Category Archives: HISTORY OF MEDICINE

Dead Ringers: Mayhem, Malpractice, and Mortality

twins: dead ringers
The 1977 New York Times bestseller on which Dead Ringers is based

David Cronenberg’s movie, Dead Ringers (1988), tells the story of the malpractice and mayhem created by twin New York City doctors in the 1970s. It is also the story of vulnerable patients, brilliant practitioners who self-medicate, organizational collusion and cover-up, and untimely deaths.

All of these elements combine to take us on a journey of horror that was first widely publicized in the news, then fictionalized in Twins: Dead Ringers (Wood & Geasland, 1977), the book on which the movie is based. A New York Times bestseller, it is described on its back cover as “An authentic shocker .  .  . a novel of eerie power . . .”

How Could Dead Ringers Be Anything But a Horror Movie?

Cinema, in its long history, has often paired themes of medicine with the horror genre—the mad scientist, experiments gone awry, perverse caregivers, frightening instruments, grotesque human anatomy,  corruption, and bodily transformations into figures of terror.

  • Countless Frankenstein movies are based on Mary Shelley’s work (Curran, n.d.) – The obsessive Dr. Henry Frankenstein plays God by creating life from body parts of the dead.
  • One Flew Over the Cuckoo’s Nest (1975) – Defenseless patients are under the ruthless care of sadistic Nurse Ratched, who mercilessly subdues them with pills and electroconvulsive therapy.
  • Coma (1978) – A surgical resident uncovers a medical conspiracy involving the harvesting of organs.
  • Flatliners (1990) – A group of medical students experiment with near death experiences.
  • An astounding 23 movies have been made about “Jack the Ripper,” who was long believed to be a doctor by day, and serial killer by night.1
  • Numerous horror films are based on Stevenson’s classic story, Strange Case of Dr Jekyll and Mr Hyde (1886).
  • An abundance of TV and cinema on vampires, zombies, and werewolves who were all human until something irreversible happened to their bodies.

What is it about the theme of medicine/human anatomy that makes for such horror and suspense? The answer is simple; it is the loss of ultimate control. That is, control over your own body. If you can’t control your body, or what happens to it, you are not in control of anything. There is absolutely nothing more horrifying to a human being than that.

Redrum twins in The Shining
Redrum twins in The Shining (1980)

Also prevalent in horror movies are twins.2 The ultimate example is one of the most famous movie scenes of all time: the Redrum twin girls in The Shining (Kubrick, 1980).

Combine medicine with twins, and the film is inevitably classified as horror. Hence, the foreboding movie posters for Dead Ringers:

dead ringers red posterdead ringers movie poster

Dead Ringers Is Based on a True Story

Perhaps even more unsettling is that Dead Ringers is loosely based on true story of real twins, Drs. Stewart and Cyril Marcus. Born in 1930, the Marcus twins lived eerily parallel lives until their simultaneous deaths in 1975. According to Rosenbaum & Edmiston’s article in Esquire Magazine (1976),3 they had the same childhood, same college, same fraternity. and the same academic honors.

Same medical school (even shared the same cadaver). Same internship and residency. Same field of medicine. Same hospital. Same practice. Only one person attempted to separate them: their mentor Dr. Alan Guttmacher, who happened to be the doctor who delivered them at birth. (Dr. Guttmacher, a twin himself, was Director of Gynecology at Mt. Sinai Hospital where the Marcus twins began their residencies.) Dr. Guttmacher, apart from his practice of gynecology, studied twins. Thus he recognized the risks of identical lives:

‘All separate identical twins may be regarded as monsters who have successfully escaped the various stages of monstrosity,’ Dr. Guttmacher wrote. Monsters lucky enough to escape physical conjoinment must constantly be on guard against slipping back into some sort of monsterhood through psychic conjoinment.

Therefore, he intentionally separated the Marcus twins; Stewart to Stanford University in California, and Cyril to New York’s Joint Diseases Hospital. The separation, shrouded in of itself in mystery, lasted 1-3 years before Stewart and Cyril publicly reunited at New York Hospital. (Nobody can account for Stewart’s whereabouts after he mysteriously left Stanford University for one year.)

