Things I Overheard While Talking to Myself (5 page)

This will matter, regardless of what business you go into. When you sell a product that you know will fall apart in a few months…. When you sell the sizzle and you know there’s no steak…. When you take the money and run…. When you write an article or a political speech or a television show that excites and titillates but doesn’t lead to understanding and insight…. When you’re all style and no substance…then you might as well be tossing poison into the reservoir we all drink from.

Suppose somebody offered you fifty dollars to throw a little poison in the reservoir? “Look,” he says, “it’s just a little poison. How much harm can it do?” What would you take to throw just a little poison in the reservoir? Fifty dollars? A hundred dollars? Ten thousand dollars? How about a half million with stock options and a Christmas bonus?

It may be “just a little,” but if everyone’s little bit of poison combines with everyone else’s…then together we’re tampering dangerously with the moral ecology.

Times have changed since the sixties. In those days, we were all out on the streets. We were impatient and passionate, and the depth of our caring was matched by the flamboyance of our gestures. But you’ve come in out of the street. They say you’re thinking more about your own careers now than about marching.

If that’s true, the funny thing is that it’s possible that you can do more to change things than anyone could in the sixties. If you can put a high value on decency; if you can put a high value on excellence—and on family—if you can love the people you share your lives with, and if you don’t shortchange them for a few bucks; if you can love the work you do; if you can give full measure to the people who pay you for your work; if you can try not to lie, try not to cheat, try to do good just by doing well whatever you do…

Then you will have made a revolution.

I stepped back from the microphone and went to my chair. I’d managed to say what I meant. As I sat there, half listening to the other speakers, the action on the East River went into slow motion and the tin can reversed its course. The wound in the scalp closed, and the girl on the running board smiled. Even the mayor of Burbank smiled.

Chapter 4

Bandages and Badinage

I walked out onto a grassy field on the Upper West Side of Manhattan, looked at the expectant faces of the young doctors and their parents, and tried to establish my noncredentials right away.

Ever since they announced that an actor had been invited to speak at this commencement, people have been wondering—why get someone who only plays a doctor when you could get a real one?

This had been a tough one. I had been asked to speak to the graduating class of the Columbia University College of Physicians and Surgeons, one of the most respected medical colleges in the country. Karen Kosovsky, a young friend of our family, was graduating that day, and I wanted to accept, but the invitation scared me. In what way could I possibly speak from my own experience to medical students? The closest I had come to a personal experience with doctoring had been trying to wash the fake blood off my underwear when it soaked through my fatigues on
M*A*S*H.
I worried that even showing up that day would make it seem that I was an actor who actually believed he was the doctor he played. I couldn’t think of an angle to come in on, and I thought I ought to turn it down. But I couldn’t disappoint Karen, and I said yes. As the day came closer when I’d have to get up and speak, I wondered what use I could be to young doctors.

Maybe the school has done everything it could to show you how to be doctors, and in a moment of desperation they’ve brought in someone who can show you how to
act
like one. I’m certainly not a doctor. In the first place, I’m not a great fan of blood. I don’t mind people’s having it, I just don’t enjoy seeing them wear it. And I’ve yet to see a real operation, because the mere smell of a hospital reminds me of a previous appointment.

I had heard too many stories of medical students fainting at autopsies for me to be able to watch actual surgery. And the idea of seeing surgeons piercing living people with a knife and spreading their ribs apart so they could stick their hands inside their warm, personal interiors just didn’t seem like fun. I had done my research for Hawkeye in books rather than operating rooms. But as hard as it was to believe, at some point in the eleven years
M*A*S*H
was on the air, in some people’s
minds,
I had become a doctor.

Once, in the middle of the night, our friend Esther’s husband fell down in the bathroom a few steps from their bed, and, hearing the thump, she woke and went to him. He was facedown, unconscious, blood spreading from his head onto the white tiles. As she tried frantically to revive him, she mentally listed all the people she could call for help. And the first person she thought of was
me.
I was what came to mind when there was blood on the floor.

Fortunately, she also came up with a couple of other people who were actually doctors, and one of them came to the house and tended to her husband. When she told us about it the next day, I was astonished that I was at the top of her list. “What did you think I could do?” I asked her. “Run over and tell him a couple of jokes?” We laughed about it, but I realized how easy it is to let playacting substitute for reality. It was a mistake I didn’t want to make myself when I talked to these brand-new doctors.

