Five Patients in 50 Years: Revisiting the Speculations of Michael Crichton’S Medical School Nonfiction
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Five Patients in 50 years: Revisiting the speculations of Michael Crichton’s medical school nonfiction Tyler D. Barrett, MA, MPS Tyler Barrett is an Assessment Clinician at the Kaiser Permanente Washington Health Research Institute, Seattle, WA. “We’re talking about what the future is; no one knows what the future is!” – Michael Crichton, 20071 uthor Michael Crichton (1942-2008) crafted con- vincing stories of speculative science and tech- nology into Hollywood blockbusters and wide Acommercial success. Throughout his career, he leveraged his medical education to construct an identity as an au- thority on science. In merging facts and scientific processes with plausible speculation, he earned a reputation for fore- sight intermittently at odds with scientific accuracy. By December 1969, the 27-year-old Crichton had al- picture industry for film adaptation. Among them was ready written 10 novels, published mostly under pseud- The Andromeda Strain, which became a New York Times onyms from the 1960s to early 1970s. Three of the Best Seller. By his own admission, Crichton was enjoy- novels had recently been purchased by the motion ing his success and recognition as an author, with trips 8 The Pharos/Winter 2021 to Hollywood and meetings with high-profile entertain- was followed by two additional Lange potboilers, and a ment executives.2. He was, at the time, also a fourth-year crime fiction collaboration with his brother under the medical student at Harvard completing clinical rotations alias Michael Douglas. at Massachusetts General Hospital. When he did return to publishing as Michael Crichton, in 1970, it was for Five Patients: The Hospital Explained, Medical school bookends a work of educative nonfiction interspersed with specu- Crichton’s experiences in medical school were both lation. This book is organized as a series of case studies, productive and terminal. While flourishing as a writer, with the narratives of five patients elucidating various his interest in practicing medicine deteriorated. During aspects of medicine and the hospital. Contemporary ap- his first year in 1966, he wrote the racy international praisals grazed the speculative nature of Five Patients fo- crime novel Odds On as a ploy to pay the bills dur- cusing mostly on its role as expository writing. A Journal ing medical school. After finding a publisher in Signet of the American Medical Association review praised Books, Crichton churned out a series of James Bond Crichton’s ability to distill the challenges of medicine 007-inspired paperbacks with names like Scratch One, while disparaging his oversimplification.6 The Harvard Easy Go, and Zero Cool, written under Crimson (a paper Crichton once wrote the pseudonym John Lange. Crichton’s for) called his historicity obvious and alias served two purposes. It protected his positions pompous, noting how the him from patient concern that he would book simulates authentic scenarios “in write about them,3 and it allowed him to typical Crichton fashion.” 7 Ironically, in compartmentalize and dissociate from 1975 Crichton would go on to publish a the medical school experience, which he New England Journal of Medicine edito- found unpleasant.4 rial deriding medical obfuscation. Only As he progressed through medical psychiatrist F.C. Redlich writing for The school, the tone and content of his writ- New York Times made special note of the ing matured. Two books proved trans- conjectures in Five Patients, sympathiz- formational in Crichton’s development: ing with Crichton’s implicit proposals A Case of Need (published under the for change.8 pseudonym Jeffrey Hudson) in 1968, and The Andromeda Strain in 1969. Why speculate? A Case of Need is identified as Crichton believed he could effect Crichton’s first work of a speculative na- change before it was needed, stating ture.5 Published five years before Roe v. in a 1970’s Scientific American ad, “In Wade, it was a harbinger of both the reproductive rights the best circumstances, fiction serves as a kind of trial movement and Crichton’s trademarks: the interface of balloon. It allows a society to experience events before society with science and technology, cautionary bioeth- they actually take place, make decisions and prepare ics, and the literary trappings of a thriller. The novel also responses to them.” 3 proved to be Crichton’s most successful to date, winning In this way, we can view speculative literature as a an Edgar Award and later being adapted to film. portent of social change on the other side of works that This success was soon dwarfed by The Andromeda raise issues ex post facto like Upton Sinclair’s The Jungle, Strain, the first novel published under Crichton’s sur- and Harriet Beecher Stowe’s Uncle Tom’s Cabin. Such name. The speculative story of a satellite returning to examples represent a response or answer; speculative Earth contaminated by lethal pathogens was timely, literature is more of a question. published just three months before the