The Patient's Dilemma

Mr Uncle Harry, a man of strong health all his life, recently had to undergo his first operation. His family physician, old Dr. Killifer, recommended a young surgeon by the name of Street. Uncle Harry said he’d never heard of him: who was he? Dr. Killifer recited Dr. Street’s surgical history. Uncle Harry remained unconvinced that Dr. Street was the man to touch his body with a knife. He said of course he’d take Dr. Killifer’s word for Dr. Street’s professional reputation: what he wanted to know was who his people were. So Dr. Killifer mentioned the name of Dr. Street’s mother; Uncle Harry looked him up in the Social Register, and marched docilely off to the hospital, his mind at rest.

This strange little incident got me wondering once more about a question which has puzzled me for years, a question only obliquely related to Uncle Harry’s curious dilemma, but still closely enough to remind me of it. The question is this: —

Why should certain members of the medical profession get all the gravy, and others nothing but a lick at the ladle? Or, to put it differently, why should certain parts of the human body be set apart as preferred stock, bringing wealth, prestige, and honor to those who have chosen them for exploitation, and certain other bits bring only a meagre reward? Why, for instance, should the man who makes it his life’s work to remove that unspeakably unattractive bit of tissue called the tonsil be invited to dinner at the bishop’s, and he who does the same thing for teeth be forever barred from such delights?

Nobody really knows the whole answer; nobody even talks about it. As in every profession, caste distinctions are rigidly maintained — and of course it is important to the medicos that they should be. Doctors have their living to make; they have social aspirations like other men; and naturally, when the time comes to choose a specialty, they like to know in advance what is pay dirt and what is n’t. The barrier that divides dentist and tonsillectomist is as if ordained by law. Though tooth and tonsil are separated only by millimetres as the crow flies, and though they are equally important to their owner’s health, the crow is n’t hatched who can flap across the abyss of caste that divides them. And we, the beneficiaries aud victims, — the surgeon’s raw material, so to speak, — are so beguiled by his professional hocuspocus that we meekly follow his lead, highhatting dentists to right and left as we go.

Not that the oral cavity, as the boys call the mouth, is the only region where such distinctions prevail — far from it. The entire body has been surveyed and staked out. The chiropodist (whom I always like to think of as chiroping at his work), lulling the agony of your ingrowing toenail, is snooted by him who props up the fallen arch of the self-same foot. Is one a greater benefactor than the other? I doubt it. Similarly the man in black who ministers to tortured souls may do more good than his brother in white who removes wens from tortured noses, but it hasn’t ever been proved — not yet. Each in his way may change the current of a human soul, bring peace and happiness where chaos reigned before. Yet the minister is welcomed on board with scarcely a glance at his passport, while the dermatologist is regularly thrown out at first base.

Nobody can deny that the obstetrician performs a useful office. Yet there is another who is just as necessary, who is in fact society’s one indispensable servant, the man nobody knows, but nevertheless the man nobody escapes: the obsequician. He performs practically the same function at the end of life’s journey as the obstetrician does at the beginning. He smells of death, it is true, not new life, which is reason enough for not wanting him around. But should the one be welcomed with open arms, the other shunned? Though the function of each is slightly mysterious, as functions go, it is hard to believe, with all the practice both have had, that the art of the one is very much harder than that of the other, or should be so much more richly rewarded.

What then, to repeat my original question, is the professional snob-value of the various muscles, organs, bones, vessels, appendices, and tissues of the human body? Why do certain bits have a higher market value and carry greater social prestige than others equally unpleasant? Why are the tonsil and the brain in, the skin and teeth out, the osteologist received and the osteopath ostracized, the chiropractor beyond the pale and the dermatologist only just within? Whence these distinctions? Why should the pectoral region, the abdomen, the joints, the earnose-and-throat, the eye, the spine, be considered socially impeccable, and the teeth, the skin, the hair, the toes, and the corpse déclassés? Is it the difference between dead and living tissue that forms the dividing line? It can’t be entirely that. My teeth are still alive— some of them. Or is it a mere matter of custom? Or fear?

Partly fear, maybe, but not wholly. Take the brain surgeon. Have you ever seen a brain surgeon smile? Of course not. He can’t afford to. He moves in a rarefied air, a cold, lonely stratosphere of professional fame so potent that the laity regard him with awe — in the same way, in fact, that savages look upon their leading medicine men. But nobody is afraid of a brain surgeon. He is merely set apart as something extra-special, and propitiated — as the tribal medicine men are propitiated — by the richest gifts the community has to offer: Lincoln limousines, boxes at the opera, club memberships, invitations to the dullest dinners in the city. It’s a tribute to his courage and skill in monkeying with the most delicate part of the human mechanism, and he probably rates every bit of it.

People are much more scared of psychiatrists, who also tinker with men’s minds — but with a difference, resembling rather the average man’s fear of clergymen. We tend to keep both of them outside the circle of our intimacy because we’re afraid, not that they’ll bite, but that we’ll give ourselves away.

As a class, though, surgeons really get more credit than they earn. What is a surgeon? Nothing but a glorified mechanic. Like his mate in the garage, he makes repairs with tools. He performs his operation; successful or not, he’s done. It’s the physician who then takes charge and pulls the patient through. But consider the difference in prestige between surgeon and physician: the surgeon gets it every time, I suppose because the popular imagination is captured by the dramatic setting of his art — the gowned figures, the mumbo jumbo of sterility, the sacred, secret operating chamber, the silence, the concentrated lights, the vestal virgins handing knives; to the uninitiated it is all as mysterious as a religious rite. The surgeon profits in proportion, although the humdrum doctor, upon whose diagnosis the surgeon generally acts, may save twice as many lives by the use of simple wisdom and knowledge. In a just world the diagnostician ought to get the wishbone and both oysters, leaving the drumstick to the mere mechanic, skillful though he may be.

I suppose the reason such things are n’t talked about is that nobody knows when he himself may be stretched out on an operating table with a mortally offended surgeon, knife in hand, hovering over his gizzard; or cowering beneath the drill of a dentist who bears him something less than good will. Not my own dentist! My dentist is the salt of the earth, exquisitely skilled in his profession. La spite of all taboos, he is my frieiad and I love him. But — but — well, I have an appointment for next week, and I think it will be a little more comfortable if these observations remain strictly

ANONYMOUS