Season 7, Episode 22: Preventative Medicine
Special Guest Stars: Dr. Anj and Dr. Chris Lewis
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WOW! What an awesome discussion!! So fascinating to hear about it from the perspective of actual doctors. It did make me check myself a little because I’ll confess in my deep heart of hearts I would always think, like, cmon… it’s just a little appendectomy…. be real with me whats the WORST that could happen… but fair play, i’ll take it as a lesson learned… for now…. But anyway, there’s so much good stuff discussed here that i had to start keeping a list!! I liked the comparison of Lacy to a james bond villain revealing his evil plan to the people who’d want to stop him most. He gave a great performance, his stillness and smooth-talk-ness make his nastiness that much harder to stomach. A colonel even Margaret couldn’t love. Makes the idea of Hawk being the real ‘villain’ of the episode send a chill down your spine! I thought of that on my rewatch and it works so well with the scene in the swamp after the appendix is out, when Hawk comes through the door shrouded in shadows and we see the blood on his scrubs before we even see his face!! YEEHAW!!! Also liked the point that this story deserved a two-parter, more consequences, more arguments, more more more everything. At least the way they wrapped it up is as good as you could hope for under the time limit, that wonderful final moment when all the fight’s out of them and theyre just left with….. Well, with themselves i guess.
Interesting to compare this episode to ‘the late captain pierce’ from season 4, similar sort of story playing out, but of course it’s been some time and things have gotten harder and Hawk’s only getting more worn down, more frantic in his need to save everyone single-handedly so help him whoever, so instead of him trying to make his point through inaction, he’s over-doing it just a tad. Still gets the same speech from BJ though, the wounded are still coming and the war goes merrily on. I do think i disagree that the way theyre left at the end of the episode speaks to a negative shift in their relationship. Honestly i love when they fight (sorry, Rob!) for exactly this reason, because it always serves to reaffirm how strong their bond is. You can freak out and drive me insane too while you’re at it and we can fight on and on through these terrible times we’re stuck in, but here’s my hand on your shoulder, real steady and not going anywhere. <3<3<3 and things of that nature.
Also love 'cutting into a healthy body is mutilation' as a BJ line. I snapshot it and keep it in a big three-ring binder in my mind that's rubber stamped with the word REPRESSION on it and filed away under D for 'depressing'. hahahahaha oh he makes me laugh. We've got a great run of episodes at the end of this season and I can't wait to hear the rest!!
Complications are always a risk with any medical procedure, and a lot of the pre-op work up is about trying to spot problems before they occur and put mitigations in place to stop the worst from happening. Removal of an appendix might seem like a “bread & butter” procedure, but there’s hundreds of things that could go wrong and cause problems. Knowingly taking out a perfectly healthy appendix could still go badly wrong, and Hawkeye is putting Col. Lacey at unnecessary risk. You can probably hear from Anj and I how unethical and unacceptable that is for a Doctor to contemplate.
I think you’re right to identify that Hawkeye has a need to try to save everyone. Quite how he squares that with the death & destruction of war going on around him, I don’t know. He is an amazingly talented surgeon, but a bit too prone to believe in his own ‘legend’ and sometimes that takes him down the wrong path.
All the talk of what could have been if this was a two-part episode was delicious food for thought. I love that Dr. Anj (I think?) brought up what Potter’s reaction might have been upon seeing Lacy in post op the next morning. Given how strongly BJ felt about not going through with the appendectomy, it makes me wonder whether he covered for Hawkeye after the fact, whether he told Potter what happened, or whether he just stayed silent about the whole thing. If MASH was going to pull a Ted Lasso and transform from a half hour comedy into an hour long drama mid-season, this would have been a great episode to do it with… ah well at least we’ll always have fanfiction.
In my head, I think Potter figured it out and thought hard about the damage he would do to the unit and their effectiveness if he held Hawkeye accountable. Then he did something — a sternly worded lecture to the senior staff on medical ethics, a private word to Hawkeye directly, or something — to let him know he’d never get away with it again.
In the current medical environment, BJ should really be whistle-blowing to Potter about what Hawkeye did , and Potter would be obligated to take disciplinary action.
Sadly the profession hasn’t historically been good about self-policing in this way, and it would be entirely believable that the 4077 doctors would close ranks around Hawkeye to protect him… even if Potter did give him an off-the-record dressing down.
Captain Entropy reporting as ordered, General Kelly, sir!
Okay, a few points before I give my answer to Dr. Lewis’s question. First, I am honored to be asked. I know Dr. Lewis thinks of me first because he’s familiar with me from the other podcasts on this network. However, I really want my M*A*S*Hcast partner, Major Joe Price, to weigh in on this, because he was an infantry officer like Lieutenant Colonel Lacy, and I think his opinion will be more valuable than mine.
