The second entry in a series on working in an OR.
I occasionally get migraines, but before today had never gotten one at work. And I got the works, so to speak: the icepick-behind-the-eye headache, the photophobia, the nausea. Migraines always arise, at least in my case, unpredictably, seemingly without rhyme or reason. They just haven’t ever done so when I’ve still got seven hours left on the clock, 20+ surgical cases ahead of me, and a team of three of us, EVS workers, having to prepare four operating rooms ASAP for incoming cases. So today was a milestone that felt a bit like a gravestone: the first time, at work, that I felt as though I’d go blind, throw up, and collapse in a heap, but couldn’t.
- Hospitals and the Common Good
There’s no other way to put it: it was a seriously shitty situation that I hope never to repeat, but paradoxically (I guess), it underscores what I love most about my job in OR-EVS. For most of my academic career, I’ve read about “the common good” as conceived by Aristotle, Aquinas, and their various followers and fellow travelers. Today, I had an immersion experience in one that taught me more fully than any previous experience what it means to be part of one.
Here’s a textbook account of “the common good” from the Stanford Encyclopedia of Philosophy:
In ordinary political discourse, the “common good” refers to those facilities–whether material, cultural, or institutional–that the members of a community provide to all members in order to fulfill a relational obligation they all have to care for certain interests that they have in common. …
As a philosophical concept, the common good is best understood as part of an encompassing model for practical reasoning among the members of a political community. The model takes for granted that citizens stand in a “political” or “civic” relationship with one another and that this relationship requires them to create and maintain certain facilities on the grounds that these facilities serve certain common interests (Waheed Hussain, “The Common Good,” p. 1).
Like a lot of idealistic academics, I’d long conceived of the academic enterprise as a common good, and still do.
In a university, the climate of academic freedom on campus is part of the common good because the special relationship among members of the university community requires them to care for this climate as part of a shared effort to care for one another’s interests in teaching, learning and inquiring (Hussain, “The Common Good,” p. 2).
Think of a college like Princeton or Harvard. Members of the university community are bound together in a social relationship marked by a certain form of mutual concern: members care that they and their fellow members live well, where living well is understood in terms of taking part in a flourishing university life (Hussain, “The Common Good,” p. 9).
It all sounds a bit romanticized (it is a bit romanticized), but I’m not cynical enough to deny the deep truth in the preceding descriptions, whether of university life or even of political life generally. Readers of this blog already know of my soft spot for democratic politics, especially local politics, which I won’t belabor any further than I already have.
But I have a soft spot for academic life, too. Despite all of my bad-mouthings of academia, I basically share Waheed Hussain’s description of it above, not just as a regulative ideal but as something sometimes realized in actual classrooms, conferences, and seminars. I live about half an hour north of Princeton University, and before the pandemic, made sure to visit campus at least once a week, if only to marinate in “flourishing university life” for the couple of hours at my disposal.
I live maybe ten minutes away from Raritan Valley Community College, a much less august institution, and sometimes just park there and take a fifteen minute stroll through campus, if only to be on a college campus for however much time I have. Deride it all you want, but in most respects, university life beats the tedium and small-mindedness of life in the average American suburb. Part of what explains that is universities’ self-conscious cultivation, however flawed, of a sense of the common good, one that the average university shares with its surrounding community. If anything, suburban bedroom communities, which pledge allegiance less to community than to caste, exist to subvert our sense of the common good than serve it.
Like academia and the larger polity, the health care system is or involves a common good, as do individual hospitals, along with individual parts of hospitals, like the OR suite. So, to some extent, the preceding descriptions of the common good apply as aptly to hospital settings as they do elsewhere. But there are some real differences, differences that I think political philosophers often miss when they focus on their favorite examples, universities and polities.
In the SEP article above, the author, Waheed Hussain, goes out of his way to stress the specifically political character of the common good. The common good (he says) is a relationship that involves citizens qua citizens. That strikes me as either a bit confusing or a bit narrow. It’s not clear whether Hussain means to discuss the (overarching, architectonic) common good as an institution, or the common good as a general concept applicable to a range of settings. In the latter sense, it’s misleading to think of the common good as intrinsically tied to citizenship. For one thing, non-citizens can participate in the common good. For another, people can participate in the common good under relatively non-political descriptions, like co-worker, which is what happens in hospitals.
