THE DOCTOR IN LITERATURE Volume 4. Gender and Sex Picture (Science and Charity, Picasso) SOLOMON POSEN i CONTENTS Introduction. 1 1. The female physician. 6 Irrational prejudices –ancient and modern. 6 Charles Reade’s women doctors. 9 Four negative stereotypes. 10 The competent Amazon. 11 “The pretty ones always marry young.” 18 Nostalgia for a “normal” family life. 24 Women doctors with non-medical partners. 28 The seductress with a medical degree. 30 The victim. 32 Contrasting stereotypes. 37 Favourable portrayals – successful and unsuccessful. 39 Contrasts between male and female shortcomings. Are women less dedicated? 48 Summary. 58 References – Chapter 1. 59 2. Doctors and nurses 78 Traditions and perceptions. 78 Genders. 79 Male nurses. 79 Healers and carers. 85 Nurses without doctors. 89 Curiosity and compassion. 92 Independent operators versus team members. 96 Flexibility and Rigidity. 98 Cynicism and Idealism. 101 Financial Status. Educational Background. 103 Summary. 107 References – Chapter 2. 108 ii 3. The nurse as the doctor’s subordinate. 116 Historical background. 116 Demarcation disputes. 118 The subservient nurse. 120 Do the nurses “deserve” their lowly status? 125 The stereotypes. 127 The sweet young thing. 127 Promotion of intelligent and competent nurses into non-nursing positions. 131 The middle-aged martinet. 132 Doctor-nurse confrontations. 133 Sick nurses. 142 How the “slaves” perceive their masters. 143 Bad doctor - good nurse. 144 The grandmotherly nurse. 147 The saintly nurse. 149 Summary. 150 References – Chapter 3. 151 4. The nurse as sex-object. 162 Historical background. 162 Opportunity. 164 The “Tree of Knowledge.” 165 Medical work as a sexual stimulant. 166 The nurse’s basic generosity. 169 Exceptional nurses. 178 Doctor-nurse marriages. 180 Summary. 182 References – Chapter 4. 182 5. Sexual fantasies and encounters: Boundaries and transgressions. 190 The physical examination and its sanitization. 190 Aberrations. 193 Doctors as lechers 194 Transient lapses. 199 Possible (but unproven) harassment. 202 Patient-initiated encounters. The Chaperone. 204 Faults on both sides? The doctor is always guilty. 215 Transgressing Female Doctors are Treated Leniently 218 iii Baseless claims and boasts. 220 Same sex transgressions. 221 Doctor-patient marriages. 222 “Le Docteur Herbeau” 224 The rarity of transgressions. 225 Summary. 225 References - Chapter 5. 226 Conclusions 237 Bibliography – Primary Sources 239 Bibliography – Selected Secondary Sources 258 Name Index 262 Subject Index 289 1 Introduction This book, the fourth and final volume of The Doctor in Literature, discusses the portrayal of gender and sex as these issues affect the doctor and medical pactice. As in the previous three volumes, data acquisition involved a number of sources. A search was made for suitable fictional works in bibliographies such as those provided by West and Kreuz, 1 Wilbanks, 2 Trautmann and Pollard 3 and Aull. 4 Works cited in anthologies 5-12 were used if considered appropriate. A perusal of the 4000 odd entries in Medline under “Medicine in Literature” and eclectic reading provided additional material so that the primary database came to consist of some 600 novels, short stories, poems and plays. The inclusion and exclusion criteria are the same as those employed in the previous 3 volumes. No distinction is made between fictional works portraying doctors and nurses as principal characters, and those that involve them in subsidiary plots. While efforts were made to include serious works, a lack of literary brilliance was not considered a criterion for exclusion. Similarly, no distinction was made between “best-sellers” and commercial failures. The included works therefore range in quality from the writings of Nobel Prize winners to material only just ahead of designated doctor-nurse romances (which were not generally used in this study), and from “blockbusters” to barely obtainable self-published material. Novels, plays and short stories not available in English have, with few exceptions, 13-15 been omitted. Criminal doctors such as Agatha Christie’s16 or Mignon Eberhart’s17 medical murderers were also excluded. No claims are made for completeness, and no statistical analyses were attempted. Throughout the book, emphasis is placed on the descriptions of doctors, nurses and patients, as they appear in works of fiction, with occasional comparisons between what is described in literature and what goes on in the real world. Semi-philosophical topics such as the definitions of “health” are not discussed. The medical histories of the authors, which may be reflected in their fictional works, do not form part of this work. 2 Some “Hippocratic” principles pervade the entire book. It is assumed that “proper” doctors observe, record, try to arrive at some sort of diagnosis, relieve the patients’ sufferings, and, above all, avoid doing harm. It concentrates on “genuine” physicians, who, unlike “alternative” practitioners, do not delude themselves or their patients into