L I F E L I NES

T H E T R A F F I C O F T R A U M A

H A R R I S S O L O M O N
L I F E L I N E S
L I F E L I N E S
T H E T R A F F I C O F T R A U M A

H A R R I S S O L O M O N

duke university press

durham and london
2022
© 2022 duke university press
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Library of Congress Cataloging-­in-­Publication Data

Names: Solomon, Harris, [date] author.
Title: Lifelines : the traffic of trauma / Harris Solomon.
Description: Durham : Duke University Press, 2022. | Includes
bibliographical references and index.
Identifiers: lccn 2021057118 (print)
lccn 2021057119 (ebook)
isbn 9781478016212 (hardback)
isbn 9781478018858 (paperback)
isbn 9781478023487 (ebook)
isbn 9781478092728 (ebook other)
Subjects: lcsh: Traffic accident victims—­India—­Mumbai. | Traffic accident
victims—­Family relationships—­India—­Mumbai. | Hospitals—­Emergency
services—­India—­Mumbai. | Emergency medical services—­India—­Mumbai. |
bisac: social science / Anthropology / Cultural & Social | history / Asia /
India & South Asia
Classification: lcc ra772.t7 s65 2022 (print) | lcc ra772.t7 (ebook) |
ddc 363.12/5650954792—­dc23/eng/20220225
lc rec­ord available at https://­lccn​.­loc​.­gov​/­2021057118
lc ebook rec­ord available at https://­lccn​.­loc​.­gov​/­2021057119

Cover art: Illustration by Harris Solomon.

Publication of this open monograph was the result of Duke Univer­

sity’s participation in tome (­Toward an Open Monograph Ecosystem),
a collaboration of the Association of American Universities, the
Association of University Presses, and the Association of Research
Libraries. tome aims to expand the reach of long-­form humanities
and social science scholarship including digital scholarship. Addition-
ally, the program looks to ensure the sustainability of university press
monograph publishing by supporting the highest quality scholarship
and promoting a new ecol­ogy of scholarly publishing in which authors’
institutions bear the publication costs. Funding from Duke University
Libraries made it pos­si­ble to open this publication to the world.
For Gabriel
CONTENTS

ix note on illustrations
xi acknowl­edgments

1 Introduction: The Traffic of Trauma

27 1 Carrying: The Lifelines of Transfer

53 2 Shifting: The Lifelines of Triage

79 3 Visiting: The Lifelines of Home

107 4 Tracing: The Lifelines of Identification

135 Seeing: The Lifelines of Surgery

147 5 Breathing: The Lifelines of Ventilation

174 6 Dissecting: The Lifelines of Forensics

200 7 Recovering: The Lifelines of Discharge

229 Epilogue: The Traffic of Medicine

237 Notes
253 References
277 Index
N O T E O N I L L U S T R AT IO N S

For the images that begin this book’s chapters, I layer textures on traces I
make from photo­graphs to think about the gestures of trauma care that
redirect and transform its traffic. I was encouraged to draw by one of the
trauma ward’s resident physicians. I noticed how they would sometimes
sketch out a prob­lem or issue at hand when we spoke b­ ecause they felt
pictures could explicate details better than words. They suggested I try it
too. I gained inspiration from accounts of ethnographic drawing, includ-
ing Czerwiec (2017), Hamdy and Nye (2017), Jain (2019), Povinelli (2021),
and Taussig (2011). I learned how to shape ethnographic inquiry through
drawing from Andrew Causey (2017) and how to stay with lines and tran-
sits from Renee Gladman (2010, 2016, 2017). I was also fortunate to take
drawing lessons. My teacher, Zoe Schein, challenged me to see how lines
of action and marks of stillness and shadow could scale up a feeling or an
idea. I continue to learn about what lines can do from the artist Ranjit
Kandalgaonkar.
I took the base-­layer photo­graphs, with two exceptions: the drawing
that begins the introduction is a traced adaptation of a photo by Steve
Evans (2008), and the drawing that begins chapter 1 is a traced adapta-
tion of a photo in Ansari (2018). All the drawings include adaptations,
rearrangements, sketched-in components, and textures that are not in the
original photo. Th
­ ere are both additive and protective dimensions to this
imaginative overlay. Inside hospitals, I never photographed patients (nor
was I allowed to). I took very few photos, in fact, and most ­were of banal
objects and architectural details: notebooks, machines, filing cabinets,
washbasins, hallways, lockers, bins of medicines, paper piles, and storage
corners.
Tracing ­these photos into a dif­fer­ent medium—­a line drawing—­
conjures memories and stories. It is an act that demands I remember who
and what constitutes a given scene. It also compels me to sit with what I do
and do not know. This involves filling in, erasing, or recasting t­ hings the
base-layer image might suggest.
 Holding a pen continuously for a stretch, and then braking, and then
veering elsewhere are actions that ­shaped how I conceptualized, wrote, re-
vised, and rethought prose. Tracing is a tactile enactment of intermittent
gestures. It tracks constellations of discontinuities. This generates a sense
of movement that words may strain to address, or the other way around.
Approaching research material from both lines and words foregrounds
uneven pathways as a critical ethnographic motif. It is a practice that cat-
alyzes questions: How does a specific line come into being? What forces
facilitate, constrain, and sustain one line’s convergences with another’s?
What kinds of restraint are necessary in depicting scenes of extremes? What
happens when lines run parallel, intersect, or diverge, even provisionally?
Is ­there something impor­tant about that provisional relationship? What
does it mean to gain proximity to a crossing—­say, a critical decision—­and
to push forward? Or to see it ahead but remain stuck in place?
Tracing renders fluctuations in density, curvature, edge, and trajectory.
Similarly, this book grapples with lines of life in flux.

x · Note on Illustrations
A C K N O W L­E D G M E N T S

I thank the patients, families, doctors, nurses, and staff at the hospitals and
emergency medical ser­vices who comprise the scenes of this book.
My research was made pos­si­ble by the support of Drs. Vineet Kumar,
Monty Khajanchi, Nitin Borle, Satish Dharap, Sanjay Nagral, Nobhojit
Roy, Kalpana Swaminathan, Ishrat Syed, and Meena Kumar. Siddarth
David, Jyoti Kamble, and Anna Aroke shared presence, analy­sis, and in-
sight through spectacular research assistance. The Thursday Truth Seekers
research working group at the Tata Institute of Social Sciences listened to
in-­progress versions of the research, offered feedback, and provided an in-
tellectual home base each week. Ansul Madhvani always shares a home
away from home, and in this case a home away from the hospital.
My fieldwork and writing ­were supported by a National Science Foun-
dation Cultural Anthropology Program ­career Award (Award Number
145433). Thank you to Jeffrey Mantz and Deborah Winslow, who made
this pos­si­ble ­every step of the way. Funds from Duke University and the
Duke Global Health Institute also supported research.
As the material simmered, many p­ eople moved it in new directions. My
gratitude goes to audiences at the University of North Carolina, Chapel
Hill; Prince­ton University; the University of Chicago; Tufts University;
Ohio State University; the University of Amsterdam; King’s College Lon-
don; the University of Toronto; the University of Chicago’s New Delhi
Centre; the University of Pittsburgh; Northwestern University; Keio
University Tokyo; the Indian Institute of Technology, Hyderabad; McGill
University; the University of Pennsylvania; and the University of Cal-
ifornia, Berkeley. A wonderful group of scholars from the University of
­Virginia’s Department of Anthropology energized a writing group about
care and offered generative feedback.
A visiting fellowship at the University of Amsterdam enabled me to
revise and complete this manuscript. I am deeply grateful to Anita Hardon
for the invitation and for enduring scholarly care. Annemarie Mol, Emily
Yates-­Doerr, Robert Pool, and Hayley Murray shared ideas and walks to
think outside the box. Niko Besnier shared a space to watch the ­water and
won­der. In the United States, Joseph Fischel and Igor Souza offered seren-
ity and hilarity at a seaside haven where I was able to revise, again.
In the early weeks of pandemic disarray, the Franklin Humanities In-
stitute at Duke stayed the course with a book manuscript workshop that
sharpened and opened up this text. Thank you, Ranjana Khanna, for your
vision, guidance, and engagement with the text at the scales of both the
line and the aggregate. I thank the participants: Anne Allison, Nima Bas-
siri, Mara Buchbinder, Jocelyn Lim Chua, Louise Meintjes, Townsend
Middleton, Diane Nelson, Charlie Piot, Sumathi Ramaswamy, Barry
Saunders, and Orin Starn. And to the discussants, William Mazzarella and
Sarah Pinto, and to my editor Ken Wissoker, thank you for making the
time to read and for creating space to think, especially amid so much un-
certainty. Thanks also go to the institute’s staff, who pivoted ­things online,
seamlessly: Christina Chia, Sylvia Miller, and Sarah Rogers.
My colleagues in the Department of Cultural Anthropology give vital
energy to ideas and ethnographic possibility. As I detail in “Seeing,” they
also kept me afloat when ­things ­were not looking good, and for that I am
grateful. Thanks to Charlie Piot, Lee Baker, and Louise Meintjes for all
your support, along with Pat Bodager, Bernice Patterson, Pam Terterian,
and Jamie Mills. At Duke, I also thank Elizabeth Ault, Nicole Barnes, Nima
Bassiri, Courtney Berger, Rich Freeman, Ranjana Khanna, Eli Meyerhoff,
Jessica Namakkal, Mark Olson, Sumathi Ramaswamy, Priscilla Wald, and
Ara Wilson. Thanks also go to my colleagues at the Duke Global Health
Institute. Diane Nelson’s friendship and imagination are treasures that
live on.
Dif­fer­ent orbits of writing groups have been honest, creative, and pa-
tient. Mara Buchbinder, Jocelyn Lim Chua, Nadia El-­Shaarawi, Dörte
Bemme, and Saiba Varma keep ­things moving each month. Maura Fin-
kelstein and Megan Crowley-­Matoka stay with storylines, arguments, and
voice and make writing come alive.
Along the way, during walks and chats and exchanges of ideas, I have been
fortunate to learn from Sareeta Amrute, Nikhil Anand, Anjali Arondekar,
Dwaipayan Banerjee, Tarini Bedi, Ka­vi Bhalla, João Biehl, Alex Blanch-
ette, Charles Briggs, Carlo Caduff, Julie Chu, Veena Das, Naisargi Dave,
Lisa Davis, Robert Desjarlais, Angela Garcia, Rakhi Ghoshal, Radhika
Govindrajan, Jeremy Greene, Shubhra Gururani, Deborah Heath, Sarah
Hodges, Lochlann Jain, Annu Jalais, Sharon Kaufman, Naveeda Khan,
Alok Khandekar, Junko Kitanaka, Hannah Landecker, Marianne Lien,

