This essay on Patch Adams is from my book called Hollywood Values.
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Special Note:
Early this year (2006) a "long-ago US Navy Hospital Corpsman 2C" e-mailed me to inform me that the enema bulb Patch uses as a clown's nose in the children's ward is really an ear syringe. I wrote this part of my book years before then (in 1999, if I recall correctly), and I haven't seen the movie since that time, so I assumed that I was mislead somehow or other. Now (late in 2006), however, another reader has e-mailed me to let me know that Patch himself calls the thing an enema bulb in the movie. It's clear to me now that that's where I got the idea in the first place! Which means that I wasn't wrong to begin with (even if it's in reality an ear syringe).

I guess I should do what Ishmael, Melville's narrator of Moby Dick, does when he boldly claims that the whale is a "fish," even though he knows that it's really a mammal.

So much then for the "enema bulb" vs. the "ear syringe" controversy!

Patch Adams (1998)

Steven C. Scheer

Screenplay: Steve Oedekerk (based on Gesundheit:
Good Health is a Laughing Matter
by Hunter Doherty Adams
Director: Tom Shadyac
Starring: Robim Willians (Hunter "Patch" Adams)
Monica Potter (Catin Fischer)
Truman Schiff (Daniel London)
Philip Seymour Hoffman (Mitch)
Bob Gunton (Dean Walcotto)
Harve Presnell (Dean Anderson)
Harold Gould (Arthur Mendelson)
Michael Jester (Rudy)

It has crossed my mind to wonder whether it isn't the point of all professions - of medicine and law as much as of philosophy and psychoanalysis - to instill deadness. Of course, the conscious self-image of every profession is that it is there to maintain high standards. And there must be some truth in this image. But what does this image cover over? Don't standards themselves impose a kind of rigidity on a practice? Doesn't a professional set of standards enable a profession to forget about standards? That is, it enables a profession to stop thinking critically about how it ought to go on precisely because the standards present themselves as having already answered the question. The profession can then act as though it already knows what high standards are. This is a form of deadness.
- Jonathan Lear, Open Minded: Working out the Logic of the Soul

The book from which my opening quotation is taken happens to have been published in the same year in which Patch Adams was released. Though the connection between the publication of the book and the release of the movie is probably purely coincidental, the thematic similarity between the passage quoted and Patch Adams is astounding. It is indeed in our best interest both to honor the tradition within which we ply our trade and to challenge it from time to time in order to keep it vital. There is a danger in honoring tradition blindly and making sure that it remains unchanged no matter what. We must at times unthink our thinking lest our thinking become unthinking thinking, for the enemy of critical thinking is habitual ways of thinking. Those who are convinced that they already have all the answers are not the best representatives of a given profession.

As Arthur Mendelson tells Hunter Adams at the time he renames him Patch, it is incumbent upon us to see what no one else sees, because by merely focusing on a problem, we may well overlook its solution. As with the puzzle of the four fingers, knowing the "right [read: settled once and for all] answer" isn't always possible in "real life." Which is precisely why the official view of things must be challenged from time to time, for officially accepted views of things (even officially accepted versions of truth and justice) aren't necessarily so (or either true or just). There are times when tradition is a dead weight unnecessarily burdening the living, those who are made to carry it. Even if it doesn't kill us, it will slow us down and make us overlook the possibility of throwing it off, of being liberated from it. It is also interesting to note that Patch gets his new name when he repairs a leaking paper cup with a piece of self-adhesive strip that was originally meant for another purpose.

The opening words of the movie ("All life is a coming home"), should remind us of the Odyssey, the ultimate or archetypal coming home story in classical literature. But in this context the words express something more than a literal return home, they express something like having found one's true place in the world. Patch also invokes the opening words of Dante's Inferno when he speaks of having lost the right path in the middle of his life's journey - the right path, which he was to find eventually "in the most unlikely place," in a psychiatric ward. What unfolds here is a clear statement of the overall theme of the movie as a whole. We see this when we witness the injection in the buttocks that Rudy receives when he acts hysterically, as if this were the only solution to his problem. And we also see this when we realize that the psychologist is not listening to Patch as the latter recounts his father's death and how his world had changed as a result of that event.

