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Raymond Chandler and Medical Ethics

The Strand Magazine has appeared with a previously unpublished short story, “It’s All Right—He Only Died,” by Raymond Chandler.  Chandler (1888-1959) is best known for creating Philip Marlowe, a private detective in Los Angeles, California.  Marlowe featured in seven novels, published between 1939 and 1953; an eighth novel was unfinished at Chandler’s death, his estate in 1988 hiring Robert B. Parker to complete it.

Chandler wrote this short story sometime between 1956 and 1958, when he was thinking about writing a non-fiction book about doctors, and until recently it sat undiscovered in files of Chandler’s papers at the Bodleian Library of the University of Oxford.  Unlike Chandler’s other fiction, it offers no mystery or detective work.  It is about a grubby-looking man who reeks of whiskey; he has been hit by a truck and has been taken to a local private hospital.  There, the admitting nurse and doctor turn up their noses at what they assume is a drunken drifter, his pockets empty, and fob him off on the county hospital.  There the man dies, and it turns out he had $4,000 hidden in his belt.

Chandler added an Author’s Note to the story, and in it he underscored the ethical questions that his story addressed.  To Chandler, the doctor in his story is a disgrace, violating his Hippocratic Oath.  “Why should a doctor in such circumstances be better than other men?” he asked, replying, “The answer is simply, that if he isn’t, he is not a doctor.”

The editors of The Strand Magazine asked Sarah Trott, author of a recent book on Chandler, to add a further note about the story.  Trott pointed out that until 1956, Chandler was a British subject and that in the last years of his life he traveled a few times to London.  For her, the story’s context is Chandler’s awareness of Britain’s National Health Service, begun in 1948.

In its issue of 24 November, 2017, The New York Times ran an article about this short story.  Written by Matthew Haag and entitled “A Prescient Rebuke of Health Care System,” it concurred with Trott, saying, “Chandler, who had spent about two decades in England, had become acutely familiar with how the health system in the United States compared with public care in Europe.”

Despite the timing of this short story’s publication, it needs to be seen not as a voice from the grave regarding current debates about the federal government’s role in health insurance, but as part of Chandler’s larger focus.  Although this story by Chandler stands outside his detective fiction, it fits into his over-riding concern for chivalry and integrity and the ethical choices made by people holding positions of trust and responsibility, whether policemen, businessmen, or medical professionals.

In Chandler’s novels a recurring character type is the corrupt medical doctor.  In Farewell, My Lovely (1940), Dr. Amthor’s medical skills include crystal balls and hypnosis as he works for a ring of jewel thieves.  In The Lady in the Lake (1943), there is Dr. Almore, described by one character as “one of those doctors who runs around all night with a case of loaded hypodermic needles, keeping the local fast set from having pink elephants for breakfast.”  In The Little Sister (1949), Dr. Lagardie is on the payroll of gangsters, first in Cleveland, Ohio, then in Los Angeles.  In The Long Goodbye (1953), Marlowe encounters Dr. Verringer, who runs a private clinic for wealthy alcoholics, much of his profits going to support his loopy boyfriend’s own drug habit.

As Trott and Haag noted, Chandler was familiar with England, but neither writer explained why for much of Chandler’s life he held a British passport.  Born in Chicago to an American father and an Irish mother, Chandler’s father was an abusive alcoholic who abandoned his family.  Chandler’s mother took the boy to suburban London so he could live nearer her family and receive a classical education.  In 1907 he became a naturalized British subject and applied for a junior post in the Admiralty.  After a year there, he tried journalism, and by 1912 he was back in the United States.  Thus, his almost two decades in England were long before the establishment of socialized medicine.

When the First World War began, he enlisted in the Canadian Army and saw combat in France.  After the war, he married and became an executive with an oil company in southern California.  Like other veterans of that war, he sought solace in excessive alcohol and extra-marital sex; after losing his job for drinking, he turned to writing crime fiction.  His personality, strong, complex, and old-fashioned, comes forth most clearly, however, in his vast correspondence.

Early in Frank MacShane’s edition of Chandler’s letters, published in 1981, is one dated 17 October, 1939, in which Chandler wrote, “I like a conservative atmosphere, a sense of the past, I like everything that Americans of past generations used to go and look for in Europe.”  On 14 September, 1949, he wrote, “Sometimes I wonder what my politics would be if I lived in England,” and he explained, “Can’t imagine myself voting for socialism now that its nasty bureaucratic soul has been revealed.”  For Chandler, voting Conservative meant voting “against,” reminding him of the 1948 American presidential election, to him a Hobson’s choice between two politicians, neither one Chandler believed “has any business in the White House.”

On 21 December, 1950, he wrote to his American agent, Carl Brandt, that a novel need not reveal the author’s views of, for example, President Harry Truman or the United Nations, adding, “I have a low opinion of both.”  On 27 February, 1951, Chandler wrote to his British publisher, Hamish Hamilton, “Of course I don’t like socialism, although a modified form of it is inevitable everywhere,” adding, “I think a bunch of bureaucrats can abuse the power of money as much as a bunch of Wall Street bankers, and far less competently.”  Aware that wealth can be confiscated exactly once, Chandler wrote, “Socialism so far has existed on the fat of the class it is trying to impoverish,” and he asked, “What happens when the fat is all used up?”

If one must bring Raymond Chandler into contemporary cultural concerns, his outlook would be more in line with that of the Earl of Grantham on Downton Abbey than with the worldview of Senator Bernie Sanders.