The Ethics of Impaired Physicians: Wolfe's Dr. McGuire and Williams's Dr. Rivers

Abstract

^ The Ethics of Impaired Physicians: Wolfe's Dr. McGuire and Williams's Dr. Rivers Janice Willms and Henry Schneiderman In Thomas Wolfe's novels Look Homeward, Angel and Of Time and the River, an extraordinary physidan appears, Dr. Hugh McGuire. This practitioner suffers from several impairments that are assodated with professional improprieties. In this paper, we compare these impairments with those of the better-known impaired physidan in William Carlos Williams's "Old Doc Rivers." Then we analyze the ethical issues, drawing additional insights from the contemporary study of impaired physidans. Of interest, in a comparison of the physidan-diararters presented by these two twentieth-century fiction writers, is the authors' most obvious difference in perspective. Williams practiced medidne for most of his life. Wolfe was not a physidan; yet he demonstrates in many of his works a fasdnation with the lives and characters of doctors. His first play, written while he was a graduate student at Harvard, focuses on a common dilemma faced by doctors—the conflicts between personal needs and professional demands.1 Scattered throughout David Herbert Donald's new biography. Look Homeward, are accounts of Wolfe's concerns with issues of disease and the medical practitioner's life. At one point Donald notes: "Wolfe said that he was going to do a book about doctors."2 Although each sees and develops the diararter of a flawed physidan, Williams does so as an inside observer, while Wolfe looks from the outside. Wolfe first introduces Dr. Hugh McGuire to the reader early in Look Homeward, Angel. In the course of a pre-dawn conversation in a diner, McGuire, drunk, contrasts himself with his surgeon colleague, in the only episode in which fellow physidans are present with him. McGuire says, " Tve never had your advantages. I'm a self-made butcher. . . . I'm a practical man. I take out their works, spit upon them, trim off the dirty Literature and Medidne 7 (1988) 123-31 © 1988 by The Johns Hopkins University Press 124 ETHICS OF IMPAIRED PHYSICIANS edges, and send them on their way again/ "3 This exchange occurs as the inebriated McGuire contemplates an operation early the next morning. Both lay and medical personnel argue in his presence about whether he operates better drunk or sober. McGuire offers the case, vividly characterized as difficult, to a well-trained colleague, who responds, " 'I'll stand by/ . . . Ί won't operate. I'm afraid of one like this. If s your job, drunk or sober/ "4 The outcome of the operation is unspecified. McGuire next appears in relation to Eugene Gant (Wolfe's autobiographical character), when Eugene acquires a sexually transmitted disease from a prostitute in his first sexual experience. Eugene is profoundly ashamed. Dr. McGuire assesses his problem rapidly, despite Eugene's paralyzing embarrassment. McGuire's management includes medication, preventive counseling, nonjudgmental language, and a reassuringly offhanded and humorous manner. As a direct result of McGuire's skill as a healer, his patient is cured—physically and emotionally. In this, Eugene's earliest encounter with the doctor, the reader finds McGuire described as bloated and burly, with a wet rigarette hanging from his lips. The foreshadowing of future events is present in this passage, although there is yet no clue to McGuire's professional impairment. Of Time and the River brings us to May 1922, when McGuire encounters Eugene's sister, Helen, who has been caring for her father, the dying W. O. Gant. McGuire is again described as slovenly and having a "brutal, almost stupid, but somehow kindly glance."5 His speech consists of barks, grunts, and shouts. In his first appearance, McGuire has expressed both admiration and protectiveness for Helen as W. O.'s caretaker. Now Helen asks McGuire if W. O.'s last attack means that the patient's end has come. Her iteration of unanswerable questions prompts an angry but effective, possibly intentional, outburst by the doctor. McGuire fails to answer her questions directly, but spontaneously addresses the real psychosodal issues. He acknowledges the uncertainty of prognostication and admits that three to four years before he did not believe his patient could live six months. He points out that W. O.'s course has fooled everyone , including...