Saw a couple of offbeat movies recently, one pretty good, one very bad. Both had doctors in them, and they got me thinking about doctoring and what we want it to be.

What happens, f’rinstance, if your doctor’s a mobbed-up, drug-using, drug-pushing, fairly psychotic lowlife with sybaritic sexual tastes who doesn’t really mind seeing you die?

Turns out that may not be such a bad thing. 

The first, and better, film was Shadowboxer, a psychological study of a mixed-generation pair of lovers who happen to be hired assassins, and of how far love takes you (Cuba Gooding, Jr. and Helen Mirren, with Mirren’s twins playing their usual supporting role). The doc is Joseph Gordon-Levitt (superb as the lead in Brick). The second, and frankly bad, film was Crank, whose premise is that this thug killer has been shot up with “the Chinese cocktail”, an irreversibly-binding (WTF?) adrenergic antagonist that blocks all the adrenaline in the victim’s body, letting him slowly run down until he dies unless he engages in non-stop pointless activity to jazz himself up enough to keep his heart beating; it’s basically a plotless premise for 83 very tedious minutes of “action” stunts that aren’t even all that exciting to people who haven’t taken the Chinese cocktail - I wanted to stab myself, not to get an adrenaline rush but just to restore my dignity by doing penance for seeing this crap. But I digress. The doctor in Crank is played by an amazingly good Dwight Yoakum; it was his performance that suggested this post to me.

See, the thing is, when you’re a hired thug killer, you tend to run into awkward medical situations that can’t easily be explained in a regular ER. So you cultivate associations with doctors who take cash and don’t ask questions.

[MINOR SPOILERS AHEAD]

In Shadowboxer, the young resident internist realizes the killers are double-crossing their boss, but he stays mum for the sake of the baby they’re protecting. This includes showing up at a motel in the middle of the night to deliver that baby, accompanied by some illegal and unreported bullet-removal (two treatments you rarely find on the same charge sheet), as well as regular stitch-jobs for the assassin, under-the-counter meds of various kinds, and similar illicit jobs for the boss they’re all double-crossing - all this while stashing away gym bags full of greenbacks, banging his heavyset, trash-talking black* skank-ho nurse and going down on his GYN patients while they’re in the stirrups. All in all, probably the coolest guy in his med-school class.

In Crank, the aging, balding, pony-tailed and love-beaded doc gets a frantic phone call from the cocktail dude, as he (the doc) is in Vegas in the middle of an erotic oil massage from several naked Vietnamese women. He advises the guy to steal some epi from an ER (which he bungles in hilarious-hitman fashion), then takes a plane home to try and help the guy out. The laid-back doc drawlingly quizzes his patient on his symptoms over the in-flight phone on the plane (”You’ve probably got blurred vision?” “Check!” “You feel cold?” “Check!” “You have a steel hard-on?” “Check!”. . . ), then treats him as well as possible in his office when he finally arrives back in LA (”So now I’m all right, huh?” “Fuck no, you’re not all right. You’re in such shit shape it’s a wonder you’re still here!”). All this while banging his heavyset, trash-talking, black* junk-food guzzling receptionist. Probably the coolest guy in his med-school class . . . back in 1972.

Eventually, the big boss in Shadowboxer catches on that he’s being played for a fool; he tortures and kills the doctor trying to find out where his renegade killers and ex-girlfriend are hiding. The doctor regains some dignity at the end by defying the boss.

The doctor in Crank is much more interesting. He has to explain to the main character that the “cocktail” is untreatable. (Never mind - it’s not the dumbest part of the movie.) The guy has few options.

You’re fucked. . . . I can put you on life support, drag it out for a couple of days. But you wouldn’t like that. Why don’t you let me give you something? - go out on a beautiful dream? . . . Do you want me to do that for ya?

The patient decides to use his last hour on earth seeking revenge on those who shot him up, and asks the doctor for help. The doc fixes him up with a transcutaneous insulin pump loaded with epinephrine, and away he goes, both of them knowing his clock is going to stop during the process.

So, neither of these guys fits the Dr. Kildaire mold. They’re both strung out, self-indulgent, crude, and way over on the wrong side of the law. They cater to criminals, hush it up, and condone or commit drug offenses as both unorthodox medication pathways and recreationally. Both know their patients kill in cold blood, and they serve as enablers. Both are ready to see (or help) their patients die. And I like them both.

