Abstract
Writing organizational ethnographies is clearly fashionable now, and thanks to that fashion, readers can learn about types of organizing that were previously outside the lens of researchers. Organization scholars become participant observers of such fields as airport lounges (O’Doherty, 2017) and escort agencies (Ślęzak, 2016). This type of fieldwork requires ingenuity, patience, and, in some cases, courage. There can be few better examples than Mark de Rond’s decision to join the pre-deployment training sessions for a surgical team destined for a 6-week tour of duty in Afghanistan. After returning home, he wrote a narrative ‘based on a thorough set of field notes on observations of behavior, artifacts and conversations, on interviews, letters and poetry given to me by the staff, on reports of past deployments, and on e-mail exchanges’ (de Rond, p. xxi). Although there is no doubt throughout the text that it reports facts along with the narrator’s thoughts and emotions, no scientific jargon intrudes on the narrative. The result is so convincing and so distressing that I was able to read only one chapter at a time. After all, as US journalist Chris Hedges wrote in the Foreword, Only those who have been to war see war. The images that reach the public, however horrific, are carefully sanitized, edited and censored. If we truly saw war (…) war would be so unpalatable it would be hard to wage. (p. x)
The first chapter (‘Hawkeye’) merely contains a short description of the pre-deployment period, but by the second (‘Reporting for Duty’), the reader obtains an answer to the question that—consciously or not—emerges from the very beginning: How can people survive such an ordeal, do something morally good and extremely important in the midst of absurd circumstances, and not go mad during and afterwards? de Rond makes it clear that M*A*S*H was not a peculiar fantasy of a crazy moviemaker: the circuit of culture is perfectly closed as real doctors relate to movie doctors, and the conclusion is that only humor can help them to keep calm and carry on.
In the third chapter, ‘Camp Bastion’, de Rond describes the camp in which the doctors operated, and does it, like he does in several other chapters, by literally ‘painting with words’. His talent at describing places, spaces, and objects is nothing short of amazing. The reader can truly see them while simultaneously learning the basics of the vocabulary used by the medical and military staff in the camp. It is in the fourth chapter, ‘A Reason to Live’, that the surgeons’ activities begin to be described in detail. But the title of the chapter comes from a short exchange between one of the surgeons and one of the scrubs. He asks whether she needs anything, to which she answers ‘Reason to live’, and his replique is ‘Now, wouldn’t that be something?’ (p. 43).
Yet, one possible reason to live is provided in the next paragraph: ‘many medical professionals experience their profession as a “calling” in much the same way clergy do: their ambitions serve a purpose other than careerism’ (p. 43). And just as members of the clergy make ample use of rituals, so do medical professionals take ‘systems, protocols and techniques very seriously. (…) This general technical focus is designed in part to desensitize doctors to emotions that may interfere with their ability to provide the best possible patient care’. (pp. 43–44)
In the fifth chapter, ‘Legs’, de Rond retells many stories told in the camp in order to demonstrate the important socializing function they play for the newcomers. Apart from those ‘tales from the field’ (Van Maanen, 1988), socializing is also achieved with the help of fictitious stories, like those given to de Rond to read before his deployment, and which he lists in Chapter 6 ‘Apocalypse Now and Again’. They varied from M*A*S*H to Heart of Darkness. The personnel also watched relevant TV series, and although de Rond suggests that the irony of watching fictionalized war stories in the midst of an actual war was lost on everybody, several pages later he reports that the same people are singing Queens’ ‘Bohemian Rapsody’ in a choir (‘Is this the real life? Is this just fantasy?’). Maybe in this situation, this mixture was not ironic, but simply therapeutic.
The seventh chapter, ‘Boredom’, reports a truly paradoxical observation: The boredom, when it hit, was wearisome. Everyone would rather it be busier, as I did, too, but felt guilty for what that implied. (p. 75)
de Rond quotes several sources (with references in the endnotes, so as not to ruin the flow of reading) to show that this reaction was common. Indeed, it is not difficult to understand from a psychological point a view. The contrast between high tension and its complete lack can be truly shocking and demobilizing.
But the medical personnel were not involved merely in medical duties. Chapter 8, ‘Christmas in Summer’, provides several examples of activities, routines, and rituals that were supposed to maintain the personnel’s contact with ‘home’—a usual procedure among expats (Gaggiotti, 2012), but in this context, producing truly bizarre results. A person carrying amputated limbs to the morgue meets two people with bunny ears carrying Easter eggs.
Chapter 9, ‘A Record-Breaking Month’, reports a period of exceptionally high intensity of medical interventions (and therefore, casualties). de Rond uses it to illustrate dilemmas arising even at the top level of professional expertise: The two leading surgeons ‘suffered no incompetence and would not stand for indecision, even if, ironically, their competing viewpoints would occasionally achieve exactly that’ (p. 91). Another common conflict, which de Rond describes in Chapter 10, ‘Kandahar’, occurred between the two professions—the military and the medical. In this chapter, de Rond follows a handover of three Afghan casualties to the local hospital. On their way back, the ramp at the back of the plane failed to close for a long while, and The lads responsible for closing the tailgate stood idly by meanwhile and, as darkness fell, killed their time and ours with a hand-shadow puppetry display, using the plane’s only light source to project their childhood fantasies onto the black, defenseless tarmac. (p. 103)
But war does not follow childhood fantasies (Chapter 11, ‘War Is Nasty’). In this chapter, de Rond quotes the relevant statistics—not only of fatalities, but also of post-traumatic stress disorder (‘Active-duty suicides among US troops reached an all-time record of 349 in 2012, exceeding US combat deaths that year’, p. 108). According to de Rond, the personnel at Camp Bastion tried to avoid such effects of the war primarily through avoidance coping (attempts to escape reality by immersion in fiction, among other methods) and escape coping (attempts to recreate ‘normalcy’, by eating pizza or bacon-and-egg breakfasts, or by baking bread).
In Chapter 12 (‘Way to Start Your Day’), de Rond describes his last day in the Camp in detail. What worried him, and is described in greater detail in Chapter 13 (‘Back Home’), was the fact that he was unable to shake the sensation of voyeurism: of intruding on private suffering with nothing whatsoever to offer in return. (…) Even at the best of times, my own academic work compared poorly to the most mundane of medical interventions here. (p. 128)
He wrote to the surgeon who was his main contact and received the following answer: Don’t feel any guilt about not feeling emotion. If we got emotional about what we have just done or seen we would never be able to do it again or live with ourselves. (p. 129)
The British Ministry of Defence wanted to stop publication of the book. (It is therefore not by accident that it had to be published in the United States.) The attitude of the Ministry could not be based on descriptions of the medical personnel, who are presented as true heroes, in a realistic rather than an idealized way. It is the absurdities behind the war that must have irritated the Ministry. As de Rond noticed, describing difficult decisions concerning the fate of the wounded Afghans, ‘one budget is used to save those a different budget tried to kill only a moment ago, both propped up by the same tax revenues’ (p. 11).
All in all, de Rond’s study is a good illustration of what Bruno Latour (2005) suggested long ago, despite many scholarly protests: we (organization scholars in this case) do not conduct our studies in order to present our results to people we have studied. It is more than likely that they know what they are doing. It is for everybody else, for those who do not know. Doctors at War should be read by anyone who hasn’t seen a war.