A Tale of Two Shitties

Extreme Examples of Expert Habitus in an Anal Cancer Prevention Clinic

Abstract

Based on 12 months of ethnographic data collection in an anal cancer prevention clinic, this article uses the extreme examples of patients involuntarily defecating through the anoscope during the procedure to highlight the relationship between the extreme and the everyday. Despite the rarity of this occurrence, I argue that these extreme examples shed light on the ways the daily clinical routines are embodied as an expert habitus. High Resolution Anoscopy procedures are specialized, highly routinized practices that are performed hundreds of times per month at the clinic. These routines result in the development of a clinical habitus that guides physicians in deploying techniques to efficiently conduct the invasive examination. Exemplary examples of ordinary procedures certainly help explain how this expert habitus is enacted through routine clinical practices; however, this expertise becomes especially observable in moments when habituated practices are disrupted, forcing clinicians to react and respond in unscripted ways. I discuss the only two instances of patients defecating through the anoscope that occurred while conducting my research, each with a different clinician. These extreme examples provide rich opportunities to analyze how clinicians with similar procedural habits navigate extraordinary situations in expert and professional but idiosyncratic ways. Whereas exemplary examples of everyday routinized procedures can show the process of developing an expert clinical habitus, these extreme examples more clearly demonstrate how this habitus enacts expertise and professionalism by highlighting the clinicians’ abilities to deftly navigate the technical and sociocultural aspects of such extraordinary disruptions.