xii · Acknowledgments
Julie Livingston, Ken MacLeish, Anindita Majumdar, Tomas Matza,
Ramah McKay, Amy Moran-­Thomas, Sameena Mulla, Haripriya Nara-
simhan, Vinh-­Kim Nguyen, Kevin Lewis O’Neill, Stefania Pandolfo, Juno
Salazar Parreñas, Sujata Patel, Heather Paxson, Adriana Petryna, Anne
Rademacher, Laurence Ralph, Lucinda Ramberg, Peter Redfield, Elizabeth
Roberts, Rashmi Sadana, Barry Saunders, Bhrigupati Singh, Kalyanakrish-
nan Sivaramakrishnan, Lisa Stevenson, Kaushik Sunder Rajan, Noah
Tamarkin, Sharika Thiranagama, Saiba Varma, Megan Vaughan, Bharat
Venkat, Kath Weston, and Zoë Wool.
Previous components of material in this book appeared in Medical An-
thropology Quarterly, and I am very grateful to Vincanne Adams for her
guidance and insight.
During the late stages of this proj­e ct, three brilliant physicians en-
tered my life to become collaborators and co-­ethnographers on a proj­ect
about covid-19: Drs. Peter Kussin, Neelima Navuluri, and Bill Hargett.
In studying the social life of intensive care unit (icu) care in the United
States together, I have learned so much from them about critical care and
what ­really ­matters in medicine.
My students at Duke continue to keep me on my toes. Several current
and former students have left a lasting impression on my thinking, and my
thanks go to Christopher Webb, Kelly Alexander, Kayla Corredera-­Wells,
Yidong Gong, Jeremy Gottleib, Jay Hammond, Alyssa Miller, Jieun Cho,
and Sophia Goodfriend. Thanks to students in Medical Anthropology for
reading and commenting on in-­progress versions of the book, to students
in two gradu­ate seminars (Between Life and Death and Science, Medicine,
Body), and to Anne Allison for being a wonderful teaching companion.
Lawrence Cohen continues to expand the possibilities of having a
thought when fueled by an ethics of kindness. Sarah Pinto is a marvelous
friend and mentor, a guide on how to write fearlessly, and a constant source
of new ideas, frames, and possibilities. Lauren Berlant s­ haped this book
profoundly and taught me how to think with situations.
A heartfelt (and additional) thank you to Anne Allison, Megan
Crowley-­Matoka, Maura Finkelstein, Sarah Pinto, and William Mazza-
rella, who read the entire manuscript, step by step, draft by draft, line by
line, idea by idea.
Thanks to Ranjit Kandalgaonkar for his expansive imagination of
bodies.
Ken Wissoker has connected encouragement to feedback with pa-
tience and precision over many years. Thank you, Ken, for the time ­you’ve

Acknowledgments · xiii
invested in making this proj­ect happen, and thank you, Joshua Gutterman
Tranen, for supporting it along the way. The manuscript’s two anonymous
readers debated it, guided it, stretched it, and strengthened it; thank you.
I wish to thank Lisl Hampton, Kim Miller, Christopher Robinson,
­Matthew Tauch, and the production team at Duke University Press, and
thank you to Matthew John Phillips for the index and Drew Keener for
the map.
Nobhojit Roy, Kalpana Swaminathan, Ishrat Syed, and Sanjay Na-
gral guide my understanding of what is truly at stake in a life-­and-­death
moment in medicine. They answer late-­night phone calls and texts, cook
meals, and offer an anchor when I become unmoored. They feel the insep-
arability of medicine and Mumbai in their bones, and they generate new
ways to think and speak about it. They also remind me what ethnography
has to offer medicine.
My ­mother, Dale Solomon, is an ethnographer at heart, always curious
about the backstories of the everyday. She sent love and encouragement
from afar and never flinched when hearing me relay difficult moments from
the hospital; instead, she responded, “And what did you learn?” I’ve tried
to stay with that question.
This book is dedicated to Gabriel Rosenberg. He has kept me alive and
moving in ways neither of us ­imagined would ever be necessary. His bril-
liance, patience, and clear seeing charge me and my words with momen-
tum. ­There is something gravitational to his love; it draws me home.

xiv · Acknowledgments
 Borivali West
West
Kandivali Kandivali Shivai Nagar
West East

Aarey Milk
Colony Airoli

Andheri East

Bandra
Kurla Mumbai Vashi
Complex
Kurla East
Bandra West
West
Chembur West
Dharavi Sion East
Fertilizer Colony
Dadar West Wadala
Kings Circle-
Maheshwari Udyan

INDIA

Churchgate Mumbai
Introduction
the traffic of trauma

YOUNG MAN ON THE

LOCAL TRAIN IN
MUMBAI. DRAWING
BY AUTHOR.
I reckon the siren like thunder: threat, distance, relation.
The sound is high-­pitched, continuous, and mechanical, and I do not
recognize it at first. The siren does not warble; its pitch is constant. Sus-
pended in traffic, the ambulance proceeds fitfully next to a Shiva ­temple
and does not move fast enough for me to perceive the wave changes of the
Doppler effect. Cars and rickshaws and motorcycles edge around the acci-
dent scene, which is less a full stop and more a diversion. The siren joins the
sonic fold of Mumbai’s traffic alongside horns offering “you go” or replying
“my turn” as cars dance. From a distance, the road looks frozen. Up close,
­things are stop-­and-go as injury and repair churn.
I reach my destination an hour ­later and never learn about that ambu-
lance, but the siren stays with me. It broadcasts traffic’s milieu, mobility’s
tectonics, and the challenges of moving injury in Mumbai. Who was inside
that ambulance? How did it get to the hospital, and once ­there, what en-
sued? How does injury move ­after the accident? And what of traffic: How
do ­people clear paths through the traffic of trauma?

A Crossing

A year passes. I am researching the social trajectories of traumatic injuries

from traffic accidents as they move into, through, and out of Mumbai’s
largest public hospital trauma ward, at a hospital I call Central Hospital.
Hearing of my work, a friend tells me to meet Kalvin, ­because Kalvin’s
friend Raghu died in a train accident. Kalvin tells me the story as we navi-
gate Mumbai’s streetscape on foot.

2 · Introduction
 Raghu left work one eve­ning and headed home on the local train with
two friends. He stepped t­ oward the train’s always-­open door to take a
phone call, and to give him privacy, his friends moved further into the
compartment. ­People began yelling that someone had fallen out of the train.
The friends could not find Raghu. L ­ ater a witness told the police, “He just
fell, gone” (gira, ho gaya). The train continued on, moving every­one ­else
who needed it. The friends got off at the next station and circled back to
search the tracks.
Kalvin reflects on the moment when the friends phoned him. He knew
what had happened from a lifetime of riding the train through the city’s
construction zones. “You know the iron rods that go in concrete? He fell
off the train and onto ­those rods.”
Kalvin sees an opening in the congestion, and we dash into the street
as he continues.
The police joined the two friends and walked along the tracks with
flashlights. They called an ambulance when they saw Raghu lying uncon-
scious. Rush hour delayed the ambulance, so one of the friends attempted
rescue. He gathered Raghu’s body in his arms, carried him back to the sta-
tion, lugged him onto the next train, and disembarked at the next station
closer to a hospital. Police ­there flagged down an autorickshaw and forced
the driver to head t­ oward the hospital, where doctors declared Raghu dead
on arrival.
Kalvin wards off oncoming vehicles with his outstretched palm, so we
can live to finish the story.
So much hope was invested in moving and being moved. But Raghu
never moved through the hospital trauma ward. The orderlies would not
wheel Raghu down the hall from the emergency room into the trauma
ward’s resuscitation area. The nurses would not twist open iv drips to
address his pain and raise his blood pressure. He would not be pushed
into the operating theater for surgery to stop internal bleeding, lying flat.
He would not exchange breath with a ventilator in the intensive care unit
(icu). His movement ­stopped at the hospital’s entrance, so medicine could
not attempt to make him live through its rhythms and tempos. Raghu nav-
igated a lifeline en route to his home. ­After the accident, his friends navi-
gated him along a lifeline to the hospital. But trauma medicine would not
be able to shift ­things further.
Kalvin rode the local train to view Raghu’s body at the hospital, and
he rode it home afterward. It was the journey’s enduring embodiment he

Introduction · 3
remembers. “It made me shiver, the iron on the train. The sound is terrify-
ing. It’s like we are traveling in death . . . ​a vehicle of death.”
Traffic transforms in the street. A clearing expands, and we cross to the
other side.

Lifelines

In Mumbai, like in many places, living demands movement through traffic

to survive. Traffic is mobility’s vital forces at work: a flux of discontinu-
ities. As in my crossing with Kalvin, living with traffic is a m
­ atter of being
in punctuated transit. Even if one moves alone, both constituting and
navigating traffic, this is often done for someone ­else: commuting to
work, shopping for vegetables, taking the ­children to school, driving for
a customer. Yet a­ fter a traffic accident occurs, uneven movements do not
cease. How might traffic continue in order to shape someone’s potential
survival? How does trauma move ­after the accident? And how does med-
icine move us?
Lifelines addresses ­these questions through an ethnography of mobility
and mortality in Mumbai. It traces traumatic injuries from traffic accidents
through differences in motion. It is a book about social life in situations
of life-­threatening imbalance. It is about trauma in its surgical sense—­
wounds that are immediately life-­threatening—­and about the intimacies
of trauma’s treatment in a hospital. It describes the transitional qualities
of relations among medical crisis, medical care, and social life. Scenes of
life at the edge of death in a public hospital trauma ward demonstrate the
increasing ordinariness of traumatic injury in India and the Global South.
They exemplify how movement shapes con­temporary health crises glob-
ally, how irregular stoppages and flows constitute clinical forms and social
relations, how injuries inflect moral and technological dilemmas, and how
medical anthropology might address ­these ­matters in new and necessary
frames.
My research tracked trauma through its dif­fer­ent contact points with
medicine, from an ambulance’s arrival to a patient’s surgery, and from
­family visitation to recovery back home. Throughout, in-­motion embod-
iments would take on new urgencies a­ fter a collision. This suggests that
the collision is not always an ending. It can be a beginning for medicine to
make injured bodies ­matter through volatile activities of dif­fer­ent forms
and scales.1 ­Those activities may be openings and closings, the staving off of

