stave off immune-rejection of the organ (among other health concerns). This obligation to punctuate daily life with the proper dose at the proper time was lived at least in part by way of patients’ 4-row by 7-column pill organizer trays, present in nearly every home I visited.
1. I worked primarily among those who were, or hoped to be, on the receiving end of organ transfer; see the work of Lawrence Cohen, Margaret Lock, Leslie Sharp, and Nancy Scheper-Hughes, to name but a few, for important critical insights into life and death among persons from whom organs are removed for transplant.
2. Mol and colleagues’ (2010) observations that there is a certain amount of “tinkering” in care (also see Han’s 2011 work, on the lived tensions between care and precariousness), also help to frame the resourcefulness of patients and kin in facing the challenges of integrating transplantation with domestic life.
Laura Heinemann is an Assistant Professor in the Department of Sociology, Anthropology, and Social Work at Creighton University. She is interested in care and caregiving, kinship, and daily home life in the context of “high-tech” medicine and U.S. health care.
Good, Mary-Jo DelVecchio. 2007. “The Medical Imaginary and the Biotechnical Embrace: Subjective Experiences of Clinical Scientists and Patients.” In Subjectivity: Ethnographic Investigations, J. Biehl, B. Good, and A. Kleinman, eds. Pp.362-380. Berkeley: University of California Press.
Han, Clara. 2011. “Symptoms of Another Life: Time, Possibility, and Domestic Relations in Chile’s Credit Economy.” Cultural Anthropology 26, no. 1: 7-32.
Heinemann, Laura Lynn. Article first published online ahead of print: 8 Nov 2013. “For The Sake of Others: Reciprocal Webs of Obligation and The Pursuit of Transplantation as a Caring Act.” Medical Anthropology Quarterly. [DOI: 10.1111/maq.12060.]
Ingold, Tim. 2011. Being Alive: Essays on Movement, Knowledge, and Description. New York: Routledge.
Kaufman, Sharon R., Ann J. Russ, and Janet K. Shim. 2006. “Aged Bodies and Kinship Matters: The Ethical Field of Kidney Transplant.” American Ethnologist 33, no.1:81-99.
Mol, Annemarie, Ingunn Moser, and Jeanette Pols. 2010. “Care: Putting Practice in to Theory.” In Care in Practice: On Tinkering in Clinics, Homes and Farms. Annemarie Mol, Ingunn Moser, and Jeanette Pols, eds. Pp. 7-20. Bielefeld, Germany: Transcript Verlag.