Apollo 11 moon The question speculative authors often ask is “what landing. The popularity of The Andromeda Strain made if?” Crichton’s interest in speculation arose in part from Crichton a household name, and validated his decision to columnist Art Buchwald’s musings on what would have leave medicine after obtaining his MD. happened if Barry Goldwater had defeated Lyndon These two novels established Crichton as a specula- Johnson in the 1964 presidential election.9 Buchwald’s tive writer and an authority on science, but did not im- imaginative considerations were bold and dubious but mediately cement his identity as such. Their publication no less captivating, a framework Crichton appears to The Pharos/Winter 2021 9 Five patients in 50 years have embraced. Even though Buchwald was considered major after feeling slighted by a professor whom he sus- a journalist, winning a Pulitzer Prize for Outstanding pected of grading unfairly. Instead, he chose biological Commentary, his satirical work often blurred the lines anthropology and graduated with Phi Beta Kappa hon- of reporting and imagining, a trait not uncommon in ors. He taught anthropology at Cambridge the following Crichton’s speculative fiction. year before returning to Harvard for medical school. Speculative fiction addresses the decisions and adap- Crichton appeared to relish an identity as a polymath, tations of humanity.10 In Crichton’s fiction, products of resisting being pigeonholed as a science fiction writer.5 science and technology appear as imminent threats to He played basketball at Harvard, directed films, pro- humanity, though their interactions with society often grammed software, and wrote nonfiction on modern art, prove disentanglable. Crichton viewed these threats as computers, and travel. Five Patients was the beginning of so immediate, he often raced to complete stories before his foray into nonfiction. a looming historical event. After spending four years immersed in medicine, While writing The Andromeda Strain, Crichton wor- Crichton was well positioned to write on the topic. Five ried he would be unable to finish it before the Space Race Patients’ emphasis on science, technology, and soci- rendered his work obsolete. Jurassic Park, written during ety followed major themes of A Case of Need and The the genetic revolution in animal cloning, appeared just Andromeda Strain, validating and reinforcing his author- six years before the arrival of Dolly the first cloned sheep. ity on such subjects. In 2002, he described the science of his nanotech- The media took note, pointing out the mystique of nology thriller Prey as “on its way.” 11 In contrast with the man who gave up medicine to enter show business.4 futurist speculative fiction authors like Arthur C. Clarke, Promotional materials by publishers heavily emphasized Crichton’s interest in the conceivable consequences of his scientific background. The publicity around Crichton, today’s science is termed the speculative present.5 the doctor writing thrillers, played strategically into his next published novel, 1972’s The Terminal Man. Collecting (on) patients The Terminal Man is a neuroscience suspense story In Five Patients, 1969-1970 offered an opportune era of about the unintended consequences of invasive medical medicine in which to speculate. Many of the technologies technology. Heavy-handed in its liberal use of medi- Crichton highlighted were current introductions, while cal jargon, the book was of comparable success to The long overdue changes in culture were beginning to tran- Andromeda Strain, receiving positive reviews and a spire. Crichton’s placement at Massachusetts General film adaptation. As a work of speculative fiction, The Hospital afforded him access to the nascent technology Terminal Man arrived at a time when electrical neuro- while providing a rich history as the nation’s third oldest stimulation entered the early Computer Age. Anyone general hospital. who had read Five Patients before The Terminal Man Crichton also had readily available, and apparently hit was primed with an awareness of technology’s rapid willing, subjects for his case studies. He states in the expansion into medicine, making the realism of The book’s “Foreword” that with each patient, he took care to Terminal Man all the more captivating. identify himself, his role as a medical student, and that he The Terminal Man, like The Andromeda Strain, was writing a book. In recent years, scholars have argued marked Crichton as a writer of science-based speculative that writing about patients can put doctors in a difficult fiction. Relatively little has been made of the classifica- position when it appears to jeopardize the Hippocratic tion speculative nonfiction of which Five Patients could Oath on confidentiality.12 Crichton attempts to preempt be considered. Modern scholars have applied the term such concerns by stating that patients’ names “and other to a range of works, often with respect to technology. identifying characteristics” 13 were changed. It is unclear, The futurology of prognosticators like Ray Kurzweil and however, whether explicit consent was ever sought.