Sunday, May 31, 2009

Don't Make a Scene: The Hospital

The Story: It must have been Hell to live with Paddy Chayefsky. You look at movies like "Network" and "The Hospital" with their "No Dolby/No Squelch" dialog and think "Did this guy ever patiently reason with the madness" or, like his movie scripts, did he just go around snuffing candles in the dark?

...with merely the Wind of his Righteous Invective.

"Dear me. What an outburst."

This scene is relatively calm. But it still seethes.

By now, thanks to TV, we've gotten used to Big Corridor Conversations, laced with arcanic medical jargon that would choke Dr. Kildare, delivered with a furrowed brow (to disguise the poor actor's panic), but "The Hospital" was something else back in the day. It's Oscar-winning script was full of vituperative denunciations, a steady drip of medical terminology, and a turbulent social satire on a medical system that could simultaneously perform miracles by design and murder by bureaucracy. It could be seen as a cry for medical reform...what?...nearly forty years ago? (Let's say that again...FORTY years ago) It was also taking advantage of grittier depictions of surgical life (thanks to Robert Altman's "M*A*S*H") by showing bloody gowns and open chests.

And hospital humor that was, well...sick.

But in 1971, this was hip and happening and now, baby—which sounds like some of the dialog from this movie. Try as Chayefsky might, he did not have a good grasp of youth culture.

Neither did George C. Scott, who was Oscar-nominated for this performance (not that it mattered to him). He has two other speeches in this scenario...another Corr-Con that ends with a ferocious "I mean...where do you train your nurses, Mrs. Christie—Dachau?!!" and a somewhat embarrassing monologue equating medical impotence with male menopause...but Scott makes it work and work brilliantly. He could be counted on to make the material better than it is.

But this is a great scene with a great point and some poignancy for the continuing factory-like nature of most modern hospitals and their co-pay-conspirators, the insurance companies. You say you want a revolution? We'd all love to see the plan.

The Set-Up:
It's been a bad day for Dr. Howard Bock (George C. Scott), Chief of Medicine at a Manhattan teaching hospital. He's down a member of his staff. Seems a temp nurse mistook him for a patient and killed him. That's bad. He's also depressed and going through a messy divorce. That's bad. He's not exactly the go-to guy for advice, but Dr. Brubaker (Robert Walden) has an ethical and procedural question for Bock. His timing could be better.

Brubaker: We've got a little thing here, Doctor.

Brubaker: The girl over there is the daughter of the patient in room 806. He is at the moment comatose and requires intravenous feeding and meds. The thing is the daughter wants to take the father out of the hospital and back to Mexico where they live.

Brubaker: The patient's name is Drummond. He's apparently some Methodist missionary and he and his daughter run...

Brubaker:...some kind of religious mission among the Apache Indians. The daughter claims to be a licensed nurse, she can give the necessary IV's and treatment. I certainly don't think he should be let out of the hospital. The attending, the guy in brown over there, concurs.

Dr. Bock: Now, wait a minute, uh, let me have all of that again now.

Brubaker: As a matter of fact, Doc, this is Dr. Beigelman's case.
Bock: Never mind the professional ethics. What happened?
Brubaker: (Brubaker sighs) I don't know why I'm covering up for that son of a bitch in Farkis Pavilion anyway. The patient, a man of 56, was admitted to the hospital 10 days ago in good health for a check-up. No visible distress. We did the mandatory work-up on him: Blood cultures, stools, LE preps, chest EKG—all negative. However, there was some evidence of protein in his urine. I don't know how that son of a bitch in Farkis Pavilion found out about it. Maybe he had one of, uh, a deal with one of the girls in the lab. Anyway...

Brubaker: ...he turned up the next day, conned the patient into signing an authorization for a biopsy.

Bock: (Bock holds up hand) What...son of a bitch in Farkis Pavilion?
Brubaker: Some post-grad guy named Ives, sir. Elroy Ives. I never met him. He's on one of the immunology research programs.

Bock: You tryin' to tell me some post-grad fella came up here and did a biopsy on the patient?
Brubaker: Yes, sir. He conned Biegelman with that old story about...
Bock: Protein in the urine.
Brubaker: Yes, sir!
Bock: And he biopsied the man?

Brubaker: And he knicked a vessel in it (Bock reacts) At two in the morning, they woke up Biegelman 'cause the nurse found the patient in shock. Biegelman called the kidney people for a consult right away. W...what was there to see? The patient was sour and bleeding. We spoke to this fellow, Sutcliffe, he referred us to a surgeon named Welbeck.

Bock: Welbeck! That barber?
Brubaker: You ain't heard nothing yet. We finally got Welbeck around four in the morning. He said go ahead, so they laid down the surgery for 8. Welbeck shows up half-stoned, orders up an IVP, clears him for allergies...
Bock: Without actually testing...
Brubaker: Right.
Bock: And the patient went into shock.
Brubaker: And tubular necrosis. They lopped out the bleeding kidney, ran him back to the room, we sat around waiting for urine. Fever began spiking like hell, uremia, vomiting. So we arranged hemodialysis. Well, he's putting out good water now. But some nurse goofed on his last treatment.

Brubaker: A shunt separated, something. Blood pressure plunged. They ran him up to ICU, gave him two units of whole blood, all vital signs are normal now, except he's comatose. That was two days ago.

Bock: In short, a man comes into his hospital in perfect health. And in the space of one week, we chop out one kidney, damage another, reduce him to coma and damn near kill him.

Brubaker: Yes, sir.

(Bock chuckles acidly)

Bock: You know, Brubaker. Last night I sat in my hotel room... reviewing the shambles of my life...and contemplating suicide. I said "No, Bock. No, don't do it. You're a doctor, you're a healer."

Bock: "You are the Chief of Medicine at one of the great hospitals of the world."

Bock: "You are a necessary person. Your life is meaningful." (Brubaker stifles an uncomfortable laugh)

Bock: Then, I walk in here today, and I find out that one of my doctors was killed by a couple of nurses who mistook him for a patient because he screwed a technician from the Nephrology Lab...

Brubaker: Hematologist...

Bock: ...And then you come to me with this Gothic horror story in which the entire machinery of modern medicine has apparently conspired to murder one lousy patient.

Bock: Now how am I to sustain my feeling of meaningfulness in the face of this?(Brubaker laughs uncomfortably) I'll tell you something, Brubaker. If there were an oven around here....

Bock: ...I'd stick my head in it.

Bock: Now, what was the name of that son of a bitch in Farkis Pavilion again?
Brubaker: Ives, sir. Elroy Ives.

Brubaker: Somebody oughta ream his ass.

Bock: I'm going to ream his ass. I'm gonna break that Welbeck's back. I'll defrock those two cannibals, they will never again practice in this hospital, I'll tell you that.

Brubaker: What do I tell the girl, sir? She says we have no legal right to stop from taking her father out. She's willing to sign an AOR form.

Bock: Let him go...

Bock: ...before we kill him.

Brubaker holds his head.

"The Hospital"

Words by Paddy Chayefsky

Pictures by Victor J. Kemper and Arthur Hiller

"The Hospital" is available on DVD from MGM Home Entertainment.

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