Bioethics and Organ Transplantation in a Muslim Society: A Study in Culture, Ethnography, and Religion

4. A Surgeon in the Field

4 A Surgeon in the Field The roles that a person assumes—the ways they are de¤ned, structured, and played out—are never completely self-determined. Renee C. Fox, Experiment Perilous: Physicians and Patients Facing the Unknown Ethnographic ¤eldwork poses the challenge of eventually producing a text that provides an intimate view of people or a community and how they construe and comprehend their lives, and yet must do so in as dispassionate a manner as possible. Geertz describes ethnographic writing as a challenge “to sound like a pilgrim and a cartographer at the same time,” transforming observations and experiences of “being there” (in the ¤eld) into a coherent and convincing account while “being here” (back in academia, among “scholars”).1 In doing so, authors perforce place their unique “signature” on the eventual text that is produced. However objectively and coolly ethnographers may wish to present their observations and analysis of what they observe in the ¤eld, these views can never be from nowhere ; they are always from somewhere. Ethnographers cannot entirely divorce themselves from the ways in which their own sense of self and identity have been construed, both in their eyes and in those of others, in the years that preceded the study, and ignore the ways in which these in®uence the study.2 What researchers focus on and what they decide to leave out, how they relate to those they study and the nature of relationships they forge in the ¤eld, are all inevitably colored by the researchers’ previous life experiences, both personal and professional. In addition, intensive immersion in the community of study, the researchers’ identity, and the ways in which they “see” themselves are constantly interfacing with and modulated by how others see them and de¤ne their role in their daily interactions. Researchers may be participating in scienti¤c work, but ¤eldwork nevertheless remains a social endeavor. Therefore, a real understanding of the study, a validation of what is being presented and how it is interpreted, necessitates self-disclosure by the researchers to some extent, a need for “objectifying ” themselves; to offer not merely re®ections on and analysis of the words and deeds of their informants but also a measure of selfre ®ection and self-analysis on how these in®uenced their choices and interpretations and impacted their own notion of “self.”3 In this chapter I present relevant aspects of my personal and professional background that preceded my research in the Institute and examine the important ways in which these in®uenced my interactions . It is an account of my journeys as a surgeon moving through several streams, traveling between the diverse social and moral worlds of Pakistan, the land of my birth, upbringing, and early adulthood, and that of the United States, the country responsible for a signi¤cant part of my intellectual and professional growth. Just as much, it is a telling of my moving from the textual universality of medical science and human pathophysiology as a physician and entering as a ¤eld-worker the contextual particularities of lived lives of patients and their families. It is a description of my struggle in shifting from a life of relative certainty and control as an experienced surgeon to one as a novice ethnographer grappling with the nuances and subtleties of lives beyond the reach of medical science. A con®uence of all these factors, smooth at times and turbulent at others, served to dictate the framework of my research and in-®uence my interactions. These factors were also largely responsible for the dilemmas with which I struggled during my ethnographic work. Some of my dilemmas were familiar and echoed with the experience of many other ethnographers, while others in my opinion were unique, speci¤c to the particular set of circumstances that had molded the identity I carried into the ¤eld. Being a cultural hybrid offered me many advantages but also served at times to heighten my sense of moral unease and ambivalence. The speci¤city of some of my dilemmas was not related merely to the fact that I undertook a study of a healthcare system in the country in which I was born; recent years have seen a number of “native” 172 Bioethics and Organ Transplantation in a Muslim Society anthropologists returning to study aspects of cultures of their countries of origin.4 I believe that the uniqueness of some of my personal moral dilemmas...