The Curmudgeon


Sunday, May 06, 2007

No-one Gets Well in Hospital

Karl Edward Wagner and the Horrors of Medicine

The mad doctor - hubristic, power-crazed, unscrupulous or just plain murderous - is a recurring figure in weird fiction. The intimidating attributes of medical personnel - highly specialised knowledge, arcane jargon, a professional interest in the miseries of others, and literal powers of life and death over lesser mortals - have helped to make their less creditable representatives a fruitful source of literary paranoia from Mary Shelley through to Thomas Harris. Karl Edward Wagner, who completed a medical degree and practised psychiatry before deciding on a literary career, wrote several stories involving the medical profession, none of them particularly flattering.

Two of Wagner's finest long tales, "The River of Night's Dreaming" (1981) and "Beyond Any Measure" (1982), touch on the horrors of psychiatry: in the former, a mental patient's memories of injections, operations and electro-convulsive therapy are intermingled with perverse fantasies of rape; while in the latter, Dr Magnus' ambitions cause him to abuse a patient's trust by giving her a post-hypnotic command without her knowledge. Later, in "An Awareness of Angels" (1988), the psychiatrist Dr Nathan Hodgson turns out to be one of a hidden race of inimical non-human parasites. But this kind of thing is hardly more than one would expect from psychiatrists in the horror genre; and the medical profession, while contributing important details, is not the central focus of the stories.

Institutional callousness rather than personal corruption is the subject of "But You'll Never Follow Me" (1990), the story of Michael Marsden's painful setting free of his aged parents from the Brookcrest Health Care Centre. Just as Marsden's siblings have placed the old people in the institution to avoid disruption to the smooth running of their jobs and families, so the cruelty and neglect of the nursing staff is part and parcel of the smooth running of the hospital: Marsden finds that "They'd removed [his mother's] dinner tray but they hadn't cleaned her up" and that his father has been tied into his wheelchair with a knotted towel to prevent his getting up and falling.

Similarly, in "Final Cut" (published posthumously in 1996), Dr Kirby Meredith (another psychiatrist, but a decent one this time) witnesses the pointless death of his cousin after a successful operation: "The intern had only just arrived at the medical centre, saw the postop incisions and fresh bleeding, obvious severe pain - and ordered a liberal injection of morphine to quell pain and agitation. He hadn't thought to check the charts for liver function, but he had been told that the patient in 221 was a hopeless drunk. Whatever. Who cares." In fact, although the cousin did drink heavily, his liver problems derive from a course of anti-TB drugs, taken over ten years at the "lawful command" of intrusive public health workers. "Final Cut", which reads rather like a staff-room anecdote for the edification of idealistic newcomers, begins with the words, "No one gets well in a hospital" and ends with the repetition of this maxim and the determination of Dr Meredith - guilt-ridden at having recommended the operation and horrified at the thought of "a thousand Cousin Bobs slowly, painfully killed by the best efforts of modern unfeeling medicine" - to quit the profession as soon as possible.

In "Passages" (1994), another anecdotal tale, the focus is on the callous doctor rather than on the victimised patient, and the heartlessness is thrown into sharp relief through the perspective of a sympathetic onlooker. Three high-school friends meet at a reunion and start exchanging anecdotes about phobias. Grant McDade, now a noted surgeon (a heart surgeon, in fact - a fine ironic touch), relates a traumatic incident in his childhood when a hypodermic needle accidentally broke off in his arm, and says he became a physician because of "the old identification with the aggressor thing, I suppose". McDade goes on to relate several of the less pleasant aspects of a medical education, including children dying of leukaemia on the paediatric ward. Marcia Meadows, who has been nursing mild hopes of finally consummating her teenage crush on McDade, asks him how he conquered his fear of needles. He replies that he learned it in medical school:

"After that, it was easy to slide a scalpel through living flesh, to crack open a chest. It's the most important part of learning to be a doctor."
Grant McDade removed his dark glasses and gazed earnestly into Marcia's eyes.
"You see, you have to learn that no matter what you're doing to another person, it doesn't hurt you."
The blue eyes that had once laughed were as dead and dispassionate as a shark's eyes as it begins its tearing roll.
Marcia let go of Grant's hand and excused herself.
She never saw him after that night, but she forever mourned his ghost.

For medicine to save lives, its practitioners must die inside; but, as "Final Cut" makes clear, the doctors' inhuman adjustment to their own inhuman conditions is itself a cause of unnecessary suffering and death.

