“The Sexuality of Care” is M.K. Thekkumkattil’s memoir in essays that explores their time as a critical care nurse, healing from trauma and abuse, identifying as trans and rebuilding capacity for relationships using the intellectual and emotional structures of kink. All the essays feed into Thekkumkattil’s vision of a world without hospitals. Many readers will likely bristle at the thought, but even if you don’t agree with everything Thekkumkattil asserts, you’ll recognize the power of their vision.
They create a distinction between “caregiving” and “caretaking.”
In “caretaking,” there is some social, professional or economic punishment for not providing the care. These punishments are common experiences for nurses, other health care professionals (who need the money from the job) and women in general. In a number of places in the book, Thekkumkattil notes how nursing is often one of the few pathways to economic independence for women of color and recent immigrants.
In “caregiving,” the caregiver chooses to give care and does so for reasons that motivate, energize and empower them, along with healing or mitigating the suffering of the person they care for. As more basic actions of life are turned into sources of rental income for the ownership class and the cost of just staying alive grows dramatically in relation to income, this distinction is a valuable framework for understanding a lot of other phenomena in our economy and society. Anyone who has ever turned a beloved hobby into a professional hustle knows how different the same activity can feel when what you used to do for joy, you now do to pay the rent.
Likewise, Thekkumkattil’s idea of “care without abuse” is revelatory to me. Whether we are discussing the violence that is often necessary for critical care (the restraints, the sedation, the needles inflicted on a patient without a gesture toward securing consent), the capitalist exchanges we need to make to survive (we should notice again why so many caregiving jobs are filled by recent immigrants with relatively few employment opportunities) or the “just want what’s best for you” employed by so many people in power, “care with abuse” might be the standard and “care without abuse” the aspiration. Though presented in the context of the health care industry, it’s another idea that ripples outward to elucidate, perhaps even condemn, more general aspects of our society.
“The Sexuality of Care” is intersectionality in practice. Whatever Thekkumkattil discusses – providing medical care, the structural challenges of nursing and health care, complex personal, romantic and sexual relationships or traumatic family history – they almost always surround the ideas with the many identities and contexts that influence, inform, even dictate the phenomena being described. No one is ever just a chart, just a patient, just a nurse, just a lover, even when, to save someone’s life, nurses or doctors must act as if they are just a vein, just an esophagus, just a series of steps to check off on a clipboard. There is something exhausting about this constant awareness, but I think that says far more about how our society so fractures our humanity than Thekkumkattil’s engagement with it. Though reducing people to a handful of quantifiable aspects is advantageous to some of our most powerful systems, and though many of us have been trained to think about our lives and other people through reductive lenses, the truth is we are less isolated individuals, and more nodes on vastly complex networks of cultural context, environmental factors and personal experiences.
Thinking with those networks can be difficult, but that difficulty has rewards. Thekkumkattil writes, “I learned to protect myself by rejecting soft, gentle, slow. This was a distortion of feminism that concealed misogyny: By adopting toxic masculinity as protection, I pretended to break free of womanhood without questioning why the feminine was such a threat.” Thekkumkattil discovered they replicated toxic masculinity and misogyny through an attempt at feminist empowerment. This phenomenon can be invisible when looking through an isolating lens that obscures networks, connections, overlaps and more distant cultural influences.
Readers of Leslie Jamieson and Maggie Nelson or perhaps even more scholarly writers such as Saidiya Hartman will likely be more comfortable with “The Sexuality of Care” than readers of Atul Gawande or Siddhartha Murkherjee, as Thekkumkattil’s writing about medicine is not trying to explain complex processes and challenges of health care, but to explore and explicate the emotional, communal and cultural significance of these relationships between patients, the technologies of survival and recovery and the caregivers who use them. Gawande fans should definitely at least give this a try, though.
As with “Red Paint: The Ancestral Autobiography of a Coast Salish Punk,” Sasha LaPointe’s memoir of recovery through reconnecting to ancestral traditions, the point of “The Sexuality of Care” is not to give specific directions on how to heal (both individually and systemically) but to open up the possibilities for healing – individually and systemically. Thekkumkattil’s specific vision for the abolition of hospitals may not fit your dreams, but it will provide a lens to help you understand how your dreams could be possible and what it might take to get there. And I would urge you to spend time with that vision before dismissing it as unrealistic. Ask yourself what it would feel like to give or receive the kind of care described. Then ask yourself what you think it should cost to get it. It is important to dream.
In a health care system so dehumanizing and an economy so demoralizing, we need radical new thinking about how we care for each other. Whether you agree with their specific analyses and conclusions or not, Thekkumkattil’s “The Sexuality of Care” is exactly that kind of desperately needed radical new thinking.
A version of this story appeared originally on the Porter Square Review of Books. Buy “The Sexuality of Care: On Nursing, Kink, and a Future Without Hospitals” from Porter Square Books.
