The Doctor is abducted and
sold to an alien hospital that uses twisted ethical practices for determining
the nature of treatment for its patients.
IN BRIEF
An effective but not fully
realized allegory on the bureaucracy of medical care.
(originally aired November
1, 2000)
Teleplay by James Kahn
Story by Kenneth Biller
& Robert Doherty
Directed by Terry Windell
GUEST CAST
John Kassir -- Gar
Dublin James -- Tebbis
Larry Drake -- Chellick
Gregory Itzin -- Dysek
Paul Scherrer -- Voje
Christinna Chauncey -- Level
Blue Nurse
Stephen O'Mahoney -- Med
Tech
John O'Heir -- Husband
John Durbin -- Alien Miner
Debi A. Monahan -- Adultress
John Franklin -- Kipp
RATING (OUT OF 4)
***
ANALYSIS
Warning: This review
contains significant spoilers for Voyager's "Critical Care". If you haven't
seen the episode yet, beware.
In "Critical Care", Doc wakes
up one morning (figuratively speaking, of course) and finds himself in
the most chaotic wing of an alien hospital. He's thrust into an extreme
situation which is written very consciously by the Voyager writers
to be "extreme."
In the spirit of shows like
last season's "Memorial"
and "One
Small Step", this outing goes down as another effective "message show"
where the story emerges from a premise specifically to make a point.
Is the story's message in
your face? Well, not to a point that makes it remotely unpalatable. But
like "Memorial" and "One Small Step," the point is not going to
escape you, because it's right there, front-and-center, which is just as
well.
"Critical Care" is an allegory
that works on its story terms and also as something that wants to be a
Classic Trekkian Commentary. After last week's awful "Repression",
which wasn't about anything at all, "Critical Care" is a relief in that
it turns out to be about something.
It plays like a good, substantive
episode of The Original Series. The allegory targets the bureaucratic corporate-ness
of HMOs (Health Maintenance Organizations), which too frequently seem more
interested in the bottom line than in serving their customers (patients)
efficiently. No, HMOs aren't the devil, and they aren't anything remotely
approaching the horrors depicted in "Critical Care", but scenes like Dr.
Voje's insistence on paperwork do echo the bureaucratic nonsense that patients
must sit through in dealing with some HMOs.
~
Quick story. One of my coworkers
injured her wrist on the job last December. That was nearly a year ago,
yet today she still suffers from significant pain that interferes with
simple daily activities. She probably should've had surgery long ago. The
case is long and complicated, but I can assure you that the insurance companies
and medical providers haven't been particularly helpful in resolving the
case in any way that would avoid her stress. Perhaps the biggest kick in
the head came when she got a letter saying she was suspected of making
the whole thing up. Believe me, if I'd been put through the amount of nonsense
she has endured, I'd probably be doing research into these companies and
setting fire to their headquarters by now.
In "Critical Care" the writers
turn up the heat and make the consequences more dire. Reducing patients
to impersonal numbers isn't simply a side effect of corporate inefficiency
here, it's an intentional means to reach a rather cynical end that has
been deemed necessary by the societal Powers That Be. And the consequences
extend far beyond the mere decomposition of one's patience and peace of
mind, and instead lead straight into death.
The plot point used to drop
Doc into this situation is that he has been stolen by a scheming opportunist
named Gar and sold to a medical facility on a troubled world. This facility
-- indeed the entire society -- lacks medical resources. This particular
area of the hospital is depicted as an understaffed, overwhelmed, dim,
dank, chaotic ER. As his Hippocratic Oath programming takes over, Doc puts
aside the fact he has been abducted and quickly lends his medical talents.
Hospital administrator Chellick
witnesses Doc's abilities firsthand and decides he would be better utilized
in another section of the hospital known as Level Blue. Doc is moved out
of the chaotic Level Red wing up to Level Blue . . . which looks about
as advanced as Voyager's sickbay.
It's here where the story
unleashes its allegory-via-absurdity approach. Level Blue offers the finest
care, but treats patients who do not require the treatment they're getting.
