Is your investigation from a professional perspective, or as a woman

Bibliographic Data

ID2260103
AuthorsAmy Krau (0000-0001-7996-7799, University of California, Santa Cruz, corresponding author)
Year2023
Volume125
Issue3
Pages638-642
Publication date2023-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAmerican Anthropologist (JOURNAL)
Journal identifiersISSN: 0002-7294 • E-ISSN: 1548-1433
PublisherWiley (PUBLISHER • GB)
DOI10.1111/aman.13886
OpenAlexW4382725578
LanguageEN
Citations received4
References cited19

By the time Dr. Z called me into the operating room, I had been shadowing different areas of the clinic for months. I'd sat with the secretaries at the front desk, drinking coffee in Styrofoam cups and helping to organize paperwork. I'd been in the ultrasound room with Dra. A, filling in the number of weeks people were pregnant on patient charts. I'd walked around with the social workers, who dictated to patients a list of acceptable reasons for why they wanted to have an abortion and required them to sign a document agreeing to use contraception, usually pressuring them to accept an IUD. I had stood and sat with patients inside and outside the clinic as they lined up, waited, filled out forms using one another's backs as surfaces to write on. Nodded yes when they asked me to carry whispered messages and objects to their companions outside who were not allowed to approach the door, let alone enter the clinic. Over the course of several months, I became familiar with the clinic staff, not so much with the gynecologists, who were minimally present until late in the morning, but with the secretaries, nurses, and security guards who started working at 5 a.m. The latter had the power to let me in or turn me away from the front door every morning. No one quite understood my purpose in being there. One afternoon, after all the patients had left, Dr. Z listed his complaints and ideas for how to improve the abortion program, fully expecting that I would document his points and turn them in to a higher authority. Although I took his perspective seriously, I assured him that I was not going to produce a report. I didn't tell him I was being trained as an acompañante with the feminist abortion-access organization Fondo MARIA, either-that I was learning how to support people as they sought a way to end pregnancy, often crossing state borders into the city to go to clinics like his. Coming from this background of feminist activism into the clinical space was a special privilege laden with discomforting compromises and dissimulations. My friend and mentor at Fondo MARIA had written to the director of the city's Ministry of Health explaining that I was working alongside them to better understand how to facilitate people's access to legal abortion. We all knew that the official permission I received was partly due to my perceived whiteness and gringa academic credentials. One of the gynecologists had also commented to someone else at the fund that the doctors at the clinic appreciated my "cintura"-the shape of my waist. With the provocation to think about forms of confession as they pose relational ethical conundrums for ethnographic writing, I keep returning to a scene in the operating room with Dr. Z. Situated as I was in the abortion clinic, I approach the confessional mode not solely as worded utterance but as an unwilled embodied relation-and potentially, an ethical practice of complicity. In distinction to the juridical confession that reveals the inner truth of the criminal subject, complicity points us to co-implication as a necessary binding on what truth can be told, as well as the pathos of the healing encounter displaced by enlightenment sciences of the body.1 Becoming complicit is a question of training our capacity to be affected, more than it is a problem of will and intention (see Despret, 2004; Favret-Saada, 2012). The abortion clinic, in this sense, is a pedagogical institution, one that teaches us how to feel, and with whom, and with profoundly racializing and gendering effects. Whereas my larger writing project dealing with the time I spent in the clinic focuses on the transformative possibilities of collective feeling between patients, the prior condition of this focus-which only makes it more urgent-was the effort to place myself with patients and to think critically about the feminist praxis of accompaniment from that space. Before I figured out how to act as a bodily ally, however awkwardly, to people going through the procedures, I'd been frozen speechless-strung-between the irreconcilable positions of the doctor, a group of doctors-in-training, and the patient lying on an operating table. When I first began fieldwork in 2013, there were only three legal abortion clinics in Mexico City providing procedures to people from all over Mexico, as well as neighboring countries. They faced tremendous demand with scarce resources, both materially and spiritually. Most of the providers had been pressured into working in the clinics on tri-monthly rotations in exchange for more vacation time or ascension into better contracts, and they channeled deep resentments about job insecurity, low pay, and extended work hours into their practice (see Vega and Maya, 2020). The structural labor inequities of the health-care system were overlaid with the contested legality of abortion, which-much like the current landscape of abortion law in the United