| The Hollywood Issue | Spring 2009 |
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The Lost World Michael Crichton ’69 was preparing to apply a cast to my right ankle, and I was taking off my shoe and sock so he could accomplish the task. There, in the bright light of a casting room, with my glasses on and my leg extended on a table, I could see to my horror that my ankle had the grubby patina of a six-year-old’s at bedtime. Excuses were beside the point, but I muttered them: that my small shower had poor lighting and that I was nearsighted, sleep-deprived, and so tall that my eyes were a long way from my ankles. The “tall” part was particularly unpersuasive, as Michael topped me by six inches. We had become foxhole buddies on our neurology rotation. All was quiet on the neurology front at Boston City Hospital that month in 1968, however, and there was little of the incipient neurologist in either of us. We became each other’s willing accomplice, slipping away for a late afternoon beer and conversation. The friendship continued as we moved on to orthopedics. Briefly Michael’s “patient,” I could easily imagine him as an academic physician, the sort exemplified by the chiefs of service in Harvard hospitals. His manner was self-contained but not aloof. Rather, his style was affably imperturbable. He shrugged off my embarrassment, put the ankle where he wanted it, and, following our instructor’s directions, covered it, grime and all, with a light, tidy cast. He was a quick study. Nevertheless, I didn’t think it likely that he would go on to a career in academic medicine. He was already a writer. While in college, under the nom de plume John Lange, he had written three or four fast-paced thrillers. Published as small paperbacks, they were easy to slip into one’s pocket and read during afternoon lectures. There was nothing ambiguous about the intention of these books; they were designed to become movies along the lines of To Catch a Thief or Topkapi. Although I didn’t know it, Michael had already written the book that would become his first movie. The Andromeda Strain had two sources of inspiration—Harvard Medical School’s second-year bacteriology course and H. G. Wells’s The War of the Worlds. Much of this book was, indeed, written while Michael was taking the bacteriology course. He went on to write two other books during medical school, and both of them stand up to rereading 40 years later. For A Case of Need, Michael, who had joked about his height with ”John Lange,” now borrowed the name of a knighted dwarf, Jeffrey Hudson, who was in the court of Henrietta Maria, the queen of Charles I. Michael often made small jokes about his height. I wasn’t surprised that he would know about seventeenth-century royalty; I always took for granted how much he knew. It would have been overwhelming to ask him where he had gleaned the tidbits that were regular and entertaining parts of his conversations. Although he had a gift for fiction, his delight often seemed to be in small facts, which peppered his writing much as they did his talk. Like the first novels, A Case of Need was an exercise in a standard form—that of a mystery in which a bystander is thrust by circumstances into the job of detection, competing with misguided police to identify the real culprit. The crime in question is an illegal abortion resulting in the death of a prominent surgeon’s daughter. The accidental detective is a pathologist who has for years helped a gynecologist colleague conceal the fact that he has safely and carefully performed abortions in the hospital. The book is a farrago of medical stereotypes: a surgeon arrogant to the point of sociopathy, a principled gynecologist, a street-smart nurse, an opera-loving homosexual psychiatrist, a mild-mannered and diligent pathologist. It is easy to read and often quite wry. It is also, despite the cover of a pseudo-nym, quite a brave book. A Case of Need, published five years before the U.S. Supreme Court’s decision in Roe v. Wade, straightforwardly addresses the distortion of values and relationships in medicine and society as a result of the nearly universal criminalization of abortion. The fact that abortions were relatively safe, Michael argued, was what made possible the large criminal market for them. Many more women were mutilated, made gravely ill, or killed by criminalized abortionists than by physicians performing the few terminations that were either legally sanctioned or disguised as another procedure. But the reality was that the substantial majority of women survived the illegal process. Thus, the black market for abortions thrived. Although A Case of Need is written to a formula, it is not a morally simplistic book. The tangle of relationships that it portrays, the painful reasons for seeking an abortion, the horrible consequences of secrecy and deception, the dangers of breaking the law, and the potential damage of enforcing it are all handled with an authority that is remarkable when you consider that Michael was 25 years old when he wrote the book. His next