Sunday, March 30, 2014

Call The Midwife: The Possibility of Transcendent Good

Click on this image to Enlarge: It's Worth It

There is no reason "Call The Midwife" should have survived more than one season, at least in America. It has no murders, no hot sex, no car chases, explosions, intrigues, no wickedly delicious villains, no "role model" male hunks, no dashing males at all, no rich people living out lives of fantasy, no flashy cars, no dazzling apartments. 

There is simply post World War II London, which is poor, scruffy, downright squalid, with kids running and playing in dirty streets, families living in tenements with communal bathrooms which reek, dockworkers who get drunk and sometimes beat their wives, children suffering from disease and neglect.  

And yet...this is a mesmerizing rendering of time and place, suffused with values of sympathy, kindness and well meaning, values which guide people who do not have a lot to give, materially, but who give what they can in kindness.

The series presents one of the most remarkable characters Mad Dog has ever met: The head nun who runs the midwifery program, who is so thoroughly kind, wise and intelligent, but who is no Pollyanna and certainly the likes of such an authority figure has not been seen since the early twentieth century.  Imagine a heroic figure who is: A. A nun B. A nurse in charge C. Immensely competent.  No Nurse Wratched this. No Hip Lips Hoolihan. Nothing flashy, nothing dramatic, just simple decency. Mad Dog is in love, unrequited as that must remain.

The greatest wrenching struggle in season one was the decision of one of the nuns, a midwife, to leave the order and to marry the doctor.  Her pain was palpable but not overdone, and her joy at her new life of love was thrilling.

Each character, from the awkward, over sized Chummy, who hails from the upper class but finds meaning and happiness among the poor, who discovers that life as a housewife and mother simply is not enough, and so returns to the calling, and that's what this show depicts better than any before it--the nature of a a calling. 

The whole point of the pre medical running of the guantlet  in college was, and still is, to separate the "dreamers" from the hardcore realists who know that a career in medicine is not for those who are primarily driven by love of humankind but by the spirit of engineering, which places highest value on how things work and how they dysfunction, not on the reaction of human beings to that dysfunction.  Kind hearts are weeded out, unless they are attached to disciplined, tough minds.  Of course, the people doing the weeding out in the undergraduate colleges are not physicians and have only imagined what qualities doctors really need. 

But, for anyone who chose medicine, or nursing, because it appealed as more than a job, "Call The Midwife" brings back all those feelings, which, it turns out, in the end, are nothing to be ashamed of.

From a policy point of view, the depiction of the early history of a system of socialized medicine is fascinating, because it so clearly portrays the modest expectations of the physicians who worked in this healthcare system, none of whom expected great financial reward or even prestige. They enjoyed the social status comparable to a much esteemed auto mechanic--important when you have an emergency, but not someone you invite to the club. There would be no place for Frederic Brandt, the cosmetic dermatologist to the stars,  on "Call The Midwife." He would be the anti-Christ on this show.

What is also apparent is what made the British socialized medicine system so superior to the American for profit system:  Midwives, nurses visited patients where they lived, did so systematically, after deliveries, after hospitalizations, to be sure follow up care was delivered, which was important because less was done in the hospital; patients were sent home earlier and recovered there, which was better for the cost to the system, but also better for the patients.

Well into the 1970's, patients were kept in American hospitals for weeks, for services which could have been rendered at home with less cost and less risk.  While politicians and American health care gurus extolled the high quality of the American system, no real, objective, scientific data was gathered to assess the difference in outcomes between American hospitals and British hospitals.

In Britain in 1972, if you were admitted to hospital with a bleeding gastric ulcer and you had bled down to a certain level of anemia, you got one or two units of blood and were put to bed.  In America, you were pumped full of fifteen units of blood, with an intern following you through the night, doing hourly blood levels and calling in the surgeons for consultation and if you passed that 15 unit mark in 24 hours, you were hauled off to surgery. 

In retrospect, filling that inner tube with so much volume, may have increased the pressure on the weak spot and exacerbated the bleeding. And the hepatitis and other blood borne pathogens conveyed with all those units of blood was no advantage to the patient, in the long run. So the Brits, with their more hard headed and less-is-sometimes-more approach were likely practicing superior medicine than their gung ho American colleagues.  In American medicine, for the second half of the 20th century, "aggressive" was a positive description and "passive" a pejorative.  This worked well for profit driven American health care, but not so well for the patients or for the nation as a whole.

But in America, any consideration of limiting what you might do for a patient has always been met with cries of "Death Panels" from the thundering ignoramuses of right wing radio, and you can always play on a visceral reaction to the word "rationing" from the American electorate. That, too,  works well for the bottom line of many health related American industries. 

Just as America keeps building submarines and fighter jets and bombers which the military no longer has any use for because it's good for a Congressman's district, just as we keep vast military bases open because a Congressman wants those jobs in his district, we indulge in misspending in healthcare in areas which do not improve the public health,  because each project fattens someone's bank account.

When we fund a military hardware system we don't need, that's not welfare, that's keeping America #1.  When we spend money on keeping an ninety year old alive on a respirator for 6 weeks, that's just the world's best medical care. 

But go back and look at England in the 1950's and 1960's, watch "Call The Midwife,"  and see where a really intelligent system came from, as it emerged from a relatively impoverished economy, which required political leaders make difficult choices, and which set a medical system on a better course than the one our own profligate system careened down.

After World War II, America was booming and we spent like drunken sailors on all sorts of things--military contracts, health care, roads, shopping malls. The Brits did not have that luxury. They had to plan with discipline. 

What they got was a healthcare system which is not perfect, but it is lean and effective. What we got was the best for the upper 10% and dismal for the rest.


  1. Mad Dog,
    As you know, many would not look so favorably on the British system. There's this prevailing belief that, expensive as it is, America's heathcare is far and away the best and that the British model would be a big step down the ladder to unacceptable waits, shortages and overall less medical quality. We are viewed, rightly or wrongly, as having all the cutting edge, latest advancements and they do not. As you point out though, these benefits are not available to all. This firm belief in American medical superiority plays a big role in the opposition to a single payer system. People seem to believe a system like Britain's is, if not a fate worse than death, a fate leading to death...

    So, you're in love with a nun Mad Dog-interesting pairing. Maybe it's not just her competence you like, perhaps like women who are attracted to men in uniform, you are attracted to women in uniform, or, uh, habits..In any case I'll have to check it out since you do consistently make great series and film recommendations...

  2. Maud,

    Actually, habits have never done a thing for me.
    Yes, you have described the story we Americans have been sold, and swallowed, but of course, how many Americans have ever experienced British medicine?
    My own experience with it as a medical student is dated, but I've had plenty of patients who wound up in English hospitals who got exemplary care and who loved it.
    We are victims of propaganda here in the U.S. of A. I'm not sure the Brits have the world's best system, but I am sure we know next to nothing about its true virtues and deficits here.

    Mad Dog