Drs. Cyril and Stewart Marcus
Drs. Cyril and Stewart Marcus

The brilliant Marcus twins were regarded as fertility gods before they spectacularly self-destructed with addiction to barbiturates, a more powerful drug than heroin. It appears that Guttmacher’s concern of “psychic conjoinment” was valid, especially when the twins simultaneously nose-dived into throes of addiction, and concurrently died under peculiar circumstances in Cyril’s apartment. However,

The toxicologist in the medical examiner’s office reported that no Demerol and no barbiturates had been found in either body.

And, later, The New York Times reported (Rensberger, 1975),

The Medical Examiner’s office determined that they had been barbiturate addicts for some time and had died of the typically severe withdrawal syndrome.

Was it “psychic conjoinment” or a personal choice for each, that one twin (Cyril) skidded down the dangerous path to addiction and the other (Stewart) was not far behind? A steady influx of disturbing reports of the twin doctors’ bizarre behavior had reached the powers-that-be of New York Hospital where they treated patients.

The reports told of their performing surgery under the influence of barbiturates, their highly inappropriate conversations, and verbal tirades with patients, their refusal to cooperate with paperwork, and an overall shockingly sharp decline of professionalism.

Excerpts about the Marcus Twins’ Self-Destruction

From Rosenbaum & Edmiston’s article (1976),

There were the mutual impersonations for instance. One twin would leave his patient in the middle of an examination and the other would return to the stirrups to complete the job.

Then there were the temper tantrums, occasionally violent. One patient, who had been hospitalized toward the end of her ninth month of pregnancy, recalls complaining to Cyril that her intravenous needle gave her pain.

‘He picked up that bottle of intravenous fluid and he slammed it down on the tray.’ When another patient disobeyed Cyril’s orders and got out of bed, subsequently suffering a miscarriage, he berated her almost vengefully.

Regarding Dr. Cyril Marcus’ performing a circumcision under the influence (Glatt, 1999),

He was like off-balance and he kind of just separated his feet a little bit to keep his balance. I was very frightened for the baby. He could have cut off the whole penis for all I know. Nurse Rowland was even more horrified when Dr. Marcus clamped the baby’s penis and began trying to cut the foreskin using the blunt handle of a bladeless knife.

Then, again from Rosenbaum & Edmiston (1976),

Nobody likes filling out insurance forms, but the Marcus twins had an unusual aversion to paperwork.
As far back as 1965, one patient reported, she had had to go through months and months of calling, pleading, and personal visits to get them to sign one simple form. Over the years the twins seemed to have developed an elaborate hierarchy of defenses against signing forms they did not want to sign. They’d refuse to respond to phone requests. They’d refuse to receive requests sent by registered mail; they’d tell patients who came to the office to get their forms signed that they’d already sent them out by mail; when the forms never arrived by mail they’d claim the post office lost them; or their mailbox must have caught fire.

New York Hospital’s Response

Dr. Fuchs was the Marcus twins’ Department Chair at New York Hospital during the time of their misconduct. It would be an understatement to say he was tolerant of postponement and delays, and took his time addressing overwhelming evidence that Drs. Stewart and Cyril Marcus were not fit to practice medicine. If anything, he appeared reluctant to interfere with the twins’ deteriorating private practice.

It took years for one ultra-persistent, “insurance form-seeker” patient to get someone to listen seriously to her frustrations with the Marcus doctors. Her breakthrough at the Department of Professional Conduct led to the New York County Medical Society Board of Censors. That, if nothing else, got Dr. Fuch’s sober attention. He then gave the Marcus twins three choices:

  1. They could take a medical Leave of absence,
  2. They could voluntarily resign, or
  3. He would recommend to the hospital board that they lose privileges to practice there.

 

Dr. Fuchs then allowed them two weeks to decide. When they didn’t come forward with a decision, an extra four days was granted. Ultimately, Dr. Fuchs made the recommendation to the board.

It would not be a stretch to say that New York Hospital‐Cornell Medical Center risked the lives and well-being of patients by not taking prompt action at the first hint of trouble with the Marcus twins. Further, upon the Marcus twins’ perplexing death, the hospital’s first response was complete denial. On July 21, 1975, The New York Times reported that the hospital had no comment (Breasted, 1975).

