The story of this piece is rather complicated, so bear with me. A good many years ago, when the philosophical world still thought I was a philosopher, I was invited to give the keynote address at the annual Symposium hosted by the distinguished philosophy department at UNC Chapel Hill. I wrote a talk which I entitled "Some Thoughts on the Distribution of Educational Resources in the United States Today," and it was announced under that title. When my time came to speak, I rose, went to the microphone, and apologized to the sizeable audience assembled. I said that when I had received this very presitigous invitation, I had thought I could write a talk that would be suitable, and announced the title which was now printed in the program of the event. But I am growing old, I said, my faculties are somewhat diminished, and I had not been able to write the talk I had hoped to present. However, I went on, I was committed, and felt that I must say something, so I had decided instead to tell the audience about a trip I had taken the previous summer. I very much hoped that they would find it enjoyable. Needless to say, the audience was rather unsettled by this pathetic and embarrassing admission, but they were committed to hearing me, so no one rose and left. I then delivered the following talk, which I call "The Pimple on Adonis' Nose." Since it is rather long, I shall divide it into several segments and post one segment each day until I am done. When I have concluded, I will tell you how it was received.
The Pimple on Adonis' Nose
Last summer, having finished the revisions for a new edition of a textbook on Introductory Philosophy and finding myself with enough money in my bank account for a brief overseas vacation, I asked an agent at the local Travel Bureau to find me someplace completely new, untraveled, and out of the way. He sifted through a dusty pile of brochures shoved to the back of a drawer and came up with the tiny Republic of Invertia, almost exactly half way around the world.
An island nation with a population of slightly more than four million, Invertia has no history, art, music, or natural landmarks of any note, and hence has been virtually ignored in the travel boom of the past twenty years. I agreed forthwith, and told him to book me as inexpensive a round‑trip flight as he could manage, together with reservations at what appeared, from the brochure, to be Invertia's sole tourist hotel. Three days later, I was on my way.
We touched down in the capital city of Invertia shortly after nine a.m., local time; by ten we were through customs, and at ten‑thirty, I had checked into my hotel, and realized that I had four days to fill and no idea what there was to do in Invertia.
Fortunately, the National Tourist Bureau, such as it was, occupied the building next to the hotel, so after a quick lunch, I presented myself at the information desk and asked the clerk what Invertia had to offer the interested tourist with several days on his hands.
"You must surely visit our national hospital, and also our national university," he said. "We in Invertia are enormously proud of both institutions, and no visitor to our island should fail to see them. I will telephone the Ministries of Health and Education and arrange the entire matter."
When I returned to my hotel at dinner time, I found a message from the Travel Agent. The next day at one in the afternoon, I would be given a tour of the leading hospital of Invertia. The following day, I would see the university.
As I came down to the lobby of my hotel on my second day in Invertia, promptly at one p.m., I found the Minister of Health herself waiting for me. Apparently visitors were rare enough to warrant the red carpet treatment no matter how unimportant they might be. We got into the official limousine at the curb, and set out for the National Invertian Center for Health, or NICH as the Minister referred to it.
Approaching the NICH, I was powerfully impressed by the size and elegance of the building, gleaming with marble facade and surrounded by carefully maintained lawns and gardens. Clearly, the government of Invertia put health care very high on its agenda. I assumed I would be driven to the rather imposing front entrance for an official tour, but instead the Minister directed the driver to pull up in front of the Emergency Room. As she explained to me, the ER was the heart of any hospital, and I would get the best possible idea of how Invertians handled their medical services by observing its activities for a while.
Walking through the automatic sliding doors into the Emergency Room of the Invertian National Hospital, I was struck immediately by how quiet, clean, and orderly everything was. My own experience of hospital emergency rooms -- not to mention the images from countless movies and television serials ‑ had led me to expect a busy, seemingly chaotic swirl of patients, nurses, and Interns, with weary family members slumped in chairs along the wall staring blankly at out‑of‑date magazines. Instead, I could easily have mistaken the ER for the reception area of a big law office or corporation.
For a moment, I simply stood and looked around, trying to adjust my perceptions to my expectations. Then the sliding doors opened again and two men came into the Emergency Room. The first was a man about my age, shabbily dressed and in obvious distress. He staggered more than walked into the ER, calling out in pain as he lurched toward the reception desk. "Please," he said in a gasping, feeble voice, "help me! I think I am having a heart attack!" With that he slumped to the ground, clutching his chest.
The second man was a tall, handsome youth ‑ a veritable Adonis ‑ who walked with an easy, athletic stride. He wore an elegant suit and tie, had smoothly tanned features, and appeared to me to be in perfect health. These impressions, I must admit, are somewhat reconstructed from subsequent reflection, because my attention was entirely seized by the poor man writhing on the floor.
