There is a group portrait of George V lying in his death bed in a gigantic bed and a beautiful quilt surrounded by clergy, doctors, politicians and family waiting for him to expire. Many of the people in the room are identifiable so as to document who were present at the event. All they did was to stand around and wait for the end, one of those in attendance to go up to the King and confirm him as having died. What was also worth noting at the time, which was 1936 and when Great Britain was one of the most advanced of medical science, was that there were no machines to intervene between the patient and the audience, when some fifteen or twenty years later there were oxygen masks and monitors that provided vital signs and beeping noises to accompany a patient who was in the process of dying. A clergyman was there at the earlier moment so as to give a benediction, while the clergyman in “M*A*S*H*” is perfunctory, given aside by the doctors laboring on the wounded and justified by his other services as someone who aid comfort to the stricken for as much time as can be spared from the more important duties. The painting of George V showed the state of the relation between his doctors and his death and how much things had changed by a generation later. I am interested in the nature of the patient at the time and whether the role of the patient has changed since that time to the present. My evidence is drawn from that time, the film “Dark Victory” appearing in 1938, a fiction able to convey what are the facts of social relations regarded as inevitable at the time, just as present day fiction attests to the fact that everyone can hook up on their i-phones while earlier generations had to rely on telephone calls, as in “Sorry, Wrong Number” as a fact that could become a gimmick in a melodrama. What, if anything, changed in being a patient since the Thirties, which are now eighty years away?
Bette Davis, who was producing every year a weepy movie that penetrated into real social issues, was the hedonistic modern woman in “Dark Victory” and the film was based on one of those well crafted plays that prevailed at the time by playwrights such as George S. Kauffman and Lillian Hellman. What those plays meant, aside from snappy dialogue that quickly identified the people of the play, was a clear arc whereby there is a first act that sets up the situation, which reveals the ordinary life of a family, a second act that presents a crisis in a family that has reverberations far beyond the family, as is the case with Hellman’s “Watch on the Rhine” and “The Little Foxes”, where Hellman dealt respectively with Naziism and capitalism, and a third act where matters are resolved in a way that the audience finds surprising and liberating, where “Watch on the Rhine” shows that covering up murder is the morally correct thing to do. “Dark Victory” is not as wellmade, but it shows a good time girl finding herself terribly ill and fatally doomed to gains character when she becomes in the shadow of death and so becomes noble as she moves to her demise, a kind of redemption that is available to everyone who must, sooner or later, meet that fate, and is sso like an adventure, something like a courtship in that a person displays character in decisive moments, even if, in the case of death, the outcome is inevitable.
“Dark Victory” is not made as well as the other well made plays of the time, but it is useful this way: it is a primer of how to become a patient. The Bette Davis character is like a small child instructed by a not quite as small child to guide the character and, hence, the audience, to go through the stages of how to learn to be a patient. At first, Judy (the Davis character) denies that she has symptoms, and then she excuses them and then she hides them from friends and even her doctor. Then she feels desperate enough to respond to the doctor who soothingly calms her while making his diagnosis and persuades her to have an exploratory operation, where she also has to learn what it means to deal with being in a hospital. She is vain about having part of her hair shorn and doesn’t like the small room or the unflattering hospital dress, and then she learns that she has a terminal illness. What the story unfolds is that the patient becomes ever more reliant on her doctor rather than spurning her because what is offered to her as the future is very dire. She does not charge off to live her way the way she had previously but decides, instead, to endure or even in a way triumph over her illness by confronting it, perhaps because she becomes more reliant on her doctor the sicker she becomes, needing for help to deal with her role as she becomes ever more confined into that role as time progresses. As it is, movie star illnesses are not as wrenching as are the illnesses that really occur in life. Judy is not ravaged by pain or the inability to control her functions or doesn’t even look particularly bad as she deteriorates, the doctors saying she will be in health until just about the very end, and so she is allowed to flourish, to become the character that her illness had mde, a person strong and memorable and worth living, considerate of people, as she moves towards death, and so ironically overcoming death in a literary kind of way. What she mainly learns is how lonely and separate from humanity becomes her own course, trying to keep a good front to others so as not to betray the fact that she will soon be gone and therefore not to embarrass her friends and loved ones. He becomes brave because there is no choice because otherwise she would be a stick in the mud.
