Not whether to respond, but how
While this scenario of a baby with clinically significant bronchiolitis is fictional, situations like it are very similar to the rooms I (BS) have walked into many times, both in this hospital and others like it, spaces that are, after fifteen years of training and practice, home for me. Like many of my healthcare colleagues in moments like these, I am exhausted, worn down by the fulfilling but emotionally charged work of looking after children and their caregivers when the former are sick and the latter are often afraid, frustrated, and exhausted themselves. Despite that, when on call, there is no choice of whether to respond or not. The only choice is how to respond to those seeking help at our doors at this late hour, a choice that may be informed by drawing upon an ethic of hospitality.
My ability to offer hospitality in this scenario is contingent upon people seeking it out in the dark hours of the night. When on call, I await the arrival of people who may never come, yet despite the above pressures and demands on time laid out above, I must be at my best if they happen to appear. Even if I create space in anticipation of receiving someone, I cannot know what that space will look like and how it will be enacted until  the person arrives. I have looked after over a hundred children presenting with bronchiolitis throughout residency and now independent practice, yet what the illness experience looks like for this family at this time in thislocation will call me into being in a unique way. Further, I might recognize the biomedical condition, but I really have no way of knowing what sort of requests or demands this  family living this  illness will make of me. So, space is made and the lights are left on, but the future is totally unwritten, the ambiguity of what could happen inexplicable until a specific person arrives, asking for hospitality.
Given the frequency of clinically significant bronchiolitis in infants, combined with the late hour and the bonecrushing fatigue that accumulates after years of training and practice, I suppose that I could be forgiven for being somewhat disinterested in this specific clinical encounter and for trying to get through things as quickly as possible. As such, diagnosis could solely exist as the means to structure biomedical treatment and fix the problem at hand. My challenge is to remember that health care encounters, while sought out, almost always involve people not really wanting to be there. There are undoubtedly countless other places that caregivers would rather be than in an emergency department with a sick baby in the middle of the night. That they are indeed here indexes a sense of being bereft of options, cast out of the familiarity of their lives, at a loss to name what is happening, and feeling uncertain as to how to help their baby.
Brought to bear on this scenario, then, an ethic of hospitality illustrates three key aspects. One, my presence in health care encounters is not a given; rather, I am called into presence as a paediatrician each time anew by patients asking for help. Certainly, I can draw on the somewhat standardized affordances that a correct diagnosis offers for biomedical aspects of this encounter – among others, oxygen, suctioning, and ensuring appropriate monitoring and nutrition. Yet an ethic of hospitality also invites me into the unique lived experience of this clinical encounter, one in which clinically significant bronchiolitis in this infant’s life is likely to be extremely rare, one in which we attend to the other, less clinical and more existential function of diagnosis: “to symbolize the source of suffering, to find an image around which a narrative can take shape. To name the origin…is to seize power to alleviate it…and is also a critical step in the remaking of the world, in the authoring of an integrated self”.13
Second, it compels us to acknowledge the sharp edges of thisfamily’s double vulnerability – the precarity that comes with the “unhomelikeness” of illness18 and the strangeness of the acute care centre world in which they now find themselves. That parents, experts in their child, come seeking answers and support from complete strangers – albeit those in socially legitimated roles like the ones physicians embody – is testament to the ruptures in everyday life that significant illness brings. Adding to this vulnerability is the common perception of the acute care hospital context as both unfamiliar and daunting to caregivers and children, particularly when under the duress that significant illness brings. Movements from triage to exam room to in-patient bed, contact with myriad health care professionals, and the indiscriminate blaring of monitors that may indicate low oxygen saturations but may also simply be reacting to the normal movements of a four-month old all confront people with a massive amount of information, often when they are already exhausted. Further, even “well-educated” caregivers, unlike the health care professionals they may be meeting for the first time, are not typically immersed in a biomedical worldview, fluent in the sociolect of professional medicine, or familiar with the logic of questioning and examination that are part and parcel of clinical encounters.
Third, then, an ethic of hospitality also lays bare that a health care professional’s expertise and experience are ways by which we may “unlock” the unintelligible aspects of this world.30While it is unlikely that anything I do will make the hospital a place where patients and caregivers will ever desire to be, I can focus my efforts upon making it less unwelcoming , acclimatizing them to this novel context and recognizing their need to incorporate this time of unfamiliarity into their broader life narrative.