4 · Introduction
bleeding or the shifting of beds in the ward. They could be efforts to hold
someone still or to shock them into activity. They may be transfers out of
the ward or regulations on access inside.
Trauma care exemplifies this clinical kinetics. P ­ eople in the wake of
trauma’s forces discern changes in movement as central to survival. Patients
and their families constantly ask what the hospital’s next move ­will be. A
change in motion ­causes injury; injury demands medicine; and medicine
constitutes new and vital pos­si­ble holds and shifts. In this light, medicine is
ultimately a prob­lem of how to move, as much as it is a prob­lem of what to
know. Medicine, then, is a pro­cess of traffic.
The movements of locomotion endanger bodies in terms of risk or
exposure. Assessing such risks is crucial for understanding the uneven
distribution of traumatic injuries from traffic accidents. This frame of
thinking asserts the trauma of traffic: how malfunctioning, over­burdened,
or degrading transport structures and infrastructures are injury’s causal
conditions. By working from this perspective, large-­scale quantitative and
epidemiological studies emphasize trauma’s conclusion in injury or in
death in order to compel policy change.
Studying the trauma of traffic is certainly necessary. Every­one working
in Central’s trauma ward agrees that transit structures can disable and that
movements and countermovements on the city’s roads and commuter
trains shape the likelihood of a patient’s arrival at the hospital ward: a
motorbike skids on uneven pavement, tumbling riders onto the road; a car
dashes a rickshaw; a truck plows down a ­woman crossing the road; a luxury
vehicle runs over pavement dwellers; a man falls out of a railway carriage.
Traffic as injury’s cause is not a ­matter up for dispute. The trauma of traffic
delivers bodies to them to work on, ­every day.
That is the arrival story. But what’s next, in terms of trauma’s continuities?
What follows is an argument about how traffic can constitute a social
field, an embodied pro­cess, and a clinical infrastructure beyond the acci-
dent scene. The argument is this: bodies may appear to leave traffic, but
traffic does not necessarily leave bodies. This argument hinges on the idea
that movements aimed at keeping someone alive continue a­ fter the collision,
and that such movements constitute traffic too. In contrast to the trauma of
traffic, this book describes injury’s relational kinetics ­after the accident. That
is, it describes the traffic of trauma.
Lifelines affirms moving and being moved as core powers of embodi-
ment, medicine, and social life. It describes the intimate, irregular, synco-
pated, and negotiated activities resulting from the occurrence of traumatic

Introduction · 5
injuries. Casting t­ hese activities as traffic, the book takes injury, injury ex-
perience, and injury care to be ­matters of differential motion. One of its
aims is to unsettle the fixity of injury, of wounded bodies, and of sociality.
I show how injury and movement connect ­people, even as a given wound
lodges in an individual’s body. This means that trauma, embodiment, and
care exist in terms dif­f er­ent than t­ hose premised on a singular wounded body
at rest. By contrast, I argue, they come to m ­ atter through patterned and rela-
tional movements that might remedy life-­and-­death situations. I call t­ hese
movement patterns lifelines.
Lifelines are relational survival proj­ects. They involve ideas and actions
chained together to transition a body through time and space. They materi-
alize through real and ­imagined differences in movement and have the po-
tential to shape the outcome of trauma. Their potential has a doubled kinetic
quality. Vital movements may become injurious, and dangerous moves may
aid treatment. Consider how Raghu went onto the train, then off the train,
first for his commute and then in his fall. Then his friend brought Raghu’s
body back onto the very same conveyance by which he had thrived mo-
ments before. Carrying the body rather than waiting for an ambulance to
stabilize it may have worsened Raghu’s injuries, perhaps, but the friends
de­cided that ­there was no choice: his survival was on the line. So Raghu
went back onto the train and t­ oward the hospital. In this example, com-
muting and carry­ing mark out provisional lifelines: they shift embodiment
by shifting movement. ­Because ­these changes may have life-­and-­death con-
sequences, lifelines are proj­ects of kinetic, clinical, and vital differentiation.
The lifelines in this book span the arc of trauma care, from the accident
scene to the hospital, through triage, treatment, surgery, intensive care,
death, and discharge. The chapters show how the particularities of trau-
matic injury shape dif­fer­ent lifelines. Together, t­ hese lifelines create terms
of relation for trauma’s traffic.
My perspective on traffic’s connections between moving and living de-
rives from the local description of Mumbai’s local train system, which is
known colloquially as the city’s lifeline—an En­glish word used across ver-
nacular languages. Mumbai’s local train moves life. The lifeline in Mumbai
is a material meta­phor for the shaky differences among the bodies of the
riders, the traffic of the city, and the politics of their relations. It signals
movement’s necessity in the face of traffic’s obstacles, b­ ecause the train
makes transit faster amid heavy road congestion in an island city with a
population density of nearly thirty thousand ­people per square kilo­meter.
It marks the train’s politics as multiscalar, folding Mumbai’s bodies into

6 · Introduction
India’s broader history of colonial and postcolonial development through
the railways (Aguiar 2011; Bear 2007; Hurd and Kerr 2012; Kerr 2003; Prasad
2016) and connecting somatic movements to crowds (Canetti 1962; Low
2000; Mazzarella 2010, 2017; V. Rao 2007b; Tambiah 1996; R. Varma 2004).2
This connection is at once vital and lethal. Mumbai’s local train moves
life at considerable bodily risk, killing nearly ten ­people each day and injur-
ing many more. To accommodate the rush hour density of fifteen ­people
per square meter, the carriage doors remain open while the train moves.3
The city’s residents observe that Mumbai’s lifeline, in Hindi called Mum-
bai ki lifeline, is si­mul­ta­neously Mumbai’s deathline, Mumbai ki deathline.
The train is a lifeline ­because it is a traffic infrastructure whose relation to
survival is provisional. It is a dangerous savior, always containing the possi-
bility to effect both livelihood and death through its moves.
The varied movements that assem­ble a lifeline might also be productively
figured as the casting out of a life preserver to a drowning person. In this in-
stance, throwing the life preserver is a provisional move. But it is a two-­way
situation, one that brings the person who is throwing and the person who
is drowning into relation. The person who throws the preserver pulls on
the rope so that the drowning person might live. Other­wise, the drown-
ing person might not be able to navigate the sea’s undertow. Yet the drowning
person can be moved in another direction by the sea’s waves if forces on
the body add up differently. Agencies of pulling may momentarily change.
Any attempt to shift a threat to life is always subject to such differences in
surrounding turbulence and interpersonal action.
A broader question of this book is how thinking about such differences
in movement can enable thinking about what lies at the heart of medicine.
Medicine unequally navigates bodies through obstacles t­ oward treatment,
always with the potential for both healing and damage. Even at rest, or
stuck waiting, patients in the grip of trauma care eventually get shifted
(willingly or not, alive or not). Strict categories of moving versus not mov-
ing may strain to describe the power formations at stake in any given scene
of medical care. Just as I am calling for a conceptual shift from the body
static to the body kinetic, I pay attention to bodies as they move unevenly
through medicine. To describe lifelines in this context is to develop a vo-
cabulary for survival proj­ects, and to specify medicine’s stutters of both
fixity and flow.
In the case of Mumbai, medicine and urbanism must be thought together
through such moving terms. The “urban” of the hospital certainly refers to its
location geo­graph­i­cally in a city, but it also entails the internalization of the

Introduction · 7
city’s unequal somatic pressures. Trauma medicine operates on the urban
environment’s fleshy incursions and focuses on injuries that open the body’s
interior to its lived milieu. By invoking the “traffic of trauma” to think about
embodied velocities, I do not remove traffic from the street and neatly apply
it idiomatically to traffic in the ward, such that the ward mirrors or mag-
nifies the street. To do so would be to separate bodies from infrastructures
and to keep bodies in aggregate, an approach often found in the sciences
of urban planning and engineering. It is in many ways a useful approach:
traffic engineers and scientists optimize that aggregate through complex
and varied calculations of how ­drivers, pedestrians, and cyclists move. They
suggest how be­hav­ior may be modified through changes in roadway design,
signage, speed limits, and redirections of flow (Wolshon and Pande 2016).
This approach can reveal breakdowns (a traffic light blinks out) and de-
viations (as a police officer diverts cars). Yet bodies are not always “users”
of transit infrastructures who can move through infrastructure untouched.
Traffic’s complexities stem in part from its qualities of both particle and
wave. Road traffic produces wounded bodies, and trauma medicine picks
up the task of moving them through its own traffic forms. Ethnography in
this context involves rethinking the yoking of bodies to traffic, through an
anatomy and physiology of traffic from the ground up.

Trauma

The biopolitics of trauma is a politics of moving and being moved. Trau-

matic injury results from shearing or puncturing forces; movement is its
very condition of possibility. Clinically, traumatic injury (and its more
abbreviated form, trauma) refers to a blunt or penetrating wound that is
immediately life-­threatening, as well as the body’s response to that wound.
Objects at rest cannot cause trauma and accidents. Only moving forces can.
­Because trauma has a kinetics, it can cause a disturbance: concrete is on the
road; now it is in your head; now the surgical instruments in the hands of
the neurosurgeon are in your brain. Disparate materials of the world collide,
damaging tissue in the skull. Organs and circulatory vessels tear, and blood
flows into spaces of the chest where it does not belong. Medicine inter-
venes and makes prior circulations pos­si­ble again.
In the trauma ward at Central Hospital, the English-­based clinical
term trauma is used in local languages to classify such wounds. The ward treats
major trauma from two categories of traffic accidents: road traffic accidents

8 · Introduction
and railway accidents. It also treats falls and wounds from physical assault,
but it tends to refer sexual assault cases to the hospital’s gynecological and
obstetrics department. This has consequences for the gendering of trauma
in the trauma ward and is not a categorical quibble; it is a reminder of how
vio­lence achieves unequal forms of clinical legibility (Mulla 2014).
In speech, injury’s circumstances may become known as an accident.
This is glossed as hadsa in Hindi, apghat in Marathi, and aksident in
Mumbai’s colloquial Hindi dialect. Both the Hindi term chot (meaning
“wound”) and the English-­derived term injury are used in conversation to
refer to an accident’s outcomes.4 ­There is much to be said about w ­ hether
accidents are r­ eally accidental—that is, about how intentionality and struc-
tural vio­lence bear on events that are hardly ­matters of chance (Figlio 1983;
Fortun 2001, 2012; Jain 2013; Lamont 2012; Perrow 2011; Petryna 2002). Public
health scholars tend to use the term injury to assert that t­ here are r­ eally
no accidents ­because all events have under­lying ­causes. I am mindful of
this distinction, and it is indeed impor­tant. However, I ­will stay with local
linguistic forms, and so my use of accident, injury, and wound reflect trans-
lations of the terms that ground the work of the ward.
The ward’s work tells a broader and troubling story about the exten-
sive burden of road and railway traffic accidents in con­temporary India
and in the Global South. For example, taking into account the variation
of rural areas less defined by traffic congestion, nearly four hundred ­people
die each day in India as a result of road traffic injuries. This makes India
the source of over 20 ­percent of global road traffic deaths (World Health
Organ­ization 2014). Each year, nearly one million p­ eople in India die from
trauma (India State-­Level Disease Burden Initiative Road Injury Collab-
orators 2020), and many more are hospitalized; road injuries have been
the primary cause of death among men age fifteen to thirty-­nine in India
in several studies (India State-­Level Disease Burden Initiative Road Injury
Collaborators 2020; N. Roy et al. 2010, 2011). Traumatic injury and death
shift gendered and socially classed ­house­hold wage-­earning structures and
broader care economies.
Living with and being in relation to traumatic injury sets the central
narrative condition and case study for this book. Being subject to lifeline
proj­ects in a hospital is a selective affordance. In India half of the p­ eople who
experience major trauma die at the accident scene or during the journey to
the hospital; they are more like Raghu than not. And of t­ hose who make
it to the hospital, studies estimate that between 12 ­percent and 20 ­percent
die within thirty days of admission, although clinical researchers believe