I like the fact that they see their patients’ needs clearly. Neither looks like much of a humanitarian, but how many doctors - however committed they are to value-neutral caregiving - will turn out in the rain, or catch a plane on short notice for one patient? How many patients feel they could call their doctors in a personal emergency? (The power company used to advise elderly customers to list their doctors’ phone numbers on an emergency-contact form in case they fell behind in their bills and were in danger of having their power cut off - the idea being that the doctor was the one person who could be counted on to have the patient’s welfare firmly in mind, and would naturally take steps to intervene. I once worked with a doctor who actually got such a call from the power company and was completely non-plussed: she couldn’t pay her bill? - what the hell was he supposed to do about it? - why was it his problem? I don’t think the utility companies do that anymore.)

I like the fact that they have human needs and human lives. How many doctors know the human heart - by personal experience, still less - well enough to know its yearnings and strange excursions? Most doctors do get pretty jaded about the kinds of trouble people get themselves into, but do they really appreciate it? I’d be impressed if I knew my doctor spent his weekends getting Fire and Ice from lithe, naked specialists in a casino hotel. And providing sexual services to patients on-duty? - OK, bad scene, for all the well-known reasons, but let’s allow some leeway for fictional license here and admit that this doctor’s a pretty well-rounded character.

I like the fact that they don’t let what’s legal get in the way of what’s right. OK - they don’t let it get in the way of what’s wrong, either, which is maybe a bit of an issue, but both will do whatever it takes to help their patients do whatever they need. As the right wing cranks ever further down on people’s lives and choices, more and more your doctor becomes the person who will turn you in for having the wrong wounds, taking the wrong drugs, asserting the wrong rights, or, as one recurrent Republican Congressional bill has it, having the wrong immigration status while you’re fighting for your life in an emergency room. Your doctor, and now your jackass hourly-wage strip-mall chain pharmacy droid, is more and more the person who prevents you from getting the medication you need. A doctor who encourages his patient to snort coke and steal prescription stimulants from a hospital is a refreshing alternative, no?

What I really like about Dwight Yoakum’s doctor is his lacerating honesty. If I’m ever so fucked there’s no hope in any way, what I want to hear from my doctor is: “You’re fucked.” All right, all right, few would employ that choice of words, but it’s OK to meet patients where you find them: that probably is the right way to talk to an LA hitman, and it works for me, too, even if not for everybody. A doctor who has the class to modify their language for uptight or prudish patients is fine; a doctor who doesn’t have the nads not to do so for someone more down-to-earth is not fine. (Recall the scene in Kinsey in which the title character tells his assistant: “No. No. No euphemisms. If you’re talking to a college graduate, use ‘masturbation,’ ‘testicles,’ ‘penis’ . . . With the lower-level male, it’s ‘jacking off,’ ‘balls,’ ‘prick’ . . . . I don’t know, Gebhard. Maybe your Harvard degree is too ivory tower for our purposes” - elitism aside, he’s right on the mark.) This doctor is deeply empathetic, but never pulls his punch and never sinks to any evasion or mealy-mouthedness. What I like most is his caring. He cares in the way that matters: by doing what he can. He flies back, treats the patient, tells him what he needs to know, offers him the relief that’s available, without fear or hesitation, then gives the patient what the patient wants, again without judgment. He respects his patient with the truth, and by offering him every available choice, and again by acceding to the choice he makes. He never makes the mistake of thinking it’s what he - the doctor - prefers that matters, and I think he does that because he hasn’t got a God-complex about himself or his profession.

In short, I like these doctors who are so busy being people they can’t even aspire to being “Doctors“. Doctors who aren’t so far above their patients they don’t know what it’s like to be human, to be fucked up, to be strung out, to be in need, to have no good choices, and to need no pity through it all. Doctors who live like the people they serve, not in the sense of class (though that would be a welcome and much-needed change) but of the content of the ugly lives most people lead.

To be more serious, I don’t really want doctors to consort with organized crime or promote contract killings. I don’t want them to ignore the moral constraints on their practice. But I felt a kind of admiration for these fictional doctors who understood their patients because they shared the same planet with them. Would a few flaws in your doctor really be that bad?

* I mention race in both cases here because the trashy foul-mouthed black woman is a long-standing “low-life” stereotype, as is the “exotic” sexuality that black stereotypes drags in with them. Aside from the criminality, drug-taking, and all the rest, it’s a sign of these presumptively upper-class white men’s perversity that they persistently have sex with non-white, working-class women. (Interestingly, the assassin couple in Shadowboxer is inter-racial as well as cross-generational and quasi-incestuous, but only the latter two are explored in the script. Apparently, Gooding’s role was not written as black, and was originally offered to a white actor before Gooding.) That’s a separate issue from the theme of this post - one that speaks to the film-making, not the doctors’ roles - but it shouldn’t go unremarked.