Another slow day. My latest Charlotte Yonge novel, A Reputed Changeling, is turning out quite gripping. It’s set starting under Cromwell, and then the restoration of Charles II, and finally James II and William III. Yonge, as a good high-churchwoman, dislikes Cromwell and sympathizes strongly with Charles and James, but is loyal enough to the crown, and William III and his descendants as Defenders of the Faith, that she can’t make her main characters take sides in any of the uprisings, but just sit unhappily on the sidelines. The title character is a poor ugly boy of a gentle Puritan family who looks so unlike the other children that the servants declare he must be a changeling. He is so unhappy with his father’s strict government that he wishfully believes he really does belong to the fairies, and takes to acting as mischievously as possible. General unhappiness results. The heroine’s mother takes pity on him, and helps his uncle take him away to Europe, where he is well educated, and becomes quite Frenchified, to the disgust of his family and countrymen. The climax of the book occurs twenty years later: the changeling was supposedly killed in a duel with the heroine’s favorite gentleman, who then exiles himself to fight in the war against the Turks in Austria. Finally he returns home, having won his family’s permission to marry the heroine – when the murder of the changeling is discovered, and the knight looks like having to die for it. Of course, the changeling isn’t dead, just wounded and disappeared with some smugglers. He now kidnaps the heroine, and proposes, for the third time, that she should marry him and run away with him. She doesn’t appreciate the idea, but can’t see how to get out of it. At that point I had to go see a patient, so will pick up tomorrow.

I want to know: Did women back then, or in Victorian times, really become weak and faint at the drop of a hat, or at the slightest emotion? Or was it just so dramatically useful that all the authors use it (not just Yonge; Dickens and Austen and others too)? Perhaps there was so much mitral valve disease, and rheumatic heart disease, and hyperthyroidism, and of course undiagnosed anxiety attacks, that a fair number of women really did collapse easily. Or is it a matter of societal expectations: then the women were expected to be helpless, so they were; now we’re expected to be able to work and run the house and everything all at once, so we manage. Are perceptions and expectations that powerful?

Cardiology continues very quiet. Dr. B takes me into his office every now and then to look at EKGs, or asks me what the female attending was lecturing about, and then quizzes me about it, to our mutual satisfaction. In one way cardiology fascinates me, because of all the medical disciplines I’ve seen so far (no experience with nephrology, which might compare) it comes closest to the surgeons’ quest for absolute, authoritative knowledge. They get called for very sick patients, and learn to deal in an offhand way with situations that make the other physicians very worried. I like that. I like how they can pick up an EKG and snap off a reading immediately; I might get most of the same features, but it takes me and the residents a good five minutes to figure that out. It reminds of the surgery residents in the trauma bay glancing through neck and abdomen CTs, and immediately picking up the important points, without a radiologist. But I don’t like how cardiology is ruled by protocols: there’s a decision tree and clinical processing diagram for everything. Acute coronary syndrome? Here. Angina? Here. Pre-op evaluation? Here. Atrial fibrillation? Here. Heart failure? Here. There seems to be a rule and a committee recommendation for everything.

Or maybe my problem is with modern medicine in general. More and more, the Committees are creating Standards, and pretty soon all you’ll have to do is feed the patient’s statistics into a computer, and a robot will come up with the answer. I hate robots. I never understood before the rioting in Asimov’s robot novels, but now I feel ready to join in.

The whole roomful of residents and fellows and I tumbled into a discussion of national healthcare today, precipitated by someone else, not me, discussing Hillary Clinton. The resident sagely observed that she can’t win the national election because the swing voters contain a lot of soccer moms, and most soccer moms, as well as many career women, hate Hillary. I don’t know for myself, I’m not a fair sample, but I hope he’s right. (Maybe it would be better if Mrs. Clinton were given to fainting fits. I would feel safer.) So then we had a long argument about healthcare policy. It scares me that people are so ready to give everything into the government’s hands, and trust Uncle Sam to take care of them. There’s a reason 1984 needs to be required highschool reading. Not just because of its impenetrable symbolism, but because it describes a real danger. Allen Drury’s sequels to Advise and Consent sound paranoid, but maybe he had reason to be. Why does everybody go to sleep when the danger is looming? Our society is so easily hypnotized into relinquishing all personal responsibility, all sense of individual identity and choices.

People! Do you not care about liberty? Does that word not mean anything to you anymore?

After all, it was only ever a minority idea, between the Greeks and the Celts. No other society ever really took hold of it. For all their current “democratic” governments, freedom and liberty as they were understood in ancient Greece, or among the Scots and Irish, never really entered the heads of the French and Germans; and the Russians have never dreamed of it, on a national level. The rest of the world doesn’t even come into the discussion. Maybe this is just a private fantasy that the Athenians dreamed up, and Scots-Irish in the Founding Fathers picked up on it; but nobody else can dream that way. It’s too bad. I like their dream. I wish there were enough other people who shared it; we could do something together still.