Star Trek and History (9 page)

Ironically, while the ideal physician wielded the whip of science in midcentury popular culture, the very real and practicing physician found himself whipped by the very knowledge that his imaginary counterpart commanded. By the 1960s, biomedical research was no longer a weapon of the renegade physician in his quest to save the world. Instead, fueled by technological advancements such as the electron microscope, biomedical research had developed into a rigorous discipline of its own, including myriad subfields that required highly specialized scientific researchers who did not always see patients.

Advances in molecular medicine, such as genetics and protein synthesis, fractured our understanding of the visible human body into a series of nearly invisible biochemical mechanisms. At the same time, the study of “morphology and function of subcellular elements detected by the electron microscope” came to replace the study of gross anatomy that was once the foundation of a medical education.
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The traditional methods of observing the human body used by Rockwell's kindly country doctor, using one's eyes and ears as well as touching the patient, could not reveal the inner workings of cancerous cells or the manipulation of DNA by viruses. In the new age of molecular medicine, then, the power of diagnosis lay not in the warm hands of the family physician, like Bones McCoy, who connected with the whole human being under his care through the power of touch and conversation, but beneath the cold microscope lens of the biomedical scientist, like Spock, who was concerned only with the bisected and highly specialized subject of his research.

The smashing of the atom and the molecular medicine that followed in its wake forced medical students to be engaged in science in ways that their forebears never were and presented them with some complicated professional choices. In the early twentieth century, most medical students aspired toward private or hospital practice, with some ambitious students opting to specialize in surgery, pediatrics, or internal medicine. By midcentury, however, these previously “specialist” fields themselves came to be seen as general medical disciplines.
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The ponderous amount of research data available in highly specialized research fields as well as the technical knowledge necessary to understand it led to the development of subspecialties within subspecialties: ultimately, the practice of medicine was fractured into many small and specialized fields.

In a medical climate where hyperspecialization was seen as scientifically sound, the general practitioner—who drew his patients from diverse populations and sought to diagnose and prescribe therapy for a wide range of diseases throughout the human body—was perceived by the medical community as something of an artifact from a time gone by. In private practice, without the scientific apparatus of a university or hospital research laboratory, the general practitioner could do little more than handle the simple cases that made up the bulk of routine health care while referring anything more complicated than a sinus infection to specialists. For all of these reasons, the prospect of entering general practice was not an appealing one to medical students who, by and large, chose to specialize and had a close affiliation with a university hospital.

Outside of the medical profession, the general public worried that the dominance of biomedical research and the increasing role of science and specialization in the practice of medicine would threaten the traditional doctor-patient relationship as they had imagined it. In the 1960s, the impossibly idealized doctor was somehow supposed to provide cutting-edge, research-based medical care, including the use of sophisticated and highly specialized technology for diagnosis and cure, while maintaining long-term personal relationships with his patients and providing them with compassionate care as whole human beings. The only place that such a perfect doctor could exist, of course, was in the world of 1960s television, where shows such as
Ben Casey
(1961–1966),
Dr. Kildare
(1961–1966), and
Marcus Welby, M.D.
(1969–1976) smoothed over the tensions between science and medicine and between the specialist and the general practitioner.

In TV shows such as
Ben Casey
and
Dr. Kildare
, we see idealistic, young, scientifically savvy physicians practicing in municipal hospitals and fighting the mechanical nature of institutionalized medicine in order to provide compassionate and humane care to patients with whom they develop meaningful relationships.
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As attentive to the human and moral dimensions of his patients as to their medical conditions, Dr. Kildare rejects the advice of his mentor, the old Dr. Gillespie, who claims that it is the physician's job to “keep people alive, not to tell them how to live.” In
Dr. Kildare
and
Marcus Welby, M.D.
, we see on the one hand the desire on the part of physicians and patients to retain all of the warmth and familiarity of general practice and, on the other hand, the need for specialization and the perceived inadequacy of general practice in an increasingly complex biomedical field.

