Damn that was a good story. I last read it in the 1970’s before I went to medical school (I am now an internist and geriatrician). It didn’t make much of an impression on me then, but it sure does now!
I haven’t listened to the podcast yet, but am looking forward to doing so. I will share my thoughts about the medical aspects of the story. There are some spoilers, so read the story first.
Medical schools are adding close reading of literature and patient narratives to their curricula. (1) This would be an excellent source for that. I’ll show how that might be done.
Page numbers are from the 1st Orb edition of The Island of Doctor Death and Other Stories and Other Stories.
Page 80 - ‘a stubble of brown hair threatened to erase the marks of the sutures; with dilated eyes…he paused’
The boy has had head trauma and/or brain surgery. A drug or toxin is likely responsible for both eyes being dilated. A unilateral dilated eye would indicate acute brain damage.
Page 86 - ‘his head swaying from side to side as he walked, like the sensor of a mine detector.’
He probably has a visual field defect, possibly related to the brain surgery/trauma.
Page 86 - “I set fires to things.”
Could the surgery have been a lobotomy to control his behavior?
Page 88 - “and cut all the way through my corpus callosum.”
Nick’s brain surgery was a corpus callosotomy. (2) This surgery is usually done in patients with difficult to control seizures. The main side effect is problems with speech and alien hand syndrome—control of the non-dominant hand. (3) Nowadays, newer medications and other neurosurgical procedures have mostly supplanted callosotomy.
Page 88 - “I only see what is on the right of what I’m looking at, and the other side…only the left.”
This is known as a hemianopsia (4) and is a result of the callosotomy. The ‘I’ is the speaking half of Nick—the left side of his brain -or- “left-brain Nick.”
Page 89 - “He had uncontrollable seizures.”
“Did you?” the girl asked.
“I had visions.”
We find out the reason for Nick’s callosotomy.
He had visual auras before the seizures when he would “see things.” Nick seemed to enjoy these auras and was probably upset when they ended.
Page 91 - “there’s something you ought to know about Diane, she gets confused sometimes, we’ve had her to doctors, she’s been in the hospital…try not to get her excited.”
Diane has some major Issues. The most likely conditions to cause a 19 year old to be hospitalized would be major depression, a debilitating anxiety disorder like OCD, bipolar disorder or schizophrenia. Although Diane is skinny, anorexia nervosa is unlikely because the treatment certainly wouldn’t be stranding her on an island with no food!
Page 92 - Diane said, “I feel better when it rains.”
“That should help you to understand yourself.”
Is Dr. Island using cognitive behavioral therapy? (5) Although this is a rather expensive way of doing it!
Page 94-95 - “Sickness is…relative”
“Diane was not functioning…you were not functioning either.”
This is a major motif of the story; illness, specifically mental illness, is defined by society. In our society, a schizophrenic person may take a night job at the post office working alone, then go home to their one bedroom apartment and pull the shades to keep out the world. They would watch TV, eat dinner, go to sleep. They are content and even happy with this routine. They are contributing to society. Are they mentally ill?
Page 96 - “We have treatment for disturbed persons…but we have no treatment for disturbing persons.”
“Disturbing persons” - people with personality disorders? The best you can do is place limits on people with personality disorders and teach their families/friends how to cope with them. If they become unmanageable, societies tend to place them in prison. Could Dr. Island be a prison?
Page 97 - ‘He noticed…that she was looking at him oddly, then realized that his left hand had risen to touch her right breast.’
Alien Hand Syndrome! (3) “Right-brain Nick” is acting inappropriately.
Page 98 - “They kept me locked up because I kept burning stuff…I bite people.”
Again, “right-brain Nick” is causing all these problems.
Page 98 - “Then they stuck me full of Tranquil-C.”
That is why Nick’s eyes were dilated.
Page 98 - “I still think you’re angry somewhere, deep down.”
Taking away Nick’s auras (visions) could be the root of his anger. Perhaps the visions occurred in “right-brain Nick” and that’s why he burns things? Or is "right-brain Nick" just frustrated at his lack of control?
Page 101 - “My knees are rough…when I came here they were still smooth…I used to put a certain lotion on them. Because my Dad would feel them…Mum wouldn’t say anything but she would be cross after.”