Mr. Richard Goldberg, administrative assistant at New York Hospital, said that he had heard nothing about  the incident with the brothers a month ago and that anyone who might know of it was not available for comment. ‘We’re not sure exactly what happened,’ he said. (The incident that was referred to was when one twin, while attempting surgery, was sent to the ER for behaving so oddly. The other twin was called, and he was also high on drugs.)

Astute observers knew better. It was not even a month later when The New York Times published another article, “New York Hospital Defends Its Actions on Marcus Twins” (Rensberger, 1975).

Officials of New York Hospital‐Cornell Medical Center said yesterday that they had become aware last year of the deterioration of the Marcus brothers, twin gynecologists who died a month ago of barbiturate addiction, and had attempted several corrective steps culminating in dismissal of the doctors from the hospital staff as of July 1.

In a lengthy defense of its actions, the hospital reversed its position of refusing to say whether it had done anything to protect patients from possible malpractice or to help the sick brothers. . . . Reports in The New York Times of the deterioration of the Marcus brothers, which may have begun at least two years ago, have stirred anew an old debate over how best to protect the public from doctors who become, through physical or mental illness, unfit to practice.
Dr. Luckey [President of New York Hospital] said his institution would join with others to devise improved ways of policing the medical profession.

Because of what happened with the Marcus twins, what was once voluntary became law. A post by Langdon (2014) says,

Although the New York State Medical Society had set up its own voluntary program for impaired physicians three years earlier, the Marcus case prompted the state legislature to pass a law that doctors had to report any colleague suspected of misconduct to the state medical board and those who didn’t would face misconduct charges themselves.

Groups Do Not Do a Good Job of Policing Themselves

The behavior of the New York Hospital‐Cornell Medical Center is not unusual. It has been shown time and time again that groups who are expected to police themselves do not do it well. Consider the Catholic Church, and its clergy handling their own accused of sexual abuse.4 Worth contemplating as well is Penn State University where Coach Joe Paterno claimed ignorance when confronted about the sexual abuses of one of his leading coaches. Also the tragedies of college girls who have reported rape on campus, where administrators in colleges and universities chose to turn a blind eye.

Waking Up Blind by Tom Harbin (2009)
Waking Up Blind by Harbin (2009)

The all-too-human tendency to protect colleagues of one’s own is prevalent everywhere, especially in the medical field where there is big money. In his book, Waking Up Blind (2009), Dr. Tom Harbin writes about Emory University’s intentional cover-up to shield itself and its renowned ophthalmologist, Dr. Dwight Cavanaugh, from the dire consequences of gross malpractice.

With supreme arrogance and greed, Dr. Cavanaugh had carelessly operated on the wrong eye of a patient, causing permanent blindness. Afterward, both Dr. Cavanaugh and Emory attempted to sweep this under the rug.

A group expected to police itself can be a source of real-life horror, as shown by the examples of the Catholic Church, university campuses, and hospitals. There is no terror so severe as a child in the company of an adult with pedophiliac tendencies. Rarely would a young person feel more scared and helpless than being asked to leave her university because she had reported the crime of rape. Or, would anyone after experiencing horror at the hands of medical incompetence.

Equal to perpetrators of terror are those who represent the real definition of monsters—people who stand by and do nothing. Had the Marcus twins’ downward spiral been interrupted with the right kind of treatment, and their careers salvaged with professional help, imagine, just imagine, what their combined genius could have further contributed to the field of infertility.

FOOTNOTES

1 Edwards’ book, Naming Jack the Ripper (2014) identifies Polish immigrant Aaron Kosminski as the killer based on DNA evidence.

2 Twins are also featured in wholesome comedy movies, e.g., The Parent Trap (1961).

3 Rosenbaum & Edmiston (1976) is a must-read for any discussion on Dead Ringers.

4 “Richard Scorer, a lawyer from Slater and Gordon who represented victims from both schools at the inquiry, said: ‘The abhorrent and disgraceful abuse in the Catholic Church has once again been laid bare by this inquiry. This familiar and shameful story of cover-up has been told time and time again, and is a devastating indictment of an organisation guilty of gross failures on child protection. It is clear the Catholic Church is woefully incapable of policing itself. That is why we urgently need a mandatory reporting law to prevent the perpetuation of the abuse of vulnerable children'” (“Child abuse inquiry”, 2018).

