Sydney, Australia (Spring 2013)
The main plot in Neil Ravin’s M.D.1 is the ongoing tension at Manhattan Hospital2 between two unevenly matched protagonists: Professor Maxwell Baptist, the Chairman of Medicine and Dr William Ryan, a somewhat naïve resident who dislikes “kissing ass,” particularly Baptist’s ass. Predictably this attitude annoys the chairman, and Ryan pays the appropriate penalty. The two have several encounters; one of them is reported here.
Baptist, nicknamed “St John,” is not held in high regard by the house staff. He is considered a poor clinician and a worn-out researcher who “had passed his prime before he was made chairman.” He has published nothing since, many years earlier, he described a kidney disease which was generally referred to as “Baptist’s nephritis.” However, “if he had done nothing else … he had organized a solid core of talented people and built an admirable department.”
Baptist’s clinical and investigational skills have atrophied, but his political acumen remains finely honed. The politically astute members of the resident staff, who believe (correctly) that their future careers depend on Baptist’s support, are terrified of displeasing him and decide not to present patients with obscure diseases at the monthly chairman’s rounds, where the professor is supposed to come up with a diagnosis. If Baptist were unable to recognize a particular disorder, he might turn vindictive. Now there happens to be, under Ryan’s care, a man with Baptist nephritis. “If there was one diagnosis Baptist ought to be able to make, it had to be Baptist nephritis.” Ryan is therefore instructed to present his case to the chairman. Regrettably, he has his doubts about the diagnosis.
The next day the assembled residents, interns, medical students and nurses filed into the solarium to hear Dr Baptist’s wisdom. He arrived with a retinue of assistant chief residents, … assorted sycophants and some visiting Professor from Greece who spoke little English but who had come to spend time in the master’s presence. [In due course] Baptist pronounced [the patient was suffering from]… Baptist nephritis and monotoned his standard lecture … Then came the question period … Ryan raised his hand. He recited the eight criteria from Baptist’s paper, pointed out … that this patient met only two and politely asked why the diagnosis had been made. … Baptist handled [the question] with a sniff. ‘Some criteria are more important than others. If checking off criteria on lists was all there was to clinical judgment then we could leave patient care to medical students and interns.’ The assemblage laughed and clapped. 160
Baptist’s revenge comes 18 months later when he uses his skills as a political manipulator to block Ryan’s promotion to a senior residency position, despite strongly favorable reports from some staff members. Baptist begins the committee meeting not by discussing the applicants but by presenting a list of candidates he proposes to appoint. Six of them have been approved when Dr Hyman Bloomberg, who has written a paper with Ryan, slips in late.
‘Have they gotten to Ryan yet?’ he whispered to one of the attendings. ‘Must have passed him,’ he whispered back. ‘Already up to T.’ There were four charts left in the Approved pile…. ‘Have we done Ryan yet?’ asked Bloomberg … ‘No,’ said Baptist slowly … ‘Why not?’ asked Bloomberg. ‘He’s not in the Selected group.’…’Why not?’ asked Bloomberg. ‘We’ll discuss the Unselected after we finish the ten in the Selected group.’ Bloomberg … judged the numbers. ‘I think we’d better discuss this now while we still have a quorum. Some private docs will have to get back to their offices by the time we get to the Unselected.’ … ‘I think its more important to approve the residents who will be with us. We can take objections and additions later,’ said Baptist.. Bloomberg took his pipe out of his mouth and blew a puff towards Baptist. ‘Max,’ said Bloomberg ‘how many of those guys in your Selected group have a lead article in the New England Journal to their credit?’ … Bloomberg stood up taking a rolled up journal from his inside coat pocket. He slammed it on the conference table. … Baptist … reached over … inspected the article briefly then tossed it back on the table … ‘That’s William Ryan and Hyman Bloomberg,’ he said with great satisfaction. ‘Everyone knows who wrote that paper, Hyman. You’re an old softie. But giving Ryan the credit won’t fool anyone.’ [Bloomberg’s protestations that William Ryan did all the work prove useless.] … ‘One paper does not a senior resident make.’ said Baptist. ‘Especially this one, all things considered.’ ‘It’s a great paper,’ said Bloomberg indignantly. ‘If you’re a co-author,’ said Baptist slyly, ‘I’m sure it is.’ Before anyone could respond, Baptist went on … ‘Anyone else want to continue this digression?’ ‘He’s a damn good kid,’ said Sidney Cohen … ‘My impression exactly,’ said Baptist. ‘He needs to do some growing up. He hasn’t got the maturity for senior residency.’ ‘He’s done good work,’ said Bloomberg. ‘Anyone else?’ said Baptist.
There is no additional support for Ryan who is informed (by Baptist) the next day he had better find himself another job for the following year.
Ryan, a hard working, intelligent junior resident, has the potential to turn into an excellent clinical investigator. However, he is not a sycophant, and during his fights against the bureaucracy he has come to the chairman’s attention on several occasions. In addition to questioning the chairman’s diagnosis, he has also offended against hospital etiquette by sleeping with the chairman’s current girl friend. At the end of the book, when we see Ryan driving a U-Haul van towards Baltimore because Manhattan Hospital “is not big enough” for him and St John, the reader feels that Baptist has lost more than his clinical and investigative skills. He is no longer an effective departmental chairman.
- Ravin, Neil (1981) M.D. Delacorte Press/ Seymour Lawrence, New York.
- Manhattan Hospital is a thinly disguised Cornell-Weill Medical Center in New York City.
SOLOMON POSEN, MD an emeritus professor of medicine at the University of Sydney, majored in English before obtaining his medical degrees (MB BS, MD) at the University of Adelaide, Australia. He is a Fellow of the Royal Australasian College of Physicians, a Fellow of the Royal College of Physicians, London, and a past president of the Endocrine Society of Australia. He lives in Sydney, Australia.
Dr. Posen taught general medicine and endocrinology at Sydney University for almost 30 years and has served on the editorial boards of several medical journals. He is the author of some 130 scientific papers (mainly in the field of calcium metabolism) and a co-author of a book on alkaline phosphatase. He is the author of a projected four-volume work titled The Doctor in Literature. The first volume, Satisfaction or Resentment was published by Radcliffe in 2005. The second volume, Private Life, appeared in 2006. This excerpt is from the unpublished third volume in The Doctor in Literature series, Career Choices.