States-is structured by proliferating legislations that differ state by state and carry varying degrees of prohibition and punitive force. Looking back from where we are now in the United States, Mexico City was the first sanctuary city for legal abortion care in North America. In addition to the pressure caused by the variability of laws between states, Catholic and Evangelical activists representing the transnational pro-life movement set up information booths and prayer vigils outside the clinic every day. All of this put public clinic providers in a gnarly position of power. By gnarly, I mean their claim to medical-legal expertise and anxious reiterations of moral superiority over patients was tangled up with a profound, often masculine, insecurity. The tall student with glasses yells at the patient, telling her what to do, she yells in general, projecting false confidence. The chubby one seems to be hiding the fact that he is overwhelmed, at one point he takes a rubber thing and pretends to hit the joints on the arm of the woman lying on the table. The other student is quiet. The woman on the table adjusts her bodily position, as they yell at her to. She keeps her eyes towards the ceiling. How many weeks did they tell you you are pregnant, my little queen? Have you given birth from below? Dr. Z is on a low swivel stool. He tells the students that this is the most common sized popote (straw-like instrument) that we use. Vaginal births require wider instruments, he says without speaking directly to the patient. Then he turns to me again. "The kids (the med students) want to know where you come from. What is the focus of your research?" One of the students interjects: "Is your investigation from a professional perspective or as a woman?" Both, I say. "Have you been in an operating room before?" I hesitate ... pues solo como paciente ... "Es muy diferente no?" I'm not sure what this is supposed to mean. Dr. Z calls over to me, now with a tone of irritation: "Do you want to see or not?" And then challenges, "Why don't you come give it a try?" Speechless. Remain standing where I am. Now he has pressed the instrument into the woman's cervix and is waiting for O, one of the nurses to wheel over the aspiration machine to connect it and complete the abortion. The woman is breathing heavily on the table in obvious pain. Her eyes rolling. Then Dr. Z turns to me again. "Que cosas extraordinarias has visto?" What extraordinary things have you seen? I am silent, cheeks burning, palms sweating. He still waits for me to respond. "I can't think right now," I tell him. "Well one day you will let me know," he says sarcastically. This was not the first time I went through a clinical abortion procedure. Prior to beginning research in the public clinic, I had been trained with a feminist abortion counselor in a private clinic in a southern borough of Mexico City. So my shock had less to do with the fact that abortion procedures can involve pain, or even the visceral flow of blood and sound, and more to do with the extra/ordinary way (to use Dr. Z's sarcasm back at him) patients could be regarded as if their pain did not matter. Our position as speaking subjects in the room-myself, the doctors-in-training, and Dr. Z-seemed to be contingent on our reciprocal recognition and obliteration of the person-in-pain on the operating table. And yet, I barely spoke; I could not think. Where, precisely, did these interpellations by Dr. Z and the students place me in the economy of active subjects and passive patienthood, of medical expertise and operable flesh?2 Was Dr. Z's invitation "to give it a try" an assertion of my complicity with him and the other "professionals" in the room? Or by way of demonstrating my inability to rise to the occasion, so to speak, did he mean to put me in my place, as a woman, like the patient, subordinate to their expertise? Either way, the disregard for the person on the operating table intensified through my presence, gaining force in a paralyzing triangulation. I'm still trying to understand the terror in the operating room that day. It's slippery, still hard to think with. I vacillate between describing the scene's continuity with medical practice, in general, and its specificity-between naming it violence and calling it pedagogy. Sameena Mulla (2014) works closely with this problem in her ethnography of forensic nursing and sexual assault intervention in Baltimore, Maryland, in the United States. She situates the coldness of the forensic nurses' treatment of victims within a professional protocol in which objectification of the victim's body is a regular technique for mediating the intimacy of a pelvic exam. Professionalism requires depersonalizing the encounter through the avoidance of gazes between doctor and patient, hence the idealization of the drape to separate a patient's face from their pelvis. And yet, in Mulla's account, patients would constantly push aside the drape to see the doctor's facial expressions. The role taken up by the "third gaze" of a victim advocate in the exam room, as she describes, is to relay these expressions, relieving the nurse of the pressure to touch flesh as object and to relate to the person at the same time. In some abortion clinics in Mexico City, the presence of a counselor beside the patient in the operation room is standard practice, and counselors strongly acknowledged that pain could be amplified in