Second, you, Dr. Anj, and Dr. Lewis knocked it out of the park. I am on record saying that I love it when you have them on the show. They bring the medical professional point of view that adds depth and even humor to the podcast. When I listen to podcasts, I’m always talking back in my head, but the insights all three of you shared (even the non-medical ones) were the kind that make me say things like “Yeah!” and “Great point!” No disrespect to Stanley Kubrick and the Fade Out podcast, but I consider this my real Christmas present episode from Rob Kelly.
Third, isn’t it amazing that M*A*S*H made their main character – who is an inspirational figure, as Dr. Lewis said — the villain for an episode, AND his crime was entirely within character? That shows how fully fleshed out the characters are, how great the writing is, and how well the creators understand the kinds of dilemmas war puts people in.
Now, with no further preamble (just a lot of regular amble), I will give my answer. Would I Corps give any consideration to the opinion of a medical colonel regarding the performance of a line officer? What if that officer was a combat arms officer commanding a battalion in combat? My short answer is a copout answer: “It depends.” But no need to worry. You already know a long answer is coming.
Dr. Anj brought up the early seasons and Lieutenant (emphasis added) Colonel Blake. Anj – rightly, in my opinion – said Blake would never have sent this kind of letter to I Corps. As a point of comparison, let’s explore why he wouldn’t have (human character foibles aside). Blake would have no authority, credibility, or status to bring to bear. Blake is a draftee talking about a regular Army officer. They’re the same rank, and they’re both commanders, but they have very different areas of expertise and very different commands. Blake saying something about Lacy’s work would make as much sense as Lacy saying something about how Blake runs a hospital.
The only thing Blake would have on his side would be the numbers – clear, indisputable facts. Lacy has more casualties than other battalion commanders. Now, if Lacy secured a proportionately larger number of objectives, that might be acceptable. You could make an argument he’s shortening the war, and thereby coming out ahead on net. That’s certainly a point someone would’ve made about General Patton’s casualty rate when he commanded Third Army. However, I don’t get the impression Lacy is at all comparable to Patton. Lacy might be a big man among his peers, but if so, it’s because he’s aggressive and charismatic, and he says the right things. At first blush, he fits people’s mental image of a battalion commander should be. We all know people who get by on those qualities more than they do on actual competence. Given his real lack of concern for the men, I suspect Lacy might have sociopathic tendencies, but since Sidney isn’t in this episode, we can’t really say.
By the way, the stereotype of medical personnel in the military is that they are very unmilitary. I have heard jokes about this at their expense. This is true even in the Air Force, and the other services see the Air Force as pretty lax (Space Force definitely withstanding). Of course, I’ve known medical officers who really were excellent military officers and leaders, but the common prejudice is that those officers are the exception. So, it’s possible that a complaint like this from ANY medical officer might be dismissed out of hand.
But what about Colonel Sherman T. Potter, specifically? Is he in a better position than Blake to send this letter? Definitely. He’s a regular Army full colonel who’s on his third war. (There’s a significant jump in authority and respect from lieutenant colonel to colonel, by the way, even though we call them both “colonel.”) Potter has a sterling record. Perhaps most importantly, he used to be a combat arms soldier – one who saw real, no kidding, combat. In his first war, he carried a rifle, not a scalpel, and everyone who knows him knows that. He can consequently bring gravitas other doctors just can’t.
Finally, Colonel Potter has an extensive network of senior line officers with whom he is on a first name basis. In almost every interaction, we’ve seen them show respect to his knowledge of real combat, what it’s like, and the situations they get into. They expect Potter to understand things they don’t expect Hawkeye or BJ to understand. That’s more than just his resume. It’s also his demeanor and the hard-won wisdom he brings to the table. So anyway, I think IF the person who opens that letter at I Corps knows who it’s from, it might have been taken very seriously indeed.
Now that I’ve said all that, what I’m about to say will sound self-serving, but I don’t mean it to. I relate a little bit to Colonel Potter. Unlike him, I was never combat arms, but I was in direct combat support positions. I was blessed to support some of the most effective warfighters in the world, and I learned a lot doing so. In my last couple of deployments, I went “outside the wire” quite a bit, sometimes leading NCOs and junior officers who were the real deal. My pre-deployment training was correspondingly more extensive than the training most others in my service and my career field received. As with Colonel Potter, those experiences have given me credibility that makes me more effective and honestly, more employable than I would otherwise be. So, I am honored, humbled, and grateful to have the respect of men and women whose service was, on the whole, far more difficult and dangerous than mine. And I have a special appreciation for Colonel Potter.
Awww, thanks for the kind words, Captain. For the record, I thought the Stanley Kubrick Fade Out episode was first class!
