In the intricate world of medical care for those living without a functioning gut, home parenteral nutrition (HPN) emerges not only as a lifesaving intervention but also as a complex, volatile metabolic phenomenon. Unlike conventional treatments, HPN embodies what scholars now describe as an “inflammable object,” a concept that transcends its biological function to highlight the continuous potential for sudden, unpredictable crises. This metaphor captures the constant tension inherent in sustaining life through HPN, where stability must be delicately balanced against ever-present risk, and where caregiving extends beyond clinical protocols into the realm of adaptive, relational management.
The case of Martin, a young patient reliant on HPN, and his mother, Vlasta, offers a vivid window into this dynamic. Together, they form an integrated metabolic unit, constantly engaged in continuous negotiation with Martin’s shifting physiological conditions and a fluctuating external environment. For example, heat and hydration levels directly influence Martin’s bodily responses, underscoring how HPN is not a static treatment but one ensconced in a “processual, relational, and situated environmentality.” This fragile balance is mirrored in the practical and emotional labor Vlasta invests in managing her son’s condition, highlighting the intimate entanglement of body, technology, and care.
Conceptually, the inflammable nature of HPN challenges traditional biomedical frameworks that often treat inflammation as a symptom rather than a complex, systemic capacity. While conventional research discusses “inflammatory” bodily reactions as responses to metabolic imbalances, the reframing into “inflammability” underscores the persistent vulnerability and potential for abrupt flare-ups. HPN, thus, is more than a medical intervention—it is a metabolic assemblage prone to ignite, demanding not just treatment but ongoing vigilance, adaptability, and relational improvisation to manage its latent volatility.
This conceptual shift deepens our understanding of chronic metabolic states by insisting that medical treatment is inseparable from the socio-technical networks surrounding the patient. Vlasta exemplifies this through her proactive role in acquiring, interpreting, and applying medical knowledge. She is not merely a passive caregiver but an active collaborator in decision-making processes that blend lived experience with biomedical expertise. Her engagement aligns with emerging research underscoring family involvement as integral to the therapeutic continuum, particularly in complex, long-term conditions like HPN dependence.
The practical reality of HPN’s inflammability becomes starkly apparent in moments of crisis, such as when Martin experienced a stoma prolapse shortly after surgery. Vlasta’s ability to recognize, assess, and respond reflects a depth of situational awareness critical to forestalling catastrophic outcomes. Her tactful communication and strategic withholding of distressing information from Martin’s father, who is less medically literate and more emotionally vulnerable, reveal the nuanced social negotiations underpinning effective caregiving in high-stakes scenarios. Such moments illuminate the invisible labor that sustains life on HPN and the necessary fluidity in roles within caregiving networks.
Beyond immediate clinical management, the relational work of maintaining Martin’s health extends into interactions with healthcare institutions. Vlasta’s interventions during hospital admissions, including negotiating to circumvent crowded emergency rooms potentially teeming with infectious agents, demonstrate how HPN alters not only the patient’s physiology but also the spatial and procedural dynamics of healthcare provision. This reordering of medical spaces and practices challenges established norms, emphasizing the need for system-wide recognition of the unique vulnerabilities associated with inflammable metabolic objects like HPN.
In managing HPN, attention must also be paid to the paradoxical imperative of assembling and disassembling relationships and connections. Physically, this involves the intricate attachment of catheters, pumps, and nutritional fluids; socially, it involves cultivating networks of allies and resources while simultaneously isolating the patient from potential contaminants. This dual logic of connection and disconnection is essential to domesticating the inherent fire risk of HPN, requiring unrelenting effort and emotional resilience from caregivers and patients alike.
Documentation emerges as a critical tool in this ongoing effort to tame the inflammable. Vlasta’s meticulous notebooks and binders, filled with chronological medical records and guidelines, perform a double role. They are both instrumental for practical management—ensuring continuity of care across settings and emergencies—and symbolic, embodying the temporal depth of Martin’s lived experience and the persistent hope for control amid uncertainty. This archival dimension challenges critiques of topological metaphors that neglect the historicity of objects, instead presenting HPN as a “folded object” saturated with time and memory.
