Doctors' Dilemmas

By S.L. Parmacek

WARD 402

by RONALD J. GLASSER, M.D. 232 pages. George Braziller. $6.95.

"They want her to die. They want her to die now." An overworked intern admits Mary Berquam, a little girl with leukemia, to the pediatrics ward of a university hospital to die. But the resident, McMillan, overrules her father's demand to let her die in peace. "I had no time for goofy parents," recalls the intern. Enter the cold, stern hematology chief, Prader. He persuades the Ber-quams to have Mary treated for the sake of scientific research. Mary's condition seems to improve.

In the background of Dr. Ronald Glasser's chronicle of hospital life are other children with fatal, costly chronic diseases, like the four-year-old boy plagued by unsuccessful kidney transplants. Mary's father stirs up a campaign of timid, deferential parents against the doctors, who never explain

anything. "A f-- cab driver asking

me about penicillin!" one doctor responds. "Talking to parents or patients was not our thing," the intern muses. "We were not very good with death." A nurse agrees: "You're all so smug and self-centered and unapproachable."

All of a sudden, Mary's spine fills with pus and she bleeds into her skin and her brain. "You son of a bitch!" shouts her father. "Haven't you tortured her enough?" He goes berserk and tries to slug every doctor in sight. The resident gives the girl special emergency treatments, including a respirator. Prader, the hematologist, now, unexpectedly, opposes the resident. "Don't you think it's time to stop being heroic?" he asks. "Don't you think enough is ever enough?" Says the resident: "There is no reason not to use everything we have," and he challenges Prader to "turn off the respirator" if he does not agree. Prader replies, "We don't kill patients." The intern pulls the plug and Mary dies.

Dr. Glasser is a pediatric specialist at Hennepin County General Hospital in Minneapolis. He composed this book, a kind of fictionalized nonfiction, out of events he has seen and others he has "heard of." Despite the author's evident concern for the unnecessary torture of children, in some ways this is a misleading effort. Glasser plays on the reader's response to suffering, as he did in 365 Days, his antiwar narrative about G.I.s mutilated in Viet Nam.

In Ward 402, Glasser's cause is not really euthanasia as such but a fashionable skepticism about progress in general. By focusing on chronic diseases, the book mixes up the anguished, specific personal dilemma of the hopelessly ill and their families with a general social crisis in American medicine. There are hard decisions to be made (TIME, July 16) about when a patient really ceases to live though he is technically still alive, as well as about staggering costs, medical needs and, indeed, the requirements of pure humanity. Such subjects, though, demand either a straightforward, rigorous, get-the-whole-story old journalism, or the fictional honesty and complexity of that other doctor,

Chekhov. "S.L. Parmacek

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