5 As one person in Happy Valley said, Joe knew when a thumbtack was moved on bulletin board on campus. But he didn’t know his top assistant had confessed to abusing children” (Callahan, 2011).

REFERENCES

Breasted, M. (1975, Jul 21). Death of twin doctors linked to despondency. The New York Times. Retrieved from https://www.nytimes.com/1975/07/21/archives/death-of-twin-doctors-linked-to-despondency.html

Callahan, G. (2011, Nov 15). Joe Paterno takes great fall. Boston Herald. Retrieved from https://www.bostonherald.com/2011/11/15/joe-paterno-takes-great-fall/

Canguilhem, G., & Jaeger, T. (1962, Dec 1). Monstrosity and the monstrous. Diogenes, 10(40), 27–42. https://doi.org/10.1177/039219216201004002

Child abuse inquiry: School ‘reputations put before victims’. (2018, Aug 9). BBC News. Retrieved from https://www.bbc.com/news/uk-england-45127284

Cronenberg, D. (Director). (1988). Dead ringers [MOTION PICTURE]. USA: 20th Century Fox.

Curran, S. (n.d.). A list of movies based on Frankenstein, 1910-1994. Frankenstein: The Pennsylvania Electronic Edition, University of Pennsylvania. Retrieved from http://knarf.english.upenn.edu/Pop/filmlist.html

Edwards, R. (2014). Naming Jack the Ripper. London: Sidgwick & Jackson.

Glatt, J. (1999). Evil twins: Chilling true stories of twins, killing and insanity. New York: St. Martin’s Press.

Gomel, E., & Weninger, S. (2003, Sep 1). Cronenberg, Greenaway and the ideologies of twinship. Body & Society, 9(3), 19–35. https://doi.org/10.1177/1357034X030093002

Guest Contributor. (2018, Aug 9). Catholic Church is woefully incapable of policing itself. Patheos. Retrieved from https://www.patheos.com/blogs/thefreethinker/2018/08/catholic-church-is-woefully-incapable-of-policing-itself/

Harbin, T. (2009). Waking up blind: Lawsuits over eye surgery. Minneapolis, MN: Langdon Street Press.

Johnny Depp inspired the hunt for the ‘real’ Jack the Ripper. (2014, Sep 8). Sydney Morning Herald. Retrieved from https://www.smh.com.au/world/johnny-depp-inspired-the-hunt-for-the-real-jack-the-ripper-20140908-10dpay.html

Kubrick, S. (Director). (1980). The Shining [MOTION PICTURE]. USA: Warner Bros.

Langan, M. (2014, Nov 27). The “impaired physician movement” takeover of state physician health programs. Disrupted Physician. Retrieved from https://disruptedphysician.com/2014/11/27/disrupted-physician-101-4/

Rensberger, B. (1975, Aug 19). New York Hospital defends its actions on Marcus twins. The New York Times. Retrieved from https://www.nytimes.com/1975/08/19/archives/new-york-hospital-defends-its-actions-on-marcus-twins-hospital.html

Rosenbaum, R., & Edmiston, S. (1976, Mar 1). Dead ringers: A bizarre case of the death of twins. Esquire. Retrieved from https://classic.esquire.com/dead-ringers/

Stevenson, R. L. (1886). Strange case of Dr Jekyll and Mr Hyde, and other stories. London: Longmans, Green & Co.

Teo, T., & Ball, L. C. (2009). Twin research, revisionism and metahistory. History of the Human Sciences, 22(5), 1–23. https://doi.org/10.1177/0952695109345418

Wood, B., & Geasland, J. (1977). Twins: Dead ringers. New York: Putnam.

Catherine Deneuve on ‘The Midwife’: Don’t analyze It!

Cinema is the reflection of life. That is a fact of society. It is not just cinema. It’s like that in life.
—Catherine Deneuve, quoted by Aftab in The Independent

How ironic it is that Movies on Chatham has chosen The Midwife (2017) as a vehicle for analysis and understanding, while, according to Kaleem Aftab (2017), its French star, Catherine Deneuve, suggests it’s “just a story.” Continue reading Catherine Deneuve on ‘The Midwife’: Don’t analyze It!