Friday, April 4, 2014

The Doctor: Compassion in Health Care

William Hurt signing autographs at the 2005 Toronto International Film Festival while promoting History of Violence. Photograph by sheksay (Tony Shek).

In 1988, Random House published Dr. Edward Rosenbaum's book A Taste of my Own Medicine, a biographical account of his experience as a doctor who develops throat cancer and is suddenly forced to understand life as a patient instead of a doctor. 

The film version was released in 1991 by Touchstone Pictures, directed by Randa Haines and starring Academy Award Winners William Hurt and Christine Lahti, and Golden Globe Nominees Mandy Patinkin and Elizabeth Perkins. The film is emotionally stunning. The first time I watched it I knew it had the potential to impact the American medical system in a profound way, but it was overshadowed by the simultaneous release of Regarding Henry, starring Harrison Ford. 

Sometimes I think we need film activists to fight for the promotion of movies like The Doctor, movies so powerful they have the ability to create change, (though the same argument could be made for Regarding Henry).

The Plot of The Doctor and how it Reflects Reality

In The Doctor, William Hurt plays Dr. Jack McKee, one of the top surgeons at what appears to be a teaching hospital. At the beginning of the movie he is shown speaking to a group of interns, explaining to them that they should avoid any emotional connection with the patients. He also has a brief conversation with his partner, Dr. Murray Kaplan, played by Mandy Patinkin. Kaplan is apparently being sued and he wants McKee to meet with him so they can "get their stories straight," as they have before, he implies, in similar situations. McKee calmly agrees.

The opening scenes of this film are vitally important to understanding the meaning of this film. McKee's behavior, and that of his partner, often resembles that of a sociopath with the lack of empathy and remorse; refusal to take responsibility for the effects their actions have on the lives of others; changing their image to avoid prosecution; shallow emotions; and grandiose sense of self. 

Mandy Patinkin on January 13, 2012, outside the Ethel Barrymore Theatre. Photo by Bearian.

McKee is next shown in a surgical setting with his partner assisting. It is a relaxed setting with loud music and inappropriate comments made about the patient who is under sedation. This was particularly disturbing to me as I experienced a minor procedure once while under sedation and I could hear and remember everything that was said about me up to the point that the doctor realized I was still awake and listening, and it was not pleasant. 

It Starts With a Cough

McKee's sociopathic tendencies become even more evident when he realizes he is sick and needs treatment. As with most illnesses, McKee's cancer first shows with a simple cough. He clears his throat. Later, returning from a dinner party with his wife, he has a coughing fit in the car. He has a biopsy, which is positive for cancer. 

McKee makes an appointment with a surgeon--keep in mind this is a woman who has the same job he does--and the doctor is just as cold and rude as he is to his own patients. McKee is shocked, offended that she would treat him this way, and yet, this is how he has trained other doctors to treat patients--he is no longer the doctor. 

A Name on a Chart

McKee tries to find out the results of his tests and is forced to wait a ridiculous amount of time. He again is angry. He works at the hospital! He demands his tests and makes a scene. Another patient, June Ellis, played by Elizabeth Perkins, makes it clear to him that his behavior is rude and inappropriate as everyone else in the room is also waiting for their tests, also have jobs and families and places they need to be, and they've been waiting longer than he has for their tests. 

McKee calms down and asks about her diagnosis and when she tells him about her diagnosis, an inoperable brain tumor. McKee lies and tells her his father once had a patient with the same diagnosis who survived. She is offended and later confronts him about the lie. He is embarrassed. He tries to explain that he was only trying to help her feel better, but he is beginning to realize that he has no idea how to connect with people. He has spent so many years building an emotional wall between himself and others that he is completely lost. 

He is also beginning to notice that his colleagues, and coworkers who were of a lower hierarchical status in the medical professions, are treating him differently now that he has become a patient. 

Abrupt Role Reversal

McKee's role has been reversed overnight and he's had no time to adjust. That's the way it is with illness. There is never time to adjust to the fact that overnight as the patient suddenly loses all social status, respect, and dignity, and becomes a name and set of numbers on a chart.

He does try to adjust, though. Slowly, McKee begins to empathize with the other patients. He learns the names of other patients. He recognizes the cold and impersonal treatment of the medical personnel, and it can get pretty cold in a hospital when a patient is in a gown with their fanny exposed! He experiences things that anyone who has ever been in a hospital can relate to, such as trying to make a comment to a nurse or compliment a technician and have them ignore the comment or act as if the patient is not even in the room while they are sticking needles and tubes into the patient's body and drawing blood from his or her veins. This behavior, ignoring the patient, refusing to respond to comments, acting as if the patient is not even there is a form of bullying and can be emotionally devastating to a patient. McKee sees all of this, and he takes it all in, absorbs it, feels it, and begins to change even more. 

He sees a man struggling with his car. The man is locked out of his car. McKee realizes this man is the same patient suing his partner. The man is in pain, angry, frustrated. McKee's colleagues tell him the man is crazy--yes, you guessed it, more bullying--and advise him to walk away. It is clear that every aspect of this poor man's life has been destroyed, not just by his suffering and pain from the mistakes made by Dr. Kaplan, McKee's partner, but by the denial, the lie. This is not only clear to the audience, but suddenly, to McKee, as well, who helps the man with his car. 

The Lie 

We are taught in our society that we cannot heal ourselves, that we must turn to medical "professionals" for help. The person, or patient, is frightened, suffering, confused by the barrage of terms, overwhelmed with bills, and most of all, vulnerable. 

