Professional performance: The case of unexpectedand expected deaths

Abstract

This paper seeks to explore some commonalties and differences within observational data derived from two research studies concerned with the management of death. The studies differ in both their theoretical framework and focus of enquiry. Yet the contextual settings for both are institutions with an overarching ethic of care and control, namely a hospital and a care home for older people. However, their location on the cure – care spectrum is different. Hospitals are generally more orientated towards cure and the business of residential homes is essentially about long-term care. Both studies explored how the same event, death, may be differently and similarly constructed within these organizations. Both accounts illustrate the importance of performance around the management of death and how this performance was choreographed according to what interventions were required of staff and how staff saw their role around the death. An anthropological framework informs the first, hospital-based, study. Its focus is the dramatic life saving intervention known as cardiopulmonary resuscitation (CPR). CPR is generally used where deaths are perceived as unexpected, untimely, unfortunate, and unnatural. They are, moreover, by virtue of skilled intervention, seen as potentially reversible. The case study used here highlights the pressurized, action orientated deathbed scene that accompanies most CPR situations with all its attendant rituals, symbols, and technical wizardry (cf. Timmermans, 19971999). It serves as a quintessential example of the medical appropriation of death (Hockey, 1990; Illich, 1995; Skrabanek, 1994). The second study, underpinned by a sociological framework, examines the production of death and dying in care homes for older people. Here death was not an unexpected or even unwanted event, but one that was constructed as “timely” and “natural” coming as it often did at the end of a long life (Komaromy & Hockey, 2001). However, the case study material used here concerns the death of a resident called James and explores the problems perceived by the staff in managing a “good death” for him. The notion of a lonely death amidst a crowd of “carers” is implicit in both cases.