The medical monster on House.

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Nov. 30 2004 3:05 PM

Is There a Doctor in the House?

On Fox's new series, Hugh Laurie plays an implausible medical monster.

House: In need of ICU, stat!
House: In need of ICU, stat!

"This is a teaching hospital," we used to say dismissively in the lofty Ivy League institution where I trained as a surgeon. "We'll teach these patients not to come here." By this we meant that as residents, we had already absorbed the lessons of emotional detachment and scientific objectivity that some of our most gifted professors exemplified, with their coolly distant technological approach to the worried sick. Ours was not a place known for empathetic care; those seeking it would have to go elsewhere.

Several decades after those self-absorbed years, I would discover as my salvation Hermann Nothnagel, a 19th-century physician and teacher whose career taught me that it is impossible to be a true healer without being imbued with the morality of compassion. Among the most quoted aphorisms of that kinder era of medical practice was Nothnagel's "Only a good man can be a great doctor." As chief physician to the first department of medicine at the University of Vienna's renowned Allgemeine Krankenhaus, he was one of the world's leading internists at a hospital to which thousands of visiting foreign doctors thronged each year, to study the latest in diagnostic and therapeutic methods. In addition to the emerging technology of the time, they also came to learn the humanistic bedside philosophy of the revered professor, who taught not only that beneficence is a moral obligation of the healer, but also that clues to diagnosis and reinforcements to therapy are the natural by-products of kindness.

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House,the new Fox series (Tuesdays, 9 ET) named for its leading character, Dr. Gregory House (played by the estimable Hugh Laurie), is about a brilliant but absurdly misanthropic diagnostician whose imperiously intolerant hostility to everyone in his orbit makes the attitudes of my former teachers seem soaked in the milk of human kindness. Dr. House, who heads a department singularly called "Diagnostic Medicine" at a fictional teaching hospital somewhere in New Jersey, bears the painful residue of a disease that is rara avis indeed, something he refers to as "an infarction of muscle" in his right thigh. Having been treated by physicians far less brilliant than he, the condition has left him limping awkwardly on a cane and popping Vicodin pills as though they were breath mints.

Dr. House is the ultimate anti-Nothnagel. Because of his bitter certainty that "everybody lies," he never takes patients' histories and, if he can, even avoids seeing them altogether. He cannot be accused of having a horrible bedside manner, but only because he is never at the bedside. When he does make an appearance in the sickroom, it is to angrily reverse someone else's orders or to growl some sarcasm or downright viciousness to the patient, the family members, or House's team of three young physicians. This crew of medical ingenues consists of a neurologist with a shady past, played by Omar Epps; an immunologist with full décolletage portrayed by Jennifer Morrison; and an intensivist in the person of Jesse Spencer, who appears to be edging his way toward a coupling with his provocative female colleague. Of course, the chief protagonist of every medical series needs a hospital director with whom to grapple, and this one is played by Lisa Edelstein (with a plunging neckline to equal that of the immunologist). Robert Sean Leonard, who appears as House's long-suffering friend (can such a man have a friend?), struggles manfully with the role of conscience (can such a man have a conscience?) and moral guide (can such a man have any morality?) but often seems so detached that one can only surmise that a small voice within is telling him he'd be better off in another show.

Of all the medical errata in this series (and there are some whoppers), the greatest is surely the conceit that a physician so remote, so neglectful of duty, so sadistic, so downright cruel as Gregory House would be tolerated in any hospital, regardless of the non plus ultra quality of his diagnostic acumen. His crippled leg is a metaphor, though a clumsily obvious one, for his crippled personality. This is a man so devoid of common decency and a sense of obligation that he accuses the anxious mother of a young patient of sabotaging efforts toward her desperately sick son's cure and refuses to see consultations unless they present a sufficient challenge to his towering intellect.

Much has been made, and correctly so, of the deplorable fact that the bedside doctor of an earlier generation has been replaced by a man or woman who might be called the "bed-end" doctor, standing authoritatively at the foot of the gurney and scanning a chart or clipboard of laboratory results while speaking above the head of a frightened patient and addressing his pontifications only to the white-coated acolytes surrounding him. Medical schools and (real) teaching hospitals have been addressing these problems on a variety of fronts in recent years. Though the progress being made is admittedly too slow and inadequate, all manner of programs in humanistic care, ethics, and professional responsibility have been established while increasing attention is being paid to teaching about moral issues that arise in decision-making. Nothing is to be gained by glorifying a medical monster who makes the legendary ice prince of surgery, Ben Casey, seem like a latter-day Florence Nightingale—thankfully, Dr. House is a medical monster who does not and could never exist.

Watching the first couple of episodes, it is impossible not to wonder how Hugh Laurie let himself become involved with such a dreadful project. If he is embarrassed to be caught uttering the ludicrous lines assigned to him—which he growls in uniformly staccato bursts as though intent on getting rid of them as quickly as possible—he is too fine an actor and too loyal a trouper to provide any sign of it. One looks in vain for a giveaway twinkle in the eye or a wry turning of the mouth's corner that might signal his awareness of being immersed up to his unshaven upper lip in balderdash.

What this show needs, in the highly unlikely event that it will survive, is a character who winks conspiratorially at the viewer, conveying his awareness that Dr. House and the plot, dialogue, and story line of this misbegotten series are as outlandishly preposterous as they are laughable.

Sherwin B. Nuland is a surgeon at Yale University and the author of How We Die and, most recently, Lost In America: A Journey With My Father.

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