One of the genius things about Hawkeye (how he’s written and in how he’s portrayed by Alan Alda) is that – whilst he’s technically brilliant and incredibly charismatic and inspirational – he’s also flawed in many ways. Doctors are only human and we all have our failings, foibles and weak spots. Anj’s comments about burnout were spot on – even the best clinician can become tired and jaded, failing to see the wood for the trees, losing insight and making poor decisions. Hawkeye’s a great example of that in this episode.
This episode sticks in my head a lot more than “White Gold”, so that watching that earlier episode is forever colored by this more gut-wrenching take on the ethics involved. Even as a kid, I understood how wrong Hawkeye’s actions were, and respected BJ so much for calling him out. Just a powerful episode and taught young Tim a lot. Great episode, all!
Outstanding podcast discussion and listener comments for this episode. This is one of the most thought-provoking episodes of the series, given the moral tension in the conflict between Hawkeye and BJ. It’s very interesting to hear Dr. Anj and Dr. Chris Lewis discuss this, and it’s great having them on for medically focused episodes. I feel like there is no real question that BJ’s view is ethically correct, but I give the show credit for raising the moral question. I guess because Hawkeye has been there longer, he has developed more of an “ends justify the means” philosophy than BJ, but Hawkeye really has gone over the line. As you discussed, this could have been a one-hour or two-part episode if they wanted to explore this further (although I’m not sure the Klinger voodoo doll B-plot could have gone on for a full hour!).
Hawkeye when asked to carry a gun and possibly protect people he knows and cares about: “I would rather kill myself!”
Hawkeye when told that a colonel might endanger people he has never met: “I will literally rip his guts out!”
Inconsistency, thy name is Pierce.
(And now for the comment that will probably get me permanently banned from Rob’s shows.)
How is anyone, character or viewer, surprised that it has come to this? Hawkeye is a bully. He has a track record of doing anything he deems necessary to anyone, friend or foe, in order to get the outcome he wants. It was only a matter of time before his surgical ethics went out the window.
It’s no wonder he went completely nuts at the end of the series. His conscience, such as it was, finally had enough and shut him down.
Yeah, but that’s a normal (imprudent and morally wrong, but normal) reaction to the abnormal state of affairs that is war. He came to the war as an intelligent person deeply committed to his morals and probably already a little skeptical of large bureaucracies. He’s now seen so much stupidity and senseless tragedy that he’s decided to take the law into his own hands, because he believes he can’t trust anyone else to do the right thing. When you start thinking this way, you start seeing “setting things right” as your responsibility. As Rob and the doctors pointed out, he doesn’t even consider that this is something Colonel Potter can do something about, because he has so little faith in the system. As viewers, we cheer Hawkeye’s vigilante action most of the time the same way we cheer Batman (except Hawkeye’s so much funnier). This time, he just took it too far for BJ or the audience.
You would know more about what would be a “normal” in situations like that, but his responses to things seem on the extreme to me. “I want something different to eat, so I’m going to drag Radar out of bed to make a bunch of calls, then pulling in all kinds of different people to get the scheme done.” Granted, that was from one of the more silly episodes, but it’s still indicative of the “by anyone means necessary” attitude he has to get what he wants.
Yeah, sometimes they’re going over the top for comedy, and sometimes for drama. I will tell you that over the course of multiple deployments, I have on at least one occasion seen a reaction that was even more extreme than Hawkeye’s work here. But in that case there was an investigation and I think a court martial, as one would expect. And of course, people do get a little obsessive about the piece of home they’re trying to bring over or keep, a la Adam’s Rib or — was it a rubber tree in the movie Ensign Pulver? But within bounds, that’s actually a healthy outlet, kind of like how I think Klinger’s dresses were perceived (although that wouldn’t actually fly — well, maybe in a medical unit).
The episode was originally going to use the similar plot as “white gold”.
During the read through, Mike Farrell objected to the plot. The argument between Mike and Alan Alda ended up being the script that they went with.
Awesome episode, Doctor, Doctor, and… Rob. The difference between this happening with BJ instead of Trapper is obvious. BJ protested, while Trapper would have not only helped Hawkeye with the surgery, he would’ve punted the dude’s appendix into a mine field.
While BJ was disgusted by Hawkeye’s decision, I also think his forgiveness was genuine. The war took away what both men most proudly defined themselves as:
BJ as the perfect family man (when he cheated on Peg)
Hawkeye as the perfect surgeon
My view is BJ knows what this cost his friend and understands he is no better.
I greatly appreciated and respected both Dr. Anj and Dr. Lewis’s thoughtful discussion on Hawkeye’s decision. But I will say, as distasteful as Hawkeye’s actions were, if I had a son under Wainwright’s command, I would’ve thanked Hawkeye. I won’t pretend to hold the moral high ground on that.
I completely agree with your assessment that the war appears to have shaken the foundations of what both BJ and Hawkeye fundamentally believe about themselves. For my money, I think BJ demonstrates more insight into that in this episode than Hawkeye does.