Has Judy or anyone else altered the course of becoming a patient since the Thirties? Yes, there are more machines and more knowledgeable clinicians in the course of the time from then to the present, but being a patient hasn’t changed. Consult the word itself. A patient is a person who endures, who deals with the slights and insults with as much good cheer as can be mustered, more subject to abiding by the desires of the healthy rather than raging or smoldering about their own condition. That is what happened when David Hume cloistered himself in his home, accompanied only by servants, when he learned that he was terminally ill, and the same is the case when elderly people go to hospices which can offer services whether at home or in a residence, so that they can be gussied up when visitors come to make their last respects. Everybody dies alone, rather than raging in the storm, in that it is a singular person who will cross the bar however much there may be people still saying soothing words at the moment of death. That, I can suppose, until such time as when there is a conquest of death itself.
There is, though, one aspect of the course towards death that is different from the time of the Thirties. Back then, it was usual to unacquainted people who were patients that they were soon to die or had a terminal illness. Judy, in “Dark Victory”, is caught in the dramatic irony that she is ignorant of her fate, and so cheerful if deluded, while her loved ones try not to be morose or to be burdened with their silence. In fact, terminal patients were even more isolated in that there was a chasm in their understanding and the understanding who were on to what was happening. Moreover, in my more modern view, terminal patients were treated as pathetic rather than tragic in that they should be shielded from the facts, no longer adults but like children, except that for all of us we are all like children in the face of death and so they might as well be sheltered for as long as possible. My mother insisted even as late as in the Eighties that my father was dying of cancer rather than just have a touch of diabetes, him saying that at least he did not have a really bad thing, which was his term for cancer, and she herself would not call cancer patients, though she was glad to have them call when she herself got cancer. I think the Eighties is when the change took place whereby people were regarded as adults in that there was an obligation to tell them their fates, however difficult it might be. That has become a new practice: the scene of the revelation of a terminal illness. A new young doctor told my wife, with some embarrassment, that she had a fatal cancer and she and I soothed the young woman about having had to disclose her news. Things get topsy turvy in a crisis, which also suggests that breaching the veil of ignorance does not do very much to alter the facts that the terminal patient is forever now separated from the rest of people. Doctors still refuse to speculate about how a life will end, because there is no certainty when it will come, Judy’s doctor giving far more detail about the facts of her demise than what was then or now possible.
Geoffrey Gorer was an anthropologist who published an essay in 1955 entitled “The Pornography of Death”. It was right on in that people are both fascinated and evasive in dealing with either one of these topics: death and sex. People engage in euphemisms, even when they try to be honest. Long advertisements to raise money for children who are patients at St. Judes Hospital and dealing with cancer are told that the doctors and staff will not rest until childhood cancer is conquered. I suppose that children are innocent and also don’t understand why they are suffering. But be a little less sentimental. Adults and old people need not regard cancer or other illnesses as necessary or unavoidable or somehow justifiable. Every death is a loss, a tragedy.
The best explanation of illness and death that I know of was offered by Talcott Parsons, the sociologist, in his “The Social System”, published in 1950. He thought of people who were ill as deviants. That meant that they were outside of ordinary life, and subject to being rejected by the normals, but given compassion by the wider society because of their frailties if they understood that they were supposed to do their best to become better or to become incurred to their suffering if that was inevitable. Ill people were even given a temporary pass in that they could stay home at work or remain even in bed until they regained their abilities to function. Parsons did not think, as Goffman did fifteen years later, that the ill might be permanently stigmatized by their medical deficiencies. Parsons was either a kinder person than Goffman, or else that dealing with illness had become more cruel for at least those marked with permanent disabilities. But this idea of the permanent disability is very long standing. Sophocles talks in Philoctetes of a wound so severe that it leads people to shun him and to try to recruit him back into humanity because of what the stigmatized person could do for them. I wonder why people would even want to be reclaimed by those who dealt with him so badly except that people are so needful of being within the human community, and so cling to it as long as they can even while they are descending into their ever more lonely fates and into their finally permanent darkness.