Editor’s note: The Final Cut is a recurring editorial series written by a member of the AAOS Now Editorial Board.

As the curtain fell on An Enemy of the People, I understood for the first time why Henrik Ibsen’s 1882 play continues to resonate with audience members, especially those in healthcare who must, day in and day out, battle with authorization personnel, hospital administrators, and other officials who fail to comprehend the danger of invading organisms and other urgencies.

The play’s protagonist, Dr. Thomas Stockmann, becomes the medical officer of a newly built health spa—constructed by local residents at great expense—to attract visitors to their small town. Dr. Stockmann soon discovers bacterial contamination of the spa’s water, risking the health of whomever enters. He tells his brother Peter, the town’s mayor, whose disbelief sets the tone for all future government officials unknowingly spawned by Ibsen’s masterpiece.

After further investigation, Dr. Stockmann concludes that the contamination comes from an upstream leather tannery, the town’s principal employer. It’s owned by Stockmann’s father-in-law, who echoes the mayor’s skepticism.

Frustrated, Dr. Stockmann brings his findings to a town hall meeting. With increasing anger, the townsfolk learn the cost of relocating the spa: lost jobs and higher taxes. They join the mayor in declaring Dr. Stockmann an enemy of the people.

Thereafter, things go bad for Dr. Stockmann: Townspeople attack his home, his daughter loses her teaching job, and he’s fired from the spa. Attempting to improve the situation, Stockmann’s father-in-law uses his daughter’s inheritance to buy majority ownership in the spa, believing this will cause Dr. Stockmann to reconsider his position. It doesn’t. After Dr. Stockmann rails against the danger of a corrupted majority, the play closes as he announces he’ll stay and fight for what he believes in.

An Enemy of the People has been through many iterations over the years. For instance, Jaws screenwriter Carl Gottlieb said that he and director Steven Spielberg referred to their film as “Moby Dick meets An Enemy of the People.”

The play also offers important lessons for healthcare practitioners who must deal with invasive microbes in their daily work. We orthopaedic surgeons, during our training, learn the importance of early treatment of evolving bacterial infections. Delayed surgery of necrotizing fasciitis or clostridial gas gangrene or a pediatric septic hip can have devastating consequences. In certain situations, however, acknowledging sepsis can be disconcerting for us, especially following an elective operation with a low infection rate, such as total joint replacement.

Contemporary advances in the management of periprosthetic joint infections make prompt diagnosis essential. Debridement, antibiotics, and implant retention (DAIR) avoids the technical challenges and costs of a two-stage component exchange but has a potentially high failure rate. For example, De and coauthors recently reported in Clinical Orthopaedics and Related Research a 42 percent hip-DAIR failure rate and 48 percent knee-DAIR failure rate, based on data extracted from the American Joint Replacement Registry. The authors noted better outcomes when the DAIR procedure was performed soon after symptoms of joint arthroplasty infection appeared. They wrote, “We recommend avoiding the [DAIR] procedure in patients whose symptoms have been present for more than 4 weeks in an established [total knee arthroplasty (TKA) or total hip arthroplasty (THA)], or more than 6 weeks after index TKA or THA.” However, the double DAIR and newer iterations may extend that time interval.

A study by Narayanan and colleagues at NYU Langone demonstrated that the single DAIR strategy was successful if it was accomplished within 2 weeks of the initial implant surgery. For this to happen, a surgeon must heed Ibsen’s perception about the dangers of delay and denial—a recurring saga in the arts, in medicine, and in life. The rapid spread of COVID-19’s causative virus also demanded prompt acknowledgment of the evolving pandemic, as well as a rapid response, to achieve a favorable outcome during the exponential growth phase of the germ’s invasion.

The mathematics of exponential growth is best illustrated by the following fable: A single bacterium, capable of doubling its numbers every minute, is placed in a jar of nutrient broth. After 25 minutes, a young descendant, alarmed by the increasing crowd within the jar, conveys his concern to an elder. “Don’t worry, Sonny,” the old-timer says, “our family has been in this jar for 25 generations and we’ve consumed only 3.125 percent of the nutrients.” Because of exponential growth’s power, as Gramps speaks these reassuring words, he and his relatives are just 5 minutes from total annihilation.

Sir Ronald Ross, the British army doctor awarded a Nobel Prize for discovering that mosquitos transmit malaria, spent many frustrating years trying to convince colonial authorities that mosquito-reduction efforts would pay off in lives saved. He wrote in his Memoirs, “Reformers are frequently treated exactly as shown in Ibsen’s comedy, An Enemy of the People, and the rewards of the medical profession are given not to them, but to persons whose work is infinitely less important.”

When submitting his new play to his publisher, Ibsen wrote, “I am still uncertain as to whether I should call [An Enemy of the People] a comedy or a straight drama.” Perhaps his quandary was based on a lack of resolution as the final curtain falls. We never learn whether Dr. Stockmann successfully closes the spa, thereby saving townsfolk and visitors from needless suffering and death, or whether his brother the mayor keeps the facility open, with a tragic outcome.

In my opinion, An Enemy of the People is neither comedy nor drama. Instead, the great Norwegian penned a horror story. When healthcare personnel or public officials are challenged by an invading organism—whether shark, mosquito, bacterium, or virus—monetary worries often overshadow potential danger. If such fiscal issues aren’t quickly set aside, disaster may follow. In these situations, the body politic is no different than the body personæ: Delay can prove fatal.

Stuart A. Green, MD, FAAOS, is cofounder and past president of the Limb Lengthening and Reconstruction Society; past president of the Association of Bone and Joint Surgeons; and an attending surgeon at the Tibor Rubin Long Beach VA Medical Center. He is the son, first cousin, and father of AAOS Fellows. Dr. Green is a member of the AAOS Now Editorial Board.