Cheryl Mattingly is an anthropologist who has spent her career studying the culture of occupational therapists who work in large inner city hospitals. She offers wise observations about the politics of class and race in urban hospitals and the poetics of encounters between professionals and patients. Reading her work gives me hope for the future of medicine. She sees clinical encounters as dramas in which each participant is actively and collaboratively making up the meaning of what has come before and of what can possibly unfold in the next moment. The long paragraph below, from her book Healing dramas and clinical plots, moves me.
"There was more generosity than I was prepared for. I saw small kindnesses rather than life-saving interventions. These went almost unnoticed by the therapists themselves. Generosity and small attentions are not the stuff of the medical chart. Even when something more dramatic (trying to help a despairing person find a reason to stay alive) is going on, there is no place to formally record these actions. They are undocumented exchanges, not part of the official purview of the occupational therapist. Therapists personally valued their own kindness and their imaginative capacity to link their interventions to the lives of their patients, but because there is almost no language within biomedical discourse for recognizing and examining exchanges which address the illness experience and because this is not a “reimbursable" part of treatment, the phenomenological aspects of treatment are quite neglected, carried out almost furtively. these attentions to the illness experience constitute an “underground practice" in occupational therapy and doubtless many other health professions. Taking careful note of the narrative structure of clinical interventions reveals “hidden values" within biomedical practice which run counter to the dominant metaphor of body as machine that holds such persuasive force in Western medicine. Put differently, it reveals how some health professionals, some of the time, recognize a physiological body which is inextricable from the imagined and lived body, the body which carries a person through social space and time."
-Mattingly, Cheryl (1998) Healing dramas and clinical plots: The narrative structure of experience. p 22. Cambridge University Press, New York.