Risky Work Environments by Christine Owen & Pascal Béguin & Ger Wackers

Author:Christine Owen & Pascal Béguin & Ger Wackers
Language: eng
Format: epub
Publisher: Ashgate Publishing Limited
Published: 2009-04-12T04:00:00+00:00

Thursday 9:10

Peter is asleep. The medical form on top of his incubator tells us he was born at 25 weeks of term and his weight is somewhat more than one pound (610 grams). Compare these figures with those for a full-grown baby (40 weeks of term, c. 3000 grams, that is six pounds) and one realizes how small Peter is.

At a desk in the middle of the unit sits a resident. He reads the previous night’s report about Peter and makes some notations. Next, he examines the information recorded from the life-support systems and monitors. He studies a long list filled with all kinds of numbers: input and output rates, body temperature, ventilator settings. He calculates means and ratios, intravenous feeding, medication, intake, and the adjustment of the ventilator. He writes his conclusions in the record and compares this information with the results of the laboratory tests.

All of this information, combined, paints a specific picture. With this impression, the resident approaches Peter’s incubator for the physical examination. After washing his hands he listens to the infant’s heart and lungs, feels the fontanelle,4 and evaluates the skin colour. After a few minutes he walks back to the desk again and writes down his findings. Now, by arranging and comparing data from different sources he is able to make a determination of Peter’s condition upon which he readjusts treatment. During rounds he will discuss his findings and treatment decisions with his supervisor.

The resident assesses Peter’s situation mainly while sitting behind a desk, with pen and calculator in hand. These do not seem to be the proper tools for examining a premature baby, nor would one expect a NICU resident to spend much time behind a desk. But a physician who has to assess a baby’s condition does not only look inside the incubator; he also studies the record, the most recent data and the monitor’s current data. Various elements converge around the baby: numbers, words, and stacks of paperwork, devices, instruments, bodies, decisions and the architecture of the ward. The table in the middle of the NICU functions as the ordering centre. Such a site is constituted by ‘gathering, simplifying, representing, making calculations about, and acting upon the flow of immutable mobiles coming in from and departing for the periphery’ (Law 1994, 104; see also Latour 1987, 227 for a discussion). This is where the resident compares and combines the various data, so as to turn them into a coherent, unambiguous whole. The record functions as a central node. The day’s report, the test results and the outcome of the physical examination are added to the record. Writing is not so much geared towards communicating information, but towards ordering information (see also Berg 1997a for a discussion). In the record everything comes together and this results in a narrative sequence of the baby’s changing situation. The record is like a travelogue that depicts the baby’s itinerary during its hospitalization. A single glance at this information directly informs the physician of a child’s current situation, including its most recent adventures.

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