AANS Neurosurgeon : Features
Volume 22, Number 4, 2013
The Media Mystique of the NeurosurgeonAllen H. Maniker, MD, FAANS
Vince Edwards, in the title role of neurosurgeon Ben Casey, is depicted with actress Kathleen Nolan, who guest-starred as Gloria Flanders in the episode, “Hang No Hats on Dreams” (1963).
Who is the most famous neurosurgeon in the world? Harvey Cushing? Walter Dandy? Victor Horsley? Are any of them the most-famous neurosurgeon ever? Not on your life. The most famous neurosurgeon, as anyone watching TV in the 1960s could tell you, was Dr. Ben Casey. He was an invention of the media, and, to this day, remains more famous than any of the “real” neurosurgeons listed above. Moreover, he is probably responsible for a good many perceptions of what a neurosurgeon is and should be. In the 1962 season, the series based on this doctor ranked as the #7 show on television with, according to the Nielsen ratings, an average share of 28.7 percent. This meant that, in 1962, on Monday night at 10 p.m. Eastern Standard Time, almost one-third of all American televisions were tuned into “Ben Casey.” In the population of the time, this meant 6 million people. The series enjoyed enormous popularity and eventually was adapted into a comic book and comic strip format.
“Ben Casey,” the American television series, ran from 1961 to 1966 for 153 episodes. Especially striking was its introduction, as a hand was shown drawing the symbols ♂, ♀, *, †, ∞ on a chalkboard as a voice intoned, “Man, Woman, Birth, Death, Infinity.” We would later learn that the voice belonged to Dr. David Zorba (played by actor Sam Jaffe), and his deep, even-toned voice, wild mass of hair and mad-scientist look emphasized that this was a physician to be taken seriously. A senior attending and head of the neurosurgery department, Dr. Jaffe’s look was certainly a contrast to that of his young idealistic mentee, the also-very-serious (and exceptionally handsome) Dr. Ben Casey (played by Vince Edwards) as he went about saving lives at County General Hospital. Although Dr. Casey was introduced as a neurosurgical resident, his demeanor and independent responsibilities would give him the status of an attending by current standards. His status seemed to be somewhat fluid, however, depending on the particular drama being presented. Each episode tackled a new major medical problem with some running themes. Well into the first season, Dr. Casey developed a romantic relationship with Jane Hancock who had just emerged from a coma after 13 years. Dr. Casey was clearly a heartthrob, but distant and unemotional as he tended to his patients. The hospital was meant to serve as a microcosm of the greater society outside its walls and clearly tackled some very sensitive issues for its day. There was an attempt in 1988, with the television movie, “The Return of Ben Casey,” (with the title character again played by Vince Edwards) to revive the character, but it was not picked up by the networks.
In the first episode, titled “To the Pure,” a patient arrives at the emergency room with increased blood pressure and decreased heart rate. She has just had a prior episode of an hour of “convulsive” seizures. When Dr. Ben Casey arrives on the scene, he curtly asks the intern, “Reflexes? Localizing signs?” After some preliminary questions, a lumbar puncture is attempted. When the patient jerks, Dr. Casey is stuck in the hand by the needle. Later, we learn that the patient was bitten by a dog that eventually died of rabies. Dr. Casey is allergic to the Pasteur series, so he just has to wait 30 days to see if any symptoms show; if none do, he will be in the clear. Need anyone be told the outcome for Dr. Casey? (Keep in mind that 152 more episodes will follow.)
Is Ben Casey the most famous neurosurgeon ever? Did his character shape how practicing neurosurgeons were — and perhaps are — perceived?
Meanwhile, a 9-year-old Hispanic child with “an arterio venous problem” is being evaluated. After seeing the patient, Dr. Casey tells his nurse that “the blood vessels in his head are all fouled up.” Casey proposes three separate operations to attempt resection because “the kid will die anyway if I don’t try.” He meets resistance from Dr. Jaffe who feels it is all just too risky and tells him not to. Dr. Casey moves forward anyway, getting permission from the mother to perform surgery, which he decides to do in the middle of the night. The patient emerges from surgery apparently intact, wearing a head-wrap dressing. There are no monitors, let alone an ICU, and no IV fluid running. Despite this excellent result, the attending staff wants to have him fired for insubordination.