I don’t know Diane’s diagnosis yet, but we have a good idea what may have caused her decompensation.
Page 104 - ‘There was no reply. The girl sat staring at the ground in front of her…she did not move when he touched her. “She’s catatonic isn’t she,” he said.
We now know Diane’s problem; she has schizophrenia. Catatonia is no longer consider a subtype of schizophrenia and is more a part of the symptomatology. (6)
Schizophrenia affects young adults and is a chronic condition. Some do well, but many others have major disabilities and suffer from problems with functioning and socializing. It seems that Diane is quite disabled and has a poor prognosis. It is possible that her decompensation was caused by an abusive father.
Page 104 - ‘The doctor had been a therapy robot, but a human doctor gave more status. Robots’ patients sat in doorless booths…and talked to something that appeared to be a small, friendly, food freezer.’
I have never heard of Amana being involved in cognitive behavioral therapy.
Page 104 - “What is the cause? I mean for her?”
“I don’t know.”
“And what’s the treatment?”
“You are seeing it.”
“Will it help her?”
With all their space bending technology, it seems that the prognosis for schizophrenia hasn’t changed much in the Wolfe-ian future.
Page 113 - “Your record shows no auditory hallucinations, but haven’t you ever known someone who had them?”
“I knew a girl once…she twisted noises.”
Auditory hallucinations are very common in schizophrenia. Ambient background noises are screened out by the normal brain. People with schizophrenia are unable to ignore them and experience the noise as voices saying bad things to/about them. The voices could also be internally produced by the brain.(7)
Page 115 - “Let Ignacio tell you a story…”
After unpacking Ignacio’s tale, it seems that he is a feral child. Unlike other feral children, he was taught language and self-care skills. His only lack was human contact and learning how to interact with others. Feral children have a lot of problems becoming socialized and integrating back into society. They usually aren’t homicidal. (8) Perhaps being a “high-tech” feral made him violent to others.
Page 119 - “Did I tell you about the bird, Nicholas?” She had been not-listening again.
“I have a bird. Inside…She sits in here. She has tangled a nest in my entrails, where she sits and tears at my breath with her beak. I look healthy to you, don’t I? But inside I’m hollow and rotten and turning brown, dirt and old feathers, oozing away. Her beak will break through soon.”
Okaaay, as Nick would say.
This dispels any doubts that Diane has schizophrenia. She has a somatic delusion, which, while not as common as paranoid delusions, are frequent in schizophrenia. “Usually the false belief is that the body is somehow diseased, abnormal or changed.” (9)
Page 119 - “I have been trying to drink water to drown (the bird.) I think I have swallowed so much, I couldn’t stand up if I tried…”
Diane has psychogenic polydipsia, which is common in schizophrenia. They can drink gallons every day—so much so that they disrupt their electrolyte balance and develop very low serum sodium levels. (10)
Page 125 - “About 100 years ago, Dr. Harlow experimented with monkey’s who had been raised in complete isolation.”
Harry Harlow is a real person who did indeed perform these experiments as Dr. Island has carefully outlined. Harlow was a Professor of Psychology at University of Wisconsin-Madison. (11) Many of those experiments are now considered an unethical treatment of animals.
I suspect that the inspiration for The Island of Dr. Death came about when Wolfe read about Harlow’s research. You might consider Dr. Death to be a 2150 version of Harlow.
Page 129 - “Nicholas, you are upset now because Diane is dead—”
“But you could have saved her!”
“—but by dying she made someone else—someone very important—well. Her prognosis was bad; she really only wanted death, and this is the death I chose for her.”
This is the death I chose for her.
Those words are the core of the story; did Dr. Island have the right to sacrifice an individual for the greater good? In medical ethics, this encapsulates the conflict and tension between the ethical models of deontology and utilitarianism. (12) It seems that Dr. Island is a firm believer in the later.
This is why The Death of Dr. Island would be a great source for a close reading of literature. It is a natural jumping-off-point for a spirited discussion of medical ethics.
Page 130 - “Nicholas, who was the right side of your body, the left side of your brain, I have forced into catatonia.”
Dr Island has essentially killed “left-brain Nick,” the person who has been our view point for the entire story.
This is the death Dr. Island has chosen for Nick. Did he have the right to do so?