Introduction · 9
that more than half of in-­hospital trauma deaths are preventable with early
resuscitative treatment and close monitoring of physiological signs such as
systolic blood pressure that can predict mortality (Bhandarkar et al. 2021;
Gerdin et al. 2014, 2016; V. Kumar et al. 2012; N. Roy et al. 2016; N. Roy
2017).5 The costs associated with treatment and death or rehabilitation can
easily exceed a ­house­hold’s limits, sending already-­poor families into cata-
strophic expenditures, poverty, and debt in a country that spends 1 ­percent
of its gross domestic product (gdp) on health and where families pay for at
least 70 ­percent of most health-­care costs out of pocket.6 The implication
is that I am telling stories about a representative sample of ­people situated
between walking away with minor injuries and d­ ying on the spot. But not
every­one gets to be in the m ­ iddle, and not every­one follows a linear path
through treatment.
The vio­lence of trauma’s c­ auses is selective and, like its consequences,
defies easy alignment with accusations of absolute speed or certain im-
mobility. Vehicular traffic in Mumbai can keep many roads in a trickling
gridlock, but the intervals between speedup and slowdown make acci-
dents between cars, pedestrians, motorcycles, and trucks very high.7 ­Those
who can afford to be in the protective cage of a car or in less crowded,
more expensive train compartments experience exposure to risk and the
pleasures of mobility differently from pedestrians or commuters in more
crowded, less expensive train compartments. While traumatic injury may
be attributed to chance or misfortune, it is also the case that bodies do
not move at random. Rather, they are invested with unequal propulsions,
inertias, and repulsions that derive from gender, caste, class, age, ­family
position, and community of origin (to name just a few of the many inter-
locking forms of social stratification in India). ­These investments shape the
aftermath of injury too, in movements ­toward a public hospital instead
of a private fa­cil­i­ty. Trauma produces, and is produced by, ­these forms of
structured in­equality and inflects the lifelines forged in response.
Se­nior surgeons in Central’s trauma ward describe ­these inequalities
partly through changes in injury patterns over time. For instance, head in-
juries increasingly define the clinical profiles of patients. A surgeon named
Dr. D runs complex epidemiological studies in the trauma ward and is at-
tempting to create India’s first trauma registry. He attributes the change
to transformations in local and national po­liti­cal economies. During the
1980s and 1990s, which he describes as the heyday of Mumbai’s gang vio­
lence and communal rioting, he would have to separate young men in the
trauma ward according to their dif­fer­ent gang affiliations. Limb and chest

10 · Introduction
wounds dominated the cases. But in sync with India’s economic liberaliza-
tion in the 1990s, the world adjustment that brought in ­Toyota compact
cars and Honda Hero motorbikes, social class dynamics shifted transit pat-
terns. More p­ eople moved through the city in owned, rented, or borrowed
vehicles. Economic precarity amplified the number of passengers on the
local trains, particularly in the less expensive and more crowded second-­
class compartments. Every­one negotiated spatial displacement as skyrock-
eting rents made living in the city’s center unaffordable and as work became
synonymous with extensive commutes.8 Scooters became ubiquitous, and
helmet laws ­were only intermittently enforced. The underworld invested
in lucrative real estate and construction proj­ects, diminishing gang fights
but intensifying the ways that everyday urban mobility entailed navigating
an obstacle course of concrete and potholes.
As Tarini Bedi notes, Mumbai’s “progressive registers of infrastructural
modernization have a dual face—of building and making and of destruc-
tion, de­mo­li­tion, and phasing-­out” (2016, 388). When Kalvin asked me,
“You know the iron rods that go in concrete?” he was not only asking
about the ­thing that killed Raghu. He was also asking that I recognize an
ever-­present feature of Mumbai’s landscape: the intrusions of salli (iron
rods) sticking up out of the ground in construction sites or fast approach-
ing a car’s windshield when the salli-­ferrying truck in front of it comes to a
sudden halt. In theory, one may take something like a pothole and cast it
as the exceptional sign of injury causation. Yet something e­ lse is at work
­here: the absolute ordinariness of iron rods, potholes, dug-up pipes, and
stray bricks and the ways that p­ eople shift around and through spaces
of injurious obstacles as they navigate t­ hose same spaces for everyday
needs.
The ordinary unevenness of motion suffuses clinical spaces. Trauma
surgeons deal in a currency of morbid jokes, in casual conversation or at
work. ­These jokes, which trauma surgeons fully recognize as modes of coping,
can distribute from doctor to patient. For instance, Dr. D, the surgeon, re-
called operating on a patient who had been run over by the train, a seeming
collision and deceleration. Beyond the trauma of the injury, the patient
was also intoxicated. He was missing both lower legs, and they w ­ ere g­ oing
to have to do an above-­the-­knee amputation—­“one of the worst kinds of
procedures,” Dr. D said. When the patient woke up, he looked at Dr. D
and posed a very reasonable question: “Where are my legs?” (mazha pay
kuṭe ahe?). Dr. D offered what he thought was an equally reasonable reply:
“­They’re coming on the next train” (agli gaḍi se aa jaege).

Introduction · 11
 The image of dismembered legs riding the train is jarring enough. But
just as striking is Dr. D’s droll certainty that a dif­fer­ent train, right ­behind
the index of the event, w ­ ill deliver the feet back to an injured person lying
in the hospital. It is a dark reminder that in­equality’s kinetics continue ­after
the wounding, that ­there are multiple and terrifying ways that bodies can
become part of the city’s traffic, and that the city can become part of the
body’s traffic. This insistence on moving embodiment as the link between
the city and the clinic also appears in the lifeline Kalvin’s friends forged to
bring Raghu’s body back onto the next train that arrived at the station, cer-
tain that it would arrive and take them onward, to the hospital. Not ­every
person working in the trauma ward may share Dr. D’s telling of the changes
in trauma cases. But it is indisputable to t­ hose in the ward that what it
works on, what its epidemiology estimates, and what my own ethnography
tracks is kinetic vio­lence in a space that is of the city, even as it is in the city.9

The City and the City Hospital

When I see injuries in the trauma ward, I am seeing the city at work. Sys-
tems of roads, railways, and hospitals are interfacing, each of them pro-
ducing and produced by structural conditions such as class and caste.10 A
lifeline in this context is a transitional infrastructure, something that pro-
vides the lifeworld of structure (Berlant 2022). I am an ethnographer, and
for me, methods and concepts are descriptive. Yet an enduring challenge
to describing infrastructures—­even provisional ones—is the prob­lem of
overcoming their determinism (Anand 2017, 172) and attending to their
episodic qualities (Berlant 2016, 2022). Closed-­ended deterministic frames
about injury’s cause (e.g., automobility w ­ ill always injure, or, the railway
system embeds its own killing force) may not in fact structure how ­people
find themselves in a given scene of injury. Conditions of cause and conse-
quence do not always match.
Therefore, with emergent motion as its focus, this book develops a so-
cial theory that is somatic and situational. It acknowledges infrastructural
wounding but does not assume that trauma resides only in infrastructure’s
failures. That framing is inadequate for the task of addressing how condi-
tional movements generate inequalities (Farmer 2004). What is necessary
is to develop a framework that foregrounds how ­people live out infrastruc-
tural disruption and infrastructural repair; I trace lifelines to do so (Anand
2017; Anjaria and McFarlane 2011; Baviskar 2003; Chu 2016; Coleman

12 · Introduction
2017; De Boeck and Baloji 2016; De León 2015; Finkelstein 2019; Jusionyte
2018; Melly 2017; A. Roy 2009).11
History imbues t­ hese connections. The power­ful polysemy of railway
accidents in urban India is a historical feature inseparable from colonial
power. Laura Bear explains that accidents on trains in colonial India
marked the “uncontrollable nature of commodities and markets” while also
confirming British colonial fears “that Indians could not be trusted with
the supervision of industrial machinery” (2007, 65). Railway accidents
are historical forms that evidenced the otherness of Indians to colonial
bureaucrats and exemplified “hierarchies of Indian society that emerged
from nationalist responses to the coloniality of its spaces” (62; also see
Goswami 2004; Thiranagama 2012). I would add to ­these insights that
con­temporary road and railway injuries are inseparable from the politics
of the con­temporary hospital, ­whether or not the injured make it that far.
The railway is more than just its accidents. Marian Aguiar argues that the
railway is the infrastructure that, for British colonial powers, promised to
make colonial India “a more manageable state” (2011, xiv). Bombay, l­ater
Mumbai, has often been at the center of this mythical and material proj­
ect (Prakash 2010a). This occurred through the nineteenth-­century urban
planning efforts that transformed the city’s fishing docks into ports of co-
lonial, global trade (Dossal 1997); the industrial booms of the city’s iconic
textile mills that circulated cotton, textiles, and wealth for family-­firm in-
vestors (Finkelstein 2019); the clearing of ­those mills and the attendant
real estate speculation that made way for phar­ma­ceu­ti­cal industry centers
in the twentieth ­century (K. Sunder Rajan 2006); 250 years of circulat-
ing capital through the Bombay Stock Exchange of Dalal Street (Kulkarni
1997); the dominance of Hindi-­language mass mediation through the film
industry (Ganti 2012); the circulation of commodity promises through
product advertising (Mazzarella 2003); and the ongoing dispossession of
the city’s poorest inhabitants from their homes (Appadurai 2000b). In
other words, transit infrastructures must be understood as historical nodes
of possibility for capital flows and their attendant affects and practices of
global cosmopolitanism and modernity. Traffic is not just a decontextu-
alized “prob­lem,” then. It is the site where Mumbai’s deep layers of urban
planning transform into embodied realities, through a politics of uneven
motion that connects the city’s ­people to capital and ­labor through local,
regional, national, and global frames.
I foreground the hospital in t­ hose shifting frames. The site at the book’s
center, a large municipal public hospital I call Central Hospital, has been