I also agree that Col Lacey’s callous and blood-thirsty obsession with his Hill should have been recognised & stopped far earlier. But Hawkeye committing actual bodily harm on the man was NOT the way to accomplish that. Potter’s letter was the correct route to raise concerns about the cavalier Colonel.
The perfect episode for these guests, it was a joy to listen!
I really like “Preventative Medicine”, there is so much to dig into and analyze here.
Last week, I made it clear that I don’t care for Flagg as a character – except his dark side – and while I was listening to your conversation, I was thinking that Lacy really is like the dark side of Flagg personified. Peel away the wackiness that surrounds Flagg, and you are left with this cold man who is absolutely crazy and relentless, obsessive about achieving his goals, a man who doesn’t care if he has to step over dead bodies to get what he wants. Like Lacy.
James Wainwright does such a wonderful job, he really manages to give his character charm and also a real sense of menace.
I remember watching this episode when I was younger, thinking that BJ was absloutely right, but had I been in Hawkeye’s shoes – I can’t say that I wouldn’t have done the same thing… And I still feel the same way. It is of course like trying to fix the leak in the Titanic with some duct tape, but at least it’s doing something. I make the worst desicions under the least amount of stress, so while I don’t condone Hawkeye’s actions, I understand them. It’s such a rash desicion, I mean, if you think about it – keeping Lacy out of commission for a while might make things even worse. He will lie there in his bed growing more and more frantic and desperat to get out there and conquer, and be willing to risk even more, put more lives at stake.
It makes perfect sense for Hawkeye not to think about that, and also to walk down this path. We have seen him do the same thing before, and in general, while he is a very dedicated doctor, he also shows a lot of disrespect for other people’s bodies and souls. He is a man who walked in on an attempted rape, and went “no, no, my friend, no time to commit a horrible crime, I have a cunning plan that needs to play out” and did absolutely nothing to have the perpetrator punished, and he is also willing to set a colleague up to be sexually assaulted, and thus inflict trauma and cause damage on her body and mind. So taking out a healty organ is another step down that road.
He has regrets after the operation, or maybe it’s more that he is mourning the person he has become, and the knowledge it was both wrong and futile. It’s like we see another stone being added to the burden on his shoulders, and it will add to the frailty of his psyche.
I really love BJ’s reaction, how he genuinely gets upset and hates what his friend did. He sees his friend in a brand new light that he doesn’t like at all, but is still there to pick Hawkeye up. I think for BJ, not having Hawkeye as a close friend is terrifying, and even though someting has changed between them, he is not letting go. This will also add to the anger in BJ that we see build through the seasons.
This episode has such a nice little Margaret-moment too, when she walks out on Lacy. Early Margaret would not have been happy about the potential loss of so many lives, but I think she would have done a little mental gymnastics. She would have lifted up a rug in her mind and swept that knowledge under there. Then she would have smiled prettily and focused on Lacy’s ambition and drive, and his lovely, broad shoulders and charm. Good for her for having reached this point, she has evolved so much by now.
I can’t say that I’m a big fan of Klinger’s story line, but I can kind of see the A- and B-plot working together here. Klinger is trying to cause bodily harm in the silliest way possible, with that (very cute) voodoo doll, and Lacy is doing it in the most sinister way.
Thank you for a wonderful episode, and a very happy new year to everyone! May she be a damn sight better than the old one.
Just catching up with these after the festive season. I don’t have anything to add but what a fascinating discussion that was.
I love this episode so much, and kudos to Drs Anj and Chris (and Rob as always) for the brilliant analysis. I have to admit, my brain went to a semi-dark place when you mused about what the plot could have been if Mike Farrell hadn’t objected. I thought, what if they did the operation and there WERE complications in the form of an infection? Meanwhile, Col, Potter’s letter does some good and Lacey is reassigned stateside. Potter goes to tell Lacey the news, but it’s too late, Lacey has died from a massive infection. Hawkeye and BJ start a binge hoping to forget, but they never will. :-O
I find it interesting that Hawkeye and BJ felt they had to deal with Colonel Lacy on their own. I could be misremembering the episode, but I don’t think they ever went to Colonel Potter with their concerns, even after they learned about Lacy’s plan to engineer a conflict. If they had, I imagine that things may have ended a bit differently. I believe Chris mentioned Hawkeye’s ego at one point in the discussion, and I think he hit the nail on the head.
I found myself contrasting this episode with Season 10’s The Tooth Shall Set You Free, where Hawkeye and BJ do go to Colonel Potter with their concerns about a racist major, who commands a combat engineers unit. In that case, they all work together to bring the problem to a much more satisfying conclusion. Perhaps, our two heroes learned something from their experience with Lacy.
Thanks for another incredible episode.