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Not a move. Even her expression hadn’t changed. Her breaths however were coming faster and faster. Then the battle began. I had to do it. I had to have a throat culture for her own protection. But first I told the parents that it was entirely up to them. I explained the danger but said that I would not insist on a throat examination so long as they would take the responsibility.
These lines occur after Mathilda knocks the doctor’s glasses off, embarrassing her parents. The doctor tries a new approach—enlisting the child’s cooperation by asking her to open her mouth while simultaneously threatening her with force. He takes her silence as a challenge and immediately says, “I had to do it.” The doctor realizes that what is about to happen will be distressing to the family and is already laying out his justifications. He has to culture her throat “for her own protection”—there is no choice. But of course, there are always choices, and his next action demonstrates that he knows it. He pretends to be willing not to proceed, as long as the parents absolve him of responsibility. The doctor says this knowing that the parents’ fear will force their compliance. In fact, he is making an excuse so that he can lay whatever happens next at their doorstep. Yet he is the medical professional; the responsibility for ethical and appropriate decisions falls to him. He maintains this effort to do what he wants while manufacturing apparently sound reasons that excuse his failure to treat the child and her parents with the respect they deserve and the compassion that might eventually alleviate the child’s fears.
Perhaps I should have desisted and come back in an hour or more. No doubt it would have been better. But I have seen at least two children lying dead in bed of neglect in such cases, and feeling that I must get a diagnosis now or never I went at it again. But the worst of it was that I too had got beyond reason. . . .
The damned little brat must be protected against her own idiocy, one says to one’s self at such times. Others must be protected against her. It is a social necessity. And all these things are true.
The doctor has just requested a sturdy spoon to use to pry Mathilda’s mouth open, since she splintered the tool he brought. This desperate act of defiance pushes the doctor to violent thoughts, and he looks forward to the “pleasure” of forcing her compliance.
Obviously, these are inappropriate feelings for a doctor to have when examining any child, much less one in Mathilda’s condition. So the doctor must rationalize his actions. He draws on professional claims: this is for the child’s own good, for the common good. The child doesn’t know what is best for her. The problem with these “true” ideas is that they’re also situational, and he understands that the current situation calls for a different approach. He is “beyond reason,” thinking in absurd absolutes like “now or never” while busily justifying what anger urges him to do. The child he had called “attractive” and “magnificent” is now a “damned little brat” who actively poses a threat to other people. His twisted reasoning suggests the challenge of making correct choices under the stress of strong emotion. This line of thought leads to the “unreasoning assault” in which he uses his strength to force the child’s head back and jam the spoon between her teeth.
