Sometimes you hear the bullet

In   Issue Volume 19 No. 2 .

A Leavy
Reprinted from: Aust Mil Med 1998; 7(1): 21-23

The comedy/drama MASH, which concerned thelives of Ameriean army medical staff stationed just behind
the front lines in the Korean War, was one of the most successful television programs of the 1970’s. During
it’s eleven year history it presented an enormous range of issues from the essentials of friendship and loyalty to the concerns of bigotry and the irony of war. In between, MASH provided a mirror for society’s changing attitudes, particularly by revolutionising the public’s perception of the medical fraternity.

MASH began as a novel by Richard Hooker and was produced as a cinematic feature in 1970 by Ingo Preminger, Between 1972 and 1983, 250 half hour episodes of the series were produced for television. During that period and
under the direction of a variety of writers, directors and producers the program remained a consistent
performer in the top twenty television programs of countries around the world.1,2,3 It collected 14 Emmys,
and the final two and a half hour special was the highest rated program of its type in American history.

Although MASH was set during the Korean war (1950- 1953), it had its roots in the late 1960’s, a revolutionary
period of history incorporating the ‘flower-power’, hippy era, rock and roll, student demonstrations and most
notably, the Vietnam War. Traditional opinions on many subjects were being challenged during this time,
notably public attitudes towards war and morality. These changes were reflected in MASH which, in many
ways, was a pioneer in television production history.

Shortly after the end of the Korean War American television was makings its first forays into the genre of medical drama. The initial result was a docudrama entitled ‘Mefie’ which made a serious attempt to present medical issues to the public. It was killed by controversy in 1956.4 In 1961 ‘Dr. Kildare’ and ‘Ben Casey’ reached the screens and each lasted five years, to be followed in 1969 by ‘Marcus Welby MD’, ‘The Bold Ones’ and ’Medical Centre’. All of these programs presented an idealised image of doctors. They were either young, alert and handsome or older, wise and definitely genteel, but as a fraternity they were, generally, infallible combatants of illness and disease, dispensers of
wisdom and justice and guardians of moral order.4 MASH chose to present a far more realistic picture of the medical profession and was aided in this by the setting of the program,Mobile Army Surgical Hospitals. the real MASH units,
were a signifieant development of the Korean War. Combat experienee established that the survival of trauma victims is inversely proportional to the time from injury to effective treatments. The introduction of
helicopters reduced transport time which was further cut by moving fully equipped surgical hospitals to just
behind the front lines .6,7,8 Time from injury to definitive care averaged two to four hours in the Korean War
which dropped as low as 81 minutes during the Vietnam conflict.8 The cost of moving the hospitals forward was
to increase the risk to the staffing personnel and hence the stressors imposed upon them. However, it was this
pressurised setting that made it possible for the MASH writers to more fully explore the limits of human
response to the variety of circumstances. Although a model of ensemble actitg, the central characters in
MASH were Benjamin Franklin “Hawkeye” Pierce and his companion in bedevillary “Trapper” John Mclntyre (replaced in later series by B.J. Honnicutt). Asprotagonists their appearance and behaviour deviated markedly from that of previous television doctors. Unshaven and frequently stained with sweat and blood, they made a mockery of any dress code. Their living and working conditions were similarly in stark contrast to the accepted television standards of the time.
One of MASH’s central themes was examining how the characters responded to being moved from their comfortable ‘Stateside’ Iifestyles to be placed in the chaotic environment of a MASH unit. This was done essentially by contrasting the response of two characters, Majors Frank Burns and Margaret Hoolihan, to that typified by Hawkeye. Burns and Hoolihan maintained a strict adherence to military rules. regulations and in anything that did not concern
their relationship, codes of ethical and moral behaviour. Their dependence on the bureaucracy of the military to provide the ground rules for physical and mental survival was contrasted with Hawkeyes irreverent overall behaviour but reliance on the basic goodness inherent in humanitarian values to guide his actions and ethical commitments. The battle between bureaucracy and humanitarianism was among many of the issues covered by MASH. As was its corollary which accepts that there are limits to individualism when survival is dependent upon team-work (for further discussion see Fasse9).

Perhaps one of the best examples of a complex theme which is always relevant to members of the medical
profession, and which was dealt with most completely in MASH, was carried by Hawkeye from the movie to the final episode. It examined Hawkeye’s ability to cope with the insanity of being stretched to the limits of professional ability and personal responsibility. In general Hawkeye and his fellows maintained their links with sanity, in the conventional sense, by inoculation with small doses of insanity in the form of elaborate pranks and hijinks. However, this form of defence is not without its limitations.