The true solution to Rudy's problem, his unduly fear of squirrels (because they may be after his "nuts" - one of the first in a series of many word plays and puns in the movie as a whole), is something that Patch accidentally stumbles upon when, partly for the sake of his own convenience, he decides to enter into Rudy's delusion and starts shooting the imaginary (but to Rudy very real) squirrels with equally imaginary guns. It is, paradoxically, by taking Rudy's delusion seriously that Patch manages to "cure" Rudy of it. Clearly what Rudy needed was not injections in the buttocks, but someone to understand what it was that he had been afraid of in the first place.

Contrary to what Patch says later (about how it wasn't the doctors that helped him, but the patients), it is really Patch who helps himself, albeit indirectly. As he puts it later, by concentrating on the problems of others, he forgot about his own. What he discovers is that God doesn't necessarily help those who help themselves, that God may well help those who help others. Thus at times it is only by helping others that we can truly help ourselves. But this isn't possible if we don't listen to our fellow human beings, if we won't pay attention to what is really bothering them. Merely being paid to help others (as in the case with the psychologist who doesn't listen to Patch) will not do the trick, even if the person being paid is an otherwise well-trained professional. Patch is right when he tells the doctor on the morning of his departure from Fairfax Hospital that the doctor "sucks" at helping others because he doesn't "listen, really listen to people."

When the story picks up two years later at Virginia Medical University, Dean Walcott is lecturing. His theme is the time-honored "do no harm" of the medical profession (part of the Hippocratic oath), but his reason for advocating it is grounded in a kind of misanthropy, an attempt to undo the seemingly natural trust that people place in doctors, because no human being, according to Dean Walcott, is worthy of trust. It is, therefore, as he tells his students, his ambition to "train the humanity out of [them], to make [them] into something better." Although Dean Walcott's message is clear enough as far as what he is trying impart to his students about the medical profession is concerned, there is an unwelcome implication in the idea that doctors, if they are to be any good, must be better than human beings, must somehow transcend and stay aloof of their own humanity. The entire class applauds Dean Walcott's lecture enthusiastically, only Patch Adams seems unmoved and without a smile on his face.

Carin Fisher reinforces Dean Walcott's message when she tells Patch, who is trying to engage her in conversation after the lecture (it seems he has been instantly smitten by her), that she is there to study medicine, period. Later, in the University Diner where Patch has gone with his newly-made friend, Truman Schiff, the two talk about the ways in which society turns spontaneous individuals with open minds into robots apparently not capable of anything but programmed responses. Patch is convinced, though, that the program can be changed. After an attempt to prove this (by suddenly dropping down head first from the branch of a tree on the sidewalk, for example, which at first scares an elderly woman but then, after a bit of delay, makes her respond with a big smile on the face to the joke), Patch and Truman get quite accidentally caught up with a bunch of meat packers who are having a convention nearby.

The purpose of the episode with the meat packers is twofold. It gives us a chance to see just how spontaneous and funny Patch can be, but it also enables us to see him suddenly realize that, in a way, what stands in his way of engaging with patients is a white coat (which third-year medical students wear in their hospital rounds). Patch uses the coat the meat packers give him in lieu of a doctor's traditional white coat. And his first act of imposture is to inquire after the name of a frightened diabetic woman suddenly surrounded by a bunch of medical students in white coats who are there to observe her from a strictly objective and professional (read: totally impersonal) point of view. As the students move on, Patch squeezes the woman's hand as a gesture of human touch, which has already become his trademark, both in a literal and in a figurative sense.

It is in order to avoid getting caught by Dean Walcott that Patch stumbles into the children's cancer wing where he first puts on the red enema bulb as his clown's nose. The sleepy, morose children in the deathly quiet ward soon respond to Patch's antics so that laughter quickly fills the room, which then almost instantly turns into a state of joyous pandemonium. It is as if for a few moments at least the children forgot where they were and why. In the scene immediately following this, we see Patch in Dean Walcott's office as the latter "lectures" him about people with brilliant minds who don't think that the rules apply to them. It is here that he tells Patch that "passion doesn't make doctors," that the likes of him - that is, the likes of Dean Walcott - "make doctors." When Patch wants to know why things have to be the way they are, Dean Walcott's simple response is the usual and rather predictable "our way of doing things is a product of centuries of experience." No doubt.