Wagner stated in his afterword to his collection In a Lonely Place that "many of the conversations and political sentiments expressed by the characters" in "The Fourth Seal" (1975) are factual. He wrote himself into "The Fourth Seal" as a certain Kirk Walker whose speculations about the existence of a "select brotherhood" during the early history of medicine are recalled by the protagonist at the beginning of the story. Walker, we then learn, "ran afoul of the administration" at a medical school "of notable reputation" and died not long after. The story's title is a reference to the release of Death over a quarter of the earth in chapter six of Revelation, and the story itself is a paranoid tale about a secret society of physicians dedicated to the development and promulgation of disease, accident and drug addiction.

"The Fourth Seal" is an effective conspiracy thriller, and a blistering evocation of the backbiting and political feuding which inevitably arise when practitioners of a supposedly "caring" profession are forced to compete for funds; but it largely lacks the psychological dimension which makes such tales as "Passages" and "But You'll Never Follow Me" so chilling. Here the callousness of doctors is neither occupational hazard nor psychological defence mechanism, but an attitude deliberately fostered in the exercise of power for its own sake; accordingly, the members of the secret brotherhood are merely self-seeking politicians who grumble about "fools who would destroy the medical profession with Communistic laws and regulations" and offer Realpolitik arguments that "to have significant power, a physician must have an essential role ... If there were no diseases, there would be no need for physicians." The protagonist's response to the conspirators' overtures is also presented simply; there is, for instance, little or no implication that his eventual decision to "pretend to acquiesce" might be the first stage in accepting the conspirators' arguments.

Wagner's masterpiece among his medical horror stories, and one of his best stories overall, is "Into Whose Hands" (1983). It depicts in convincing detail the exhausting and depressing routine of Marlowe, the duty physician at a psychiatric hospital:

It was Friday night. Until 8:00 Monday morning he would be the only doctor on the grounds at Graceland. In that time he might have twenty to thirty admissions, on an average, in addition to the task of overseeing the well-being of some five hundred patients within the state hospital complex. A demanding situation under the best of circumstances, and impossible without a capable staff. Marlowe often wished for a capable staff.

Between dealing with admissions ("It was a pleasant day, and families liked to carry their senile grandmothers and Valium-addicted aunts to the hospital on weekends"), overseeing regular patients ("At three in the morning, Willy Winslow on South Unit smashed the salt shaker he had stolen earlier and sawed at his wrists with the jagged glass"), correcting the errors of juniors ("the Pakistani resident had been eight weeks in the US and six weeks on South Unit, and still hadn't discovered the distinction between q.i.d., q.d., and q.o.d. when writing medication orders"), Marlowe keeps himself going with coffee and frozen meals which his beeper won't permit him to finish, snatches occasional catnaps, and wanders the hospital's seven miles of corridor. Into this nightmare Wagner injects two patients - one violent and involuntary, the other depressed and voluntary - on whom Marlowe checks at intervals during the weekend. When the depressed patient is treated as an involuntary (i.e. dangerous) admission, it seems at first that "Into Whose Hands" is, like "Final Cut", simply a tale of institutional confusion and carelessness; but the ending makes clear that the situation in this story is, if anything, worse. Indeed, although it can be read as a non-supernatural tale of insanity, there are hints at various stages (Marlowe's first name is Chris, or so he claims; the hospital is known to some as "Camp Underhill"; asked by a patient what kind of God would curse the elderly with loss of sphincter control, Marlowe bitterly replies "An angry god. And vengeful") that the Graceland State Psychiatric Hospital is a literal Hell.

In his afterword to Wagner's posthumous collection Exorcisms and Ecstasies, C Bruce Hunter notes that Wagner's disillusionment with the medical profession was such that it "kept him from seeking the medical attention he needed at the end of his life". Certainly, his feelings were strong enough for him to return consistently to the horrors of medicine from the beginning of his career in the 1970s until his death in 1994. Wagner's doctors are not irresponsible vivisectionists like Shelley's Frankenstein or Wells' Moreau; still less are they murderous geniuses like Hannibal Lecter. In an appreciation of In a Lonely Place, Ramsey Campbell described the conspirators in "The Fourth Seal" as "professionals who have sold their souls to the job"; an apt description of all those characters in Wagner's tales who epitomise "modern unfeeling medicine".


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