In one episode, Dr. Kildare and his fellow internist, Dr. Carl Noyes (played by William Shatner), are approached by an established general practitioner who has been observing them at the hospital. Even though Dr. Noyes is accused of being “a mechanical man” when it comes to practicing medicine, the older physician would like to bring both men in as partners to expand his practice. Dr. Noyes is indignant at the suggestion, arguing that “general practice isn't exactly one of the highlights of medicine in this particular day and age. You should be talking to one of the interns!” Noyes then accuses the general practitioner of hunting big game with a “pea-shooter.”
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Marcus Welby, M.D.
moves the drama out of the hospital and into private practice, pitting Marcus Welby, the aging doctor fighting to practice general medicine with a humanistic flair, against his younger partner, a cutting-edge “mechanical man,” who prefers specialized medicine. While Welby is very much a modern practitioner who uses sophisticated medical science to fight disease, he is also a rebirth of Norman Rockwell's kindly old family doctor who carries a big black medical bag, makes house calls, and cares for the souls as well as the bodies of his patients.
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The character of the biomedical superhero and the family “doc” are likewise intertwined in Bones McCoy, the compassionate practitioner with old-fashioned common sense and space-age medical technology.

Against this background, we might gain a new appreciation of Bones McCoy, the general practitioner in space, and his relationship with the mostly mechanical Spock, a living metaphor for biomedical science and technology.
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McCoy is, at heart, a country doctor whose primary approaches to patient care include diagnosis through direct observation and the maintenance of health by basic therapeutics such as diet, rest, and exercise, all delivered with a healthy dose of wit, wisdom, and paternal authority. Diagnosis almost always begins with the use of the tricorder that McCoy carries in his black physician's bag or, aboard ship, the biobed that monitors a patient's life signs. These technologies, which essentially function as advanced stethoscopes, are only the first step in determining the physical state of the patient, beyond which McCoy uses traditional approaches such as palpation (touching the patient), observation, and talk therapy as methods of diagnosis and the means of human interaction.

Palpation, one of the oldest methods of medical diagnosis, recurs throughout the original
Star Trek
; after taking preliminary tricorder readings, Bones often palpates his patients manually to glean further information and to develop human relationships with them. In “Operation—Annihilate!” for example, McCoy uses the tricorder to ascertain that Kirk's Denevan nephew is still alive, after which he feels the boy's neck and wrists in search of a pulse and an assessment of his temperature. Clearly, Bones's scanner might have reported this basic information, but his impulse as a physician is to make physical human contact, which itself has healing powers, with the sick and suffering. Again, in “The Deadly Years,” Bones uses his tricorder on Kirk's joints, but then he verifies his diagnosis by manipulating the captain's knuckles; Kirk's physical response confirms what McCoy has suspected, that he suffers from advanced arthritis.

In “Friday's Child,” we find a humorous example of Bones using traditional palpation and, in essence, playing the role of the old-fashioned country doctor-cum-midwife. While bargaining for mining rites on Capella IV, McCoy becomes the primary caretaker of a pregnant woman with a burned arm named Eleen, the wife of a chieftain or “high teer.” Complicating matters, the woman's status means that she may not and will not be touched by any man other than her now-dead husband. Out in the wasteland, with only his basic equipment, Bones must examine and treat a patient who refuses to be touched. Undaunted, Bones uses his familiarity with Eleen's culture to coerce her into compliance by speaking forcefully and authoritatively: “Now listen! You may be a Capellan woman and the widow of a high teer, but I'm a doctor, and it's my tradition to care for the sick and injured. Now, let me see that arm!” Seeing his power and conviction, Eleen readily submits to him and is shocked at the quick and painless treatment he provides.

