Sunday, February 16, 2020

Josh Seim's "Bandage, Sort, and Hustle"

Josh Seim is Assistant Professor of Sociology at the University of Southern California.

He applied the “Page 99 Test” to his new book, Bandage, Sort, and Hustle: Ambulance Crews on the Front Lines of Urban Suffering, and reported the following:
From page 99:
Mark and Danny found Rob sleeping on the sidewalk a few blocks from the county’s flagship public hospital. Apparently, someone called 911 for a “man down.”

Surprised to encounter an ambulance crew, Rob nevertheless asked to go to a hospital. However, he didn’t want to go to the emergency department he was recently discharged from, the facility that was only a short walk away. At first, Rob said he had had a seizure, but upon further questioning from Mark and learning that this chief complaint would limit which hospital he could go to, he then said he did not have a seizure. Mark never told me how he classified the call, but he agreed to take Rob to a smaller hospital in a neighboring city of Agonia County. As he later told me, this was at least partially a strategy to get his and Danny’s ambulance out of the busy ghetto where they found Rob.

In some respects, this particular transport was a win-win for those in the ambulance. Not only did this transport bring the crew to a somewhat slower area of the county that they preferred to work in; it also brought Rob to an emergency department that he preferred. When Danny and Mark pulled Rob’s gurney from the rig and began to roll him toward the emergency department doors, Rob began to nod in approval. “One thing’s for sure,” he said, “Your damn ass will get a bed here.” The last emergency department that discharged him is a “sorry ass place,” where getting a bed is less likely and the meals are of worse quality. At least that’s Rob’s opinion.

Ambulance crews seem to be greasing a revolving door of emergency medicine. They bring back a number of people who have already been processed and discharged by emergency department personnel. Sometimes they bring them back to the same facility but they’re also frequently taking them to different ones.

This isn’t just a pattern for so-called frequent flyers or even those whom crews find with hospital wristbands, EKG electrodes, and other emergency department materials still attached to their flesh. Ambulance crews are often bringing in people who have visited the emergency department in the past month or two. It’s not uncommon for crews to draw on the history of these previous encounters to make their patients. For example, they frequently use discharge paperwork and other documentation held by the patient to help them fill out their own reports. EMTs often copy demographic information, insurance policy numbers…
The Page 99 Test works well for Bandage, Sort, and Hustle. There are more gripping and insightful pages in the book, but I’m reasonably proud of page 99. Of course, the Page 99 Test is a quality test, and quality is a bit subjective. I can only assume that those who find the above excerpt to be interesting would enjoy the rest of the book.

I nevertheless feel compelled to contextualize page 99 a bit. Bandage, Sort, and Hustle is a three-part book, and each part details a specific way that ambulance workers in Agonia County (pseudonym) handle suffering populations in the economically and racially polarized metropolis. Part I is titled “Bandaging Bodies” and it argues that ambulance crews offer superficial responses to deep structural problems. Part II is titled “Sorting Bodies” and it argues that ambulance crews help distribute suffering populations across an array of street-level institutions. Finally, Part III is titled “Hustling Bodies” and it argues that ambulance crews rush people through (but not necessarily toward) interventions.

Page 99 is in Part II and more specifically it’s in a chapter that details how ambulance workers distribute suffering bodies in and across emergency departments. Paramedic Mark and EMT Danny sort Rob into a particular hospital. Rob, however, is not just a passive object of paramedicine. He can, and does, influence how he is sorted by adjusting his chief medical complaint. This taps into an important claim made throughout the book: frontline labor can affect clientele but clientele can also affect frontline labor.

As a bonus, page 99 signals a few of the major sociological topics that Bandage, Sort, and Hustle covers: labor, medicine, city, and suffering. Those who read the rest of the book will also read about the sociologies of state, punishment, inequality, and more.
Learn more about Bandage, Sort, and Hustle, and follow Josh Seim on Twitter.

--Marshal Zeringue