As I stood there frozen, watching what seemed to be the last moments of a dying man, the ER erupted into movement. The attendant behind the reception desk spoke a few quick words into the phone at his elbow, and moments later the swinging doors flew open as an Intern hurried into the room pushing a wheel chair. I prayed that they would be in time to save the man on the floor, who was now straining for breath with great raking gasps.
To my astonishment, the Intern rushed past the stricken man and instead approached the young Adonis, whom he gently guided into the wheel chair. Then, solicitously settling a blanket about the young man's feet, he made a detour around the body on the floor, glancing at it somewhat irritatedly, and carefully pushed his new patient to the reception desk. As I watched, too horrified as yet even to speak, the man on the floor gave a last cry, and died.
Throughout these events, the Minister of Health stood beside me calm, unperturbed, a satisfied smile on her face as if to say, "Well, that is how things are done here. Isn't that splendid?" Meanwhile, the receiving attendant was taking the young man's medical history and inquiring as to his needs. Mesmerized, I drew closer to listen to the interview.
So far as I could make out, this was the first time he had ever found it necessary to seek medical assistance. What had brought him to the hospital was a small pimple on his nose, just to the right of center. He was greatly concerned that the pimple spoiled his otherwise exquisite profile, and he wanted to know whether there were specialists in the hospital who could remove it without leaving an unsightly scar.
As he said this, the Minister of Health, with a great air of self‑satisfaction, held up her hand, as though to say to me, "Watch this!" The attendant spoke again into the phone, and immediately a distinguished looking doctor appeared who introduced herself as a plastic surgeon. She assured the young man that every facility of the hospital would be put at his disposal, and she expressed herself as absolutely confident that her team could remove the pimple with no visible scar whatsoever. She had removed many such pimples, she said, and had never lost a patient. With that, the Intern rolled him through the swinging doors, and followed by the surgeon, he disappeared. A short while later, two orderlies brought in a large waste bin, pushed the dead body roughly into it, and exited again.
I was so appalled by what I had witnessed that I had trouble finding the words with which to give voice to my thoughts. During my first few hours in Invertia, I had felt quite comfortable and at home. The people all spoke English, and the manners, the facial expressions, even the body language of the men and women I had met seemed so much like those of my own home town of Amherst, Massachusetts that I had begun to believe that I understood the Invertians quite well indeed. Yet the utter incongruity of the reactions in the Emergency Room to the two men who had presented themselves as patients made me vertiginous.
Most mysterious of all was the obvious satisfaction with which the Minister of Health had observed the events. Her pride at the treatment of the young man's pimple, and her utter unconcern for the dead man, bespoke an attitude, a moral framework, a world view, so different from mine that I could scarcely imagine where to begin my questions.
"Well," she said, breaking into my troubled stream of thoughts, "now you have seen us at our very best. What do you think of the Invertian health care system? How does it compare with that of your own country?"
Very quietly, with great self‑control [for, truly, I feared that I had somehow stumbled into a madhouse, and could not anticipate what those around me might do next], I undertook to discover some explanation for what I had witnessed. "Let me start," I said, "with the man who died of a heart attack on the floor before us. Why did no one try to help him? Why wasn't he immediately taken into an examination room, given emergency treatment, put on oxygen, given drugs? Is your hospital not equipped to handle such cases?"
"Oh, we are more than adequately equipped to handle a heart attack, but what would have been the point? He was clearly close to death when he came through the doors of the ER."
"But with quick action, you might have saved him! He died at our feet!"
"Exactly," she said, as though I had proved her point. "Over a period of years, we have kept quite careful records of patients admitted while suffering massive heart attacks, and our experience shows that such patients have a very poor prognosis for recovery. A considerable number ‑ almost half, I believe ‑ actually die during our efforts to save them or shortly thereafter, and a majority of those who do live through the first days or weeks of treatment emerge from the hospital in something less than perfect health. Many need further medical treatment, a number have subsequent heart attacks, and taking all in all, the prospects of heart attack patients for full recovery and healthy, happy post‑attack lives are quite poor. So you see, it makes very little sense to devote our splendid medical resources here at NICH to treating what can only be considered marginal patients."
In order to grasp the utter callousness of this speech, you must understand that it was delivered not apologetically, or hesitantly, or with an embarrassed awareness of the inadequacies in the Invertian health system thereby revealed, but with a sort of self‑satisfied assurance, not to say smugness. The Minister of Health clearly was a woman supremely pleased with the performance of those under her command, and confident that I would share her pleasure once I understood the marvelous efficiency of NICH.
"Do you never treat anyone suffering from a heart attack?" I asked.