Hospital life is in a sense political, but in a somewhat idiosyncratic way not captured by Hussain’s account. Hospital workers generally don’t talk partisan or electoral politics at work (it’s a bit of a taboo), but we’re governed by, and hyper-conscious of, the legal-regulatory framework within which we operate: one false move can cost a reimbursement, a job, a fine, a lawsuit, an accreditation, or public good will. And, of course, the usual sort of bureaucratic office politics takes place in hospitals just as it does everywhere. So the “model for practical reasoning among members of a political community” doesn’t quite work to capture what goes on in a hospital.
The contrast with academic life is, if anything, sharper. Yes, there are important similarities between what goes on in a university and what goes on in a hospital, but speaking from my experience working in the OR, the stakes are higher, the pace faster, and the sense of teamwork, social connectedness, and solidarity far more intense in a hospital than anything I could have imagined from within academia.
These three factors (stakes, pace, teamwork) are all related considerations, really three aspects of the same consideration. Ideally, it takes two or three EVS workers to clean, sanitize, and prep an OR between cases. Sometimes you have ten minutes to pull it off, sometimes five, sometimes two. Sometimes there are three of you, sometimes just two of you, and sometimes you’re on your own, because your colleague is on their own in the OR next door. Sometimes the pace is set by some surgeon’s busy schedule, sometimes by the hospital’s imperative to push cases through in the name of revenue stream, and sometimes because the patient’s appendix, life, or limb is on the line. Sometimes you get Alexa to play Metallica to push you through, sometimes Katy Perry, and sometimes it’s best to work in dead silence. But no matter what’s playing or what’s happening, what matters is that every one of you has to work together, in a coordinated, synchronized, carefully sequenced, usually wordless but implicitly choreographed ballet of rags, mops, and equipment, all tracking the same end. The balancing act of individual responsibility and common purpose has to be enacted to be fully understood.
That leads to a further, closely related difference between the common good of an OR and that of a polity or university. Given the sharp constraints of time and energy involved, virtually everything that takes place in the OR takes place from within the first- or second-person perspectives, not the third. Even at its most participatory, politics and academia feel spectatorial by comparison with what takes place in an OR. There are no bona fide emergencies in academic life, and relatively few in electoral politics. When someone proclaims something an emergency in political or academic contexts, they’re usually bullshitting you. Not so in an OR. When someone says, “hurry up” in an OR, they really do mean hurry up. There’s no time to luxuriate in second-order reflection on the meaning of it all, at least not then. In politics, if you miss a deadline, you might lose an election or lose a vote. In academia, you might lose your funding or chance for tenure. In the operating room, you might get someone killed. Those facts, I think, intensify the sense of commonality among EVS workers. We really do work together or hang separately.
OR 2, Hunterdon Medical Center, Flemington, NJ (photo credit: Hunterdon Medical Center)
2. EVS and the Medical Learning Curve
Which brings me back to my migraine. When there are three of you on the shift turning around four operating rooms with only minutes to spare–cleaning them up, disinfecting them, setting them up for the next case–you don’t have the luxury of “tapping out” for a migraine. You only get to tap out of the OR if you’re bleeding and can’t stanch the flow, or unconscious and can’t initiate action, or so infectious that your very presence at the hospital is counter-purposive. Otherwise, the work just has to get done, and at some level, you know that you can’t be the weak link that explains why it went undone. Everyone is already working at 100% capacity, or so it seems. If you crap out, you’re forcing your co-workers–your comrades–to do the impossible, to work at higher than 100% capacity. You might as well tie weights to their arms and legs and expect performance according to standard operating procedures. In a common enterprise like this one, your defaults are acts of cruelty imposed on others. So either you pull your weight, or you drop it on someone’s head.