The young patient looks at Dr. Casey and asks: “Why do you never smile? Is it because you don’t like me?”
The patient’s mother in heavily accented English asks: “This attending staff, they are doctors?” Dr. Casey answers: “Doctors are like all people when you ask them to trade in a new idea for an old one: They jump out of their underwear.”
Thanks to Dr. Zorba’s intervention, the attending staff gives Dr. Casey a second chance. The second operation takes place nine days later. They begin at 7:20 a.m. and finish six hours later; a donut headrest is used but no magnification or loupes. The patient is extubated on the table and again awakes immediately, fully intact.
In the meantime, Dr. Casey is involved in a budding romance with one of the female MDs. We never learn her specialty, but we hear from Dr. Casey: “I don’t care much for female MDs; they are too unstable, and they would over-manage a case. We are neurosurgeons, and we have hands of steel.”
Ben Casey never develops rabies; the kid does well; and Dr. Casey continues to date the female MD.
In a later episode, titled “In the Name of Love, a Small Corruption,” a man with a beard and an accent arrives at the hospital with his plain X-rays. He demands to see a neurosurgeon. When asked why, he states, “If I don’t, I will go blind.”
The patient relates that his vision was acting up, and he was told by a missionary physician that he needed surgery. Dr. Casey begins his exam. He checks for nuchal rigidity, he checks the pupils, he checks for babinski. He uses an ophthalmoscope and notes to the intern that “the optic disc is pale, the margins sharper than usual and these findings suggest that there is atrophy of the optic nerve.” He observes that the skin is puffy and sallow and pasty. He performs visual field testing and notes that “the fields are better medially.”
“Do you drive?” Dr. Casey asks. “No, I gave up ’cuz I got to be like a horse with blinders on, everything was looking down the long end of a tunnel,” was the reply. With a knowing look to the intern, Dr. Casey pronounces, “bitemporal hemianopia.”
The patient then presents his X-rays, a plain skull film. Dr. Casey notes: “ballooning of the sella turcica, it’s twice its normal size.” In viewing the episode, it should be noted that indeed the sella was ballooned on the film that was shown. This demonstrated a rare attention to detail, not often seen in medical television dramas even today.
The patient goes on to have an operation and is seen post-operatively in bed, wide awake and in a head wrap. Needless to say, he has an excellent clinical result.
Clearly, the series had a consultant well-versed in neurosurgery with its references to arteriovenous problems, bitemporal hemianopias and ballooning sellas. This individual, according to his New York Times obituary, was the acclaimed neurosurgeon Dr. Joseph Ransohoff. Dr. Ransohoff was professor and chairman of the department of neurosurgery at New York University from 1961 until 1992. Many say the character of Ben Casey was partially based on his personality and figured into the writing of the scripts. The scripts of the show were also overseen by The Physicians Advisory Committee on Television, Radio and Motion Pictures, a standing committee of the American Medical Association (AMA). This committee had close contacts in New York and Los Angeles and monitored the various media to assure authentic portrayals of medicine and the profession. This input was acknowledged with a closing credit, thanking the AMA for its assistance in checking scripts for medical accuracy. The portrayal of Dr. Ben Casey was clearly influential and colored the way Americans viewed neurosurgeons. As an example of its influence, in Vietnam, medics were often referred to as “Ben Casey.”
What has the media instilled in the public as the image of a neurosurgeon — at least in the era of Ben Casey?
We are male.
We are white.
We are handsome.
We are unemotional.
We are chauvinistic.
We are arrogant.
We are risk-takers.
We are abrupt.
We are decisive.
We are impatient.
We are opinionated.
We are confident.
We are cool in the face of chaos.
We care deeply about our patients.
The list goes on and strikes one as not all laudatory — and clearly even laughable in today’s society and practice environment. However, elements of these personality characteristics remain in the public’s imagination and the media-constructed mythology of what a neurosurgeon is and should be. But this then begs the question: If the series had a neurosurgical consultant and the imprimatur of the AMA, who should we blame?
Allen H. Maniker, MD, FAANS, is chief of neurosurgery at Beth Israel Medical Center in New York City. He is a professor of clinical neurosurgery at the Albert Einstein College of Medicine. The author reported no conflicts for disclosure.