My knowledge of anatomy resides in the clear understanding that the hipbone is connected to the legbone. I am not a doctor. But you’ve asked me here, and all in all I think you made a wonderful choice. That’s because I probably first came to your attention through a character on television that I’ve played and helped write for the past seven years: a surgeon called Hawkeye Pierce. He’s a remarkable person, and if you’ve chosen somehow to associate his character with your graduation from medical school, then I find that very heartening. Because I think it means that you’re reaching out toward a humane kind of doctoring. And toward a real kind of doctor. We didn’t make him up. He really lived as several doctors who struggled to preserve life twenty-five years ago during the Korean War.

It was surprising, actually, how many people had come up to me and told me they knew the actual doctor Hawkeye was based on; if they had, there would have been twenty-five or thirty Hawkeyes. There couldn’t have been that many. But he seemed so real to people, they believed they’d actually known him.

There’s something especially engaging about him because he’s based on real doctors. He has a sense of humor and yet he’s serious. He’s impertinent and yet he has feeling. He’s human enough to make mistakes and yet he hates death enough to push himself past his own limits to save lives. In many ways, he’s the doctor patients want and doctors want to be. But he’s not an idealization. Finding himself in a war, he’s sometimes angry, sometimes cynical, sometimes a little nuts. He’s not a magician who can come up with an instant cure without sweating and ruining his makeup. He knows he might fail. Not a god, he walks gingerly on the edge of disaster—alive to his own mortality.

There was, in fact, a complexity to Hawkeye’s character that wasn’t easy for me to understand at first. As actors, we pretty much had only our imaginations to rely on when we began the show. Somehow we had to take on the look and feel of people who had gone through years of grueling training and then months of combat surgery. Gene Reynolds, who produced the early years of the show, knew we couldn’t be expected to come up with all this out of pure imagination and had a medical adviser on the set when we shot the first episode.

In one of the opening scenes, we were up on the helipad, shielding our eyes as the helicopter landed, raising a cloud of dust. I ran over to it, crouching under the spinning blades—not so much because they were low, but because I had never been that close to a helicopter before and I didn’t want to get my head whipped off. I called out directions to the orderlies as they lifted a wounded man off the chopper and carried his stretcher to a jeep. I jogged beside him, concerned, checking him out as we ran. Dr. Walter Dishell, our medical adviser, was watching us from behind the camera.

We did a couple of takes, and then Walter came over to me. “You know what? Don’t look so compassionate,” he said. “You’ve done this hundreds of times. Just get the job done.” I looked at the fake blood on my patient.
How can I just take that in stride?
I thought. Walter looked at me with some sympathy, but he was firm about it. “You’ve seen this over and over,” he said.

In the next take, I took my foot off the empathy pedal and the scene went better. Hawkeye’s concern for the patient had more power when it was more visible in his actions than on his sleeve.

If this image of that very human, very caring doctor is attractive to you—if it’s ever touched you for a moment as something to reach for in your own life—then I’m here to cheer you on. Do it, go for it. Be skilled, be learned, be aware of the dignity of your calling…but please don’t ever lose sight of your own simple humanity.

You’ve spent years in a grueling effort to understand the structure and processes of human life. It’s required the knowledge of complexities within complexities. You have skills that have been hard to acquire. I only ask one thing of you: Possess your skills, but don’t be possessed by them.

I was talking about how hard it can be to deal with people in a crisis. It’s more comfortable to retreat to cool skills and expertise. But the right mix of cool and warm isn’t easy to achieve. Even for those of us who were just
playing
doctors, finding the right mix was at the center of what we had to learn to do on
M*A*S*H.
The show would be serious and funny. There would be light moments and dark. Empathy mixed with shenanigans. The real doctors we were playing cared about their patients, of course, yet when they operated on them, they would often be joking with one another. I was surprised when I first heard this about surgeons, but then I realized that they would have to take the pressure off themselves in some way. And in fact, that’s what happened to us as we played those surgeons. After twelve or fourteen hours of shooting in the operating room, under pressure that scrambled our brains, we started playing practical jokes on one another. At the end of a take, anyone who had been especially sincere or heartfelt during the shot would get pelted with wads of rolled-up surgical tape as soon as we heard the word “Cut!” Or we would sneak up behind an actor and see how many surgical instruments could be clamped to the back of his surgical gown before he noticed he was dragging a half pound of metal behind him.

