House

Thank heavens, the fall television season has begun. Yes, I like television, and I found a lot to like last season. This season looks as promising. Also, it is wearying to write about something as dreary as Islam and all related to it continuously--to put it in perspective, if these Muslims did not get into our faces, we would never, ever notice them, give them the time of day, or care one way or the other about anything Islamic at any time whatsoever. Life has so much of interest, and nothing Islamic falls into that classification.

One of my favorite programs is "House." House himself is my favorite character, and he is played masterfully by Hugh Laurie. To my astonishment, I just learned that Mr. Laurie is not only English, but he is a modern blue blood, given his growing up and education.

As a physician, I have to hold my nose about the behaviors of his "house staff," a medical pun, of course. I mean his junior colleagues who are either in post residency fellowship or early professional staffdom. For example, these three doctors exist apparently without benefit of supportive staff, including nurses, laboratory and radiological technicians, and all the others the rest of us depend upon. They do MRIs, cardiac catheterizations, all laboratory chemistry procedures, and even direct neurosurgeons, cardiac surgeons, and everyone else presumably. This aspect of the program is frankly hokey. These juniors seem to work 36 hour days, 10 days a week, and 10 weeks every month, without needing another soul.

In reality, those other souls, the technicians, nurses, and other medical support personnel know much more about doing all radiological, laboratory, and similar procedures than residents, fellows, and even senior staff physician specialists. Also, NO surgeon I ever met would ever stand for some internal medicine "puke" telling him or her how to do their jobs.

However, I know that these renaissance juniors of House exist to make House come to life.

My biggest complaint comes from how they formulate differential diagnoses. Whoever does the writing bypasses the cognitive chain of evidence in favor of shotgunning a differential. The three juniors throw up possible diagnoses and indicated procedures as if they had computers doing random sorts of diagnoses and procedures, by-passing clues and the tiniest scraps of evidence which lead them to posit possibilities.

By now, it may be obvious that I am a physician. Although no longer actively practicing, I started out in a damned good, and new, medical school in the 1960s and met a few really sharp diagnosticians, like House, but with very different personalities. Like House, they were all egocentric as well as eccentric. None suffered fools lightly. We referred to being in their presence in any capacity as "gathering pearls." Presumably they were casting pearls before us swine.

House's persona has been battered through life, clearly. These batterings have given him strength and fragility as well as eccentricity. So it was with all those other diagnostician greats in whose umbra I basked.

Yet, with House, there is no compromise with the most important quality of all: rationality. Getting it right, for the patient, is the most important thing of all to House. Who gets wounded or slighted in the process is at best secondary.

Of course, it is nice to give group hugs, but as the actor Hugh Laurie puts it, most of us would rather have someone who is not nice but right over some warm fuzzy who is wrong. It is life and death on the line.

In this sense, House joins the previous season or so and this season in a clatch of programs in which reason reigns. Excluding the alien invasion stuff which has yet to prove itself, look at Bones and all the CSIs and their new spinoffs. Logic and reason, the stuff of rationality, dominate--with all the fluff as secondary. House follows suit.

I will hazard a speculation. We have lived since the 1960s with cultural corruption, with reason derogated, and sitcoms as well as endless made-for-television movies and dramas mired in the goo of rampant emotionality and unreason. The art coming from contemporary television is telling us that change is underway. We are on the road to the reassertion of reason and its offspring. House and the other pro-reason programs, however flawed, are the harbingers.

Take heart.