Introduction · 13
connected to traffic accidents since its opening in the mid-­t wentieth
­century. Central sits in the heart of the city, and the city pumps through
it. It began as a military hospital in 1944 for the Indian naval forces in-
volved in World War II and was built at a central railway node to ­handle
the transport of the sick and injured. ­After Indian in­de­pen­dence in 1948, the
hospital’s governance shifted over to the municipality of Mumbai. Its
trauma ward is the city’s busiest Level 1 trauma center and one of the few
such dedicated centers in India. The trauma ward is a point of pride for
the hospital’s administration. This fact is often a talking point for visitors, the
other being the hospital’s proximity to one of the country’s largest slum
neighborhoods, which the hospital serves intimately.
Sarah Hodges notes that hospitals in nineteenth-­century India ma-
terialized state power and “provide distinct templates for our under-
standing of the colonial state’s crisis-­driven extension of public welfare”
(2005, 398). I would suggest that Central Hospital’s trauma ward offers
a contemporary resonating case. Its rhythms are modes of postcolonial
governmentality and reflect the challenges of providing public medicine
as public works (Adams 2002; Amrith 2006, 2007; Arnold 1993, 2004;
Baru 2003; S. Patel and Thorner 1995; Qadeer 2000, 2013; Sivaramakrish-
nan 2019).12 This too constitutes the cityness of the city hospital. In this
light, I offer a contrast to impor­tant works about the politics of injury
that begin a­ fter the injury has settled into e­ ither tort law ( Jain 2006) or
traffic policy (Barker 1993, 1999). The cases I describe in this book are
still in motion and set the public hospital into counterpoint with other
movement crises.
The hospital’s cityness often gains legibility in scenes of somatic disrup-
tion. Perhaps it is not surprising that scholars of urban South Asia turn to the
gruesome injuries that occur on transport systems to theorize sociality, a
conceptual approach that I extend from the street to the hospital. For ex-
ample, cultural theorist Ravi Sundaram (2009) details how the bodily and
psychic shock of the modern and the urban in India now forms as road ac-
cidents. Centering his analy­sis on Delhi in the 1990s, when spectacular car
accidents proliferated as private car owner­ship did too, Sundaram argues
that con­temporary India is suffused with what he terms wound culture. He
critiques con­temporary, Eurocentric urban planning logics that uncritically
map cities meta­phor­ically as pure flows. In such Enlightenment-­inflected
models, the intersections of the city are like agile connective joints, and
expressways are like unobstructed blood vessels. Unobstructed movement
gains centrality among such ideas.13

14 · Introduction
 Wound culture, by contrast, is a framework open to the ways that
urban public culture may operate in terms dif­fer­ent than flow. Through
an analy­sis of Delhi’s widespread traffic accidents, Sundaram argues that
in India t­ here is a public cultural sense of being overwhelmed by trauma
on the road, such that “divisions between private trauma and public trag-
edy blurred, suggesting a traumatic collapse between inner worlds and the
shock of public encounters” (2009, 170–71). A focus on wound culture
highlights the interruptions of moving between flesh and space and shows
that wounds can emerge from both stasis and flow (Edensor 2013; see also
Hansen and Verkaaik 2009; and Gidwani 2008).
Sundaram writes of Delhi, but his insights can certainly be considered
in Mumbai, Lagos, Jakarta, Mexico City, or many other settings where traf-
fic is “absolute” and seemingly intractable (Lee 2015). He develops a way of
thinking urban entropy differently than scholars who take the generalized,
unwounded body as the city’s metonym (Sennett 1994). He challenges
models in which the crash and the wound are destined to be aberrations
­because of erroneous assumptions about circulatory flow and equilibrium.
In regimes of wound culture, injurious traffic is the city, and cities must
move with crashes. Pro­cesses of moving and pro­cesses of wounding must be
thought together.14

Movement

Raghu did not move through the trauma ward at Central Hospital,
but Subhash does. It’s a few years a­ fter Kalvin and I talked. An orderly
wheels Subhash in on a gurney; his leg is crushed, and a friend accom-
panying him explains how kinetic actions turned deadly. Subhash leaned
out of the local train’s open door, and as a second train passed by in a dif­
fer­ent direction, a man on the passing train grabbed Subhash and pulled
him out of the compartment. He fell under­neath one of the moving trains.
Someone must have pulled the emergency chain to alert the driver to stop
the train, and once it halted, a group of men extricated him from u­ nder
the train and carried him to a taxi. The doctors attend to the most vis­i­ble
wound—­Subhash’s leg—­and begin assessing him for signs of chest and
head trauma. Subhash’s b­ rother arrives soon a­ fter; walking into the ward,
he takes in the scene, halts, and falls to his knees. He gathers himself, wipes
his tears, and positions himself by the gurney, in Subhash’s field of vision,
and tells him that ­things ­will be okay and he ­will move again.

Introduction · 15
 Trauma frustrates but may not always exceed singularity. T ­ here are
often many unknowns that suffuse moments when the injured person may
be unable to speak and/or should not be queried so that they can recover.
For the surgeons, Subhash’s injury has a precise location. Subhash’s b­ rother
sees this too. At the same time, for Subhash’s ­brother (and for the surgeons
too), trauma extends beyond the bounds of the subject in a not-­injured
person’s commitment to stand by the one whose life is in danger.15 This
means that trauma is relational and social but also that ­these terms require
greater specificity to address the intimacies between bodies on unequal
terms of activity.16
To specify t­ hese terms requires an expansive sense of the metacategory
of movement involved in the trauma care context. Movements may take
shape as speedups and slowdowns. Sometimes they involve a change in
place but sometimes they take form as a desire to shift out of being stuck
in one spot. A binary framework that opposes absolute flow to absolute
stuckness is inadequate for the task of describing movement and traffic in
this context. In such a binary framework, impor­tant but intermediate
movement relations might get muted in the ser­vice of affirming extremes
of stoppage, attrition, schism, and loss accompanied by surplus significa-
tion (Caruth 2016; Leys 2010). ­There are consequences to depicting move-
ment in extremes. A focus on interruptive freeze and amplified signs tends
to fix trauma in an individual’s strug­gle against the immobilizing grip of a
collision event or to pin trauma to par­tic­u­lar historical trajectories (Fassin
and Rechtman 2009). Stuck in the crash and a stop-go frame, it can also be
difficult to ascertain the ongoingness of the injured pre­sent (Berlant 2011,
81) and the moving after-­ness of injury (Wool 2015).
Recall Kalvin’s invocation of the local train as a “vehicle of death” as he
heard the sound of its rustling metal components, a sound of motion. He
heard ­these sounds as he continued to ­ride the train, a habit he did not
cease. Intermediate, reverberating, habitual, and emergent shifts may shape
how beyond clinical technicalities, traumatic injury becomes traumatic. A
halting collision may not be the only place to find trauma’s signs. I am sug-
gesting that to understand the impacts of mass injury and death, intimate
episodes of transition deserve close attention. To ­people caught in ­these
episodes, they may feel dif­fer­ent than aggregate extremes. Being subject to
trauma’s movements may not be the same ­thing as being broken by trauma.
Nor must “movement” mean a large-­scale change in location. Consider
the ways Robert Desjarlais (1997) discusses movement in his ethnography
of a homeless shelter in Boston. Desjarlais describes how residents of the

16 · Introduction
shelter pace, come and go according to scheduled routines (or not), how
they shift from one spot to another. Homelessness, he suggests, may not
neatly align with “a metaphysics of presence, dwelling, and stasis” and in-
stead entails dislocation and movement (103). Dislocation can mean the
difference from standing in one corner of the shelter compared to another.
Movement involves transition, desired and/or actualized, but often does so
in ways that are dif­fer­ent than a ­grand journey.
Thinking about movement in terms of small but vital displacements
can address a tendency in some trauma studies scholarship to frame trauma
as knowledge that the individual or collective should or should not face.
While impor­tant, this stance may make it harder to grapple with trauma’s
terms that may operate beyond reconciled knowing. For instance, debility
and disability can si­mul­ta­neously mark bodily difference and the unequal
ability to make claims on that difference (Addlakha 2018; V. Das and Ad-
dlakha 2001; Friedner 2015, 2022; Jain 2006; Kohrman 2005; Livingston
2005; Wool 2015). Furthermore, trauma and the medicalization of trauma
are not the same t­ hing (Ralph 2020). The medicalization of injury and
disability may in fact have depoliticizing effects (Dewachi 2015, 2017; Jain
2006; Kafer 2013; Ralph 2014, 2020). As Lochlann Jain (2005) explains,
injury and its reverberations in medicine and law should be understood as
more than a sum of individual harms. Injury is materially and socially gen-
erative precisely ­because it is structural, relational, and unequally distrib-
uted. Th­ ese scholars point t­ oward the need for the ethnography of injury
to situate itself somewhere between individuals and collectives.
Differences in bodily movement are a power­ful site to do so, b­ ecause
movements can be ambivalent, power­ful, elusive, and transformative. In
Subhash’s case, this could mean considering trauma’s disturbance in ­family
ties and also in Subhash’s leg. It also could mean understanding Subhash’s
injury as a disturbance to a specific space—­a public hospital ward—­where
­there is no guarantee that individuals are afforded the space and time to
encounter their calamity alone. And it could mean considering how medi-
cine, the ­family, the state, and the law can disturb Subhash, as each domain
strug­gles to authorize a connection between itself and his wound.
My emphasis on describing bodily movement patterns, assembling
them as lifelines, and aggregating them as traffic is a way of thinking about
relationality. Relationality can mean how persons and structures intersect.
For example, in Rhythmanalysis, Henri Lefebvre writes of bodily rhythms
that he calls “becoming irregular” (dérèglement)—­rhythms that are “symp-
tomatic of a disruption that is generally profound, lesional and no longer