So I began to see a paradox both in doctoring and in acting: the need to be empathetic and coolheaded at the same time. You had to have some distance from it, but not too much. We had to be precise in our work; words and motions had to be exact. You needed to get your hand into a sticky surgical glove in exactly the time it took to speak some complicated medical talk. Sometimes the comic business needed split-second timing. Yet if there was no simple authenticity about it, it would look mechanical. To keep technique from dominating us, we cut through it with playfulness. We were a little like the surgeons in this: For the patients’ well-being, we layered them in bandages; but for our own well-being, we laid on the badinage.

As I talked to the young doctors graduating from Columbia P&S, I was struck by this tension between technical skill and the human connection and how sometimes they could be at odds with each other.

You’ve had to toughen yourself to death. From your first autopsy when you may have been sick or cried or just been numb, you’ve had to inure yourself to death in order to be useful to the living. But I hope in the process you haven’t done too good a job in burying that part of you that hurts and is afraid.

I know what it’s like to be absorbed in technique. When I write for
M*A*S*H,
I’m always writing about people with what I hope is compassion and feeling. Yet one day I found myself talking to someone who was in a real crisis, in real pain, and I remember thinking,
This would make a great story.

Becoming set apart—becoming your skill—can make it tough to face your feelings, and you get left out of the loop.

I was unqualified to talk to them about medicine. But I
was
an expert in one area of medicine: I had been a
patient.
This was an expertise from which I could speak to young doctors from the heart.

With all your study, you can name all the bones in my body. You can read my X-rays like a telegram. But can you read my involuntary muscles? Can you see the fear and uncertainty in my face?

If I tell you where it hurts, can you hear in my voice where I ache?

I show you my body, but I bring you my person. Can you see me through your reading glasses?

Will you tell me what you’re planning on doing to me, and in words I can understand?

Will you tell me when you don’t know what to do? Can you face your own fear, your own uncertainty? When in doubt, can you call in help?

Even if, in time, you don’t deal directly with patients—if you’re in research, administration, if you write—no matter what you do—eventually there is always going to be a patient at the other end of your decisions.

Will you care more about the case than the person? (“Nurse, have the gastric ulcer come in at three.”…“How’s the fractured femur in room 208?”)

You’ll know you’re in trouble if you find yourself wishing they would mail you their liver in a plain brown envelope.

Where does money come on your list? Will it be the standard against which you reckon your success?

I didn’t know then that one day medicine in our country would be run by accountants and that actual doctors would have little chance of making any money—unless they ran an HMO. If they did, there would be a special waiting room for them in the outer office of heaven, where they would sit forever.

Where will your family come on your list? How many days and nights, weeks and months, will you separate yourself from them, buried in your work, before you realize that you removed yourself from an important part of your life?

And if you’re a male doctor, how will you relate to women? Women as patients, as nurses, as fellow doctors—and later as students. Will you be able to respect your patient’s right to know and make decisions about her own body? Will you see nurses as colleagues—or as handmaidens? I hope you men will work to grant the same dignity to your female colleagues that you yourselves enjoy.

And if you’re a female doctor, I hope you’ll be aware that you didn’t get where you are all by yourself. You’ve had to work hard, but you’re sitting where you are right now in part because way back in 1848 in Seneca Falls, women you never knew began insisting you had the right to sit there. Just as they helped a generation they would never see, I urge you to work for the day when your daughters and their daughters will be called not “a woman doctor” or “my doctor, who’s a woman,” but simply “my doctor.”

When you think about it, there isn’t an area of your work that won’t be affected by what you decide to place a high value on and what you decide doesn’t count.

Well, that’s my prescription. I’ve given you kind of a big pill to swallow, but I think it’ll make you feel better.

I thank you for taking on the enormous responsibility of caring for other people’s lives and for having the strength to have made it to this day. I don’t know how you’ve managed to learn it all. But there
is
one more thing you can learn about the body that only a nondoctor would tell you, and I hope you’ll always remember it:

The head bone is connected to the heart bone—don’t let them come apart.

Many years later, a young woman came up to me in an airport and told me she had been there that day in the graduating class. She said that for a long time she had carried a copy of the talk around with her to remind herself of the kind of doctor she wanted to be. I was moved by the thought that someone had actually taken my words to heart. And it wasn’t until then that I got the real message of what I’d said that day: how much more alive you can feel—even a sense of purpose—knowing there are real lives at the other end of your ministrations, or your art, or your talk, or even your jokes.