In the movie Hawkeye is instrumental in helping the character of Painless (the dentist) to overcome his fears
of sexual impotency. Throughout the television series it is Hawkeye who must deal with questions concerning
his own worth and ability, hence his potency as a healer. An example of this occurred in the 1972-1973 season in an episode entitled ‘Sometimes You Hear The Bullet’ written by Carl Clein-schmitt. When Hawkeye was unable to save the life of an author friend and is discovered in tears by the commanding officer, Henry Blake, he is counselled with the advice that there are two rules: 1. Patients die and 2. Doctors can not change rule number one. Unfortunately Henry’s advice is valueless in the final episode of the program (Goodbye, Farewell and Amen, 1983) when Hawkeye
witnesses a mother suffocate her baby in an attempt to silence it and avoid detection when an enemy patrol
approaches their stranded bus. The baby’s death devastates Hawkeye and he retreats through a process of denial. His eventual recovery and acceptance of reality, tragic though it can be, is a slow process guided by a psychiatrist, Dr. Sidney Freidman.

In the final episode MASH comes full circle, recapturing the sentiment of the theme song for the movie, the lyrics
of which did not follow the music in the transition to the small screen (see below). Essentially, life is often
difficult and death and suffering raise awkward questions. In order to survive these questions doctors need
to return to the roots of their profession and become, where healing fails, philosophers, It is not enough to turn away from the questions of “Why?”, some attempt at an answer must be made for the sake of the patient’s, the relatives’ and the doctor’s own mental wellbeing.

In the end, MASH lasted’ three times longer than the Korean War which it depicted. In doing so it provided a
valuable medium which tempered drama with come die relief and thus allowed the viewer to confront difficult
and often dark issues without the risk of being engulfed by them. MASH also demonstrated the need for doctors
to acknowledge not only their humanity and humility but also the vulnerability of that humanness.

SUICIDE IS PAINLESS
Through early morning fog I see
Visions of the things to be
The pains that are withheld for me
I realise and I can see

*That suicide is painless
It brings on many changes
And I can take or leave it
If I please

The game of life is hard to play
I’m gonna lose it anyway
The losing card of someday laid
So this is all I have to say

* chorus

The sword of time will pierce our skin
It doesn’t hurt when it begins
But as it works its way on in
The pain grows stronger
Watch it brim

* chorus

The only way to win is cheat
And lay it down before I’m beat
And to another give mv seat
For that’s the only painless feat

*chorus

A brave man once requested me
To answer questions that are key
Is it to be or not to be
And I replied .’Oh, why ask me?”

* chorus

Lyrics: Mike Altman
Music: Johnny Mandela
Chappell Music

Acknowledgements

References

References l Tindall K, Reid D. Television’s Children. Audiovisual Research Volume I. Sydney Teachers’ College 1975 2. Tindall K, Reid D, Goodwin D. Television: 20th Cenhry CYCLOPS. Audiovisual Research Volume 2 Sydney Teachers’ College 1977 3. Lealand G. American TV Programs on British Screens. Broadcasting Research Unit: Working Paper 1984 4. Alley RS. Media, medicine and morality. 1n Adler R, Carter D (eds). Television as a Cultural Force. New York: Praeger Publishers I 976 5. Lewis FR. Prehospital Trauma Care. In Trunkey DD, Lewis FR (eds). Current Therapy of Trauma 1984-1985. Philadelphia: BC Decker Inc 1984 6. Flint LM, Flint CB. Evolution, design, and implementation of hauma systems. In Zuidema GD, Rutherford RB,Ballinger WF (eds). The Management of Trauma. Philadelphia: WB Saunders Company 1985; 4th Ed 7. Antopol MR. Advances in the military management of mass casualties. 1n West JG (ed). Trauma Care Systems: Clinical, Financial, and Political Considerations. New York: Praeger Publishers 1983 8. Trunkey DD. Predicting the community’s needs: Local solutions to local problems. 1n West JG (ed) Trauma Care Systerns: Clinical, Financial and Political Considerations. New York: Praeger Publishers 1983 9. Fass PS. Television as cultural document: Promises and problems. In Adler R” Carter D (eds). Television as a Cultural Force. New York: Praeger Publishers 1976