Crucial medicine that would save lives on Level Red is wasted to treat
medical conditions that do not yet and may never exist in these patients
because, as Chellick and Level Blue's Dr. Dysek tell Doc, "it increases
life expectancy
Why are patients on Level
Blue afforded better treatment? Simple: It comes down to something called
the "TC" -- "Treatment Coefficient" -- a formula essentially derived from
a patient's current value to society. Engineers who work on projects important
to society have a higher TC than, say, expendable mine laborers, and patients
with a higher TC get the priority for medical resources, even if they don't
really need them.
Medicine throughout the facility
is rationed by "The Allocator," the hospital computer that Chellick has
supplied with inflexible directives. Doc is outraged. His outrage is irrelevant.
Chellick tells him in no uncertain terms that This Is The Way It Is.
~
What's amazing is how Chellick
is able to make his reasoning seem close to plausible. There's a potent
scene where Doc confronts the local approach to patient treatment and Chellick
responds that this once-dying society has improved dramatically under such
measures. I liked Larry Drake's performance -- not a villain so much as
a cold, inflexible pragmatist who has been given a job to do and is determined
to do it ("They brought me here to make the hard choices they don't want
to make") even if it means the lower tiers of society may pay with their
lives.
This doesn't wash with Doc
one second. Instead, he makes it his new mission to save lives on Level
Red by stealing medicine from Level Blue.
While on this mission he
recruits reluctant Level Red Dr. Voje -- a wonderful example of a decent
guy trying to do his job within the confines of a much bigger system --
to bend and eventually break the rules, manipulating the TC of Level Red
patients and later administering stolen medicine. Voje is understandably
reluctant and annoyed; when you've been brought up on an ethics system
as screwed up as this one, turning around and risking your career to oppose
it isn't necessarily the first thing to come to mind.
The Level Red situation is
reduced to the microcosm of a teenager named Tebbis, who is played fetchingly
-- almost to a fault -- by Dublin James. He's a Sick Boy and a Nice Kid,
and thus might as well have "Dead Meat" scrawled across his forehead in
a story like this. I liked the doctor/patient relationship Doc establishes
with Tebbis, even if he ends up as the episode's thematic equivalent of
the proverbial drowned kittens.
~
Indeed, one of the real strengths
of "Critical Care" is the way it portrays Doc completely in the role of
a healer. He takes pleasure in his work, where the highest reward is in
making the sick get well. And when Tebbis unexpectedly dies and Doc learns
that Chellick sat by and let it happen because the rules said so, there's
a scene where disbelief, surprise and disgust are conveyed about as well
as can be. Picardo, as usual, puts in stellar work.
There are other really good
moments here, like when Doc cleverly uses the backwardness of the system
against itself, convincing Dysek that if Level Blue uses more resources,
it will lead to getting more resources (which Doc then of course
steals and routes straight into Level Red). I also liked the riff on automated
bureaucracy in the recorded message that greets Janeway when she tries
to hail the medical facility.
What only worked kinda-sorta
for me, however, was the ending. It seemed kind of . . . anticlimactic.
The idea of making Chellick a patient in his own hospital is appropriate
enough, but the final act lacks a certain follow-through and ends up being
pretty simple.
And it doesn't really come
to any resolution. By having Chellick cave in to Doc's demands at the last
moment, we're not really solving any problems. Perhaps we're not supposed
to be solving anything, but the story's mistake, I think, is that it doesn't
really commit to a larger picture for the ending, one way or the other.
Do things get better after Doc's intervention, or worse? Is any change
effected? Should there be?
I also didn't quite understand
Dysek's motives in going along with Doc's use of this "leverage" over Chellick.
Early in the episode Dysek seems to buy completely into Chellick's way
of doing things as a matter of necessity, but by the end he flip-flops
without much in terms of motivation.
I guess it doesn't much matter,
because the episode is about this isolated case, and it keeps the focus
on Doc. By the end, it indicates a certain growth on Doc's part, permitting
him to infect a man with a disease in order to save a dozen others. It's
an ironic situation, and it's good that the episode -- and Doc himself
-- realizes this is the case.
For Doc, it's a conflict
his programming shouldn't permit, because his ethics are clear: Do no harm.
But something else in him -- call it necessity -- takes over by the end
of "Critical Care."
Interesting.
TUNE IN NEXT WEEK
Lieutenant Barclay returns
as a pawn to ... Ferengi? "Inside
Man".
Copyright 2000 Jamahl
Epsicokhan. All rights reserved. Unauthorized reproduction or distribution
of this article is prohibited.
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