When I wrote yesterday’s post about House, M.D. I figured I might have more to say about it, but I didn’t have any explicit plans to do so. When I woke up this morning, I had an idea or two. These ideas center around community.
In this case we’re dealing with community on two levels. On the one level there’s the local community centered on our protagonist, Dr. Gregory House. This community includes his boss, Dr, Lisa Cuddy, his team of associates, Dr. Eric Foreman, Dr. Robert Chase, Dr. Allison Cameron, and his best friend, Dr. James Wilson. This local group then “shades out” through the hospital more generally. On another level there’s the community at large. This is where the patients come from. The hospital serves that community.
Illness and injury threaten that larger community. When a person is ill, they cannot participate fully in the community. When a person dies, the community is diminished. The hospital community exists to serve that larger community. The House-centered community operates within the hospital to serve that larger community.
The irony of the show is that at the center of this web of communal interactions we have an unpleasant misanthrope. House isn’t interested in the community. He’s interested in disease. What is the role of disease in the House community, if you will?
It structures their interactions, gives them purpose. In particular, differential diagnosis seems to be the central organizing activity in that local community. They meet, discuss and argue, and then go about their various tasks, usually assigned by House, who then may hang out in the office, while continuing to think, listen to music, watch TV, whatever. Those tasks will mostly take place elsewhere in hospital, though House’s associates will regularly venture outside the hospital to investigate patients’ homes and/or places of work.
The activity of differential diagnosis itself takes place through talk and writing on a white board. The talk is highly technical. I assume that it’s more or less technically correct, but I don’t know enough about medicine to judge that and I assume that’s true for most of the audience. What’s important is that we see the activity. We see investigation taking place. We experience diagnosis as a communal activity. How does this little community maintain itself in face of disease and under the pressure of the often at odds personalities of these doctors? That’s what we’re seeing. That’s what the show is about.
And then there’s serendipity. The process of differential diagnosis is driven by evidence, a patient’s symptoms and history, and by medical knowledge. And then there’s serendipity. Something accidental happens, someone notices something that might be totally unrelated to the case, but it sparks a train of thought the becomes relevant. Serendipity takes as to the edge of community, if not beyond it.
The upshot is that we see the social construction of truth, a construction that is tested in the process of treatment. The detective show does the same thing, but with a different set of procedures. We know that House was inspired in part by Conan Doyle’s Sherlock Holms and we know that the character of Holms was based, in part, on that of a surgeon, Joseph Bell. So we’ve got a century’s worth of narrative history trailing behind House, M.D., with each title having its particular mix of ingredients. It’s my impression that most of the titles don’t focus on the process of reasoning as closely as House, M.D. does. But this is not the place to even begin to sketch out the coordinates of that space.
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Addendum 7.3.24: I should have at least mentioned that, more often than not, the differential diagnosis is a race against death. Generally House and his team win the race, but not always. So, that’s what’s at stake in the various discussions about House’s disregard for procedures and dogged pursuit of the diagnosis. This is a show that forces us to confront and think about death.
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