When things go bad, as they sometimes do, you need a workaround. A workaround, Wikipedia tells me, is “a method for overcoming a problem or limitation in a program or system.” Here’s the apparent paradox: On the one hand, you don’t want to saddle your co-workers with extra work, especially not work they can’t possibly do. And yet, when you are the problem (as I was), and there’s no simple fix for what’s wrong with you (or it isn’t here yet), your co-workers inevitably have to become your workaround. How does that work?
Part of what happens is that everyone discovers new latent capacities they didn’t know they had. It may have seemed as though everyone was working at 100% capacity, but it turns out that they had some capacity in reserve: your amp was turned up to 10, but you discover that in a pinch, it goes up to 11. Another part of what happens is that you, the weak link in the chain, make a certain crucial but subtle distinction on the fly. You distinguish sharply between relying on your co-workers as a workaround to fix your problem and get back to work, and relying on your co-workers to exploit their labor so as to become a free rider on their adrenaline-fueled efforts. It seems an obvious enough distinction to comprehend when you’re reading about it in a cool moment, but it isn’t an easy distinction to apply at every moment when you’re living it in an OR with a migraine. Part of being a member of a common good is learning how to make the distinction, and cultivating what it takes to apply it.
So there I am, looking and feeling like an idiot, holding a canister of hazardous waste in one hand, and shielding my eyes from the light with the other, as my neurons do their best to poke my right eye out from inside my brain. My co-worker Ben* notices that something’s wrong, asks me about it, and asks if I want something to tamp down the pain. Fentanyl is my first thought, but Advil is what he’s got in his locker. He’s kind of surprised (and kind of not surprised) that I don’t have any in my locker: only an idiot or a newbie (same thing) would try to do this job without painkillers on hand. So we tap out of the OR for as long as it takes to go to the locker room and get the Advil. I’m tempted to ask him to hold my hand, but resist. Instead, he gives me a much-needed pep talk along the way. “You’re doin’ really good work, man. Real good. Keep it up.” The obvious intended implication is: “So take some fucking Advil, get rid of that headache, and don’t crap out on us now, dude. We don’t have time for this shit.”
I take two tablets, and head back to the OR suite. Given the situation we’re in–three people turning over four rooms–I have no choice, despite my newbie status, to turn over one of the ORs entirely on my own. In other words, I’ll have to do the room myself, and given our case load, won’t have the opportunity to have one of my supervisors check my work after I’m done. I’m on my own, working without a net.**
This is a clear (and to me, daunting) case of what Pierre LeMorvan and Barbara Stock call (the problem of) “the medical learning curve,” a systematic and unavoidable problem that
arises from the fact that medical expertise must be learned….[D]eveloping and acquiring medical expertise requires practising on patients, with one’s performance improving along a learning curve. Thus, patients treated at the beginning of the learning curve are exposed to higher risk, with later patients benefiting from this exposure (Pierre LeMorvan and Barbara Stock, “Medical Learning Curves and the Kantian Ideal,” Journal of Medical Ethics 31 , p. 513).
Using patients in this way, LeMorvan and Stock argue, is, at least prima facie, a violation of Kant’s injunction to treat other rational agents as ends-in-themselves, and never merely as means to our ends. Though LeMorvan and Stock focus primarily on cases involving physicians, residents, and medical students, they’re absolutely right to say that the learning curve problem is ubiquitous in health care. It not only applies to the physician-centered situations they describe, but to nurses, to medical technicians of every description, to EVS, and really to everyone who works in the hospital.
I’d had maybe three weeks of training when my migraine struck. I certainly knew the basics of the job, and knew some of the finer points. I could likely have passed a written exam on what I had learned, and passed it with flying colors (though not if I took it while having a migraine). (I got 100% on the one written test I had to take, on fire safety.) But as LeMorvan and Stock correctly insist, “‘book learning’ is not enough” in a clinical setting (p. 513). You need the skill, judgment, and resolve to do what’s required of you. It’s harder than it sounds.
