The Chief of Medicine
Genre: Short Story
- Aull, Felice
- Date of entry: Mar-10-1998
A woman medical student finds herself in a hierarchical dilemma while rotating through her internal medicine clerkship. She is helping to take care of a middle-aged man who has been hospitalized for a diagnostic work-up. As a consequence of invasive procedures ordered by his physicians to determine the cause of his symptoms, the patient has suffered serious complications and is moribund. The doctors are evasive with the patient and his family, who beseech the medical student for an explanation. Even though she has been instructed by the physicians to refer all issues back to them, she follows her own convictions and tells the truth: "Your father is dying."
As a result of this "insubordination," she is called in to see the head of the department, a man of "legendary diagnostic skill" with a long tenure at the hospital. He says that he will have her dismissed, and launches into a long diatribe, making the case for a paternalistic medicine in which the patient needs to believe that the physician is omniscient and possesses quasi-magical healing powers. "Miracle, mystery, and authority," he says, are at the heart of what physicians can do for their patients and to undermine these is to do harm to the vast majority of the sick. Having made his point, he terminates the interview but reinstates the student, who, it is suggested, is so grateful (for his advice or for not being dismissed?) that she kisses him.
Hastings Center Report, July-August, 1991
The Hastings Center
Briarcliff Manor, N.Y.
This provocative piece may disturb and dismay, as it forces consideration of a number of issues in medical education and medical practice. The "story" centers on the priestly role assumed by the physician in the eyes of many patients. Brody seems to argue that in the move to empower patients, this primeval need is being neglected, to the detriment of those who are ill. At the same time he mocks some of the manifestations of this medical paternalism. Also at issue are the medical hierarchy, student responsibility, and the moral obligations of medical professionals.
In a communication to this annotator (12/18/97), author Howard Brody points out that the essay was very deliberately planned as a parody/imitation of "The Grand Inquisitor" chapter from The Brothers Karamozov by Fyodor Dostoevsky, from which "miracle, mystery, authority" is a direct quote. The medical student fills the role of the Christ figure in the Dostoevsky story. In the Christ motif,the kiss would be interpreted as forgiveness; but the intent of the scene in the story is deliberately to keep it ambiguous.