"Deviation of the tongue," says a member of the study group sitting around a table in the library. One cannot help but think that this transition from Walcott's office to the scene in the library is well punctuated by a "deviation of the tongue," for (indeed) it seems that someone somewhere has misspoken something. The irony implicit in the title of the book Patch holds in his hands in this scene should not escape the viewer either: The Business of Medicine. Of course, the word "business" can function in multiple ways, but (again) one cannot help but feel that the medical profession was never meant to be simply a business, like any other business, in business for profit and profit alone (the Hippocratic oath makes this very clear, too). At this point Carin once more rebuffs Patch when the latter seems more interested in discussing why people want to become doctors than the biology lesson immediately at hand, the "deviation of the tongue."

What follows is a series of pranks in which Patch in one way or another is trying to drive home the lesson that "laughter is the best medicine." Carin is not buying any of this, but when she sees the grades posted on the wall in the hallway and realizes that Patch's grades are among the highest in the class, she begins to waver. Indeed, all those reviews of the movie that pan Patch on the grounds that they want serious doctors rather than clowns overlook not only the whole point of the movie but also the fact that Patch is not simply a clown but a serious and highly competent doctor-to-be who, in addition to all the other qualifications any doctor may need, also has a sense of humor and believes that a touch of humanity is never out of place in the healing profession. In any event, Carin is now ready to assist Patch in yet another prank to cheer up one of the patients. Patch's antics usually pay off, except in the case (an admittedly difficult case) of Mr. Davis, a patient dying of pancreatic cancer. Patch doesn't give up, though. He goes to Room 305 at one point dressed as an angel and finally gets through to Mr. Davis with a series of word-plays on a "preview of coming attractions."

In spite of repeated warnings from Dean Walcott (who firmly believes that "patients don't need to be entertained. They don't need a friend, they need a doctor"), Patch goes on with his antics. When he is put in charge of the welcoming committee for the "medical seminar/retreat for the fellowship of the American College of Gynecologists," Patch outdoes himself. The gigantic papier-mâché legs spread out on either side of a doorway, which thus functions as a vagina (a huge pun on the birth canal through which the visiting gynecologists are to enter the auditorium), proves too much for Dean Walcott. He uses this attempt at humor on Patch's part to dismiss him from school. It is only because his antics have obviously improved the patients at the hospital that Dean Anderson overrides Dean Walcott's decision and allows Patch to stay in school.

In the meantime, though still wary, Carin is more and more responsive to Patch's larger than life humanity. This becomes especially obvious when Patch throws her a surprise birthday party where, in the balloon-filled room, he begins to read her from a poem which he is not going to be able to finish until much later, in rather sad circumstances. The opening lines of the poem are:

I do not love you as if you were salt-rose, or topaz,
or the arrow of carnations the fire shoots off.
I love you as certain dark things are to be loved,
in secret . . .

When Patch encounters a frantic woman who is not allowed to see her dying daughter (the victim of a drunk driver who has already taken her son and husband), because she hasn't filled out certain forms yet, he is ready to act. It is in the University Diner that he suddenly sees what he needs and wants to do, to create a free clinic where bureaucracy never stands in the way of people helping people. As Patch tells Carin, he wants this to be the "first fun hospital in the world" where "love is the ultimate goal." To the still skeptical Carin he says that "there is more to life than power and control." Carin's "people get hurt" remark carries an ominous ring. Patch sympathizes with her and wants to know who or what it was that had hurt her in the past.

When the Gesundheit Institute opens out in the countryside in the midst of imposingly verdant mountains (thanks to Arthur Mendelson's generosity who owns this particular piece of land), everything seems right with the world. So much so that Carin's final reservations are broken down as, one evening on the steps in front of their newly renovated building, she confides in Patch about a troubled childhood (it seems she has been victimized by men in a sexual way early on in her life) and confesses her love of him. The only thing they don't see eye-to-eye about is a certain suicidal person, Larry by name (whom we have already seen briefly in the emergency room after one of his attempted suicides). Carin thinks he is "weird" in an unseemly kind of way. Patch ignores her premonition.

When late one evening Larry calls wanting to talk to someone, Carin responds by going over to his house. Larry is seated at the piano in his ornate living room playing Beethoven's "Für Elise" when Carin arrives. He has inherited this house from his father, who died two years earlier and whose death is apparently at the root of Larry's suicidal tendencies. As he closes the door of the closet into which he has just placed Carin's coat, the screen goes dark. The next thing we know is that Patch is called to Dean Anderson's office who informs him that Carin was murdered the night before.

