Slicing Up the Medical Profession
In youth, we tend to think of doctors and hospitals as avatars of near-mythic potency and benevolence. In glum middle age, adverse information starts to emerge. A relative enters the hospital with cancer, expected to live 18 months to two years. Instead, he acquires an infection the hospital provides him at no extra charge and is dead in two weeks. Oh well, he would have died anyway, right? A friend’s father falls, suffers a broken hip, goes to the hospital, catches an infection, and dies. Dying of a broken hip — isn’t that Victorian? Is this the best we can do in modern medicine?
A glance beneath the surface of what the medical profession is up to reveals a staggering array of incompetence, intransigence, and disregard for life. It was just in the past 20 years or so that doctors started to consider maybe washing their hands once in a while; before that, hand-washing was at less than 50 percent, and surgeons and anesthesiologists were ruled the leading offenders. As recently as 2009, after years of retraining by the medical establishment, hand hygiene stood at an estimated 74 percent. A one-in-four chance your doctor didn’t wash his hands before he started examining you, in some of the world’s best hospitals, in 2009! Some of the world’s most expensively trained doctors have no more concern about hygiene than your four-year-old. Dr. Filthyhands is a big reason that 1.7 million patients pick up infections in hospitals annually, which contributes to an estimated 90,000 deaths each year, according to a 2009 survey by the World Health Organization.
Trainee doctors are saddled with absurdly long hours as their punishment for being rookies — 28-hour shifts were common until that was dialed down to 16 hours. In 2017, the panel that decides these things declared that 28-hour shifts, twice a week, were okay after all. How do you feel about having a doctor examine you while crazed by sleep deprivation? Are you surprised that a 2008 study in Oregon showed there is no significant health difference between being on Medicaid and having no insurance plan whatsoever? Imagine the immense expense of Medicaid being worth nothing in life outcomes. The top three killers in the U.S. are heart disease, cancer, and medical errors.
Saying all of this out loud won’t win you a lot of friends among the doctors who could hold your life in their hands, which is why criticism of medical professionals (as opposed to those nasty insurance companies) tends to be whispered rather than shouted out the window à la Howard Beale. Yet Beale’s creator, Paddy Chayefsky, wrote a perfectly devastating satiric indictment of technologically sophisticated, bureaucratically sclerotic modern medicine. Of his two mighty satires, the one that remains spot-on is, naturally, the one that was forgotten. Chayefsky’s Network (1976) has aged poorly, what with its fretting about Arab petro-states taking over U.S. media, its soothsayers, its Maoist terror groups. The Hospital (1971), on the other hand, is timeless. Both films won Chayefsky Academy Awards, though only one of them really made him nervous. When he checked into a hospital for cancer treatment in 1981, he told friends that doctors “are going to get ahold of me and cut me up because of that movie I wrote about them.” He died soon after that, at age 58.
The Hospital, which is streaming now on Amazon Prime Video, had its genesis in what Chayefsky saw as the shabby treatment of his wife, Susan, in New York City hospitals in the 1960s. “Nothing got him going like anger,” observed the playwright Herb Gardner, a friend, in Shaun Considine’s biography Mad As Hell: The Life and Work of Paddy Chayefsky. Chayefsky dove into research and emerged with the head-spinning tales that he put into The Hospital. He claimed that everything that happened in the movie was taken from stories told to him by medical professionals. That’s quite something, given the slam-bang story that launches the film. As dryly narrated offscreen by Chayefsky himself, it sets the tone for a movie-length indictment far more relevant and far more chillingly credible than any of the over-the-top doings in Network:
On Monday morning, a patient named Guernsey, male, middle 70s, was admitted to the hospital complaining of chest pains. He had been referred by a nursing home where the doctor had diagnosed his condition as angina pectoris.
It is axiomatic that nursing-home doctors are always wrong. The intern who admitted Mr. Guernsey, however, accepted the diagnosis and prescribed morphine, a drug suitable for angina, but not at all suitable for emphysema, which is unfortunately what the old man actually had. Within an hour, the patient became unresponsive and diaphoretic and was raced up to Intensive Care, with an irregular pulse of 150, blood pressure 90 over 60, respiration rapid and shallow.
The resident on duty in Intensive Care compounded the blunder by treating the old man for pulmonary edema. He gave him digitalis, diuretics, and oxygen. This restored the old man’s color. He was sent to his room in the Holly Pavilion ruddy-complected and peacefully asleep. But the patient was in CO2 narcosis, and died at 7:30 that evening.
I mention all this only to explain how the bed in Room 806 became available.
What happens in this single, two-bed room is the subject of a two-hour condemnation of systemic failure as seen through the eyes of a brilliant but disillusioned and alcoholic head of surgery, played with furious despair by George C. Scott. Scott was so simpatico with the self-torturing nature of his character that he missed the first several days of filming because of a bender during which he was also named the Academy Award winner for Patton while he was home asleep. “Now you come to me with this gothic horror story in which the entire machinery of modern medicine has apparently conspired to destroy one lousy patient,” says Scott’s Dr. Bock. “How am I to sustain my feeling of meaningfulness in the face of this? . . . If there was an oven around, I’d stick my head in it.”
The Hospital is so drenched in verisimilitude that it hits you like a documentary, and after Chayefsky fired original director Michael Ritchie for making the hospital look too glossy, his replacement Arthur Heller filmed the black comedy in an aggressively dingy, dishwater-toned palette typical of early Seventies filmmaking, on location at Metropolitan Hospital on Manhattan’s Upper East Side. In one especially cold and consequently especially harrowing scene, a young woman who is mistaken for a 53-year-old is taken into an operating room and dies suddenly as a team of professionals around her react with hardly a shrug of remorse, although a surgeon at least frets about a potential malpractice suit.
Chayefsky bores in on how, even among well-meaning doctors and nurses, the complexity of the system creates what amounts to an ongoing serial-killer scheme functioning in plain sight. To literalize the idea, he places an actual murderer in the background, arranging ironic punishment for the incompetent and the oblivious. He draws a far more perceptive and subtle parallel between madness and ordinary systemic function here than he does in Network, balancing the murderer against a blithely revenue-maximizing surgeon who bleeds his patients and Medicaid with equal gusto. (The surgeon is scheming about his various legal and financial dodges on the phone when he interrupts himself to say, “I gotta cut open some guy in a couple of minutes, I’ll make it as fast as I can.”) Another doctor in the movie acknowledges mistakes are being made but insists things aren’t as bad as Bock observes: “It’s all perhaps coincidental, but I don’t think I’d call it grotesque,” he says, defensively, leaving it to the audience to note how wrong he is. For every 20 movies exploring wickedness on Wall Street, there might be one about how hospitals work. But Gordon Gekko merely took your money, not your life.