During my training, I kept a notepad in my back pocket, and in “spare moments” (lunch) made a list of the mistakes I’d made on the job in the past 24 hours or so. It’s a list so embarrassingly long that I hesitate to put it into print, but here’s part of it:
- The first ten beds I made were crooked.
- I put the surgical pillow into its cover upside down at least a half dozen times before I got it right.
- I constantly tied knots (in garbage bags, while wearing laetrile gloves) that were too loose, and some that were too tight.
- I started wiping equipment before all the trash was removed from the OR suite.
- I started wiping instruments in the wrong sequence, then forgot what I’d done and what I’d left undone.
- I wiped instruments, but missed spots of blood or propofol.
- I almost shattered an OR light with the top of an IV pole. I did hit my head on the light, then hoped that no one saw (they did), and pretended it didn’t hurt (it did).
- Mopping was its own special train wreck, despite my having done it before in a hospital setting: My mopping technique (meaning, the actual physical motion I was using) was wrong from the outset; it had to be corrected. I typically started mopping a room in the wrong place, headed in the wrong direction, and ended in the wrong place. I had to correct that. Every now and then, I’d miss parts of the floor. I had to be called back to do them. I once forgot to unlock the bed and mop under it. I had to get another mop and do that (we’re not allowed to use the same mop twice). I missed bits of flesh and bone on the OR floor; I had to pick them up with a Sani-Wipe. And on and on and on. In my initial job interview, I had told my interviewers, sincerely, that hospital mopping was my forte. If that’s not a Dunning-Kruger effect at work, I don’t know what is.
- I almost forgot to take my gown off before leaving a room requiring heightened infection precautions (until my supervisor literally grabbed me by the shoulder before I did).
- I blew through a hallway intersection without looking, pushing a heavy bin full of trash at top speed without bothering to see whether anyone was headed around the corner. Had someone been coming through, I probably would have put them in the ER (luckily, no one was).
- I threw a hazardous waste bag into the regular trash (“That’s a no-no!” my supervisor said when he saw it, grabbing it out of the bin. “A $10,000 no-no!”).
And so on and on and on. EVS, by the way, is considered an “easy” job requiring no education beyond a high school degree. I have a Ph.D. and managed to fuck things up big time for quite awhile. Luckily, my supervisor was always there either to correct me or to laugh at me (or both). So none of my mistakes had any further repercussions.
I agree with LeMorvan and Stock that there’s no humanly possible way of eliminating the medical learning curve from health care. No matter how careful we are, and how much redundancy we build into the system, it’s bound to be there. If someone in EVS forgets to wipe something down, or forgets to mop a patch of floor, or disconnects or connects the wrong piece of equipment, or makes a crucial mistake in setting it up, or fails to stock the OR with the right medical device, or leaves a presumptively contaminated item in the OR after they’re done cleaning, they could end up infecting or killing someone. The greener you are on the job, the higher the likelihood of that happening. Yes, the presence of a supervisor will mitigate the risk to some degree. But a supervisor can’t be present everywhere, all the time.
Suppose (God forbid) that the worst happened. I could plead the excuse that I was new on the job, and didn’t really know what I was doing. I could plead that yes, my supervisor showed me how to do X, or mentioned that I shouldn’t do Y, but he showed me and mentioned a lot of things, and I didn’t take it all in. But if someone dies on my shift at my hands, no one will care about my excuses, not the malpractice lawyers, not the regulators from the Joint Commission or State Health Department, not the friends or family of the deceased. “You chose this line of work,” they’ll say. “Yeah, you chose it at $13 or $14 an hour. Yeah, you had a migraine that day. But none of that matters. That dead body is your doing. You killed Kenny–you bastard!” I don’t want to be the one to kill Kenny. Nor do I want to use Kenny as a mere means to doing better next time. I want to get it all right in one take, with a month’s training. But no one can, and no one does.
Naturally, they don’t show you EVS coming in to clean it all up afterwards.
