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Eyewitness in Erewhon academic hospital
  1. I de Beaufort,
  2. F Meulenberg
  1. Erasmus MC/University Medical Center, Department of Medical Ethics and Philosophy of Medicine, Rotterdam, The Netherlands
  1. Correspondence to Inez de Beaufort, Professor of Health Care Ethics, Erasmus MC/University Medical Center, Department of Medical Ethics and Philosophy of Medicine, PO Box 2040, 3000 CA Rotterdam, The Netherlands; i.debeaufort{at}

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This isn't a hospital! It's an insane asylum! And it's your fault! (From M.A.S.H.)

Shaking her head lightly, Doctor Van Tintelen leaves the room and softly closes the door. Empathy streaming through her veins, she never gets used to the unpolished grief of a patient she has to tell of inevitable death, never. She thinks, “There should be pipes to drain the tears in every room, or at least rinsing basins for grief. What a job.” The crying is that of the sisters Barrio. Miranda and Monica are twins who always refer to themselves as M&M. Though Monica cries the hardest, it is Miranda who was just told that her breast cancer has spread into her liver. No more treatment available.

“Don't cry, Monica, I took the risk purposely. We both knew breast cancer runs in our family. You had the test, I didn't.”

“And now you see the result, Miranda, you are going to die. We aren't even fifty yet. Damn.” The irony is that the clock in the room doesn't work, its pointers silent and stiff.

“Do you really think you are better off? I've never completely understood why you had the preventive double mastectomy.”

“I have never felt less of a woman. You know that.”

“I know, but some men felt differently about it.”

The remark hurts Monica almost physically, and Miranda apologises immediately. “Sorry, sweetheart, I shouldn't have said that. The sisters embrace for the hundredth time.”

“Maybe I was too much of a coward,” Miranda says, resigned, “or too proud of my breasts.” For a second she lifts the big breasts sadly with her hands. Cynically: “After all, they were my trumps in eroland.”

“A coward? You? How about me?” Monica seems to calm down somewhat. “I was too afraid of the continual fear of getting cancer. I chose certainty. Should I be proud of my fear? I don't know. At this moment I'm definitely not.”

“Well who can distinguish pride and cowardice, I can't. What is the right thing to do? And now our daughters are facing even more and more difficult choices. Brenda talked to me about having preimplantation genetic diagnosis (PGD) because she doesn't want to risk having a daughter who gets breast cancer, given what I have been going through. I didn't know what to say. It makes sense but it is also so rational, so … I don't know, you select your sickness-gene-free embryo—I mean, what if they find a treatment in the meantime? It 's like taking over direction from God. To want to be in control.”

“I can understand; I would do it if I had the choice now.”

“Well apparently the doctors are hesitant, it is a relatively-late-onset disease. How odd, late onset, it is always too early. Brenda will have the surgery in a few years. She says it is a duty towards her future children. The certainty of not ending up the way we have ended up, either without breasts or without future. That is the choice we had. Help me to sit up in bed, will you.”

They look at each other, deeply saddened. Grief is supposed to be in the lines of a face, not in the memory. That takes time.

“The round-up begins,” says nurse Jake Cummings to his colleague Gwen Loyd. From different rooms patients appear who will be discharged from the hospital today. The most attention, visual and auditory, is attracted by the obese Mrs Robinson, who has lost a bit more than two kilos during her stay, including the removed gallbladder and all its stones.

“Guys, I'm off, I would have liked to say it was an agreeable stay, but it wasn't. Being operated on is no fun in the first place, but if you cannot serve your patients a decent meal, then it is life in the gate of hell. This is no hospital, it's an asylum.” In a corner, Mrs Van Clausen, sitting in a wheel chair, is waiting for her son. The shaking palsy of her Parkinson's disease is not controllable, despite the heavy medication. She keeps a sad silence, after having heard yesterday that there will not be an embryonic stem cell treatment for her in the short run. “Not our choice,” the doctor said, “but it is too complicated politically and ethically.” Almost tripping over Ishmael's mopping contraption, who again gently swings his hips listening to B B King's Bad Luck, Mrs Robinson yells: “Well, see you, I mean, no, not see you again …”

With his piercing eyes, boyish doctor Hank Smith, demonstrating again his addiction to wrong ties, looks at the man in front of him. It's Jeffrey Saunders, the 46-year-old brother of Mrs Saunders who has been admitted to Erewhon waiting for a donor kidney. She gave a kidney to her sister years ago and now is herself desperately in need of a kidney, which her brother refuses to donate. The conversation between the men has already lasted more than an hour. They keep exchanging arguments, arguments that gravitate towards each other, circling around one point: a confession.

“Good … yes, good … it has to be done. I'll come with you, Doctor Smith.” Slowly Saunders rises from his chair, almost physically resisting the movement. His head may have been convinced, but his gut is not. And isn't the human gut the organ that most often is right?

