2 February 1996

Theatres of cruelty

On television medical dramas

At the beginning of the first, ambulance-chasing episode of Blues and Twos (ITV), a documentary series about the emergency services, a male voice intones: “Everything you are about to see is real.” The good idealist chuckles in the face of such an extravagant claim; so should the good television audience. The ways in which documentary films are artificial and selective need no rehearsing. But in order to explore the phenomenon of medical programming – which at present occupies more than six hours per week of the prime-time British schedules – we might, temporarily, accept that naïvely realist boast. For this will furnish a tool for unmasking the comparable, but inexplicit – and perhaps more pernicious – claims made by the current slew of medical drama series.

In part, Blues and Twos has borrowed the flashy threads of its fictive cousins. Here, for instance, is the identikit music: the unearthly microtonal melody of a siren cudgelling the composer’s harmonic ambitions (such as they might have been) into the minimalist shape of a visceral four-square riff. Here, too, are the introductions to the dramatis personae: “leading ambulanceman Stevie Watkins, and his partner, paramedic Stuart Murdoch”. Here is the mixture of unsettling catastrophe (a woman suffers a heart attack and dies) and light relief (a 12-year-old boy has drunk himself stupid on lager), in the mini-stories of the patients. Here is the pre-advertisement cliffhanger, and the final tying-up of loose ends: the stitching-up of the therapeutically violated body of “reality”.

But tune in to ER (C4), a gripping, witty US drama series set in the emergency room of a busy metropolitan hospital, and some differences are immediately obvious. The construction of naturalism through restless photography has become a stylistic trope in America since NYPD Blue, a police series which began three years ago. That programme uses a jerky, hand-held camera; ER, by contrast, makes the most extensive use yet, for a television series, of Steadicam technology’s smooth kineticism. This is to make up for the fact that the action of ER is mostly locked up in one building, and so lacks the topographic momentum of a detective investigation. The camera whizzes through corridors, latching on to handy passing extras, and swoops vertiginously around the operating table, like a circumspect vulture. Since the cameraman in Blues and Twos shoots an ordinarily steady picture, this syndrome in ER looks not like an attempt to dissolve a fourth wall (for television has never had one), but like a judicious admission of one part of the medium’s artificiality, in order to deflect our suspicion from the rest of the naturalist edifice.

Such dramas also have to treat differently the recondite technicalities of medical language. In Blues and Twos, there is an explanatory voiceover: when an elderly lady is diagnosed with complete heartblock, we are reassured that “Complete heartblock means that Margaret’s heart is too slow to pump the blood round her body”. Similar glosses are on hand in Great Ormond Street (BBC1), a saccharine “real-life” series that films operations on children, and 999 (BBC1), whose remit is sensationalist “dramatic reconstructions” of actual emergencies. ER, on the other hand, revels smartly in the epistemic asymmetry that is fundamental to the practice of medicine. It is essential that doctors and nurses know what “Chem seven… Cross stable six five… He needs a peritoneal lavage” means; it is not essential that patients know, and it is even desirable that they should not, if they are conscious and inclined to argument. Whereas, in Blues and Twos, the real doctors occasionally speak with basic human woolliness – “Is he much the same, conscious-level-wise?” – the ER doctors create a sense of dramatic urgency through a precise use of (apparently very accurate) jargon. ER thus relieves us from the burden of comprehension, instead inviting us to marvel at the jagged beauty of these phonemes, and the mysterious way in which they translate into bloody physicality.

If medical vocabulary, then, shares with liturgy such characteristics as exclusivity and a tendency towards the perlocutionary (a diagnosis, like a blessing, is brought into existence by being uttered), we should not be surprised. For hospitals to some degree are the churches of modernity. They are now those places where individuals from all classes and walks of life gather together, united by fear of death and hope of salvation. Not for nothing did Philip Larkin, in “The Building”, paint a hospital with specifically hieratic tones, calling the patients “congregations”. That word is built from grex, the Latin for flock, and it is precisely a blind, sheep-like trust which we are enjoined to have for our doctors, as we were for our priests.

The long-running British medical drama, Casualty (BBC1), draws heavily on this idea. Unlike ER, where patients are for most of the time unconscious slabs of flesh, in Casualty they are for most of the time awake. What are they doing? Confessing. It is language that is salvation’s vehicle, and that is no new idea. The link between moral discussion and medicine stretches back at least as far as Epicurus. The student of Epicurean philosophy, submitting himself to the purgative arguments of his teacher, needed first to confess the false beliefs with which he was diseased. Similarly, telling one’s sins to one’s priest is necessary for expiation. And similarly, a conscious patient must tell a story about her symptoms to her doctor.

In Casualty, patients do not only confess to their doctors, however; they enjoy teary bed-side epiphanies with relatives and friends. One recent episode was about a girl named Aisha, whose brother Zaf shoved a broken bottle in her face because he had seen photographs of her, naked, in a soft-porn magazine. She had posed for the pictures because she needed the money for an abortion. Aisha at first kept quiet in front of her doctors, but then Zaf appeared, prowling around in a leather jacket (such vestments always identify the villain), insisting on taking her home. Eventually, everything came to light, and in a risibly unconvincing volte-face Zaf was made to recognise, sobbing, the enormity of his crime, by gazing at his sister’s lacerated cheeks. “You’re ill. You need help,” said a disgusted hospital porter. “Doesn’t everyone?” asked Zaf.