So I walk into OR 6, confronting the usual blood- and iodine-soaked mess. You sometimes wonder, on walking into a surgical theater after a case, whether you’re walking into a medical facility, or the scene of some grotesque food fight. How do these trained professionals manage to make such a goddamn mess of the room? Blood here, iodine there, a suction device over there, random bits of gauze and bandages strewn all over the place, half the equipment thrown around like something out of a ballroom blitz. What the hell is this? What were they doing in here? There’s got to be a neater, cleaner way of slicing people up, and sewing them back together again. But there doesn’t seem to be, and figuring one out is beyond my pay grade.
I stare in momentary stupefaction at a stainless steel table with little body parts on top. “Oh, no worries,” a nurse says helpfully, “I’ll handle that.” I stand there wondering what she means by “handle,” when she grabs the kit underneath the mess, mushes it all into a compact ball, and hands it over to me. Thanks, lady. You’ve just given me a year’s worth of body-part nightmares. No worries!
One of my favorite nurses, Melissa, walks over. “What do you need me to do, Irfan?” she asks. Still in a bit of a daze, I hand her an Oxivir TB-soaked rag and hear myself saying, “You can do lights and bed.” What planet am I on? A veteran nurse with a decade or two of experience is asking me, the OR equivalent of the village idiot, to give her orders, which she’s ready and willing to carry out the moment I utter them.
Try to imagine an academic equivalent of this scene. I can’t, despite 26 years of experience in academia at a dozen different institutions on two continents. Try to imagine a Dean or Provost offering to cover an adjunct instructor’s intro class in a pinch. Or a tenured professor offering to mop the floor in order to give Housekeeping a break for the night. Or the Registrar helping the cafeteria crew wash dishes. Or a full time instructor refusing the temptation to bump an adjunct out of a coveted slot on the teaching schedule because, after all, the entire department is a team, full time or adjunct, and it’d be wrong to wreck someone’s schedule by pulling rank on them. No, academics take great pride in the fact that anyone dealing with them is “herding cats.” They tend to forget that domesticated house cats are coddled, self-indulgent parasites who spend the day doing nothing, then loudly demand the sky at odd hours. So you’d think the cat metaphor was one best avoided. Guess not.
By contrast: Melissa asks to take marching orders from me. She takes the rag, wipes the lights, then wipes down the bed. She gives no indication that EVS work is “grunt work” beneath her dignity or pay grade. She just does what needs doing with the intention of doing the next thing, until it’s all done. I’m mopping the floor as she wipes the bed, looking wildly around the room for what’s missing or shouldn’t be there. I thank her between gasps for breath; she responds by making a dismissive gesture that might be translated “pshaw,” then moves to the next task. This is, frankly, unfamiliar territory for me, an egalitarianism I’ve read about in obscure left-wing tracts on worker’s democracy, but have never seen enacted in space and time, and never expected to. But here it is.
Sarah, another EVS veteran, has just finished up OR 3 as Melissa and I finish up OR 6. I needed help to finish my OR but Sarah needed none to finish hers. That’s the difference that experience and efficiency make on this job.*** OR 6 is basically (but not completely) finished, so as I tweak the last details, Sarah asks Alexa to play Soundgarden at top volume. “Am I annoying the shit out of you yet?” she asks, laughing sadistically, making a few inside jokes that I don’t get, and probably wouldn’t have gotten even if I didn’t have a migraine.
I’m bad at multi-tasking, particularly bad at multi-tasking to music, really bad at multi-tasking to Soundgarden, and hopeless doing any of this with a migraine. So I have trouble answering Sarah’s question. “How much more of me can you put up with?,” she laughs demonically. “Demonic” is not an exaggeration: last year, Sarah worked part-time as a demonic goat-creature in a haunted house, and this year, she won the hospital’s Halloween contest for “scariest costume.” I can’t upload a picture of it here, but trust me, it’s scary AF. I smile grimly behind my mask, saying nothing, but the truth is that she’s annoying the living fuck out of me, and if I had a third hand, and didn’t have a migraine, I would strangle her, then hunt down the living members of Soundgarden, and strangle them, too. But the truth is, Sarah’s also distracting me from the agony of my migraine, and whether intentionally or not (she later insisted it was unintentional) helping me get through this. So I guess I’m glad that my hands are full.
