Wednesday, July 02, 2008

Waiting in Limbo

While waiting in a New York City emergency room someone fell off their chair and died. No one noticed for about an hour. The security video shows patients, nurses and doctors walking past as the woman lies face down on the floor. I could write about the sad diminishment of our instinctive concern for the well being of others or how such a thing is surely only typical of a cold-hearted metropolis like NYC, or validly make enquiries about class and race but I think something else needs to be considered here. If that person were to fall over on the street, in a subway car or in a store I think people would probably call for medical help. Ironically where medical help is most abundantly available no one moves to do so.

We need to consider the context and environment within which the event occurred. Whenever one finds oneself in a typical human environment there are a whole set of understandings, assumptions and expectations around what happens in such situations. To some extent the sidewalk on which you walk, the subway car in which you sit or the mall in which you shop can be viewed with some ownership. It is your town, transit system or shopping area. If something unexpected occurs like someone falling face down in front of you, this event is processed within the background of what you would expect and what you are supposed to do as citizen, customer, or human being. You would in most cases do something to help and we would all be reassured of our human dignity.

The hospital ER is an alien place unlike many environments that people know. It feels more like a transitional realm between the living and the dead. Like one of Dante's circles of hell it is terra infirma and terra incognito. People don't really know how to act or what to expect while waiting there and the fact that it is a highly regulated and designed environment leads people to assume that every contingency has been considered and that things will funnel through this process and fall where they should. They have an implicit faith in the system to take care of their needs.

Unlike their everyday earthly surroundings patients have no sense of ownership of their environment in an ER. In their alienated situation they are disassociated from their otherwise normal set of human practices; like acting in concern for another human being. All of this while very likely being acutely concerned with their own injury and their own mortality. One can almost understand, if not accept, the failure of the other patients to act but the callousness of the staff is unacceptable. It is here that we can question whether something more basic like human dignity is being compromised. As functionaries within a way of life in which they are also the designers they should have been able to notice the anomaly and acted accordingly. If they couldn't, then they need to be criticized for how they have so poorly designed the system in the first place.

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