Performative Lecture within the exhibition Cast a Cold eye on Life on Death: The Remake: Medicalised Death in ICU at SCA Gallery University of Sydney, Australia
This video is of Stage One of the Performative Lecture and includes this quote from an ICU nurse followed by a fairy-tale;
Each day I would come in praying that I would not see her name on the whiteboard with my name next to it. And each day both were there. She moved from near death crisis to near death crisis with her vitals often hovering at levels that we all knew were not survivable - yet she survived. Analgesia was difficult due to hemodynamic instability. Her liver failed, she developed an irreversibly metabolic acidosis, and renal replacement therapy became unavailable as her cardiac output fell. Mottled and bleeding she slowly dies. She was almost at the end, a nurse summoned to her bed in the night by an alarm. Her death had taken 2 months and 4 days.[1]
[1]David Crippen, End-of-Life Communication in the ICU: A Global Perspective (New York: Springer, 2008): 52.
The next stage of the Performative Lecture was to play the card game Racing Patience ICU, a rough, fast game of life and death. In stage three the group moved to the apparently empty exterior space around a hospital where the audience either smoked or just passed time. Stage four thrust the audience back into the economic drivers of human farming and sale by auction of blood and blood products. This theme continued into stage five where human farming became more closely aligned with our expectations of agriculture, of farming animals for meat and milk with the final stage being adjacent to the No Exit work where choice is limited indeed non existent as all doors are closed.
From May 10th to 18th, 2019 Fiona Davies, undertook a series of performative lectures within the exhibition Cast a Cold Eye on Life on Death: The Remake Medicalised Death in ICU. This is an examination exhibition, the culmination of four years of practice-led research into medicalised death in ICU. There are a series of installations, object-based works, performances and interactive works. In each performative lecture Davies led a small group of viewers through these works, involved them in activities and if they wanted to. encouraged them to participate in conversations about medicalised death.
Warning: The exhibition and the performative lecture contain images, sounds and activities that deal with death, dying, hospitals, violence, blood and body parts for transplantation.
'Cast a Cold eye on Life, on Death' is a quote by WB Yeats
Surveillance in an ICU could initially be described as direct observation of the body, further observation of the body through imaging and collection of data including those observations and the subsequent visualisation of that data. As increasingly observations became coded and translated into numeric or alphanumeric data or its equivalent these initial processes of surveillance have replaced the body with data and relied on the creation of data doubles to be the ongoing manipulable record of that surveillance.
The liquidity of surveillance is described by David Lyon in 2010 as something that ... not only creeps and seeps, it also flows. Zygmunt Bauman in conversation with David Lyon in 2013 states ‘it’s crucial we grasp the new ways that surveillance is seeping into the bloodstream of contemporary life and that the ways it does so correspond to the currents of liquid modernity. Jacklin later in 2013 expands this comment by outlining that …. The metaphor is a complex one, involving the fluidity, mobility and ubiquity of surveillance practices in twenty-first century societies as well as the internalisation of surveillance by twenty-first century subjects and, therefore, the relationships between surveillance and health, identity and the human body. [1]
In a similar manner to death there is a focus of representation of the body in contemporary art practice at this intersection of surveillance and identity.[2] At its most basic ICU surveillance consists of a combination of observation of the human body, and data in a manipulable form. This manipulable component of data and the its next logical step, the processing of that data by algorithms and the ability to determine automatic or semi automatic decisions about treatment and survivability has not yet been fully addressed by contemporary art. However speculations about this logical step can be found within ICU Literature.
I haven’t been able to find specific references but in my experience there is an overwhelming presumption that surveillance in ICU is somehow benign, inherently valuable and in the patient’s interests. I want to give you an example from within ICU practitioners where this is questioned. Schuman wrote in ‘Managing your patient's data in the neonatal and paediatric ICU [3]
Usually what we would like to measure and what we can realistically measure are not the same. .... systematic but unexplained differences in mortality across participating hospitals accounted for 84% of variation in mortality. When models prove uninformative, we ought to reconsider how we determine the factors to which we think we need to pay attention.
And further that the model tending to be used within the medical profession to exchange information, opinions etc is by oral story telling; how something happened. Data is resistant to the idea of storytelling lacking nuance and functionality[5].
The medical monitors in ICU commonly record a visualisation over time of data related to at a minimum the patient's cardiac output, hemodynamic parameters, blood oxygenation and body temperature. This data is visualised as a screen-based construction by sign, image, text and sound. While this form of imaging could not be understood as direct representation of a physical object, it functions as a representation of the performance of that object. A representation can be developed through data visualisation by wave forms, text and symbols, or sonification through the sound of alarms as the data diverges from pre-set ranges defining normality. This focus on set point alarms has been researched as tending to be ignored as it describes a situation already known or describes norms inappropriate to the patient. Increasingly more sophisticated sonification of monitors is used in specialist situations such as under anaesthesia and in ICU to describe trends rather than assume everything within the normal range is fine and once a toe is set outside the alarms go off.
[1] Dr M. Jacklin 'Surveillance in the Blood Stream' private correspondence on Davies' installation at Campbelltown Arts Centre in 2013.
[2] Network Surveillance Studies, "Surveillance & Society," no. Journal, Electronic (2002), http://usyd.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwdV25DsIwDLWACSauiqtSJzagTUKTzIiKHXaUqyNCQBGfT9q03MyRLEVxnu0XPwcAo3k4-8CEiBqudSRiakE5VMaGtTjVXOS6TiY0eme2oVIUVM0cjxfepwb9u9m5dI0KUQuYPz65rwW2vrYkdajbnL26wQ6ylxQ5gRahNB-uSd-G8hUAmrRtsCpzxA7UzKELrZeJgT3wttnpavKfguxhBdPg7Jou--An691qM8vt7UtKZi8xI7YuCm_Yg4Yt880AAsJDrjAWDBtDUixlqjjSiiIhiWIsHoL328bo38IYmsXfJQVhMIHG5ZQZ3-3sDhJldtM.
[3] Joseph Schulman and B. M. J. Publishing Group, Managing Your Patients' Data in the Neonatal and Pediatric Icu: An Introduction to Databases and Statistical Analysis(Malden, Mass: BMJ Books/Blackwell Pub, 2006).p 346
[5] Ibid.p352