It hurts less when I have to keep moving, and I have no choice but to keep moving. We’ve got another room to do. And another. And another. And another. The OR doesn’t stop, and doesn’t care if you haven’t caught your breath. Mercifully, the Advil is kicking in, my head hurts less, and I’m finally confident that my migraine is fading.
Ben sticks his head in the room. “You OK?” he asks. “Is the Advil working?”
“It’s working,” I murmur. I can’t manage more than a murmur.
“Good,” he says, taking my semi-bullshit answer at face value. “I always keep some in my locker.” I’m not sure whether he means he’ll always spot me some when I need it, or that I ought to follow suit and get a stash of my own, or both. I make a mental note to get some.
Another room. And another. This day is never going to end.
And then, before I know it, it’s over. I go home. I take a shower. I power down. I lack the energy to get food from the grocery store, or for that matter, to eat very much, so I eat what happens to be in the fridge: a healthy but half-assed salad of watercress and radishes, liberally garnished with Thousand Island dressing. A strange, unfamiliar emotion overcomes me. I believe they call it “gratitude.” I don’t know where it comes from, or why it’s there. I just feel it, roll into bed, and go to sleep. It’s 9 pm. I have to do this again tomorrow morning.
I don’t want to say that patients are literally an afterthought to what I do at work, or an afterthought to what motivates me to get out bed each morning and head to work. They’re not. But patients are, from an EVS perspective, ghostly, anonymous figures wheeled into the OR from “Holding.” They’re half-anesthetized, covered in bed linens, and obscured by medical equipment when they do come in. They can’t talk or act, and even if they could, would hardly be in the mood to strike up a conversation with the nearest EVS worker. So we rarely if ever interact with them, much less get to know them. They’re the ultimate raison d’etre of what we do, but not the proximate thought or image that elicits action.
I vaguely remember a debate I once overheard at a conference on Aristotle’s normative theory.**** The question under discussion concerned the ontology of the common good: what kind of thing is it? The SEP article I quoted at the outset refers to it as “facilities–whether material, cultural, or institutional.” Some describe it as a set of interests, values, norms, or goals. I’d have to sit down to work this out, but the proposal that stuck in my head was the idea that the common good is a temporally extended set of joint actions, carried on by moral agents standing in specific relations to one another. The common good is fundamentally something we do.
At any rate, that’s about how I’d describe the common good involved in EVS work: as my supervisor likes to say, it’s about the work. And of course, about the people who do that work. What gets me out of bed each morning is not so much the image of patients in need, but of the co-workers beside me responding to that need, along with the grandeur and misery of the activities we jointly enact. If it weren’t for that, another month of this job might seem like a prison sentence served out in a labor camp. The solidarity of joint effort in a common cause is what makes it a liberation, and makes it feel like one.
*I’ve used pseudonyms throughout for the workers I refer to here, whether nurses or EVS staff.
**I don’t want to overstate the risks here. While it’s true that my supervisor couldn’t check my work that day, the last line of defense in an OR is the clinical staff, not the supervisor of EVS. And the clinical staff is by definition always there to check mistakes. So had I made a mistake, it’s likely that the clinical staff–nurses, anesthesiologists, equipment tech, physicians–would have caught it.
I should emphasize that my saying that my supervisor didn’t check my work that day is not intended as a criticism of anyone or anything. Regardless of one’s line of work, there comes a day when you have to do the job on your own without anyone there to check your work. Those who find this discomfiting in a hospital context might want to think of something more commonplace, like driving a car, something fully as dangerous as anything I do in an OR (probably much more so). Believe it or not, we let 17-year-olds drive cars without supervision, and no one has a problem with it. The same “learning curve” applies to driving as applies to medicine.
***As LeMorvan and Stock point out, “T P Wright coined the term ‘learning curve’ to describe the rate of increase in the productivity of airplane manufacturing workers” (“Medical Learning Curves,” p. 513). See T.P. Wright, “Factors Affecting the Cost of Airplanes,” Journal of the Aeronautical Sciences 3 (1936), pp. 122-8.