When medical professionals fail to help, or make the situation worse, and respond with bullying, abuse, and lies as they do in this film, then collaborate to literally "gang up" against their patients with more lies when the case goes to court--as it often must so the patient can afford the help he or she will need for the remainder of his or her life--the effects are devastating and not surprisingly, often lead to patient suicide, at which point the medical professionals respond by claiming the patient had mental issues from the start. 

This is actually typical behavior of bullies and abusers documented in spousal abuse studies. Perhaps it is time that cases like the one presented in this film require a mental examination of the doctors, as well, and laws forbidding doctors to discuss the case in advance so they can work on a lie, which is what Kaplan asks of McKee throughout the film. I believe it is time that an appropriate, compassionate beside manner is taught and demanded of medical professionals.   

The Disappearance

McKee's friendship with Ellis deepens even though he knows she is going to die. He is taking a great risk with his emotions, and he does so willingly. He has clearly changed from the man he was as a doctor and become a patient, a person, a human being. However, there are still many connections he has made in his life that he has failed to build into relationships, such as the connection with his wife, his partner, and his students.

When Ellis mentions that she has always wanted to see a specific Native American Indian show, McKee surprises her by trying to drive her to the show, which proves to be too much for her. He has forgotten to inform his wife of his plans, though. He has bonded emotionally as a patient, but still failed to connect with other people, even the most important people in his life. His wife is struggling to understand the sudden changes in her husband, but he has become a stranger to her, a man she's never met before, and she is understandably frightened and concerned.

Cancer as a Metaphor

The radiation treatments do not stop McKee's cancer. It is destroying his vocal cords. The cancer is also destroying the man he once was and he must change completely in order to survive. The disease has become a metaphor for McKee's life, even though it is killing him. It will kill him metaphorically. It must in order to destroy the old Dr. McKee so a new man can emerge.

McKee finally confronts his doctor, calls her out on her cold, callous behavior and ends their doctor/patient relationship. He then turns to another doctor, Eli Bloomfield played by Adam Arkin. It is clearly a difficult conversation for McKee as he admits that he and his partner, Kaplan, often mocked Bloomfield, which brings in another issue of bullying in the workplace as discussed in my last post and the many reasons this takes place.

McKee begins his conversation with Bloomfield with an apology, which is a big step for him, then asks Bloomfield to perform the surgery on his vocal cords. Bloomfield replies with a joke, saying, "Well, Jack, I've always wanted to slit your throat." Bloomfield smiles, and his smile tells it all. Bloomfield is McKee's foil in the plot. Where McKee and his partner are the bullies of the hospital, Bloomfield is the voice of compassion in the workplace, which makes him the target of bullying and abuse by the other doctors for many reasons including power, control, and psychological issues.

The Trade-Off

June Ellis dies. As a writer, I knew this had to happen. She is the sacrifice. Her death is necessary to make McKee's transformation complete. She is the caterpillar who disappears, and the healed McKee is the butterfly that emerges. Her death is, of course, devastating to McKee who no longer displays the personality traits of a sociopath. Ellis leaves him a private letter that speaks from the heart and provides even more fuel for change. He empathizes. He understands. He hurts. He clearly loved Ellis, not on a romantic level, but as a friend and as a fellow human being.

McKee is told that his cancer is completely gone, and we, as intelligent viewers, realize he had to recover because the disappearance of the cancer, his healing, is vital to his complete transformation. Of course, there is always the chance that cancer will return, but as a viewer you can almost hear the victims of bullying in the audience sigh with relief when McKee discovers he will survive because it has now become clear that he is a permanently changed man and we know that in the end scenes he will also change his ways in the hospital and his personal life.

A New Man

When McKee returns home he cannot speak. He uses a chalkboard to communicate with his wife. They both quickly discover she is not ready to accept him into their home, a place that has become her solace, her private space while he works ridiculous hours (yes, I do believe we expect way too much of doctors and invite potentially deadly mistakes from exhaustion), attends parties, meetings, and even disappears with fellow patients. Anne makes it clear to her husband that she no longer knows who he is, not only because he has changed through the process of the illness, but also because they have grown apart through years of relationship neglect. 

McKee uses a bell and his chalkboard to communicate his regret and his desire to begin again in a heart-wrenching scene as he chases his wife through the house, begging for a second chance, but to Anne, he is even more of a stranger. His desperation is clear and his performance at this point Oscar-worthy. He needs her, he tells her, and we, the audience, know this is true, more than ever. 

McKee eventually returns to work. He has transformed. He confronts his partner with the fact that Kaplan did, in fact, make a terrible mistake and should take responsibility for his actions. Kaplan is stunned. McKee, however, has a clear conscience because he now has a conscience! 

McKee then meets with his students. He instructs the interns to change into medical gowns, exposing their own fannies to the world, leaving them completely vulnerable, essentially and metaphorically naked and exposed as their patients will be when they become doctors. 

McKee has files in his hands with the titles of various illnesses written on the front. He tells the patients that in the following weeks, instead of following him around (as he makes snide remarks about patients and other doctors and instructs them to keep an emotional distance), they will now become the patients, each with a specific illness. He orders the appropriate tests for each intern so they will know how it feels when a nurse sticks a needle in their arm, ignores their small talk, pretends they are invisible. They will live the experience of being a patient. They will feel the pain. 

I believe this film should be required viewing for anyone who works in a medical profession. I believe it represents a flaw in the system. No, it is more like an open wound that festers and is growing more deadly with time. The new, transformed Dr. McKee represents the many medical professionals who know that it is time for a change, that there is a desperate need for compassionate care in medical settings. These men and women, in my mind, are heroes.   

May God bless them, each and every one.    

  • The Doctor. Dir. Randa Haines. Perf. William Hurt; Christine Lahti; Elizabeth Perkins; Mandy Patinkin; Alan Arkin. Touchstone Pictures: 1991.

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