This, in fact, is the consistent argument of Casualty: that disease and injury are not accidents but the wages of social disharmony. Humanity’s moral sickness cannot but be instantiated in physical aberration. This is no less than a secular version of the religious argument, that physical suffering is a punishment inflicted by God upon the wicked. It is a sociological expansion of the notions of, for instance, Mary Baker Eddy, the founder of Christian Science: “Disease is an image of thought externalized… It is fear made manifest upon the body.” It is significant that, of all medical programmes, Casualty has the best title music. It is the only tune with a sense of narrative: the resolution of a yearning dominant chord is postponed several times, and a syncopated cello theme is elaborated by ever more agonistic counterpoint. Casualty tries to live up to the teleological promise of this music, by bolting moral narrative onto accident; but the drama is never more than schematic. See the construction worker, who gambles away his family’s housekeeping; one day in the JCB, he hears his horse lose on the radio, and crushes his colleague with a chunk of concrete. See, too, the alcoholic advertising man, brought to his senses only when his girlfriend vomits blood after a binge. Such are the penalties of gambling and drink.

Precisely insofar as it is like a church, then, the hospital is an obvious and facile choice of milieu for the programme-maker, providing as it does a ready-made social panorama. Outside-broadcast costs are low, because the wounded and sick come to the hospital, and not vice-versa. But hospitals are not exactly churches. For one thing, it is a function of religion to uphold moral absolutism: Thou shalt not kill, whatever the circumstances. But clearly, you cannot be a moral absolutist about the business of cutting into bodies: people on the street armed with machetes should not do it, but doctors on occasion must. They should even enjoy it: as one surgeon remarks in ER, “Gimme a good sick body, needs a little slicing, and I’m a happy man.” It is this kind of Galgenhumor, this impiety about bodies (most thoroughly explored in the extremely cynical BBC2 series, Cardiac Arrest), which differentiates the doctor from his priestly colleague.

Indeed, television glories in doing extraordinary things with bodies: they can gush arterial blood (“Whoah! I gotta pumper!”); they can convulse with electric shocks (“Clear!”); they can be ashen or livid; they can be primly intubated, or roughly carved open (“I’m in!”), disclosing their pink, meaty secrets. At the beginning of The Vet (BBC1), a series about a rural veterinarian practice, comes the disclaimer: “We’d like to assure you that no animals were harmed during the making of this programme.” Such an admission on the part of a hospital show would be a turn-off. The audience does not want to be reminded that the gore is counterfeit.

But, despite the best efforts of the special-effects technicians, medical drama cannot show us those things which are ostensibly at the heart of its subject. Television cannot show us disease, for disease is invisible. Television cannot show us death, for death looks much like mere unconsciousness: it must be intimated by the laconic green line of an electrocardiograph, and declared by a doctor. Wittgenstein was right to say: “Death is not an event in life”; all television can do is show us death as an event in the lives of others. Sometimes the others are families, but usually they are the doctors themselves, who have occasion either to shrug or to weep over the deaths on which they have attended. Non-predeterminist religion offers salvation to all, but medicine grapples with triage: the allocation of resources to the most needy. A seven-year-old shooting victim in ER is abandoned when the unsentimental chief resident snaps: “There’s a fourteen-year-old we can save”. By contrast, another episode of ER examines the soiled heroism of Dr Green, who misdiagnoses a pregnant woman and then chooses to perform an emergency Caesarean when obstetrics are too busy to help. She dies, but we stay on the side of the stricken living.

How should we sympathize with, or aspire to be, such screen doctors? They may, in ER, be unfeasibly good-looking; they may, in Casualty, be sensitive and wise; they may even, in the silly Call Red (ITV), fly around in glamorously scarlet helicopters. They may all have interesting sex-lives and enticing career-paths: it is these which make up the overarching impetus for every series. But most of us cannot imagine having to make such highly specialized choices about other people’s lives, and most of us would not want to shoulder that responsibility. And this is where one begins to recognize the real attraction of medical drama. The genre is usually criticized for its voyeuristic exploitation of our fears of death and sickness, but in portraying doctors (mostly) as akin to gods in their expertise and care it, if anything, palliates those fears. On the contrary, if such are the doctors, we want to be the patients.

Medical dramas seduce us into thinking thus by refusing to draw a picture of disease or trauma in the context of a lived life. No individual case ever extends beyond the end of a particular episode. There is no televisual interest in months of aftercare. A patient is either cured, happily, or dies an illusory death, a useful catharsis for others. Not for ER or Casualty the brutal glimpses into the future offered by Blues and Twos: of a resuscitated heart-attack case, we are told: “Sadly, three months later, Margaret died from cancer.” Medical drama shows us only the ecstasy of sickness: a place where the sedated mind is freed from the demands of the body, where the luxurious burden of personhood is entrusted to another. (A patient, after all, is the opposite of an agent.) In an age of libertarian politics, medical drama temptingly says: “Forget the existential fear of infinite choice and the demands of personal conscience; here is a blissful dream of absolute irresponsibility.”