Introduction · 17
functional” and that occur “by passing through a crisis” (2004, 44). For
Lefebvre, irregular bodily rhythms and movements mark an impasse be-
tween how authoritative institutions demand that bodies move and how
bodies may not comply.
Relationality can also mean how ­people interact with each other in a
crisis situation. Focused more on crisis as an ordinary form than Lefebvre,
Lauren Berlant takes the glitchy rhythms of everyday life as a site for “in-
venting new rhythms for living, rhythms that could, at any time, congeal
into norms, forms, and institutions” (2011, 9; see also Berlant 2022). Ber-
lant calls t­ hese rhythms disturbances and highlights how movement can
be something that brings p­ eople into relation (2011, 6).17 Infrastructure,
agency, and embodiment can change terms through a small gesture, and
a disturbance’s potential lies in its power to shift situations. Movement is
what makes relationality; it’s not just what signifies it. Movement is “the
activation of a new field of relation,” Erin Manning argues. It is “always cue-
ing in the complexity of the speeds and slownesses around you” (2016, 18,
120). Always containing the potential for both habit and novelty, move-
ment blurs a singular body and the situation in which it is emplaced.
Movement can also underlie therapeutic relations: the demand for subjects
“to realign themselves with the timings and shared truths of ­others” (Des-
jarlais 1997, 175).
Social infrastructures emerge through relational movements (Elyachar
2011, 96). Relational movements also constitute subjects: “Bodies do not
map easily onto subjects,” Lawrence Cohen observes, and subjects emerge
“as relations among and between bodies and their presumptive parts” (2011,
50). Ethnography attentive to such moves can deepen analyses of medi-
cine, certainly, but also forms of vulnerability more broadly (De Boeck
and Baloji 2016). It can shift the frame from injury to injury’s sociality,
and from the wound to the attempts to reckon with and repair the wound.
This is b­ ecause movements are provisional and therefore po­liti­cal. They
bridge bodies and environments. They seed crisis, crisis response, and crisis
theory. If sociality can be located in “a provisional moment,” as Lauren Ber-
lant and Kathleen Stewart (2018, 21) argue, the sociality of trauma might
be located in provisional movements, through subtle gestures that amplify
structural intensities: A scalpel’s incision. A limb’s jolt. Pushing a hospital
trolley into the operating theater. Queueing to see the doctor, shuffling
forward. Fin­gers dialing a phone number to notify a ­family that their child
is in critical condition. Easing someone into a hospital bed. A test run of
walking with crutches. A palm’s muscular compression on an open wound.

18 · Introduction
 Any analy­sis of the movements of medicine in con­temporary India
must begin from the social fact that differences in flow and stuckness con-
cretize home, work, kinship, classes, and castes, determining who facilitates
which critical transitions (Narayan 1992; Raheja and Gold 1994). Move-
ment can render life transitions into meta­phor, allegory, and poesis. This
occurs as marriage, aging, and death are spoken of as shifts in time and
place (Cohen 2000; Desjarlais 2016; Parry 1994; Pinto 2008b). Movement
is a site of social and personal valuation in South Asia, a way of describing
both ordinary life and life’s crises, and movement constitutes the depen-
dencies that make social relations legible (Bedi 2018; Sadana 2010, 2018).
Urban settings or­ga­nize ­these phenomena, from the “train friends” of daily
commutes to threats of sexual vio­lence in transit systems (Amrute 2015;
Phadke, Khan, and Ranade 2011). Lifelines entail such differential shifts
and affirm Central’s trauma ward as a South Asian lifeworld ­because of
motion’s continuities and breaches.

Medicine

Each of the book’s chapters examines how different lifelines shape trauma’s
traffic. This includes carry­ing the injured, done by emergency responders
and ambulances, which forms lifelines of transfer (chapter 1); shifting patients
and evidence awaiting care in casualty wards, which constitutes lifelines of
triage (chapter 2); visiting, as patients’ kin visit the ward and the ward visits
its workers, moves that constitute lifelines of home (chapter 3); tracing the
identities of the high number of unconscious, unidentified patients with
traumatic brain injuries, done by medical workers and the police to consti-
tute lifelines of identification (chapter 4); seeing an operation, in the con-
text of both my fieldwork and my own personal surgical crisis, to grapple
with lifelines of surgery (an interlude titled “Seeing”); breathing through
mechanical ventilation for chest trauma and the bioethical dilemmas of
life support, which makes up lifelines of ventilation (chapter 5); dissecting
corpses in the hospital’s morgue, which forges lifelines of forensics (chap-
ter 6); and recovering with disability back home, which forms lifelines of
discharge (chapter 7).
As a book structure, ­these chapters may seem to suggest that trauma’s
traffic has a linear shape. However, the path I follow from transfer to treat-
ment to discharge is an ideal type and only one model. At any point, t­ hings
can branch in dif­f er­ent directions. I do not claim that it is the only shape or

Introduction · 19
that it is the path that every­one follows. But linearity and seriality, real or
­imagined, often guide confrontations of trauma as patients, their kin, and
clinical providers contemplate what happens next, and how. Even in the
stickiest traffic, ­people reach a destination, eventually.
Together, t­ hese patterns tell a story about the power of movement
into, through, and out of the clinic, one that joins accounts of the clinical
and po­liti­cal potentials of movement by medical anthropologists. In an in-
patient psychiatric hospital in North India, for instance, Sarah Pinto (2013,
2014, 2015) examines the “choreography” of patients as they wander, itin-
erant both physically in the ward but also in narratives that shift genres
among personal accounts, dreams, films, and clinical notes. Ethnographies
of postcombat wounded soldiers in the United States describe how care
involves movements of limbs and of labile diagnostic categories such as
post-­traumatic stress disorder (ptsd) (MacLeish 2013; Messinger 2010;
Wool 2015; Wool and Messinger 2012). In Sharon Kaufman’s (2005) work
on d­ ying in American hospitals, movement structures medicine’s ethical
textures, a ­matter also described by Scott Stonington (2020). I share with
­these scholars an interest in how movements constitute the lived dilemmas
of medicine and how that which moves around and through an unresolved
wound can easily flicker between the concrete and the illusory.
Trauma medicine is a par­tic­u­lar site of uneven motion b­ ecause it is mul-
tiply institutional. The story of trauma in the United States is often the story
of large public hospitals in major metropolitan areas. Traumatic injury in
India demands an especially public sort of medicine, a government-­funded
health-­care apparatus that is in constant relation to the casualization of
­labor in the health-­care sector and the privatization of health care more
broadly (Baru 2003). Most large hospitals have an emergency department,
especially newer, private and corporate-­run hospitals. Most smaller public
hospital emergency departments are staffed with general prac­ti­tion­ers, but
they are not necessarily staffed with the surgeons and ready-­to-go operat-
ing theaters that are necessary to address life-­threatening major trauma.
Trauma surgery is primarily practiced in public, government hospitals
and is crisscrossed by ambulances and also by the private hospitals that pa-
tients often arrive at first, only to be refused care on the grounds of inability
to pay, which shifts them to public facilities as a consequence (see Bhalla
et al. 2016, 2019; Sriram, Gururaj, and Hyder 2017; and Sriram, Hyder,
and Bennett 2018).18 The exceptions are higher-­end private hospitals that
draw the very few specialists in emergency medicine in India, a field that

20 · Introduction
 few physicians w ­ ill specialize in b­ ecause of l­ imited residency spots (Sriram,
Baru, and Bennett 2018; Sriram, Hyder, and Bennett 2018). The setting of
Central Hospital’s trauma ward is thus unequivocally biomedical. While
­people in urban India seek out varied health-­care providers and medical
modalities for sicknesses from colds to tuberculosis, and while medical ex-
pertise mingles forms of “traditional” and “modern” medicine (Naraindas
2006), every­one knows that a major accident requires biomedical atten-
tion, and it is unthinkable to go anywhere but a hospital.
Based in the trauma ward, I explore a return to the hospital to craft
an ethnography of medicine and science. Hospital ethnography is often
regarded as an institutional study by medical sociology, and like similar
institutional studies, sustained research “inside” the site can yield insight
into social life “outside.” And yet ­there are also calls to move hospital eth-
nography out of this edifice complex and to describe it neither as a mirror
of its presumptive outside nor an exceptional space. What, then, can a hos-
pital be?
In foregrounding differences in motion, I hope to reveal the instability
of what counts as “the field” in the rapidly shifting scenes of a hospital. This
is not just about getting out of the edifice complex; this is about finding
analytic terrain to address how the hospital is both institutional and transi-
tional. The hospital can indeed be a space of reification (Taussig 1980), and
bodies in clinics are a canvas for power over life, formations of self, and sov-
ereignty (V. Das 2003). But this does not mean that the hospital is a fully
insulated institution. It cannot be, ­because it is selectively open to shifts
in ­people and situations. In my previous work (Solomon 2015, 2016), this
idea guided my approach to questions of how the clinic inflects lifeworlds
inside homes, in markets for drugs and therapies, and in public spaces.
Moving back into the hospital, I am guided by ethnographies and histo-
ries that track social in­equality as a clinical intensity and that depict how
social class, kinship, religion, ethnicity, and community histories infuse
clinical spaces (Banerjee 2020; Livingston 2012; McKay 2017; Pandolfo
2018; Pinto 2014; Rosenberg 1987; Street 2014; Van der Geest and Fink­
ler 2004; Van Hollen 2003; S. Varma 2020; Venkat 2021; Winant 2021;
Zaman 2004, 2005). If the hospital is understood less as epiphenomenal
and more as a pro­cess of embodying motion, the social worlds of the hos-
pital can be better understood as emergent and in transition.
Annemarie Mol has written at length about the d­ oing of medicine,
that is, the ways that medicine must be approached as a ­matter of practices

Introduction · 21
(Mol 2002; Berg and Mol 1998). This framing moves away from medi-
cine as a prob­lem of knowing. Mol suggests that we understand medicine
through its praxiographic terms. This entails tracing par­tic­u­lar medical
practices and reflecting on what ­these practices do rather than limiting the
ethnography of medicine to what medicine knows. For Mol, differences in
medicine are differences in ­doing medicine.
For me, differences in medicine are differences in moving medicine.
Trauma medicine produces shifts in sociality and technics and relocates
the consequences of unplanned convergences from the street to the clinic.
It closes open wounds and manages spaces that have been breached. It
shifts bodies into dif­f er­ent shapes and shut­tles them through dif­f er­ent spe-
cialties. Pain medi­cations stream through iv drips, and air courses through
a ventilator’s breathing tubes. Care also trudges through paperwork and
multiple consults. In medicine, differences in moving are the differences
in ­doing at stake.