LeMorvan and Stock are anxious to stress the differences between airplane manufacture and health care, which is fair enough, but I think they slightly overstate things.
Learning curves occur in any process where performance improves as a function of practice–for example, playing the guitar, teaching, or performing surgical procedures. In these examples, however, one is normally more interested in the improved quality of the results, rather than the decreased time and effort that Wright emphasised (“Medical Learning Curves,” p. 514).
I wouldn’t make so sharp a distinction between quality and economy. Certainly in guitar playing, there’s a connection between quality and economy: the more economical player usually sounds better than the one who exerts greater effort in moving from chord to chord or note to note. And speaking only for myself, my own teaching improved in quality as I got more efficient as a teacher. (In other words, I not only decreased the time I was obliged to put in, but improved as a result of putting less time and effort into prepping.)
Something similar is true, I think, of surgery. In the United States, at least, health care is a money-making industry, and the OR is likely to be one of the main revenue producers for any given hospital. Hospital managers typically want improved outcomes, but they also want those improvements to come in ways that improve the hospital’s bottom line. That implies that every worker, from the neurosurgeon down to EVS, is expected to improve quality through decreased time/effort spent. There are certainly times when decreased time/effort spent probably affects quality in adverse ways. But EVS managers often insist on the desirability of “working smart” to “working hard,” where “working smart” is a matter of improving quality through marginal improvements in efficiency. Part of that is skill at setting priorities.
To cite a common example: when wiping equipment down, EVS workers are often directed to prioritize wiping the parts of the equipment that are most likely to have gotten blood spatter, not to wipe the whole piece indiscriminately on the assumption that wiping the whole thing is “better” than wiping only a part of it. Wiping the relevant part turns out not only to be faster and less effort-consuming, but more likely to clean off what actually needs cleaning.
I’m not certain that what applies to EVS applies to clinical work, but it’s very possible it does. (Both surgeons and nurses often speak as though it does.)
****The paper under discussion was John Cooper’s “Political Community and the Highest Good,” eventually published in Being, Nature, and Life in Aristotle: Essays in Honor of Allan Gotthelf (Cambridge, 2010). If I remember correctly, the proposal (common good as a set of actions) was Cooper’s as well. Princeton’s annual classical philosophy conference is, by the way, a nice paradigm of an academic institution realizing a genuine common good.
Thanks to Maureen Andary, William Elliot Byrd, Nancy Gable, John Holt, Pam Olson, Chris Sciabarra, Jodi Shelly, Michele Trippodi, Margaret Welsh, and especially to Roderick Long for both supportive and critical comments on an earlier version of this post on Facebook. And obviously, thanks to everyone at HMC OR for being who you are, and doing what you do.
This post represents my own thoughts and opinions, and is no way intended to represent the views of Hunterdon Medical Center, its parent organization, Hunterdon Healthcare, or any of its affiliates.
One of my worries about a citizen-focused conception of the common good is that it lends itself all too easily to nationalism: the common good of *our* country as against everyone else. Against this stand not only the universalist cosmopolitan ideal of allegiance to common humanity, but also the more distributed cosmopolitan ideal that we each belong to many overlapping communities — religious, professional, ideological, cultural, etc. — with the boundaries of the nation-state not necessarily defining the most important one. I certainly feel more affiliation with, e.g., left-libertarian anarchist philosophers in the u.k. than with my fellow American citizens Donald Trump and Joe Biden.
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Related is my resistance to the Rawlsian notion that society as a cooperative venture for mutual advantage somehow coincides with the boundaries of the nation-state, so that concern about the just distribution of the benefits and burdens of such cooperation is a purely domestic issue (as opposed to the weak tea of his Law of Peoples). It’s not as though problematic economic exploitation stops at national borders.
(Of course I also disagree with Rawls as to what principles define just distribution — my views look more Nozickian than Rawls would like, though also more Rawlsian than Nozick would like — but that’s a separate issue.)
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Thank you, Irfan.
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