believing that “satisfaction is guaranteed.” Clinical skills, including the ability to communicate effectively, are considered desirable, while close personal contacts with patients, particularly sexual contacts, are not. With rare exceptions, no attempt is made to discuss what ought to have happened in particular situations, or how certain difficulties might have been avoided. The term “Healing” is used to encompass both cure and relief of symptoms. In Volumes 1 and 2 of this work, historical and geographic factors were largely ignored. Medical behavior patterns transcend national boundaries,18 and while treatments have changed over the years, twenty-first century doctors who ask their patients to disrobe behave exactly like their predecessor of 2400 years ago who says to his patient: “Take off your shirt and let me have a look at your chest.” 19 However the doctors described in Volumes 3 (“Career Choices”), and in the current volume, obviously function under conditions that differ profoundly from those of Classical, Medieval or Renaissance times. Women doctors, hospitals with their hierarchical structures and the modern nursing profession all date from the late 19th century. On a more trivial level, the institution of the boarding house, 20 which formed an important part of the lives of medical students in the early 20th century, 21-23 had virtually disappeared in Western countries 100 years later. There is therefore a greater attention to historical context in the later than in the earlier volumes of this work. Chapter 1 of the current volume discusses the fictional portrayal of women doctors, their behavior in clinical practice and their personal lives. There is particular emphasis on the the representation of stereotypes and the perception of differences between male and female physicians. The interaction between doctors (mostly male) and nurses (mostly female) occupies three chapters. Chapter 2 contrasts the traditions and attitudes of the two professions, Chapter 3 discusses the power structure, while Chapter 4 deals with the 3 nurse as a sex object. The last chapter of the book describes sexual fantasies and encounters, as these involve doctors and their patients. Three indices have been provided. The bibliography is based on authors’ names listed in alphabetical order. It enables the reader to find what part of a particular work is quoted, where to find the relevant material in the original work, and where to look it up in this book. For instance, the reader searching for works by Tennessee Williams will find that material from Summer and Smoke is quoted on page 203 of this book. The name index provides a list of fictional physicians, such as Scott Fitzgerald’s Richard Diver,24\ fictional nurses like Kafka’s “Leni”25 and fictional patients, like William Carlos Williams’ Jean Beicke,26 as well some indication where these characters appear in literature and where they are to be found in this book. The name index also contains place names such as Boston or Paris and names of institutions of higher learning where these are clearly identified. The subject index contains a list of medical diagnoses, aphorisms, such as Peter Goldsworthy’s “more comfortable in the operating room than in the consulting room”27 and other topics of potential interest to browsers. References - Introduction 1. West MC, Kreuz L (1940). The Doctor and Nurse in Fiction. Bull Med. Libr. Assoc. 28: 198–204. 2. Wilbanks ER (1958). The Physician in the American Novel, 1870-1955. Bull. Bibliog. 22:164-8. 3. Trautmann J, Pollard C (1982) Literature and Medicine: An Annotated Bibliography. University of Pittsburgh Press, Pittsburgh, 228 pp. 4. Aull F(ed) Literature, Arts and Medicine. Database at New York University School of Medicine, http://litmed.med.nyu.edu (last accessed August 3 2013). 5. Cole H (ed.) (1963) Under the Doctor. Heinemann, London, 301 pp. 6. Ceccio J (ed.) (1978) Medicine in Literature. Longmans, New York, 324 pp. 7. Cousins N (ed.) (1982) The Physician in Literature. Saunders, Philadelphia, PA, 477 pp. 4 8. Mukand J (ed.) (1990) Vital Lines. St Martin’s Press, New York, 426 pp. 9. Reynolds R and Stone J (eds.) (1991) On Doctoring: stories, poems, essays. Simon and Schuster, New York, 428 pp 10. Gordon R (ed.) (1993) The Literary Companion to Medicine. St Martin’s Press, New York, 1996, 431 pp. 11. Ballantyne J (ed.) (1995) Bedside Manners. Virgin, London, 266 pp. 12. Bamforth I. (ed.) (2003) The Body in the Library. Verso, London, 418 pp 13. Daudet L (1894) Les Morticoles. Fasquelle, Paris, 1956, 360 pp. (in French) 14. Duhamel G (1928) Les Sept Dernières Plaies. Mercure de France, Paris, 295 pp. (in French) 15. Ewerbeck B (1939) Angela Koldewey. Verlag Neues Volk, Berlin, 325 pp. (in German). 16. Kinnell H (2010) Agatha Christie’s Doctors. BMJ 341:1324-5. 17 Eberhart MG (1929) The Patient in Room 18. Heinemann, London, 1938, 328 pp. 18. Osler W (1906), Unity Peace and Concord. In: Osler W Aequanimitas, H K Lewis, London, 1920, pp. 447-465. 19. Plato (4th Century B.C.) Protagoras.