"Of course we do," she replied, "but only when we determine that the patient has a very good chance of complete recovery. Before we will admit a heart attack patient, we require an extensive physical examination, a complete medical history, and letters from the patient's previous physicians explaining why they believe that the patient's heart condition is not an accurate indication of his or her general health. If, in light of the entire medical dossier, we decide that the patient can reasonably be expected to recover from the heart condition quickly and live a long, healthy, productive life without further medical intervention, then we are quite prepared to make an exception. Indeed, our admitting attendants are specifically instructed to keep an eye out for promising patients who might in the ordinary course of events be overlooked because of apparently contra‑indicated previous conditions." This entire speech, you understand, delivered in that patronizing tone so often used by experts, especially medical experts, when explaining things to lay people who cannot be expected to grasp the most elementary matters.
"And the handsome young man with the pimple on his nose?" I asked. "He does not seem to have gone through an elaborate background check or a series of admissions tests."
"Quite true," she replied. "Ordinarily, any patient seeking admission to the hospital must go through the entire procedure of medical evaluation, but every so often, we see a patient who is obviously bursting with good health ‑ fit, vigorous, strikingly attractive. When such a patient comes along, needing only the very slightest medical adjustment to emerge in perfect condition, a patient with whom our chance of success is virtually 100%, we are prepared to waive the normal procedures and speed the admission process. That young man was one of the most promising patients I have ever seen. Our Cosmetic Surgery Department's success with superficial pimples is close to perfect. As soon as I saw him, I was sure he deserved admission to the hospital. When he is released, he will be an outstanding specimen of Invertian youth. I would hazard the guess that he will never need medical attention again."
I was struggling to find my bearings in what seemed more and more to be a Kafka‑esque hall of mirrors. "Let me be absolutely sure I understand what you are saying," I said, in one last effort to make sense out of this nightmare. "You operate this hospital on the general principle that patients will be admitted only if they have relatively minor ailments which you can be virtually sure of curing. When someone is desperately in need of medical attention, such as the man who died here only a few minutes ago, you deny it on the grounds that such people have a poor chance of being totally and completely cured. But when young Adonises or Venuses present themselves to have a pimple removed, a hang nail trimmed, or a slight headache treated symptomatically ‑ in short, when patients appear who do not need medical care in order to survive, but merely want it so as to become even healthier and more attractive than they already are, then you lavish the full resources of this magnificent modern hospital on them. Do I have that right?"
"Just so," she said. "I think you are now beginning to understand how the Invertian medical system works."
"But men and women are dying every day, some of whom could be saved by your hospital. And in return, all you get is the satisfaction of knowing that your healthiest, most attractive young men and women are pimple and hang nail free! How can you possibly justify devoting all your medical resources to such frivolous ends?"
Oh, dear," she replied, obviously distressed that I understood so little of what she had been saying. "I am afraid you have things quite upside down. If we were to do as you suggest, and admit to our hospital patients with heart attacks, cancer, internal injuries from automobile accidents, and heaven knows what else, we should be swamped! We might manage to handle a few, though it would mean turning away thoroughly qualified patients like that young man who was just admitted. But to let them all in would be impossible!
"Indeed," she went on, "we couldn't do it even if we wanted to. Our medical staff is not trained to deal with life‑threatening ailments, save for a handful of specialists in the Trauma Center. What would all our supremely well‑trained Plastic Surgeons, Podiatrists, and Dermatologists do to keep busy? Besides, we haven't the physical facilities to treat such patients. In this hospital, there are four entire wards of Plastic Surgery, each completely staffed and outfitted, including a Nasal Reconstruction center. But there are only two physicians with any experience of major heart ailments, and neither of them has the capacity to treat more than three or four patients at a time.
"All that is entirely secondary, however, for what is at stake here is a matter of fundamental principle. Invertian society has need of an elite core of superbly healthy men and women whose every last imperfection or blemish has been meticulously removed by the most modern techniques of medical science. In an ideal world, where there are infinite resources, we could, I suppose, build endless hospitals to treat those suffering from heart disease, cancer, severe internal injuries, and other life‑threatening physical problems. But resources very definitely are not infinite, and as I am sure you will recognize, it takes much more in the way of those resources to treat each dying patient than it does to correct the minor imperfections of healthy patients. When you consider that many of the really sick patients simply die despite our best efforts, you will concede that it would be utterly quixotic of us to turn our entire medical system upside down, all for the purpose of trying to save the lives of men and women who, even if they do live, will never play a set of competitive tennis, run a respectable marathon, or grace our city with their good looks."
I am a philosopher by profession, and argument is my stock in trade, but the image of that poor man dying in agony at my feet blotted out all thought of logical by‑play. I listened to the Minister's arguments with a heavier and heavier heart. When she had finished, I asked meekly whether we could leave, and without seeing anything more of the NICH, I returned to my hotel. The next day, I was slated to visit the university. I could not even imagine what I would find there. Nazi‑style experimentation on human subjects, perhaps. Lock‑step courses in Invertian ideology. A Department of Astrology and Dianetics.
I spent a troubled night.