book, Five Patients: The Hospital Explained, was published in 1970 as a work of journalism. The five patients of the title were all people brought to Massachusetts General Hospital for treatment: a man who has suffered cardiac arrest, another with a fever of unknown origin, a third who has almost lost his hand in a crush injury, a woman with chest pain, another with a rare presentation of lupus. The patients’ stories serve as five remarkable essays not only about MGH itself, but also about the role of the modern hospital as a technological, economic, and social institution. In certain details Five Patients is dated. The man with fever of unknown origin spent a month at the hospital and incurred a bill of $6,172.55. (No, I didn’t move a decimal point.) Another quaint feature of the book is the author’s habit of referring to physicians only as men; no woman doctor appears in the book and no note is taken of the possibility that women would come to play a significant role in medicine. Michael spent much of that year at MGH as a participant and an observer in the life of the hospital. He listened in on such legendary physicians as Alexander Leaf and Daniel Federman ’53 as they made recommendations for diagnosis and treatment. He interviewed many of the most interesting and active leaders at the hospital. And he read very, very widely. The resulting book remains readable, informative, and formidably intelligent. One has the sense that Michael got what the hospital was about and had an uncanny sense of where it was headed. Perhaps one of the more striking features of Five Patients is the security of its tone. Here is a fourth-year medical student giving opinions with a self-assurance bordering on the magisterial. And he gets away with it. Four decades on, I mostly don’t mind being guided in my thinking about hospitals and medicine by a 27-year-old. When writing a new preface to the book in 1994, Michael had little reason to change his conclusions or his tone. He wrote, “This country must finally adopt some form of national health insurance…other industrialized nations spend less on health care and get more for their money. At the moment, our national debate on health care is in the phase of blame and recrimination….But the truth is that everyone works within the constraints of the present system—and it is the system itself that must be changed.” The same year, his television series, ER, premiered. It was to be, of course, a hugely successful drama of people living and working within the constraints of the current system. Looking back on his career, it seems inevitable that Michael would have chosen fiction and film over the conventional practice of medicine. When we were students together, however, I think the choice was less clear. He did not take an internship, but if he had I think he would have been successful—if chafing at his loss of writing time. I did not see him again after graduation and have only now, after his death, returned to thinking about his relationship with medicine. In rereading his books from that time, I noticed two clues, in addition to the obvious ones, as to why he left medicine as a career. In A Case of Need and Five Patients the most painful moments come at the beginning. Both scenes are set in emergency departments—one as fiction, the other as reporting of a real event. In both, a young patient has unexpectedly died, and the physician must tell the family. The agony of the moment, in both books, is intense and, to my reading, heartfelt. Whether Michael privately dreaded this aspect of medical practice I can’t say. Nor can I say that in turning to medical fiction he also had a didactic intention. But at the very end of Five Patients—having written at length about hospitals and doctors, having looked at the history of medical technology and institutions, and having made some predictions as to where they would go—he wrote, “…patients are more knowledgeable about medicine than ever before. Only the most insecure and unintelligent physicians wish to keep patients from becoming even more knowledgeable.” Michael then goes on to emphasize the importance of a knowledgeable public to medical institutions. “Hospitals are now changing,” he wrote. “They will change more, and faster, in the future. Much of that change will be a response to social pressure, a demand for services and facilities. It is vital that this demand be intelligent, and informed.” In ER Michael not only created one of the longest-running entertainments in the history of U.S. television, but he also built a bully pulpit from which to instruct about the triumphs, failures, and horrors of medical practice. William Ira Bennett ’68, a psychiatrist in private practice, is also editor-in-chief of the Harvard Medical Alumni Bulletin. Photo caption: Jurassic Park, the 1993 movie based on the bestselling book by Michael Crichton, led to an explosion of dinomania—and an eponymous name for a new ankylosaurus species, Crichtonsaurus bohlini. Photo: Douglas Kirkland/Corbis |
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