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Leaving the field.

As journeyers into the field, participant observers, and chroniclers, we have been involved in the development of organ transplantation, the artificial kidney, and the artificial heart throughout most of their contemporaneous medical and social history and for many years of our working lives. Since 1951 (RCF) and 1968 (JPS), we have had the privileged opportunity to watch from the inside how dialysis, and kidney, heart, and liver transplantation, which began as "desperate remedies for desperate patients," with certain "desperate[ly] hopeless" conditions,[1] evloved into "nonexperimental," though far from ordinary, interventions to treat a wide gamut of end-stage diseases. During those years we have seen the range and combinations of different organs transplanted, the numbers performed, and the array of artificial organs designed increase dramatically, and we have charted at first hand the early phases of the drive to replace the human heart with an artificial device. Our intensive, long-term relationship with these therapeutic innovations and their clinical unfolding has had many of the characteristics anthropologist Margaret Mead identified as inherent to field research, no matter where it is located or what its subject matter may be. Field work, as she described it, entails not just the unique but also cumulative experience of immersing oneself in the ongoing life of another people, suspending for the time both one's beliefs and disbeliefs, and of simultaneously attempting to understand mentally and physically this other version of reality.... Immersing oneself in the field is good, but one must be careful not to drown. One must somehow maintain the delicate balance between empathic participation and self-awareness, on which the whole research process depends.... Only very slowly did we [field workers] begin to take into account that we ourselves change with each step of the journey, with each new image presented to us...and with each day in the field.[2] Our research did not transport us to geographically and culturally isolated primitive villages, where we lived and worked day after day for months without the respite of returning to our home-world. Yet, in many crucial respects, our field experiences parallel those of Mead. We have journeyed far, horizontally and vertically, in our questining after transplantation, dialysis, and the artificial heart--coast to coast in this country, and to Europe, Hawaii, Majuro, and China; down long corridors into the high-technology surgical and intensive care chambers of the modern hospital; and ever more deeply into the corridors and chambers of ourselves. The people we have studied have been our "teachers" as well as our "subjects," helping us to learn their language and their ways. We have risen "at cock crow" to accompany transplant teams, donors, and recipients into operating rooms, and we have stayed up all night to "listen for some slight change" in a patient's or prospective donor's condition and to "revel or mourn" with medical professionals, patients, and families. We have "used ourselves as instruments," striving to attain and reattain the "kind of reflexive objectivity that calls for continuous self-scrutiny and self-analysis, along with observing and interpreting the actions and interactions of others." For years, as participating observers and observing participants, we have walked the thin line between detachment and concern and between "belief and disbelief." And like Mead, "only very slowly did we realize" that, as a consequence of our "immersion" in the field, deep and enduring changes were taking place in us.[3] Foremost among the people whose "reality" we have been allowed to share are the physicians and nurses, patients and families who have been the chief actors in the "experiments perilous" through which organ transplants, dialysis, and the efforts to fashion a viable artificial heart have been advanced. It has kept us in close contact with the grave illnesses and frequent deaths they have mutually faced, with the hope and renewal, the "breakthroughs," the despair and dissappointments they have experienced, and with the ways of navigating and coping they have forged. …