“I appreciate it. It takes a lot of courage to take this step.” Amicably Hank Smith takes Jeffrey by the hand and puts an arm over his shoulder. Together they go to the room of Jeffrey's sister Gloria. After hesitating slightly and each taking a deep breath, they walk into the room.

“What are you doing here, get out. I don't want to see you!” Gloria sneers.

“Sorry Mrs Saunders,” Hank says soothingly, “but please hear him out.”

“Why should I? Words, but no kidney.” Words full of contempt.

“Please Mrs Saunders.”

It takes a short while before the electrostatic charge dissipates, and then Jeffrey begins. “Gloria, dear Gloria, I'm so sorry to see you suffer, and I cannot help you.”

“But you can!”

Gloria's protest is silenced by a gesture from Hank Smith: shut up.

“I know you need a kidney. And I have two, but there is something else, something you do not know. You can't know because I've never had the courage to speak about it. Now I have to.” His eyes wet with tears look at his emaciated sister. “Gloria … I'm gay.”

Gloria's mouth falls open like a garage door operated by remote control.

His head bowed, Jeffrey continues: “And that is, not the only thing … I have been stupid or careless.” He looks at her, his lips trembling. “I'm HIV positive, I may have two kidneys but, Gloria, they are contaminated. You die because I had to have unsafe sex. You pay for my choices … I'm so terribly, terribly sorry.”

In the silence that follows Hank puts his right hand on Jeffrey's shoulder. Ill at ease, brother and sister look at each other. Shreds of misunderstandings first prevent an embrace. But not for long. “Why are there so few organ donors, why do all those campaigns not help? Don't people see?” Jeffrey snivels. Gloria, fully aware that possibly her last chance of life has vanished, comforts him: “More die of heartbreak than anything else, but there are no mass movements against heartbreak or demonstrations in the streets.”

Stately Gordon McIntyre, the prima donna assoluta ethicist, strides into the ward.

“Long time no see,” Jake mutters.

“You did call me, my dear?”

“Yes,” says Sarah, “there is a Very Interesting Patient you have to meet.”

Jake smiles, good for her, she did it, she got him out of the Nuttree Pavilion, that hotbed of thinking ethicists daily cleaning their hands under the tap of arguments, to meet the nutty guy. Who that is soon becomes clear. The heavyset man with the enormous beard approaches them immediately. One symptom is obvious: he suffers from a severe case of loquacity. He throws Gordon a piercing look with his big blue eyes, this self-appointed chair of the Society for Tramps with Cold and Sweaty Feet.

“And pray who may you be? You're a doctor? I don't believe in doctors. We need no doctors in this post-modern world. We have reached the PostDoctorEra. What good have they done? Manipulated us, medicalised us, turned us into medicine-dependent, doctor-craving zombies, wanting to be pampered, reassured, enhanced, vaccinated. Botoxifixation, screenification, antibiotification, pills and pills against the pills and pills against the pills against the pills, preventitis universalis; what's wrong with dying when it's your time? And all that paid for by the taxpayers such as yours truly, well actually I'm post paying taxes now, but I used too. Do you care, actually care, about the sick? Or do you only care about your summerhouse, winter boat, spring holiday, and autumn—whatever you want to spend money on in autumn? Are you enhanced? You do look dehanced to me. Though you don't even wear a tie.”

“Well actually I'm not a doctor, I'm an ethicist. So I don't have a summerhouse or winter boat or so on. Even though I'm quite a well-known ethicist, you may have heard of me—I'm often on television actually—”

With a dismissive gesture: “What makes you think I waste my time watching television? We don't need ethicists in this post-modern world either. If you didn't manage to stop the invasion of medicine in our lives, what good are your theories, your egoethomaniacal flashy television sound bites?—like the medium itself: much tele, little vision; it's just rearranging the chairs on the Titanic. That's where we are, on the Titanic. Convenient and slippery theories for politically correct people. Footnotes to Rawls. Stating either the obvious or the non-obvious, and profiting from the cursed popularity of extreme arguments … A dry postmenopausal barren woman, that's what ethics is. “How medicine saved the life of ethics,” yes, yes, yet another life medicine should not have saved if you ask me, but then nobody asks me. Not any more.”

Sarah cannot help overhearing; in fact, she planned to stay close in order to overhear. She winks to Jake, who also listens in. That will teach Gordon a lesson. Let him get out of this all by himself … In a conspiratorial tone the tramp whispers in Gordon's ear, “Are you sure you're not a patient? We are all patients. That's what they want us to believe.” Unfortunately for the reader, Gordon's answer is inaudible. Knowing Gordon, we suppose he does not consider himself a patient—which doesn't prove, of course, that one isn't.

A couple enters through the revolving doors. They are Maria and Geoff Peters, the parents of the unfortunate Claire, who died too young and may have been murdered. The officer standing guard lets them pass, and out of the blue Captain Furillo appears. The parents are excited and scared. “Look. Look at what came in the mail.”


  • Competing interests None.

  • Provenance and peer review Commissioned; not externally peer reviewed.

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