Methods and Writing

What sorts of methods are adequate for researching and narrating trauma’s
traffic? As p­ eople move through situations of injury (and ­people ­here in-
cludes the ethnographer), the lifelines of trauma are wrought from within
the domain of movement, not outside its bounds. Lifelines create possi-
bilities and prob­lems for ethnography, ­because narrating lifelines means
narrating how ­people are in the ­middle of injurious transitions that may be
generative even as they are exhaustive.19 How might ethnographic writing
account for such scenes?
Methods are part of the answer. I began this proj­ect in 2014, struck by
the significant number of injuries and deaths from traffic accidents that
kept appearing in the Mumbai neighborhood I had lived and conducted
research in for many years. My sense was that traffic was deeply embod-
ied. I wondered if conversations about infrastructure in anthropology and
beyond might look dif­fer­ent if infrastructure and flesh ­were not so easily
separated. I questioned why scholarship on cities had mostly overlooked
medicine as a critical site of the urban. Perhaps ­because of reasons of ac-
cess, medical anthropology had to date not addressed injury from within
clinical spaces.
I met with epidemiologists in Mumbai who study traumatic injury. The
social dimensions of trauma ­were not yet part of their mostly quantitative

22 · Introduction
 research, and they w ­ ere interested in a qualitative study of the contexts,
­causes, and consequences of trauma. I proposed fieldwork in two clinical
settings: in the casualty ward of a smaller hospital I call Maitri Hospital
(detailed in chapter 2) and in the trauma ward of the larger hospital I
call Central Hospital (detailed from chapter 2 onward). Two municipal
hospital surgeons I knew introduced me to the staff and faculty at Mai-
tri and Central and facilitated discussions and the formal institutional
permissions from hospital deans and municipal health authorities that
enabled me to conduct fieldwork. My research was governed by three
institutional review board approvals. One approval came from my home
institution in the United States, and two approvals w ­ ere secured in India:
at each hospital the research was governed by an in­de­pen­dent ethics com-
mittee protocol review pro­cess. In the day-­to-­day activities of research, I
was supervised by se­nior faculty, attending physicians, and charge nurses.
I presented deidentified research results at vari­ous stages of the proj­ect
to hospital staff, and to a study group of Indian physicians, public health
workers, social researchers, and students.
The trauma ward at Central was the site of my most intensive periods of
fieldwork over eigh­teen months between 2014 and 2020. I observed cases
from arrival through treatment, as they progressed through dif­fer­ent way-
stations of care and endured the choreography of trauma’s dif­fer­ent clin-
ical practices: general surgery, anesthesiology, neurosurgery, orthopedic
surgery, and nursing. At Central, like at many public hospitals, the team
of providers who make the ­thing called trauma medicine happen approach
a single case by integrating ­these dif­fer­ent domains of medicine, each with
its own epistemological orientations and habits of practice. This is b­ ecause
­there are few seats for postgraduate training in trauma surgery and for spe-
cialized trauma nursing in India. The trauma team includes other work-
ers who add another layer of specialization, a ­labor of care that I try to
spotlight through accounts of technicians, orderlies, sweepers, paramedics,
police, and mortuary workers, who each connect differently to a traumatic
injury, to a patient, and to patients’ kin. Their connections could be dis-
missed as informal clinical l­ abor in contrast to the work of doctors, but I
have chosen to treat them as central ­because they shape lifelines too. My
purposeful inclusion of them in the book emphasizes the diverse ecol­ogy
of a public hospital, upholds the power of clinical l­ abor, and reveals how
the social in social medicine coheres beyond doctor-­patient relationships.
I conducted observations during dif­fer­ent hospital shifts (morning,
after­noon, and overnight) to understand dif­fer­ent rhythms of the ward

Introduction · 23
as well as to ensure repeated, representative interactions with the ward’s
staff. Individual interviews with staff ­were conducted at a time of the work-
er’s choosing, secured through a formal informed consent pro­cess, and
recorded when pos­si­ble or allowed by the interlocutor. Semi­structured
interviews elicited data on a staff member’s own educational and work
experiences, memories of the first day in the ward, notable/memorable
cases, and opinions on the ward’s functions and on the social aspects of
trauma care. Interviews ­were conducted by me along with an in­de­pen­dent
research assistant who was not a hospital worker and who was a Mumbai
local able to converse fluently in the respondent’s preferred language. In-
terviews w ­ ere transcribed and translated by me and by the research assis-
tant and ­were analyzed for emergent concepts and connective themes. My
understanding of the broader contexts governing the municipal hospital
system and traffic accidents came from analyzing city newspaper coverage
of health care, transit and traffic politics, and specific accidents. This was
done using database software set to search Marathi, Hindi, and En­g lish
sources.
In each chapter I reflect on dif­f er­ent methodological modes and the re-
sulting differences in narrative conditions. In stretches of more accelerated
storytelling, I do not wish to attribute a sense of chaos to ­those working
in the ward and by extension to attribute blame to providers. In trying to
capture intervals of downtime, I do not wish to paint a one-­dimensional
portrait of bureaucracy’s gumminess. Rather, I develop an emergent eth-
nographic method to contend with ethically complex situations. This
method is grounded in questions of what the ethnographer can and should
follow and what they should leave unmoved. The difference between can
and should ­matters, especially when one accounts for patients and families.
I did not pursue an interview with a patient u­ ntil they ­were deemed stable,
or they requested that we speak. At that point, informed consent would be
solicited for an extended, recorded interview. While the circumstances of
injury events sometimes surfaced in t­ hose interviews, I did not ask about
them. Inquiry can be disturbing in this context, and disturbance is not
what I want someone with traumatic injury to experience. I want them to
rest, en route to discharge. I do not want the ­people who make my study
pos­si­ble to continue to make my study pos­si­ble. I want them to exit the
ethnography alive. So ­there are limits to my understanding, and ­there are
time delays. I see this as a research ethic of mea­sured refrain.
I also came to understand the necessity of being careful in research and
writing regarding eventedness. I did not assume I knew what “the event”

24 · Introduction
of trauma was for anyone ­else. The ethnographer may enter a scene ­after
its “original” event—in my case, I enter the scene of the hospital ­after an
accident that I do not see—­but ­people may still be pro­cessing the event.
Furthermore, “the event” as such is often unstable and plural. Ambulance
workers might compare dangerous intersections. Triage doctors inquire what
is happening in the patient’s body, right now, and remix the responses with
perceptions of a wound’s backstory. Visiting f­ amily members and police
sometimes ask questions about “the event.” Sometimes the events of the ac-
cident are withheld from the critically injured, especially t­ hose who cannot
speak when on ventilator support. The hospital morgue attempts to derive
­causes of death from the postmortem. Patients who achieve discharge may
revisit the accident once home, in reflection, in accusation, and in appeals
for compensation. Simply being a patient in a hospital involves its own
qualities of eventedness. Consequently, the chapters pay close attention to
what ele­ments of trauma get to become an event, for whom, and on what
terms.
It is inaccurate for me to assume that when I see someone in the hos-
pital, I am definitely seeing the bottoming out of their world.20 This can
be a difficult ethnographic commitment to uphold, given the severity of
injuries one observes in trauma and the intensity of care that providers are
making happen to ensure someone ­will survive. But ­there is also the risk
of assuming the injury and its care completely define someone’s life in the
pre­sent and for the foreseeable f­ uture. The injury and the hospital are parts
of someone’s world but not the only parts. For the person who has been
injured, what ­matters to them may not plot out on a grid with clear-­cut
coordinates. The psychic resonances of trauma do not necessarily operate
through ready-­made scripts. Experiences of street, train, office, ambulance,
hospital, and home often mingle. One cannot assume that the clinic must
be the de facto narrative anchor for clinical stories, especially at the hinge
between living and d­ ying. Trauma—­like any medical calamity—is mul-
tivocal, and t­ hose voices can be out of sync and out of place (Briggs and
Mantini-­Briggs 2016). It is also critical to remember that many of the pa-
tients in Central’s ward do survive.
A person in a hospital bed in pain can do many ­things besides feel pain
in a hospital bed. They can put themselves together and reflect on life’s cir-
cumstances. They can reaffirm assertions of the self that may not be allow-
able or hearable elsewhere. They may resist lifelines: changes in movement
deemed helpful by o­ thers may in fact be experienced by patients as violent
or unnecessary, ­because medicine’s potentials can be damaging even as they

Introduction · 25
are therapeutic. Patients devise their own lifelines too, presenting them-
selves to hospital staff in ways they think the institution desires, ­because
they believe this may secure their release. The ethnographer, the patient,
and the doctor may be in the trauma ward together, but that does not
mean trauma moves them all equally. Traffic is always open to novel micro-­
maneuvers, even if not much appears to have moved from a distance.
Where does that leave the ethnographer? For my own part, I regard my
position as one principally defined by a freedom of mobility that grants
the privilege to observe, listen, ask, and write on terms of my choosing. I
could always calibrate my own proximity to scenes and could always leave
the hospital. I had the ability to exit, to not have to be in situ in the ways
patients, families, and health-­care workers must be. My engagements with
this proj­ect also stem from relations to Indian physicians and researchers
who authorized my presence and guided the work. To the degree that eth-
nography operates as a lifeline for me, the traffic it produces connects to
my own gendered, racialized, nationalized, and professional mobilities.
Narratively, I employ dif­f er­ent forms of pacing to contend with visceral
scenes that may shift quickly or may get bogged down. Care may sound
clamorous or register as laggy; wounds appear as gross and extraordinary
even as they get normalized. One might address this as a ­matter of content:
What does the reader need to know? However, I work from a dif­fer­ent
question: How does a scene need to move? This is a question about dif­fer­
ent aspirations and actions of transition and one sparked by the drawings
that begin each chapter. Wondering how p­ eople come to inhabit move-
ment’s language and action, I looked to photos of transition. I then traced
the lines of the photos in drawings, ­because tracing lines compelled me to
stay with the constitutive ele­ments of a given situation. This is more than a
question of repre­sen­ta­tion. It is also a m
­ atter of action. Implementing this
book’s findings to improve trauma outcomes requires focused attention on
the dif­fer­ent ways medicine moves ­people. I aim to model that pro­cess by
tracing trauma’s shifts.
In traffic, so much moves while slowing. So much drags while quick-
ening. Lines through traffic may not guarantee resolution, yet they create
potentials for transition. Where ­will ­these lifelines lead?

