»  The Straggler, No. 90

May 17th, 2010

   The Voice of the Derg

Science fiction writer Robert Sheckley wrote a story titled "Protection" whose first-person protagonist acquires a guardian angel. The angel is actually a validusian derg — an invisible, immaterial being from another plane of existence, present only as a voice in one's head. The derg's sole satisfaction is to keep a human being safe from harm.

Like all pacts with the supernatural, this one turns out to have a downside. By taking on the derg, our narrator has made himself conspicuous to that other realm. Dangers multiply. The derg explains:

"If you accept protection, you must accept the drawbacks of protection …"
"Are you trying to tell me," I said, very slowly, "that my risks have increased because of your help?"
"It was unavoidable," he sighed.

I think of this story every time I visit the doctor, or read something about health-care policy. It seems that the more shields we erect against medical misfortunes, the more we need.

Consider, for example, the human prostate gland, which, says Gray's Anatomy, "consists of two lateral lobes and a middle lobe." Imagine a person, a sixty-something male in good condition, who learns on routine examination that the lobes of his prostate are somewhat asymmetrical. Is this bad? he asks the physician. Not at all … necessarily, he is told; but one cannot be too careful. Of course not.

A biopsy is arranged. Our patient is given prescriptions for large doses of antibiotics. Why? he asks. The physician explains: The biopsy is done from inside the gut, by shooting a hollow needle through the gut wall into the suspect gland. The gut being chock-full of bacteria, there is a chance of introducing infection into the gland; so at biopsy time it's wise to be loaded up with antibiotics.

But, frowns the physician (as the patient is still struggling with the concept of having needles blasted through his viscera), sometimes the gut bacteria are resistant to the entire prescribed range of antibiotics. So then the patient ends up with a nasty infection anyway, and must be hospitalized. The physician closes with "I have to tell you this," the patient now wondering if he is trapped inside one of those TV ads for miracle medicines that consist of 30 seconds cheery promotion followed by a 90-second list of terrifying side effects.

And I recall — I mean, the patient recalls — having been told by a different physician that hospitals are dangerous places, their very air a soup of hostile microörganisms. So being hospitalized for the infection one got anyway because the bacterium evaded the antibiotic when the precautionary biopsy was done in response to a possible morphological abnormality, is itself a slight additional hazard. The voice of the derg is coming through loud and clear by this point.

Prostate cancer is of course a very nasty thing, to be avoided by all means. The patient, a person ever keen to reduce things to arithmetic if possible, persuades the physician to look up the percentage probabilities at each step of this progression from bilobal asymmetry to hospital infection. Some quick mental work with Bayes' Theorem then convinces him that the biopsy is worthwhile, and the appointment is confirmed.

I am an iatrophobe; I avoid doctors as much as I can. It takes several months' relentless nagging by Mrs. Straggler to get me to the "annual" check-up. This is a family trait, though whether nature or nurture I would not venture to speculate. My father's attitude was fixed firmly in the 19th-century conception of hospitals as places where poor people go to die, and of physicians as being at least as likely to harm as to heal you. In forty years' close acquaintance with Dad, I don't recall ever seeing him take prescription medicine, though he suffered from the average number of minor ailments — colds, cramps, colics. He died aged 85 from pneumonia, "the old man's friend."

My mother, a professional nurse, was somewhat more receptive to the medical arts. Even so the household pharmacopoeia was not large: aspirin for pain, band-aids and germ cream for cuts, and something called "calamine lotion" for insults inflicted by stinging plants or insects. We were medical minimalists.

There are national differences, too. Here is my half-brother, 22 years in Her Majesty's armed forces followed by 20 more as a traffic cop, now well past retirement age and enjoying life on three sturdy pensions. (Sound of the Straggler's teeth grinding.) He spends considerable time in resorts, and is much amused by his American coevals. "They rattle when they move, they're all carrying so many pills around with them. They ask me: What are you taking? I tell them: Nothing. They can't believe it."

The U.S.A. has had a long infatuation with pills, potions, lotions, and patent medicines. A vigorous nation with a strong work ethic, driven forward by healthy young adults, it wants to banish age and all symptoms of age. The more resigned British attitude was expressed by Winston Churchill: "Most of the world's work is done by people who do not feel very well."

Possibly these oddities of national temperament account for the differences in health policy. Radical Tory Enoch Powell, a worshipper of Hayek, and one of the very few Anglosphere politicians to have resigned from government in protest at his colleagues' refusal to cut spending, happily served three years as Minister of Health in charge of Britain's socialized medical system. Perhaps a national health service can only work where the generality of citizens have the same fatalistic attitude to disease that World War One Tommies had to artillery shells: "If it's got your number on it …" Not much work for validusian dergs over there.

(Sheckley's story ends badly, of course. A very malign being called a thrang slays the protecting derg, though not before the derg has been able to explain that the narrator himself will be safe from the thrang so long as he refrains from a certain simple, everyday human action: "You must not lesnerize." And "lesnerize" is derg-speak for … what? The protector is slain before he can answer, leaving the poor narrator not knowing what commonplace action he must at all costs avoid. To compound his distress, he has a cold coming on. "Now I have to sneeze …")