Monday, May 17, 2004

More on doctors: my previous entry got me thinking about something I read years ago in a college english class, a story entitled The Use of Force by William Carlos Williams.

Williams was a doctor in the first part of the twentieth century who wrote semi-autobiographical stories about medecine. The Use of Force tells the story, in first person, of a doctor who is called to check whether a girl has diptheria, only to find upon his arrival that the girl refuses to open her mouth and let him look at her tonsils. The parents scream at her, throw tantrums, all to no avail. Eventually, after he has had enough, the father of the girl decides to forcefully pry her mouth open, and sets to the task together with the doctor. Diptheria, after all, is lethal and they must find out immediately whether she has it or not. The story, which switches back and forth between the narrative and the doctor's thoughts, provides some disturbing and graphic imagery (the emphasis is mine):

If you don't do what the doctor says you'll have to go to the hospital, the mother admonished her severly.

Oh yeah? I had to smile to myself. After all, I had already fallen in love with the savage brat, the parents were contemptible to me. In the ensuing struggle, they grew more and more abject, crushed, exhausted while she surely rose to magnificent heights of insane fury of effort bred of her terror of me.

The father tried his best, and he was a big man but the fact that she was his daughter, his shame at her behavior and his dread of hurting her made him release her just at the critical moment several times when I had almost achieved success, till I wanted to kill him. But his dread also that she might have diptheria made him tell me to go on, go on though he himself was almost fainting, while the mother moved back and forth behind us raising and lowering her hands in an agony of apprehension.

Put her in front of you on your lap, I ordered, and hold both her wrists. But as soon as he did the child let out a scream. Don't, you're hurting me. Let go of my hands. Let them go I tell you. Then she shrieked terrifyings, hysterically. Stop it! Stop it! You're killing me!

Do you think she can stand it, doctor! said the mother.
You get out, said the husband to his wife. Do you want her to die of diptheria?
Come on now, hold her, I said...

Aren't you ashamed, the mother yelled at her. Aren't you ashamed to act like that in front of the doctor?
Get me a smooth-handled spoon of some sort, I told the mother. We're going to go through with this. The child's mouth was already bleeding. Her tongue was cut and she was screaming in wild hysterical shrieks. Perhaps I should have desisted and come back in an hour or more. No doubt it would have been better. But I have seen at least two children lying dead of neglect in such cases, and feeling that I must get a diagnosis now or never I went at it again. But the worst of it was that I too had got beyond reason. I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her. My face was burning with it.

Eventually the doctor succeeds, with the help of the father, in prying her mouth open only to see a sore throat -- no diptheria.

In class discussion, the most common response is usually to defend the doctor. After all, he did nothing wrong; he had to know whether the girl had diptheria; he had to forcefully open her mouth, for her own good. Not only that, but all his actions were done with the permission, and assistance, of the parents.

And yet consider the rhetoric I put in boldface in the excerpt above. Would you entrust your daughter to a doctor that thought these things? Even if you could not detect these thoughts affecting his actions?

Williams' stories are interesting because they explore the eerie surrender of privacy and the blind trust that characterize doctor-patient relations. The Use of Force is part of Williams' The Doctor Stories, available on amazon.


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