Moreover, these documents mitigate the fear surrounding exposure to HPN by rendering the unknown known. The comparison with epidemic “fire objects” underscores how such metabolic conditions generate “locative fears” in social spaces, infusing them with indeterminate danger. The hesitancy of schools or hospitals to engage with Martin’s condition evidences the social contagion of those fears. Documentation, therefore, is a boundary object that negotiates these fears, providing tangible evidence of past flare-ups’ resolution and a roadmap for future interventions.
Emerging from this sociotechnical and emotional landscape is a clear imperative: managing inflammable metabolic objects requires anticipatory relations and strategic mobilization of resources. Vlasta’s reliance on neighboring countries for travel, where she can communicate effectively and assure continuity of care, exemplifies this preemptive relational infrastructure. Yet, as Martin matures and envisions solo journeys abroad, more profound challenges arise—symbolically described by Vlasta as severing an “umbilical cord,” both literal and metaphorical. This moment not only marks a rite of passage toward independence but exposes the limits of existing support frameworks in addressing the mobility and autonomy of HPN patients.
The introduction of certified mobile pumps marks a technological leap forward in this context, offering new possibilities for patient mobility and autonomy. However, the persistence of Vlasta’s ever-present readiness to intervene highlights the lingering precariousness of inflammable metabolic assemblages. Physical devices, no matter how advanced, cannot fully resolve the relational and emotional labor embedded in sustaining life without a gut. The journey from dependence toward self-management is thus a socio-technical transformation fraught with uncertainty and risk.
Understanding HPN as an inflammable object offers a crucial analytical lens for reimagining chronic metabolic care. It foregrounds the multidimensional challenges—biophysical, relational, and institutional—embedded in the constant work of domesticating metabolic volatility. This perspective invites healthcare practitioners, policymakers, and researchers to reconsider how care is conceptualized and delivered, extending beyond the immediate clinical sphere to encompass the broader social and environmental conditions shaping patient experiences.
As HPN patients navigate fluctuating health landscapes that defy predictability, the notion of inflammability compels us to rethink medical stability as an ongoing, active achievement rather than a static state. It accentuates the importance of adaptive knowledge practices, tailored communication, and responsive infrastructures that accommodate the fluid boundaries between illness and health, presence and absence, connection and disconnection.
Furthermore, this case illuminates how chronic metabolic conditions intersect with questions of autonomy, mobility, and social inclusion. The careful negotiation of risk inherent to inflammable metabolic assemblages draws attention to the social disparities in access to knowledge, resources, and institutional support, especially for patients and families managing complex, rare conditions like HPN. In this light, the transformative potential of patient associations and technological innovation needs to be understood not merely as medical progress but as components of a broader socio-technical ecosystem.
At its core, the inflammable object metaphor calls for a holistic approach that recognizes the entanglement of bodies, technologies, environments, and social relations. Such an approach can illuminate paths toward more resilient, patient-centered models of care that embrace uncertainty and variability without succumbing to fear or resignation. By attending to the lived realities and creative labor of patients and their families, healthcare can move closer to sustaining not only life but also dignity and agency in the face of profound metabolic challenges.
The lessons drawn from Martin and Vlasta’s journey resonate far beyond individual experience. They echo urgent questions about how society understands chronic illness, how health systems adapt to unpredictable trajectories, and how technology mediates the fragile dance between survival and crisis. In reimagining HPN as an inflammable object, this research bridges the often-disparate domains of biomedicine, social theory, and patient advocacy, offering a compelling framework for future inquiry and innovation.
Ultimately, sustaining “life without a gut” demands more than clinical competence or technological solutions; it requires embracing complexity, fostering collaborative partnerships, and nurturing attentiveness to the subtle, ever-shifting fires that pulse beneath the surface of metabolic existence. The inflammable object is thus a powerful reminder of the delicate balances that enable survival—fraught with risk, bound by relationships, and charged with hope.
Subject of Research: The sociotechnical and relational dimensions of sustaining life on home parenteral nutrition (HPN) through the conceptual lens of the “inflammable object.”
Article Title: Inflammable object lessons: sustaining “life without a gut” on home parenteral nutrition.
Article References:
Porkertová, H., Stöckelová, T. Inflammable object lessons: sustaining “life without a gut” on home parenteral nutrition.
Humanit Soc Sci Commun 12, 1399 (2025). https://doi.org/10.1057/s41599-025-05751-6
Image Credits: AI Generated
