Saturday, November 15, 2014

On Moral Superiority

He was nice to his dog. Not so much to the prisoners.

Noah Cross enlightens.


"Some day, you may  discover that under the right circumstances, at the right time, you are capable of doing just about anything."

--Noah Cross to Jake Gittes, "Chinatown"

With those words, Noah Cross explains how he could impregnate his own daughter and shrug it off.

Watching a BBC documentary about Auschwitz, the Phantom asks himself how anyone could be capable of the cruelty, the indifference of the camp guards, who ushered children to the gas chambers, who fired their guns into helpless prisoners.

But thinking back, the Phantom asks himself the disquieting question: Just how incorruptible is he, his own self?

At Memorial Sloan Kettering, people died in such numbers, with such relentlessness, we got numb.  Call off the efforts; end the code; wrap the body. 

One day, after the Grim Reaper had made a particularly thorough sweep of the ward, the Phantom came face to face with his own limitations of empathy. One of his patients, a twenty-three year old,  was the youngest person on the ward. She was a joy--always full of stories and questions.  He looked forward to reaching her room on rounds and felt disappointed if she was off the ward, having some test. She was a colonial archaeologist, working on some site near Battery Park when she noticed a mass in her neck and two days later wound up on our ward with a nasty variety of Hodgkins Disease. That morning, her aunt was visiting,  and the Phantom noticed a certain vacancy in his patient's  face, and asked if she felt all right. 

"A little dizzy," she replied. Then she turned to her aunt and said, "Aunt Sally, remember when uncle Kevin died and we got those little white cards to write thank you notes to all the people who came to the funeral?"
"Yes, dear," the aunt replied, looking alarmed. 
"Well, I think you are going to need to get some more cards, now."

Those were the last words she ever said. Her eyes rolled up into her head and she slipped into cardiac arrest  right in front of the Phantom, and despite all his efforts, the paddles, the IV epinephrine and Lidocaine, the chest compression, she was gone.

The nurses stayed behind to wrap her body and the Phantom lingered but then looked at his watch, realizing how much time he had lost, thinking of how he could catch up on all the things he had to do now that he had got behind schedule on rounds. He had thirty two more patients to see and attending rounds in just 90 minutes.

Then it struck him:  One of your favorite people just died and you are thinking about being late for rounds. What have you become?

Of course, had he been thinking about how much he liked her, he could never have functioned during the code. He could never have slipped in the three large bore IV lines, one in each arm and one in her neck, and he could  never have ordered the right drug syringes to be slapped into his hand, or cleared the bed to apply the paddles and detonate the 400 watt seconds to her chest to restart her heart.  But now it was over, he just didn't feel much. Just another body in the bed, now.

The Phantom stepped into a bathroom and composed himself and told himself he had better feel something or he was in trouble, and then he went on with rounds.

As a high school student, the Phantom got persuaded to go off to some "leadership training" camp at the U.S. Naval Academy. It was supposed to be a big honor and it would look good on your college applications, he was told.  He found himself living in the plebe's dorms, making his bed so a quarter would bounce off the tightly strung blanket, getting molded into a functioning unit by the Marine drill instructors.  At first he thought it was great fun--a boy's fantasy about becoming a soldier, a lean, green, killing machine. Within days, all he cared about was running his company's flag up the hill ahead of all the others, knocking down boys from other companies in the combat drills with the padded cudgels. What a thrill to be the first company, to lead all the other companies into the dining hall and to be seated first. We were told someday we might be able to do this for real. To serve our country. As if what was happening inside each of us was somehow going to keep Americans free. Within a few years a lot of the boys who played at Marine that week were doing it for real in Vietnam.  Killing babies to serve their country and to fight for freedom. 

All this happened within a single week, and then he was sent home.

What the Phantom learned is how quickly and effectively he could be socialized into group think, to behave without thinking as an individual, to react to command. This is necessary for any military unit to be effective, but the Phantom had learned something about himself which disturbed him.  If people you like are doing something, you sometimes become part of it. You don't want to let other people down.

Now, the Phantom is less capable of despising those who transgress, who do things which seem morally outrageous.  He thinks back to Noah Cross and thinks: What am I capable of doing?




3 comments:

  1. Phantom,
    I would agree with you that the majority of us are capable of sinking to any number of heinous behaviors under the right circumstances, which only makes the behavior of those few who do the right thing in the face of horrific conditions and high risk all the more amazing. In Amsterdam I toured the Anne Frank house-disconcerting and disturbing in it's ordinariness-a row house on a small charming street like so many others in the city. It was difficult to imagine that on that street, in our parents' lifetime, people were snatched from their homes and everything they'd worked their whole lives for stolen by jack booted troops following orders. But not all their countrymen participated in the horror or watched passively and silently-a few courageous souls were the reason the Frank family survived underground for as long as they did, despite tremendous personal risk. It does make you wonder what allows some individuals, throughout history, to refuse to cave to fear and authority-people who really could lay claim to some moral superiority.

    On the other hand, your detached response to the death of a patient you knew and liked seems like it was your only choice-you didn't have the luxury of a natural response to the extreme circumstances-going home for the night, because you were upset, wasn't an option. Clearly you cared, or you wouldn't recall the episode in such detail so many years later.. I recently saw the trailer for "American Sniper" the new movie directed by Clint Eastwood. In the preview, the sniper, played by Bradley Cooper, has his rifle scope trained on a young Iraqi or Afghan boy with a bomb under his coat. All the while Cooper is having flashbacks to his own kids back home. You don't get to see whether he pulls the trigger or not, but I know what my money is on...On the surface it would seem a doctor and a sniper couldn't be more different-their missions are polar opposite-one's job is to save a life and the other's is to take one, yet they both are expected to remain cool and level headed under the most extreme and unnatural circumstances. It's why there's heroics involved in being a good doctor. I know, you'll say it's just doing what you've been trained to do, but one doesn't negate the other. Firefighters train every day of the year, but that doesn't make their running into a burning building any less heroic...
    Maud

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  2. Maud,
    Many doctors do want to be heroes, at some point in their careers and lives.
    The difference between the firefighter and the doctor is even in the most dire circumstances , nobody's shooting at you and no building is collapsing--your life is not at risk.
    It's more like coming to bat--you want to perform well, but you're not going to die.
    As any one who watches ER knows, the scene is dramatic because someone is on the brink of death, but the docs do not feel heroic or even admirable. You just focus and try your best.
    So no hero badge for me.
    Yes, the real wonder is all those people who help the Ann Franks of the world.
    How typical when you were in Amsterdam you went to see the Ann Frank house.
    Why am I not surprised?
    Phantom

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  3. Phantom,
    Well we'll just have to agree to disagree-I still say heroic.. no your life is not at risk, however, I think there are a lot of people, myself included, who would find the constant responsibility and stress of making life and death decisions regarding others far more daunting than personal risk...
    Maud

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