E. The anthropologist travels, finally.
The 1998 Radiological Society of North America (RSNA) Meeting. McCormick Center, Chicago, IL.
The experience of travel— the entry to the fieldsite— is an irreverent entry. Trespassing, despoilation, imposition, unwelcomeness. Countless narratives of difficult arrival and unhappy departure. Like Levi-Strauss "I hate travelling and explorers. Yet here I am proposing to tell the story of my expeditions." In this case, however, this experience reverses itself. Not only did my Amicae provide me with a badge, a hotel bed, hospitality beyond the call of my weak promises, but the conference itself has taken over Chicago. The distancing and defamiarizing power of travel is reversed here. Consider RSNA 1998, upwards of 45,000 attendees installed for one week, in a conference center the size of a small town. 45,000 people sharing not names or nations but membership— professional identity. Consider this professionalism the contemporary pretender to nationalism, identity to identity. Structural similarity, spatio-temporal randomization. If so, then the signs at the airport, the chartered buses all over town, ubiquitous welcoming marquees make of Chicago a placeless place for these men and women (not even considering the Starbucks and McDonalds that do so for the permanent resident), where home (i.e. profession) is temporarily constructed, a virtual private network in the windy city. Not everyone at O'Hare will get such treatment.
As I picked up my luggage, I tried to decipher the signs and maps to figure an inexpensive way to Hall B of the McCormick Place. I walked haltingly, angering swifter radiologists and businessmen. Then I saw what others knew to look for (though hard to miss, for anyone but me): the gigantic red banner that said "RSNA Members check-in here." I was issued a map, several booklets about fine Chicago dining establishments, and a fare by airport shuttle (rountrip $29) to the convention center. The shuttle made three stops at hotels, each one featured a doorman wearing a red RSNA button and a marquee that read "Welcome RSNA Members!" When we arrived at McCormick Place there was line of taxis and buses. Departing the good ship RSNA, I wandered in. After recovering from the initial disorientation, I asked at the large information booth where Hall B was. Remarkably, the women in the booth did not know, but handed me an elaborate map nonetheless. I asked where I was, and she said "Level One" which seemed somehow incommensurable with the alphabetical system I was prepared to navigate. After a few spins, I headed for the escalator.
Emerging onto the main floor of the convention center was a shock I was only partially prepared for. Clearly my past experience of conventions and trade shows had been worlds apart. First visible were the towering two-story signs for GE, Siemens, Toshiba. Second, the shock of realizing that those two-story signs were perched atop two story booths. The number and ostentation of the booths was overwhelming, here was potlatch. I walked for about a mile, passing roww after row of radiology-oriented companies, until I found the main hallway. Signs pointed to Hall B, and at the back, I found my informants, huddled around a kiosk that looked startlingly modest in comparison to the mall that Philips had erected next to them. Arrival.
Turns out, the badges are elaborately coded. When I mentioned to Jan in September that I intended to go to the RSNA meeting, she had offered to put my name on their guest list, and get me a badge for the conference. This was a coup, since the most inexpensive membership was $695 for students. It also seemed preferable to trying to finagle a press pass based on my contributions to a certain journal published by The Economist Intelligence Unit, called Healthcare International (this would have to wait until February and the HIMSS conference). The first code was that the badge said "Christopher Kelty, Amicas Inc." In addition the badges had color codes: brown for commercial exhibitors, red for non-members, blue for members, green for "associated sciences", light blue for staff. This meant my badge marked me as a commercial exhibitor from the company Amicas, Inc. Sean explained that this meant I was like a vampire— not allowed to go into another exhibitor's booth unless invited. In theory this is a reasonable constraint, guaranteeing openness to the radiology community coupled with secrecy in competition between companies. In practice, it is either ignored, or precipitates paranoiac behavior. In practice, it really only applied to booths belonging to direct competitors, that is, no one was going to notice me wandering around in the Philips Mall, or the GE Galleria, and no one was barred from entering the "Info-rad" village or the scientific exhibits hall (though Sean did relate stories of how this line between science and commerce produces unsightly effects as well— in particular, commercial vendors using academic credentials as marketing tools, and paranoid researchers refusing to share information with the brown-badgers). Nonetheless, the badge, it turns out, is everything.
At the end of the day, everyone heads for the bar. Jan Moe notes that all the Amicas employees head for their email, not the bar, and that there is some strange relationship to testosterone levels. She later observed a similar relatioship to elevator buttons and walk-sign buttons. We discussed the possibility of a hydraulic theory of testosterone, where repeatedly pushing an elevator button was actually a release of dangerously high levels. Jan suggested more research was in order. I go to dinner with Sean, who has had three hours of sleep and a very long week before that, but is nonetheless hyperactive for it. Sean suggest a Wolfgang Puck franchised Chicago Spago where we suffer a waiter in emphatic and cheesy wait-mode— like melodrama, but interactive. As usual, when in discussion with a polymath-autodidact-dilletante with second-nature modesty and never-ending wonder, topic ranges. The four volume Chinese novel Journey to the North had been occupying Sean's "free time", so he related various parts. He talked wavelet encoding, paleontology and sword-swallowing (everyone's favorite 'scientific' exhibit was a set of images of a sword swallower, offering scientific explanation of how the master performs the trick, diaphragmatically speaking). My end of the conversation freeloads on Sean's; he talks, I learns.
