Day: October 1, 2019

For some reason, my anthropological imagination, these past months, has circled around renewed wonder about that reality indexed by words like “community” (polity, unum, cohort, congregation, plenum, etc.). This was first triggered as I tried to distance myself temporarily from what was bringing me to the neurological intensive care unit of a Large Urban Teaching Hospital. I knew enough to wonder what host of human beings were needed to keep my wife alive hooked to multiple machines in constant need of re-adjustment by this, but not necessarily by that, human being–with instructions by some to others to NOT do this or that.

So, I stood by the door, looking out. What struck me were the huddles of intense interaction and the spaces and silences between these. There had been the huddle who had greeted me with concerned stances, explained stuff I could barely register, asked me to sign various documents I did not read. They had introduced themselves as those who would operate on my wife—though I only found out later that their leader, the one with the ultimate authority (and responsibility) was not there. That huddle, I never saw again. But by the 2nd or 3rd day, I could identify recurring huddles. There was one I labeled “physicians” (students/residents/interns—clearly a divided community, even if they huddled together on the floor). There was one or more huddle made up of those I labeled “the nursing staff” (I discovered later that they too were divided into multiple units). There was a small one made by the police who were guarding one of the rooms. There was the janitorial staff. They were all in view of each other, often quite close physically. And yet they remained distinct. I could sense differences in the tenor of the speech each used (I was amused listening to flirting among the young cops…). But always they maintained boundaries which, I know from every research on the matter, require ongoing work to NOT acknowledge one another’s presence in the performance of their parallel duties—even when these duties required asking the other to move their bodies as happened regularly when floors had to be cleaned, or examinations done.

This led me to wonder about one limitation in the model of the “community of practice.” When I teach Lave, I focus on the power of her model to deal with classical problems in social structural analysis: the problem of the grounds of participation to a position (usually resolved by invoking “socialization”), and the problem of movement across the structure (usually ignored). Lave taught us that socialization (“learning”) follows participation (rather than being a prerequisite) and that all participation moves people. I knew that Lave was cagey about the boundary issue. She and I once had a friendly disagreement about this as she asserted that boundaries were not “real” when I countered that, of course they were, though always in need of repair. Maintaining boundaries is hard work. I have since mused about the “gravity wells” that some communities produce as they induce people to seek participation. In that metaphor, boundaries would be “event horizon” beyond which one cannot ever escape, in their future, “having been a participant” (even if one has quit, or been thrown out).

What I had not noticed is that all these theoretical developments were made in term of research in what are treated as just one entity, be it alcoholics in meeting, tailors, midwives, etc. So, of course, physicians in hospital training would be a classic “community of practice” (see dissertation by Yan-Di Chang (2017)). Nurses, police, even the janitorial staff could be advantageously looked at as polities of some sort where legitimate participants move into ever fuller positions. The paper by Magolda and Delman on campus custodians (2016) could easily be interpreted in that fashion. The question I now have to ask is: what happens when nurses, police, physicians and janitors move side by side? How are we to model the work of maintaining boundaries, particularly when the actual bodies arrange themselves in a limited physical space? To build on Yeats’ wonder about the individual and the dance, one must also wonder how, in ballroom dancing at least, the couples do not bump into each other.

Though of course, some time they do bump. On a hospital floor there are those who have not yet been in that dance even though they are now fully caught in it. Most salient probably among the newbies are probably the next of kin, in their anxious multitudes. They are in the paradoxical position of not “belonging” to any of the communities even as these communities are very ostensibly about them. I know what can happen to newbies for having been one in, eventually, five such ensembles of communities of practice, in the various “floors” and “services” of hospitals and the like. Newbies like myself keep addressing any person that passes by in often desperate efforts to get an authoritative voice to tell them something and give them hope. But how is this newbie to know which human being to address or evaluate this or that person’s authority to speak/act? This has to be a problem for all the dancers on the floor. Minimally, they must spend time instructing the newbie about who can say what about whom. They probably must resist the temptation to explain what they may not explain, or give interpretations about each other that would break the boundaries. One nurse, in one hospital, did make negative comments about one of the doctors treating my wife. I was surprised, not by the fact that she had such opinions, but by the fact that she told us about them, when, I suspect, she could have been sanctioned for doing this. As anthropologists well know, custodians may be best source of information about an institution, nurses about doctors, students and junior faculty about the elders who may, or may not, allow them to move into a fuller position. But this only makes more salient the ongoing work to maintaining boundaries against recurring challenges.

More on this another time.

 

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