Having healed Eleen's arm, Bones then uses his scanner to assess her unborn child; finding such readings of limited value, he then reaches out to palpate her abdomen with his hand, eliciting a violent reaction from his patient: she slaps him. McCoy responds aggressively, stating, “You listen to me, young woman. I'll touch you in any way or manner that my professional judgment indicates!” After she slaps him twice, Bones slaps her back. Having gained her respect, he proceeds with his gentle palpation of her belly and concludes, “Just as I thought. It can come anytime now.” Eleen is amazed at McCoy's strangely soft hands and asks him how he can know so much just by touching her. “Because I'm a doctor, that's how I know.”

From this point forward, McCoy is not only the only man who can touch Eleen. She also proclaims him the father of the child that he delivers into the world the old-fashioned way: on his knees on the bare ground. Like a good country doctor, Bones not only delivers the child but also teaches the mother—and more humorously Spock—the proper way to hold and ultimately care for the baby who will one day be high teer of the Capellans.

Bones's successful treatment of Eleen and her son, Leonard James, hinged on Bones's humanist ability to understand and interact with his patients as individuals, each with his or her (or its) own thoughts, emotions, histories, and cultural contexts. Sometimes, bridging this gap is more challenging than others; for example, in “The Devil in the Dark,” Bones is called upon to heal the Horta, a silicon-based life-form that has been wounded by a phaser. When the doctor first meets his patient, he responds with “Help that? You can't be serious; that thing is virtually made out of stone! I'm a doctor, not a bricklayer!” Kirk reminds him, “You're a healer. There's a patient. That's an order.” Ultimately, McCoy heals the Horta by empathizing with the patient; since she
is
virtually made out of stone, he cures her by troweling a hundred pounds of thermal concrete into the wound. Once again, Bones heals his patient not with elaborate technology but with observation, respect, and old-fashioned common sense.

Bones's sensitivity to his patients in conjunction with careful visual observation of their behavior are at the center of “The Empath,” in which Kirk, Spock, and McCoy are presented with a beautiful and mysterious being who is clearly in distress but cannot speak. Using his scanner alone, McCoy is only able to determine that the creature, whom he names Gem, does not have vocal cords; careful observation of his subject from a distance, however, reveals her ability to heal Kirk's wound by internalizing his pain, leading McCoy to determine Gem's unique nature. “It fits, Jim. She must be an empath. Her nervous system is so sensitive and highly responsive that she can actually feel our emotional and physical reactions. They become part of her.”
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Like Gem, the empathic healer, Bones himself has the ability to connect with his patients emotionally. At times, he is a kind and gentle father figure. In “The Enemy Within,” for example, Bones examines the wounded hand of Fisher, who has fallen off a rock into a pile of magnetic ore. He treats the wound with what appears to be a handheld vacuum cleaner and two spray bottles of liquid. The young man's hand rests on a towel cradled in the kind doctor's palm throughout the painless treatment, while McCoy lovingly jibes him and sends him on his way, much like a parent would treat a child. At other times, McCoy takes on the role of a bartender who listens to his colleagues' problems and dispenses wisdom as well as medical advice; to this end, he keeps Saurian brandy on hand in the sickbay, and he is not above prescribing a good, strong drink in times of stress.
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Gentle and reassuring, Bones is nevertheless confident in his authority as a doctor, an authority that extends from Nurse Chapel to Captain Kirk.
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When Kirk denies a prescribed painkiller in “The Empath,” McCoy injects him against his wishes, stating, “I'm still Chief Medical Officer of the
Enterprise
. I'll tell you what you need and when you need it.” In “The Corbomite Maneuver,” Bones routinely questions and counters Kirk's authority when it comes to issues of health. McCoy completes Kirk's physical exam despite the flashing red-alert light; when Kirk reprimands the doctor on his decision, he says, “Finally finished a physical on you, didn't I? What am I, a doctor or a moon shuttle conductor? If I jumped every time a light came on around here, I'd end up talking to myself.” The doctor even changes Kirk's diet without his approval, prescribing a salad of “green leaves,” which Kirk finds distasteful.