Jottings - Slice of life - 425 ( Coma - the movie, and a few thoughts on the moral dilemma of medicine, doctors, and hospitals)
One of my haunting cinematic memories is that of a large secure hall suffused with mellowed chromatic light, containing dozens of pale naked bodies of men and women suspended in mid-air on translucent pipes feeding oxygen, and a control panel adjacent to the bodies designed to regulate the homeostatic condition — flipping the blood flow this way or that, or increasing or decreasing the oxygenation levels — to keep the organism barely alive, and nothing more. This scene is from the movie Coma, released in 1978, and it is based on a wonderful 1977 book by Robin cook — a medical doctor turned novelist. I remember watching this movie in Coimbatore with family. We were warned that it is a disturbing film, and it definitely was. For several nights, the image of those floating bodies terrorized my dreams as a horror film would, but, little did I realize the tremendous significance and symbology of that stunning image then, and the utter helplessness it personified of those caught in a medical system that had somehow metamorphosed from a benign institution of healing to a commercial enterprise driven by avarice and financial gains.
The transformation of small homely clinics - with family doctors who attended to their local communities, to giant-sized hospital complexes in their sky-scraping glory with elaborate treatment processes orchestrated by minions of doctors and nurses — each attending to one part of the treatment - is largely a phenomenon that grew out of the two world wars of the twentieth century. It is also a consummation of Adam smith’s economic theory of division of labor to meet the increasing number of sick people. The art of personalized doctoring gave away to a mechanical understanding of the body in terms of causes and effects. Given a set of injuries, or disease, a regimen of treatment is started, and very soon impersonal voices and machines take over the care of the patient. The standardization of diagnostic procedures, the infiltration of technology into every aspect of medical science, the need to monetize every aspect of the treatment - has led to a state where the patient becomes a mere cog in the wheel, unaware of what is being done to them, and what the consequences are. The declaration signed before even the simplest of surgeries takes away all responsibility from the doctors themselves, and the patients are inexorably sucked into a system — the outcome of which is uncertain to all the stakeholders.
In Coma, a young lady doctor, Dr. Susan Wheeler - played brilliantly by the underrated Canadian actress Geneviève Bujold - is intrigued by a pattern she sees in the hospital she works in. Patients wheeled in for routine surgical procedures come out of it in a state of coma. Her fiancee Dr. Mark Bellows( played by the handsome young Michael Douglas), a doctor aspiring to the next chief resident of the hospital, downplays Susan’s concern, but she is persistent. When her close friend and colleague in the hospital goes into surgery for a routine abortion, she succumbs to the same fate. Susan’s doubt begin to solidify. It seemed inexplicable why patients are not showing any signs of distress during the surgery, but just that they fail to come out of anesthesia. And the anesthetist administering the dose is himself clueless on why this should happen? Susan attempts to get hold of the medical case files to study for any abnormality in the diagnostic numbers or the patient's medical history, but she runs into insurmountable bureaucracy and blatant male chauvinism even in accessing the files. The more the system pushes back, the more she is convinced something fishy is happening, which is quite not tangible or readily visible in the documentation. She informally consults with a couple of morticians to understand how a patient can be eased into a coma without any visible distress. They inadvertently give her a clue, and that sets Dr. Susan on a wild hunt along the underbelly of the medical system. Her tenacity brings her face to face with some of the worst truths of the medical practice, and the unfortunate price that helpless and vulnerable victims have to pay to keep such a system afloat.
It is the climax of this movie that stands out as one of the best. As Susan struggles to expose the corrupt system, Dr. Mark, Susan’s fiancee, in the middle of a sudden outburst by the chief of surgery Gr George Harris ( played by Richard Widmark), on a very inconsequential detail, suddenly realizes that Susan had been right all along. She had alerted mark to this possibility days ago, but he had ignored the caution thinking that Susan was becoming increasingly paranoid about the issue. But in that single moment of an unwarranted outburst by the senior-most doctor in the hospital, the pieces of the puzzle fall into place, and the story races to its conclusion. The last scene is a gem: Dr. Harris walks away from the operating table after a perfunctory procedure. He slowly removes his surgical gloves confident that his patient would not wake up and would slip into a coma with any suspicion, as all the others have in the past. As he basks in his glee, he is stopped in his tracks by the joyful cry from the anesthetist that the patient is regaining consciousness, and the pupils are dilating as it should. It is an unbelievable moment, and the sheer look of perplexity on the Doctor’s face says it all. Through the swinging glass doors of the operating room, we are shown a few policemen waiting outside. The game is over.
Coma was brilliantly directed by Michael Crichton - who was also a great novelist and scientific evangelist himself. Robin cook had published just one novel before Coma, and after this book, he continued to churn out medical thriller every other year. The success of Coma propelled him to worldwide fame. Of late, I have been revisiting a few old novels and their movie adaptations. It is interesting how as a reader, one's perspective changes over time, and we begin to see things we did not when we were young. Maturity is all about looking at life from different angles. It is only the exuberance of youth that makes one look at life as black or white. As we get older, we clearly see the layers of grey in-between, and we learn to acknowledge and embrace its presence.
In retrospect, Coma is not just about bad doctors doing bad things to good people. It is much more complicated than that. What I realize is that Medical science is no more an art form or a method of gentle spiritual healing. It is a hardcore science and a full-fledged industry - with all the jarring financial connotations of that term. While healing is one part of the job ( still an important one), the other part is to keep this enormous and complex machinery of the hospitals running smoothly. In this context, patients become occupants of beds, and the success of a hospital is measured in terms of occupancy, and the turn around time. Healing itself is a number game, and not emotional and spiritual wellbeing. If you are blood pressure and sugar are all “normal”, you should be OK; else, something is wrong. Tremendous advancements in medical science have made organ transplants possible, but again this boon can quickly turn into a curse if such transplants are administered to the highest bidder. When money takes priority over other vital things, then no matter how holy an institution maybe — it tends to get rusty, corrupted, and dilutes the moral fiber. The pandemic this year has exposed the preparedness and operational efficiency of the Medical facilities around the world. We hear and read of so many stories — so true, some apocryphal, and some definitely false. But we must realize that systems and institutions reflect our own choices. It is the law of life that we get what we deserve. It is also important to remember the doctors are human beings too, though their profession puts them on a higher pedestal. They are also driven by the same desires and goals that drive each one of us. Furthermore, medicine is not a complete science. It works in many cases, but there is definitely a fair degree of fallibility in it.
Atul Gawande, in his beautiful book “Complications: A Surgeon's Notes on an Imperfect Science,” writes:
“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”
Watching and reading Coma after three decades, I understand the full import of Dr. Gawande's observation.
God bless…
yours in mortality,
Bala
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