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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The Strand Magazine has appeared with a previously unpublished short story, “It’s All Right—He Only Died,” by Raymond Chandler.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.

Bede for Christmas

Imagine a Roman Catholic priest, a Benedictine monk in his early sixties with a sense that he is not long for this world.  He has visited one of his former students, a diocesan priest, recently settled into his post as bishop of a major city some seventy miles south of the monastery.  Back home, the old priest-professor writes a letter to the new bishop to offer some farewell thoughts on the current state of the Church in their region.

His concerns include the sorry facts that the lay faithful are not attending Mass regularly, monasteries have become lax, and priests are so poorly educated that they cannot say even the Lord’s Prayer in Latin.  Moreover, there simply are not enough priests.  The bishop really ought to do something about these problems.

The letter was written in late 734, and its author was an Anglo-Saxon man we know as Saint Bede the Venerable, or usually the Venerable Bede.  He lived from around 673 to 735, and from age seven he was either a student at a monastic school in northeastern England or was a monk of that monastery and as such taught in his old school.  Best known today for An Ecclesiastical History of the English People, he was in his own day renowned as a Scripture scholar.  He wrote several biblical commentaries, and he compiled in two volumes fifty of his homilies on the Gospels.

Just as Bede’s letter to his new bishop has a familiar ring to it, his homilies have messages for Christians today.  Bede’s fifty homilies are available in English translation, quoted below, two paperback volumes by Lawrence T. Martin and David Hurst.  Four of those homilies are for Christmas, and another one is for the Octave Day of Christmas.

One of Bede’s Christmas homilies is for Christmas Eve, his text being Matthew 1:18-25.  His other three Christmas homilies are on Luke 2:1-13, Luke 2:15-20, and John 1:1-14; for the Octave Day he preached on Luke 2:21.  Here we will consider the second one for Christmas Day, on Saint Luke’s account of the shepherds visiting the Christ child.  In these homilies Bede made similar points, so very likely they were not delivered to the same congregation all in the same year.

By the early 700s, when Bede was preaching, the Church had developed much of her teaching, and Bede inherited a long tradition of biblical scholarship.  He learned that just as Christ has two natures, fully human and fully divine, so does Scripture have two senses, literal and spiritual.  It is an insight the Church still believes and teaches, as one can find in the Catechism of the Catholic Church, Number 115.

Accordingly, Bede began each homily by looking at the literal or historical sense of the Gospel text, and then he went deeper and expounded upon the spiritual sense.  When preaching on the shepherds going to see the newborn son of Mary, Bede accepted as historical fact that one night outside Bethlehem angels appeared to shepherds.

However, on that aspect of the text he spent only a few lines.  Rather than belabor a point, Bede guided his hearers beyond the dry outer layer, what he elsewhere compared to the crust of bread, into the richer core of the biblical narrative.  From the basic history he entered another level of meaning, and that spiritual sense took him further into the sacred mysteries of his faith, making for Bede the spiritual sense also a mystical sense.

“Mystically,” he explained, “these shepherds represent teachers of flocks, and also directors of the souls of the faithful.”  Bede noted that the angels appeared to the shepherds at night, and the darkness of night stands as a symbol for the “dangers and temptations” against which spiritual shepherds are always guarding themselves and their flocks.  Bede also pointed out that shepherds are pastors and that the shepherds near Bethlehem went to see the Good Shepherd, who would after His resurrection command the man Bede called “the supreme shepherd,” Saint Peter, “If you love me, feed my lambs,” (Jn 21:16-17), meaning, “Strengthen your brothers” (Lk 22:32).

Lest his hearers think that by equating shepherds with pastors Bede was addressing only his fellow priests, he told them, “It is not only bishops, presbyters, deacons, and even those who govern monasteries, who are to be understood to be pastors, but also all the faithful, who keep watch over the little ones of their house, . . . insofar as they preside with solicitous watchfulness over their own house.”

Bede added that the lay faithful, whose pastoral role derives from their parental responsibilities, are joined also by the lay brothers of his monastery.  “Every single one of you, brothers,” Bede told them, “who is believed to live as a private person holds the office of pastor, and feeds a spiritual flock, and keeps watch by night over it, if, gathering a multitude of good acts and pure thoughts to himself, he tries to govern them with just control, to nourish them with the heavenly pastures of the Scriptures, and by vigilant shrewdness to keep them safe against the snares of evil spirits.”

It was a point made also by one of the great saints of the twentieth century, Monsignor Josemaría Escrivá.  In his spiritual classic, The Way (1939), he wrote, “You have the obligation to sanctify yourself.  Yes, even you.  Who thinks this is the exclusive concern of priests and religious?  To everyone, without exception, our Lord said:  ‘Be perfect, as my heavenly Father is perfect’ [Mt 5:48].”  From his writings as a whole, it is clear that for Saint Josemaría, sanctifying oneself means being open to and working with God’s grace.

This understanding of sanctification and pastoral service being open to all Christians occurs in the Catechism of the Catholic Church, Number 1546.  There it is explained in the context of baptism giving a believer a share in Christ’s priestly ministry.  All participate in Christ’s servant leadership to the extent that their calling enables them.

As he did in other homilies, Bede presented to his hearers a practical example in the Virgin Mary.  The historical shepherds went away rejoicing after seeing the baby Jesus.  Her joy and her sorrow came from seeing Him from crib to Cross.  In the silence of her heart, she pondered the mysteries about her son, bringing them forth when it best served others.

I don’t do Christmas trees

I don’t do Christmas trees.

It’s not a bah humbug thing, and it’s not some kind of protest about the commercialization of Christmas or a supposed paganization of it. It really has to do with that happy sadness of memory.

I was the only child of a single mother, and we were very poor. I remember one Christmas in Atlanta when I was ten. She was working two jobs as a waitress and we had a one-room apartment with a kitchenette. There was a bathroom downstairs that we shared with a basement apartment. I remember sleeping in my coat. Mama bought one of those little plastic gumdrop trees and set it on the dresser, filled it with colored gumdrops and wrapped my Christmas present – I think the landlady gave her some paper. It was two pairs of panties. They were so pretty; one was pink, and the other blue and they had a bit of lace trim. They were nylon. I’d never had anything but white cotton panties before. They were beautiful. I don’t remember being unhappy. It was Christmas and I was ten and I was loved.

Much later, not so poor and a lot older, we were still like children together at Christmas. She loved decorating and giving presents. I always had a lot of gifts; she’d even wrap a can of coffee she knew I liked and put it under the tree. This continued after her divorce and after my own. I always made it home for Christmas. It would have devastated her if I didn’t. It was Christmas and she was 70 and she was loved.

The last couple of years of her life, it was a struggle for her, especially that last Christmas, but she tried for my sake, and I tried for hers.

Mama made the most beautiful beaded ornaments and gave them to everyone she knew. I had a zillion of them, and in the first couple years after her death I decorated a Christmas tree with them. But it wouldn’t do. I gave them all away.

A few days ago, I met a friend in the parking lot at church. She lost her husband almost two years ago, and she was crying. “You said I’d get to a place where it wouldn’t hurt so much. Well, I’m still not there. It’s the memories. I hate them!”

“You will get there,” I said. “You’ll know you’re there when the memories don’t make you cry, but make you smile. And then you won’t hate the memories but cherish them.”

For the past several years I haven’t bothered with a tree; after all, I have no ornaments now. But this year, I think I’ll put up a small tabletop tree in the living room window with just some white lights. I’m pretty sure it will make me smile.