Sean is angry with some folks at Sun because they requested a collaboration, offered to send him Sun's Java Wavelet encoding software and then waited until Friday (a day before they left) to do send it to them[1]. Sean was expected to incorporate this into Amicas and make it work in time for a demonstration in Sun's booth— even more than that, they somehow expected that Amicas would be in Sun's booth, but had made no arrangements for that. The code was so buggy and broken that he coudn't get it to display more than one image at a time, this after spending four days and nights at the hotel (they brought his and Jack's computers, so they could program in the hotel) trying to finish "Personal Amicas" so it could be demonstated at the show. The demo eventually happened, but Sean seemed to think it wasn't helping anyone. I asked if this was management disorganization, if it was a question of too many demands, not enough resources. Sean demurred, modesty overcome, to suggest that was a strict disregard for other people, nothing more.
The next three days provided the most visceral 'participant' observation, especially where badges are concerned. Kevin Conway said to me: "Aren't there other people here you want to talk to, surely you must want to talk to other people besides us?" It seemed reasonable, and yes, I thought, I do want to talk to other people. Resolved to ignore my brown badge, I marched over to several of Amicas' direct competitors. I presented myself as an MIT social scientist studying the impact of IT on radiology and that I would like to talk. At MedWeb, the woman listened to me, looked at my badge, then looked at me and said: "Maybe you could come back later, right now we have customers." The people at Access Radiology/Telemedicine believed me, and were happy to talk, though it was the CEO that recognized the name on my badge, not the random employee I had walked up to. The CEO thanked me for my interest and wished me good luck with my "paper." At Algotec, an Israeli company in direct competition woth Amicas, I explained who I was again, got that peculiar look, and my interlocutor said, "You know Amicas is our competition?" And I said, "Yes, I know that, but as I said, I'm not with the company, this is an academic project, and I'm simply trying to find out if you would be willing to talk?" And he replied: "No, I do not think we have an interest." And I was shooed on my way. By now I was probably getting a reputation, and rather than risk Amicas' hospitality further, I decided it would be best just to talk to random people not involved in the internet or the PACS business in any way. This proved more enjoyable, but much less useful.
Back at the Amicas booth, I ask Dr. Keith Batchelder, an occasional consultant to Amicas, what he finds surprising about this years meeting. Some things were surprising, he responded, but none were exciting. He explained that radiology is a declining market, that everything is going digital but nobody really knows what that means, that functional MR/CT is forcing the "memorizers" out of business. Memorizers, he explained, were radiologists who memorize anatomy so that they can say "oh that's 'bad anatomy'— that artery probably has stenosis," whereas functional MR can tell you flow volume in an artery is x cm3/s— it gives numbers, and you no longer need a radiologist. So I asked, how are radiologists protecting themselves from that? Some are vying with IS/IT in the hospital to control images, others are becoming functional specialists, some are just getting out. Later I asked Adrian about what Keith had said, and Adrian just said: "Well, you can't get any more pessimistic that Keith."
It was at about this time, as I was standing in the Amicas booth talking to the occasional interested radiologist, chatting with staff, that Suzanne Fishman from WorldCare stopped by. She recognized me and we chatted briefly about the conference and she suggested I come by the WorldCare booth and talk. I thought nothing of it, but didn't take her up on her offer. This seemingly innocuous interchange would eventually sediment the reality of my badge.
Suzanne Fishman, COO of WorldCare, whom I had interviewed on one occasion and briefly talked with on another, worked closely with Walter Terner of Partners Telemedicine Center. Shortly before RSNA, I had been working with Walter Terner to try and get access to some of the foreign connections with Partners Telemedicine. I had designed a questionnaire, which Walter had kindly revised into a marketing instrument for Partners. Walter had suggested that I contact Suzanne to ensure that any such instruments were okay with WorldCare, and I had scheduled a meeting after RSNA to discuss it with her. When I returned from Chicago, I received a message that Suzanne Fishman would not be meeting with me, and that she regretted the inconvenience, but had no time. Shortly thereafter, Walter Terner called, and said, very abruptly, "Who do you work for?" I said I was a student at MIT, and that I didn't work for anyone.
My explanation seemed to satisfy Suzanne, but it was easy to tell that there was no healing this suspicion. Adrian, Sean and Jonathan had all worked at WorldCare at some point. Sean had built the first versions of the technology they presently used, and now Amicas was their competitor, taking business away from them. It was more than reasonable that she be concerned, paranoid even. Academic credentials, the trust of my word, had nothing on my badge.
Batches? We don' need no stinkin' batches...
"Yes, but who do you work for?"
"I answered that already."
"Chris, Suzanne has information that you are under contract with Amicas, Inc. She is concerned you are spying for them on WorldCare. Do you work for Amicas?"
"No, and I don't appreciate being accused of being a spy."
"No one's accusing you."
"Only assuming. I think there has been some major miscommunication, and I have no idea who told her that I was under contract. Perhaps I should call and explain the situation to her."
"Yes that would be very good, but I think you should wait, and calm down, you're agitated right now, you might say something you don't mean."
"Yes. I will do that."
Last Modified 11-Sep-99 9:23 PM ckelty@mit.edu
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