26 · Introduction
NOTES

Introduction

1 On volatile movements, see Grosz (1994).

2 Marian Aguiar (2011) describes the train in India in terms of the affective relations
among speed, life, and death. For instance, the train forms the still backdrop to the
carnage of the 2008 terror attacks on Chhatrapati Shivaji Terminus and also sits still
as it frames the fast-­paced dancing for the closing montage of Slumdog Millionaire.
3 Like many of my Indian colleagues who talk to ­people about the Mumbai local trains,
I frequently face a ­simple question: Why ­don’t the doors close? Common answers
include: ­because no institution ­will pay for it or ­because doors that can close safely
while still maintaining the trains’ roughly thirty-­second stay at a given station are
expensive and too new a technology. Air-­conditioned trains with closed doors have
begun to run in recent years on the Western Line. For a comprehensive history of
the Mumbai rail system, see Aklekar (2014).
4 Importantly, injury also has a ­legal definition: ­under Section 44 of the Indian Penal
Code, “the word ‘injury’ denotes any harm what­ever illegally caused to any person,
in body, mind, reputation or property.” Available at https://­www​.­indiacode​.­nic​.­in​
/­handle​/­123456789​/­2263​?­sam​_­handle​=­123456789​/­1362.
5 The picture of mortality from road accidents comes primarily from burden-­of-­disease
reports, which have been the linchpin of advocacy for the uptake of transport in-
juries as a legitimate and growing public health concern. Figures from a nationally
representative survey in India based in verbal autopsy data estimated a death rate of
20.7 deaths per 100,000 ­people for men, and 5.7 per 100,000 for ­women (Hsiao et al.
2013). The global incidence of t­ hese injuries is e­ ither static or decreasing in most geo-
graphic regions, except, notably, South Asia and Africa, where they are in fact rising
(India State-­Level Disease Burden Initiative Road Injury Collaborators 2020). Injury
prevention is an established field of public health, and roads have been in its sights for
quite some time. But, increasingly, surgery has become a key domain for making sense
of and sounding the alarm around road traffic injuries. This coincides with the rise of
“global surgery,” the christening and renaming of the enterprises of surgical outreach
teams and Lancet Commissions that circulate conferences, camps set up to perform
operations, white papers in journals, and on-­site training visits. ­Here, the ­matter of
road traffic injuries—­which are technically classified as trauma—­may fall ­under the
umbrella of other types of surgical interventions, such as obstetric procedures or
 neurosurgery. Questions of cost-­effectiveness and feasibility, such as “Is surgery for
the rich, or can surgery be done safely worldwide?” guide ways of researching injury.
­These dif­fer­ent assemblies of expertise, commitment, ethics, and resources structure
how the world might understand the deaths of 200,000 Indians from road traffic ac-
cidents in 2015. And like many aggregates, this number hides the specifics that m ­ atter,
such as the location of deaths: 36 ­percent on the spot at the crash site, 11 ­percent
during prehospital transport, and 53 ­percent at the hospital—­with ­little known about
postdischarge mortality and morbidity. See Gururaj (2005) and N. Roy (2017) for
in-­depth analyses of mortality statistics. Also see V. Patel et al. (2011); and I. Roberts,
Mohan, and Abbasi (2002). On global injury burdens, see Meara et al. (2015).
6 See Mohanan (2013) for a study of the “shock” of accidents on h ­ ouse­hold economies
in India; Manoj Mohanan delineates how in the face of serious injury of a person in
the ­house­hold, families are able to smooth out spending in many domains, but debt
remains an impor­tant and common way to do so. Also see Krishna (2011). A study
from North India estimates the prevalence of catastrophic expenditure resulting from
injuries (primarily road traffic injuries) at 22.2 ­percent of participants sampled for the
study; catastrophic health expenditure refers to expenditure on health care above 30%
of consumption spending; see Prinja et al. (2019).
7 On “the interval” as a critical space-­time form, see Fisch (2018).
8 See Sundaram (2009) on how discourses of urban degradation move from decrying
the failures of infrastructures to proposing neoliberal solutions.
9 My thanks to Nikhil Anand for this provocation.
10 Lewis Mumford’s Technics and Civilization (2010) proposes technics as a rubric for
understanding the relationship between technology’s affordances and its damages to
­human life. Mumford recounts dif­fer­ent ways that medicine itself has a technics. From
antiseptics like carbolic acid that derive from coal to the light bulbs in X-­rays, medicine
itself works through intimacies with technological shifts, intimacies that Jennifer Terry
(2017) frames as “attachments” in her case study of con­temporary biomedicine’s en-
tanglements with war-­making technology. My use of traffic gestures to ­these attachments
between medicine and vio­lence but makes a par­tic­u­lar claim about the centrality of
movement and mobility to such attachments. On writing vio­lence, see Nelson (2009).
Theorists of the accident in cultural theory often fetishize the agent of wound-
ing itself as the accident’s primary source (Figlio 1983), and gesture to prob­lems of
compensation as an accident’s core consequence (Figlio 1982). Many appeal to Paul
Virilio’s argument that technology embeds its own disaster, what Virilio (2007)
terms “the original accident,” such that the shipwreck lies in the invention of the
ship. This is a suggestive framing, but it is too static for my needs. It is premised on
looking backward, not forward to the prob­lem of living on with trauma. This is why
I can only take technology-­focused structural claims so far: they make it difficult to
remain open to surprises in the moving after-­ness of injury, in forms that may not
replicate what seemed preordained. See Fisch (2018); Jain (2006); and Siegel (2014).
11 ­These might be understood as “shifting poetic forms” of the road (Stewart 2014),
such that infrastructures reveal their aesthetics. This builds on, but also differs from,

238 · Notes to Introduction

 urban theory that takes generalized movement as its central assumption (Thrift
2008). For Penny Harvey and Hannah Knox (2015), incidents of harm on roads
create “ambivalences” and open up questions about the difference between reckon-
ing infrastructure through its prior relations of neglect, on one hand, and its ­futures
of risk management, on the other. But ­because I am immersed in the trauma ward
where the pre­sent moment of an accident is still unfolding, my approach is necessar-
ily dif­f er­ent.
12 On health care in colonial Bombay, see Ramanna (2002, 2012). That Central Hospi-
tal is a postin­de­pen­dence institution means that both oral and written histories of its
work bear dif­fer­ent kinds of attention to British colonial power than the histories of
other large hospitals in Mumbai that opened before in­de­pen­dence.
13 A set of complementary ideas to wound culture are t­ hose of “signature injury” and
“woundscapes,” as detailed in Terry (2009).
14 The figure of the flaneur cannot hold as an exemplar for southern somatic urbanisms
if one follows Sundaram’s claim that the bodies in the cities of the Global South are
in a foundational relationship to traffic accidents; the flaneur is already embodied
in relation to the environment. What I suggest ­here is that the environment is in
relation to the body, such that to walk is to be exposed to planned infrastructural
vio­lence even as it is to enjoy the city and to move for life. One must move to live,
but ­doing so comes with a significant chance of injury, which sparks movements anew.
The flaneur, discussed at length in Walter Benjamin’s commentary on Charles Baude-
laire, also inhabits much of the critical theory of “everyday life.” This occurs, notably,
in the work of Michel de Certeau, whose essay “Walking in the City” has the flaneur
guide the reader through po­liti­cal possibilities and constrictions (de Certeau 2011). De
Certeau elaborates themes of habitability, exile, and visibility in speaking and walk-
ing, deeming the latter to be poetic. Walking is one form of what de Certeau calls a
“tactic,” a practice integral to everyday life. In urban space, such a life is based on what
we might describe in shorthand as the shock of the urban in Benjamin (W. Benjamin
1968; Buck-­Morss 1992) and Georg Simmel (1903). Yet Lauren Berlant resists certain
ingrained ways of thinking the urban and shock, by asserting that such “everyday
life theory no longer describes how most ­people live” (2011, 8). ­Here Berlant aims to
depart from a model of life based on the “cognitive overload in the urban everyday”
(9). One challenge is to read this insight alongside, through, and sometimes against
assertions of body/city reverberations; as Simmel notes, “Man does not end with the
limits of his body or the area comprising his immediate activity. Rather is the range
of the person constituted by the sum of effects emanating from him temporally and
spatially. In the same way, a city consists of its total effects which extend beyond its
immediate confines” (1964, 419). For a dif­f er­ent genealogy of shock’s epistemic force
and location in war, see Geroulanos and Meyers (2018).
15 Michel Foucault adapted the term milieu from Georges Canguilhem to address “the
space in which a series of uncertain ele­ments unfold” (Foucault 2009, 20). For Can-
guilhem (1991), milieu refers to the contextual environment of an organism. For Can-
guilhem, notions of normality and pathology are relative and may vary according to

Notes to Introduction · 239

 what gets counted as “the environment.” In Foucault’s rendering, a milieu is “what is
needed to account for action at a distance of one body on another” and “the medium
of an action and the ele­ment in which it circulates” (2009, 20–21). I draw on facets
of both definitions to clarify trauma as medium, action, and object of relational relo-
cation, fixation, runaround, and feedback loop. See Annemarie Mol’s (2002, 122–23)
reading of Canguilhem, particularly on the ­matter of norms, and Veena Das’s (2015)
approach to norms.
16 On tracing, see Napolitano (2015). As I explored in my previous work on metabolism
and metabolic illness (Solomon 2016), bodies and environments may not re­spect hard-­
and-­fast inside/outside bounds. I make a similar claim ­here: traffic and trauma operate as
connected modes of embodiment through unsteady and uneven passages and set the
terms of how the world gets inside bodies and how bodies exist within the world.
17 Berlant’s engagement with shifts and adjustments in action is meant to assess par­
tic­u­lar qualities of everyday sociality rather than specific internal states of a body
(as Lefebvre does). Disturbances allow Berlant to analyze social and po­liti­cal tec-
tonic historic changes—­such as the attrition of the social support net in the United
States—as they manifest in interpersonal encounters that may not scale up to “an
event” as such.
18 The history of ambulances in India is mostly traced as the history of the St. John
Ambulance ser­vice. For a con­temporary ethnography on ambulance ser­vices in the
United States, see Jusionyte (2018).
19 Stories “find cracks in the order of ­things, then wedge themselves into the cracks and
shape them with the resonance of other stories” (Lepselter 2016, 55).
20 Lauren Berlant and Diane Nelson taught me this, a painful gift. I miss you.

Chapter One: Carrying

1 On gesture, see Birdwhistell (1952) and Manning (2016).

2 The paper cited ­here was published as a state-­level ems ser­vice began in Maharashtra.
The authors anticipate the rollout of the ser­vice and find its potential a relatively
“moot point” ­because of the high cost of funding the system. Instead, the authors rec-
ommend “reinforcing the existing system of informal providers of taxi ­drivers and po-
lice and with training, funding quick transport with taxes on roads and automobile
fuels, and regulating the private ambulance providers, [which] may prove to be more
cost-­effective in a culture where sharing and helping o­ thers is not just desirable, but is
necessary for overall economic survival” (N. Roy et al. 2010, 150). The speedy response
desired is the transgression of traffic. This would ensure that the injured do not die en
route, a phenomenon that occurs enough to merit news attention, although the more
likely (and, in some ways, more complex) doom scenario is that an injured person’s
vitals become so muted while in transit to the hospital that, upon arrival, the systemic
damage is too extensive to remedy fully. Much of the choreography of ambulances in
India both derives from and continues to relate to pregnancy, ­labor, and delivery.

240 · Notes to Introduction