___5.___

The Senator

James McCready let his mind wander as the latest doctor— what was his name? Bulmer?—began to speak. He had heard all he wanted to hear on this subject long ago.

Besides, he didn't want to be here. He felt tired and weak. He felt old.

Fifty-six and he felt like a hundred. Thank God he could sit now and regain the strength he had spent just walking here from his office… and sitting down. If they only knew what it cost him to seat himself slowly when every muscle in his body screamed to allow him to flop into his chair.

And mornings were his best times! That was why he scheduled these hearing for the crack of dawn. By the afternoon he could barely fake it. Good thing he'd been wounded in Korea. That old, nearly forgotten injury had finally served some useful purpose.

Keeping his head still and moving only his eyes behind his dark glasses, McCready scanned the committee room. He had started wearing the heavily tinted lenses when his upper lids had begun to droop. He had feared at first that people would think he was trying to look like a movie star. Instead, they said it made him look like General Douglas MacArthur. Well, if he had to look like somebody, he could certainly do worse than MacArthur.

His gaze came to rest on Congressman Switzer.

There's a man to watch out for. He smells the weakness in me and he's readying himself for the kill. The first time I stumble, he'll be on me. Look at him there, the little weasel bastard! Hanging on his pet doctor's shoulder, egging him on. Probably coached him for weeks. These doctors can't think on their own unless it's about medicine, and even then they screw up plenty!

McCready, above all else, knew about medical screw-ups. But he chided himself for begrudging Switzer a pet doctor. After all, he had plenty of his own.

He focused in on the doctor. What was his name again? He looked at the list. Oh, yes—Bulmer. He couldn't resist a smile. Poor Dr. Bulmer … probably thinks he has a real ally in Switzer. Wonder if he realizes that his buddy will drop him at the first hint that it would be advantageous to do so?

He heard the doctor say the magic words, "In closing…" and decided he'd better tune in. It had been a brief address and he was ending it while he still had everyone's attention. Maybe this doc wasn't so dumb.

"… that these so-called guidelines are cookbook medicine of the lowest sort. It allows a doctor no leeway in tailoring therapy to a particular patient under particular conditions. It reduces doctors to robot mechanics and reduces their patients to assembly-line cars. It is the most dehumanizing piece of legislation I have ever had the misfortune to read. It will drive out the kind of doctor who shapes his therapeutic approach to the individual patient, and will encourage the rise of the physician-bureaucrat who does everything unswervingly by The Book. Medicine will become as personal as Welfare, as efficient as the Post Office, and as successful as the war against the Viet Cong.

"Only one party will suffer in the long run: the patient."

From somewhere in the room there came the sound of one pair of hands clapping, then two, and then many.

Obviously ringers, McCready told himself. But then more and more hands joined in until the whole-room—some committee members included!—was clapping. What had this Bulmer character said? He'd brought no graphs or charts, and he couldn't have gone over too many facts and figures because McCready would have noticed lots of glazed eyes. Which meant that he'd probably done a "Dr. Sincerity" number on the room. He clenched a fist. He should have listened.

Well, no matter. He'd have a little fun with him, then cut him down to size. He cleared his throat and the room silenced.

"So tell me, Dr. Bulmer," he said, noting the persistent rasp in his voice, "if American medicine doesn't need guidelines, how do you explain the health care crisis in this country?"

Bulmer nodded toward him. He seemed ready for the question.

"Besides you, Senator, who says there's a crisis? A recent nationwide study showed that only ten percent of the people polled were dissatisfied with their personal health care, yet fully eighty percent were under the impression that there was a health care crisis in America. So I have to ask myself: If ninety percent of the people are satisfied with their own health care, and have not personally experienced a 'health care crisis' of any sort, where do they get the idea that there's a crisis? The answer is obvious: They have been told so often about a health care crisis in America that they believe it exists, despite the fact that ninety percent of them have no beef with their personal health care. As inheritor of a chain of newspapers, Senator, I figure you're in a better position than I to explain how this perceived crisis in health care might have been manufactured."

The bastard! McCready thought as a smattering of applause died out before it really got started. The doctor was trying to put him on the defensive. He debated mentioning that the McCready newspaper chain was being held in trust and run by a board of directors while he was in office, but decided against it. Better to ignore the remark—not even dignify it with an answer. He waited until the silence bordered on the uncomfortable. When he finally spoke he treated Bulmer's last remark as if it had never been uttered.

"So everything's just hunky-dory with American medicine, eh?"

The doctor shook his head. "No, Senator. Everything's far from 'hunky-dory' in American medicine. Doctors in general aren't doing their job as well as they should or could. I'm not talking about competence—anyone graduated from a U.S. school can be assumed to be competent. I'm talking about the void growing between doctors and their patients. The technology that allows us to diagnose and treat illness as never before is building a wall between patient and physician."

McCready wasn't too sure he liked the way this was going. He had expected some bromides about how doctors were only human and were doing the best they could. He didn't know what Bulmer was leading up to.

The doctor paused, then continued. "I really hate to bring it up before a committee such as this, but here goes: As doctors, we must—we need to—keep touching people, and by that I mean an actual laying on of hands, even when it's not necessary. It's letting that person know that there's another human being among all this hardware.

"A simple example: A doctor can listen to a heart by standing to the patient's right, grasping the head of the stethoscope with the fingers of his right hand, reaching over, and pressing it against the patient's chest wall—only the diaphragm of the stethoscope touches the patient. Or he can lean close and steady the patient by placing his left hand on the patient's bare back. He's not hearing any better, but he's in contact. It's a very simple but very personal thing. And there are diagnostic bonuses that come with touching. You can often pick up little cues from the feel of the skin and tissues beneath. It's not something you can get from a textbook, it's something you can learn only by doing. It's hands-on medicine, and too few doctors are doing it today."

The committee room was silent. Even the reporters had stopped their chatter.

They like him. The senator decided he'd do better being gentle with Bulmer rather than trying to cut him up.

"That was very well put, Dr. Bulmer," McCready said. "But why did you say you hesitated to bring it up before this committee?"

"Well…" Bulmer said slowly, obviously measuring his words. "The operating premise of this committee seems to be that you can actually lay out guidelines for good medical care. So I wouldn't be surprised if my comments inspired a new federal guideline requiring every doctor to touch each patient for a predetermined number of minutes during each examination."