Sometimes you hear the bullet

The comedy/drama MASH, which concerned the lives of American 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 lngo¬ 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 televi¬sion 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 re¬sult was a docudrama entitled ‘Medic’ which made a serious attempt to present medical is¬sues 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, infalli¬ble 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 significant development of the Korean War. Combat experience established that the survival of trauma victims is inversely proportional to the time from injury to effective treatment. 5 The introduction of helicopters re¬duced 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 min¬utes during the Vietnam conflict. And 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 cir¬cumstances. Although a model of ensemble act¬ing, the central characters in MASH were Ben¬jamin Franklin “Hawkeye” Pierce and his companion in bedevillary “Trapper” John Mcintyre (replaced in later series by B.J. Honnicutt). As protagonists their appearance and behaviour deviated markedly from that of previous televi¬sion 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 ac¬cepted television standards of the time.

One of MASH’s central themes was examining how the characters responded to being moved from their comfortable ‘Stateside’ ¬life styles¬ to be placed in the chaotic environment of a MASH unit. This was done essentially by con¬trasting 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 con¬cern 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 Hawkeye’s irreverent overall ¬behaviour¬ but reliance on the basic goodness inherent in humanitarian values to guide his ac¬tions and ethical commitments. The battle be¬tween 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 de¬pendent upon teamwork (for further discussion see Fass9).

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 it’s 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 Cleinschmitt. 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 cannot 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, when 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 well-being.

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 comedic 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.