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The American health care system can be...


The American health care system can be as incomprehensible and as frustrating as the mysteries of mortality itself.

"The Doctor," the movie starring William Hurt, is based on the real-life experiences of Dr. Edward E. Rosenbaum, a Portland, Ore., physician whose bout with throat cancer showed him what it was like to be on the receiving end of the doctor-patient relationship.

Like many movies, this one takes liberties with the real-life story. William Hurt's character, Dr. Jack McKee, is a young surgeon, not a 70-year-old rheumatologist. Even so, the message is the same: When illness strikes, not even a medical degree or rank on a hospital staff makes one immune to the indignities of disease and the fear of death.

As a talented and respected surgeon, Dr. McKee tells the young physicians who train under him that the job of a surgeon is to be able to make quick, life-or-death judgments, a task that demands emotional detachment from the patient. His operations are accompanied by raucous music and risque banter.

For a while, he treats his persistent hoarseness with the same cocky attitude. As many physicians do, he relies for too long on informal advice from colleagues. When he does see a specialist, jTC she keeps him waiting, then greets him with the same offhand words he has used so often himself: "Sorry to keep you waiting; it's been a busy day."

That encounter begins Dr. McKee's transformation into Patient McKee, an infuriating process. He discovers that no list of credentials can spare him the paperwork, the endless waits and the occasional humiliating mix-ups -- such as a barium enema meant for the patient in an adjoining bed -- that can happen to any patient.

In this context, his surgeon's creed -- "get in, fix it, get out" -- begins to seem empty. The mechanical competence of doctors, which he knows is fallible, does little to speak to his feelings and his fears.

He begins to feel the helplessness and dependence that come from putting one's life in someone's else's hands. He knows that even if surgery successfully removes the tumor, his vocal cords -- his ability to speak -- could easily depend on something as unpredictable as how the surgeon was feeling that day.

Physicians have the awesome power to save a life, and dealing with that responsibility can sometimes blind them to their patients' hopes and fears.

Dr. McKee never paid much attention to the importance of

wielding that power gently and with compassion -- until he realized that he, too, had become just another patient who didn't want to die.

In a sense, "The Doctor" is the old story of walking a mile in someone else's shoes and being transformed by the experience. Dr. McKee never expected to know the tribulations of a patient with a life-threatening condition, but those unfamiliar shoes were not really someone else's. What he faced was reality: the fact that despite his ability to stave off death for others, he could not save his own life. Doctors are mortal, too.

One important aspect of this story is the way Dr. McKee's (and Dr. Rosenbaum's) loyalties moved from the medical "club" -- the mystique that doctors must protect each other -- to the patients who suffer the consequences when doctors place more importance on their relationship to their colleagues than on their loyalties to their patients.

"The Doctor" does a great service by pointing out some of the missing links in our medical system. It also shows us how one man, by facing his own mortality, became a better person.

Send your comments and questions about death and dying to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore, Md. 21278.

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