There are two scenes from very different theaters which the Phantom cannot forget: The first is from "Gone With the Wind," where Rhett Butler (Clark Gable) looks over his shoulder as he accompanies Scarlet O'Hara and Melanie Wilkes along a road leaving burning Atlanta, and he sees old men and young boys trudging along in the opposite direction, going to fight the Yankees, to defend their homes and city. Butler has been disdainful of the arrogant rebel "Cause," of all those fools who shouted they would beat the Yankees in ten days, that one Southern gentleman on horseback could whip ten Yankees. Butler had pointed out there were only three munitions factories in the entire Confederacy at the beginning of the war, and that the Union navy would blockade the ports, and Union trains would transport the federal host to overwhelm the Confederates. The whole idea of a righteous war was ridiculous, Butler argued, and he would have no part in that fight.
But looking at the bedraggled, all but defeated stream of what was left of Southern manhood, marching off to fight against all odds, Butler acknowledges that for the first time in his life he felt ashamed, and he turns to join them, leaving Scarlet to manage Melanie and her newborn baby and the wagon along the escape route out of burning Atlanta. Butler has to do the thing which is honorable, for once, even though it will cost him, and is clearly not the profitable thing to do.
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| Omar |
The Second scene is from "The Wire," where Bunk, the workaday detective in his sweat stained suit, confronts Omar, who makes a lot of money at gun point, robbing other players "in the game," living by his own rules and turning a good profit at it. Omar has engaged in a shoot out in broad daylight , leaving two dead behind on a Baltimore street. Bunk tells Omar that when Bunk arrived on the scene afterwards, children, who had witnessed the shootout, were re-enacting the scene, each one wanting to play Omar, who they idolized as a great street hero.
"Oh, how far we've done fallen," Bunk tells Omar. He means how far the Black folk of Baltimore, where they both grew up, have fallen. What a bankrupt, degenerate, decadent world they have created. Later, Omar decides to aid Bunk in an investigation, arranging for the return to the Baltimore Police Department a police gun, and that costs Omar considerably, and he is told, "Conscience do cost." The police gun was important to the chiefs of the BPD, as it was a symbol--a police gun should never be captured. Omar shakes his head, just as Rhett Butler did, angry with himself for doing the foolish, right thing.
In each case, the right thing, the righteous thing was ridiculous, the empty ideal of a power structure which was sanctimonious, beyond misguided to delusional. But still...there was something noble about fighting for a lost cause, stupid as it might be.
There is another story, likely apocryphal, about Lenny Moore, the wonderful football player, who won a scholarship to Penn State, and one day in class a professor asked him a question and Moore just stared at him. "Uh, Mr. Moore," the professor said, "I asked you a question."
"My name is Lenny Moore," he replied. "I don't answer no questions. I just carry the ball."
Of course, what Moore was saying is that he was at Penn State as an employee of the athletic department, and he was being paid to play football. He might be required to attend class, but that was just a ruse, a lie to make the big hoo-ha's in the college administration feel righteous, as they talked about "student athletes." Student athletes, of course did not have to be paid. Moore would get his financial reward in the pros, and Penn State was a farm team for the pros.
Another story: the Phantom was driving to work listening to NPR when a story about a medical student came across. This student was first in his class at the Mount Sinai Medical School in New York City and the Dean of the medical school called him into his office. "I see you've applied to a residency program in Florida, at a community hospital. You could match for Mass General, Columbia, or Stanford, any of the best programs in the country, and you are applying for a community hospital which has nothing to recommend it beyond the fact it's accredited? Why?"
"If I did my residency at those big name programs, I'd spend three years doing their scut work and then another two working for their professors on their research papers. For what? I am going to Florida, where I'm going to learn to do colonoscopies, and every day by three o'clock, I'll be on my boat, living the life, making more money than any of those professors."
The Phantom nearly drove off the road.
Years earlier, the Phantom walked into the office of the Chief of Medicine at Cornell, with an application for the dermatology program at NYU. The Phantom had done a 6 week elective at NYU because the Cornell New York Hospital had no dermatology department and the NYU program was known to be the best in the city, and the Phantom loved it. All the little surgeries, learning how to make "Augenblick" diagnoses (in the blink of an eye.) The NYU department had an in patient service for people with the most severe conditions, like bullous pemphigus, not that there was anything much you could do for them, but still. The staff was warm and welcoming and Derm was fun.
"You've spent four years learning how to treat the very sickest patients," the Chief said. The Chief was a hematologist and he had patients with leukemia on his service. "You've learned how to rescue a septic leuk in the middle of the night. You've been on the cardiac team. One night, when you were alone, you rescued a seventy year old man who went into florid pulmonary edema, who was bubbling froth from his mouth, and you did that with just a nurse and a vacuum bottle, all by yourself. And now you want to go into dermatology?"
He made that word sound almost obscene.
"There's a reason The New York Hospital-Cornell Medical Center does not have a department of dermatology," the Chief said. "It's not really medicine. It's dentistry with stethoscopes and you don't even really need the stethoscope."
The Phantom slunk out of the office, the application to the derm program balled up in his hand.
But, twenty years later the Phantom looks at the salary schedules for the various specialties: Dermatologists come in around $500,000 annually, but rheumatology, neurology, endocrinology, all those honorable specialties where the sick patients go, about half that.
The most competitive specialties are now Dermatology, Ophthalmology, Anesthesiology and Radiology. And radiologists, except for the invasive radiologists, never even lay a hand on a patients; often they never even see the patients. But those specialties are called "the ROAD" (the first letters of their names) to happiness.
The fact is, the four years of medical school is likely a sham as well. The Brits send their doctors to medical school right out of high school. And most of what has been done only by doctors is now done by nurse practitioners and physicians assistants. They do not do internships or residencies; they learn on the job as apprentices.
Big healthcare systems like Hospital Corporation of America hire nurse "endocrinologists" who have never done an endocrine fellowship or even a medical residency, much less gone to medical school. What they are saying is you don't need to know the molecular biology of diabetes to prescribe insulin. The whole long trudge to board certification for a variety of specialties was just a guild's efforts at throwing up a gauntlet to restrict supply of providers.
When the money managers take over, there is no sentiment about saving lives; it's all cost/benefit and if you miss a diagnosis here and there, or render the wrong care, and there's a lawsuit, well, that's just the price of doing business.
And now "student athletes" are recognized as what they have truly always been--employees of the colleges, and they are paid accordingly and may even soon be allowed to unionize.
Our American system is a commercial system, operating on capitalistic for profit principles, even at the nominally "non profit" academic hospitals. If a hospital is making profit in the emergency room, the radiology department but losing money supporting community practices in neurology, rheumatology, diabetes, it will and by the rules of the American game, it should cut the loss leaders and focus on the profit centers. The executives in their thousands are not bad people; they are doing the jobs they were hired to do: make a profit for the corporation.
They are not hired by the community, but by the corporation. Until the community, i.e. the government decides to get in the business of healthcare, the business of healthcare will be to maximize profit for some profit center, whether that's Partners or Hospital Corporation of America or United Healthcare Insurance Company.
It's a choice the American public has consistently made, even if it doesn't know it's made that choice. When Bernie Sanders rails about profit poisoning health care, about the need for Medicare for all, citizens think to themselves, "That'll cost me more," and they vote against him.
The financial realities are now being faced. Doctors incurring debt to go to medical school cannot afford to be seduced by the myth they are doing something heroic, no matter what you see on "ER" or "The Pitt," or "General Hospital."
There is no glory. There is just commerce, transactions and deals.
There are no backward glances for Rhett Butler, no welling up of shame for Omar.
It's all the art of the deal.
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