Getting Out of Bed at Night

To the Editors:

The review by Michael G. Michaelson of William A. Nolen’s The Making of a Surgeon (NYR, February 25) is a typical specimen of the perceptual isolationism of some current styles of sociological criticism. In his socio-ethical response to Nolen’s alleged insensitivity to the pain, suffering, and dignity of his patients, Michaelson ignores the bold manner with which physicians such as Dr. Nolen approach some of the more overwhelming facts of social life. To criticize Nolen and his colleagues at Bellevue for telling a “lie to families to get them to donate blood” is nothing short of ignoring ingenuity, desperation, and the dedication of such an act. The other instances which he cites of the transgression of the modern physician on the dignities of the patient are for the most part equally trivial.

By denouncing Nolen for his aspirations to someday be head resident, Michaelson overlooks that pattern of behavior which those aspirations produced, namely a man who would serve Bellevue for five years, “get out of bed at night,” and even apologize to a patient for a temporary misuse of position. It produced a person who could see through the amassed human misery of a large, urban, city-operated hospital, and view with admiration the service of the normally derided Puerto Rican and homosexual. It even sustained a man who can call a colleague a “bastard” for demanding a fee while rendering no service.

In short, in his urgent quest to validate some pure system of medical ethics, Michaelson overlooks the cogent ethical posture of a man sensitive to the everyday realities of the social world of life, death, pain, suffering, and fear. Certainly Nolen’s book overlooks some tremendous social ills. They are not enumerated for they are obvious. The more relevant story to be told is how the flesh and blood creatures in the white coat and on the table can learn to cope with the terrifying problems mutually faced in an all but perfect social situation. For that we need the courage and perception of Nolen and his like, not the ingenuous sociological ethics of Mr. Michaelson.

James J. Dahl

Department of Social Science & Religion

Hofstra University, Hempstead, L.I., N.Y.

Michael G Michaelson replies:

I am somewhat perplexed by phrases like “perceptual isolationism,” “socio-ethical response,” and “ingenuous sociological ethics,” but what sense I can make of Mr. Dahl’s letter suggests, I think, one of the major problems facing the serious critic of contemporary American medicine. Because the manifest goals of medical practice—healing the sick, “serving” in a hospital—are humane, criticism of medical practitioners and institutions is too often deemed sacrilegious. But the fact that doctors work in hospitals does not exempt them from charges of being selfish, arrogant, or abusive, however “bold” their manner. The fact that Puerto Ricans and homosexuals are “normally derided” does not excuse the condescension so evident in Dr. Nolen’s “admiration.” And the “amassed human misery” in hospitals like Bellevue does not transform crude manipulation and deceit into an act of “dedication.”

I have certainly not ignored the “ingenuity” and “desperation” of Dr. Nolen. In my essay I suggested that these qualities (which Nolen so often drew upon to make things easier for himself without regard, generally, for his patients) might be put to better use in an effort to get at the root of the “terrifying problems mutually faced” by doctor and patient. The practice of American medicine, in hospitals and in physicians’ offices, is very far indeed from the “all but perfect social situation” Mr. Dahl claims it is. Dr. Nolen’s book makes that, if nothing else, abundantly clear. But precisely because it is a world of life, death, pain, and suffering, the hospital may provide a focus for a radical transformation of human relationships, of the medical (and the more general) “social situation.”

The emergence of a new “health movement” which I briefly described is an occasion for hope. Mr. Dahl’s dismissal of the modern physician’s transgressions as “trivial,” his conviction that Dr. Nolen’s disregard for human dignity is evidence of a “cogent ethical posture,” seem to me, on the other hand, to be an occasion for despair.