the absence of someone for the person on the table not only to make eye contact with but to reach for and touch. Objectification, then, is also an agential-relational capacity on the part of the patient. Cruelty is not inherent in objectification; rather, it is tied to the material history of racialization in biomedical practice and the way it surfaces here.3 My point is not to affix a universal ethic of responding to pain and point to its absence among Dr. Z and the students but to track "how pain enters politics" in this scene-how learning how to feel and who to feel with makes and unmakes boundaries of body and community, or what Sarah Ahmed (2002) refers to as "intensifications" and "skin." Intensifications, or the effect of fixity or boundary, are cumulative; they have the ways we read one another's pain folded into them. In a resonant way, Mónica Figueroa (2010) analyzes lived experiences of racism in postcolonial Mexico as a matter of "distributed intensities" rather than explicit recognition of racial identity (as in the United States). Whiteness, as a normative value, is distributed in scenes and encounters between bodies relationally. In other words, whiteness (almost indistinguishable from class) must be performed differently depending on the assemblage of others present. It depends on who you're talking to. It's a matter of occupying space and the company you keep. Dr. Z and the medical students ignored the patient's pain and invited me to perform this disavowal with them-it was a matter of sharing the stance of unfeeling that would make us all professionals.4 They spoke to me while touching her body in pain. In this context, whiteness and femininity were conduits in a tense economy of sympathy and subjectivation. At the same time-through the same gestures of professional alliance-the patient became "flesh ungendered," losing her rights to feminine protection and modesty.5 Alternately, if we were women if I was "doing this investigation as a woman"-would feelings disrupt the order of the operating room?6 Accompaniment is a concept that feminist abortion care activists have grown from the practice of supporting one another and other people through the experience of clandestine abortion (Vivaldi and Stutzin, 2021). It shares with the word accomplice: from late Latin: "complex, complic-'allied,' from com 'together'+ the root of plicare 'to fold'" (Oxford Dictionaries). It's also a concept that helps us imagine how we become politically and ethically bound doing research in ways that far exceed the reproduction of the discipline of anthropology (see McLachlan, this section). Binds are constraints on producing a certain kind of knowledge (whether for the academic marketplace or before the law).7 If we take the transformative labor of accompaniment seriously, we might likewise approach fieldwork as a practice of rebinding. This would mean we aim to hone our capacities to be affected against the institutionalized pedagogies of racialized gender and that we rehearse the confessional mode to be folded in with specific others.8 In resistance to state technologies of individuating the criminal, as well as the rights-bearing subject, Latin American feminist protest chants include "Abortamos en manadas/we abort in packs." How might we train one another for such complicity-our "erotic intelligence," to borrow a formulation from Paromita Vohra-with ethnographic writing?9 Marilyn Strathern (1987) maps what she calls "the awkward proximity" of feminism and anthropology, arguing that the two disciplines rely on diametrically opposed practices of inquiry. Whereas feminism reclaims experience from an Other (often identified as men, or patriarchy), the anthropologist opens, or lends, her experiential capacities-"her body (of writing)" in Veena Das's (1998, 192) words-to the other. Both modes may pose radical challenges to the Eurocentric epistemological canon, but they do so through practices that are irreducible to one another. In short, feminist knowledge is made through a project of antagonistic self-making, while anthropological insight is achieved by self-undoing-by disinheriting oneself from the tradition one embodies (Strathern 1987, 289). Strathern concludes that feminist ethnographers must maintain the tension between these two relational modes rather than hope to assimilate one into the other. In this spirit, those of us doing feminist activist anthropological research could ask ourselves when, or for whom, we lend our bodies and experience; with whom we cultivate complicity.10 Complicities are embodied relations, unwilled. They are also a practice. I'm grateful for the collaborative, counter-institutional ethos we tried to enact in the fieldwork confessionals writing group; thank you to the organizers and to all who are involved. This essay was especially moved by comments from Katsuya Oi, Alonso Gamarra, Ali Feser, Amy McLachlan, and Chloe Ahmann, and by critical suggestions from Lorenzo Granada reminding me with whom I write for and pushing me to think more rigorously about histories of the body and the senses

Abortion · Desk · Family medicine · Front (military · Morning · Political science · Power (physics · Pregnancy · Sign (mathematics · Engineering · Healthcare Systems and Challenges · Law · Medicine · Posthumanist Ethics and Activism · Psychology · Qualitative Research Methods and Ethics

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