Patch's world now falls apart. He blames himself for Carin's death. As he says later, "I taught her the medicine that killed her." At the funeral, when the service has ended and when everyone else has departed, Patch stands with tearful eyes by Carin's coffin and finishes reading the poem he has begun to read at Carin's surprise birthday party in the balloon-filled room. He has attempted to finish the poem on a previous occasion, the morning after Carin had confided in him and confessed her love for him. During the evening in question Carin spoke of her childhood envy of caterpillars which could "turn into beautiful creatures that could fly away untouched." The morning following this magical evening we see Carin still asleep in her bed under a window in the middle of which is the large stained-glass image of a butterfly. Patch stands over her bed and reads a few more words from the poem: "I love you without knowing how, or when, or from where . . . " Now at her coffin Patch finally finishes the poem after which, crying, he kisses the coffin in desperation, as if kissing Carin for one last time.

Though both Truman and Mitch, his roommate and former nemesis, urge Patch not to give up, Patch's heart is no longer in his vision for a better world in which hospitals are places of fun as well as places of healing. He goes up to the mountain where the Gesundheit Institute is located and, standing on top of a cliff, he obviously contemplates suicide as he accuses God of having rested on the seventh day of creation instead of devoting it to compassion. As he turns back from the abyss, he sees a butterfly land on his old leather case. The butterfly then lights on his chest, where his heart is. Then in lands on his hand whence it flies away. The implication is that this butterfly (a traditional symbol of the soul) is Carin's spirit or at least her emissary.

The visit to the mountain top refreshes Patch's revolve to go on with life as a doctor-to-be. He now helps Mitch with Mrs. Kennedy (who wouldn't eat) to fulfill a fantasy of hers to splash about it a pool filled with "noodles." But things are not getting back to normal. Dean Walcott strikes. Patch is threatened by expulsion on the grounds of practicing medicine without a license. At his trial in front of the State Medical Board he speaks eloquently in his own defense. The room is filled with people who are rooting for him. He tells the panel of doctors sitting in judgment of him that if "you treat a disease, you win, you lose," but that if "you treat a person, you win, no matter what the outcome." During his impassioned defense he turns around to address his fellow students in the balcony. He urges them not to let themselves "be anesthetized," not to let themselves be "numbed out." Prior to the verdict, the children from the cancer wing come and put on red noses in a show of solidarity. When the doctors return from their brief deliberations, they tell Patch that, although they disagree with some of his methods, they can "find no fault" with his passion for his patients. They tell him that Patch carries with him a "flame, which one could only hope would spread through the medical profession like a brushfire." And they also tell Dean Walcott that he need not bring Patch's case in front of a tribunal again but that he ought to perhaps himself practice of a bit of "excessive happiness."

The story concludes with the graduation ceremonies that make, among other things, Hunter "Patch" Adams a doctor. Viewers may think that mooning the audience (which laughs with delight) as well as the august professors up on the stage is a bit much, but upon further reflection it may simply be a final confirmation of what is really important. Clearly, it is not merely academic gowns and degrees. Nor is it merely the time-honored title of "doctor of medicine." Rather it is what the gowns and the degrees and the titles are for. They are not ends in themselves. They are means to a greater end. What Patch's mooning makes fun of is our tendency to allow the trappings of what we do take precedence over the essence, the heart of the matter.


The poem used in the movie is by Pablo Neruda. It is Sonnet 17 of Neruda's 100 Love Sonnets available in English translation by Stephen Tapscott. It is this translation that Patch reads in the movie. Here is the text of the poem in its entirety:

I do not love you as if you were salt-rose, or topaz,
or the arrow of carnations the fire shoots off.
I love you as certain dark things are to be loved,
in secret, between the shadow and the soul.

I love you as the plant that never blooms
but carries in itself the light of hidden flowers;
thanks to your love a certain solid fragrance,
risen from the earth, lives darkly in my body.

I love you without knowing how, or when, or from where.
I love you straightforwardly, without complexities or pride;
so I love you because I know no other way

than this: where I does not exist, nor you,
so close that your hand on my chest is my hand,
so close that your eyes close as I fall asleep.

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Copyright 2000 - 2004 © by Steven C. Scheer. All rights reserved.

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