This time on Nova, a unique behind the scenes look at what it really takes to become your
doctor.
A minute or two to figure out how the gown works, but most of them. How did she look?
She was way over this way.
Okay, right. It feels like such a costume right now.
Here's the ligament right here.
I just want to show you that this is a perfectly normal break.
Oh man, this needle can be killed.
David, will you shut up?
The story begins in September 1987 as a new class enters Harvard Medical School. Almost
immediately the students embark on a journey into our bodies and minds. A process that
will change them from ordinary mortals into fully initiated members of the medical tribe.
The first thing I want to do is take your vital signs.
Let me see under your tongue.
For 14 years our cameras have been there. From the early days of medical school through
the sleepless nights of internship. Nova has followed seven men and women through their
grueling medical apprenticeships.
We all did well in school and to come in and be given a test where you know nothing, it's
really hard.
Last year I felt I was incredibly ignorant and I couldn't possibly be in the hospital
as such an ignorant person. This year I realize I'm still pretty ignorant but I've gotten
used to it.
As soon as he said I'm having heart problems my heart just sank because I said there tend
to be the most difficult cases and all these questions that I know I should have asked
I'm sure I didn't.
I know right now is not the time to make a decision whether the price is too high to
pay to become a doctor which is what I want to do but I sometimes wonder whether it's
all worth it.
It's like a kid going into a candy store. It's overwhelming. I mean there's just so
much there and there's just so much that you'd like to do.
What if there's a split second decision that I have to make and I don't know what to do.
This ain't no party, this ain't no disco, this ain't no fooling around. This is like
the real deal. People are really sick.
This is the tale of Tom Tartar, one-time bouncer, weightlifter and mechanic now transformed
into a doctor.
I never thought that I would get to a point where I was comfortable with medicine. I mean
I can stand alone in an emergency department and anything that comes through the door I
can handle it.
I was born to be a mechanic. I was born to be a carpenter. I was born to be a janitor.
I mean that's what I was born to do in this society. We do not have a classless society
and it's just nice that I've been able to be so socially mobile.
It's the beginning of the morning. It's 11.30 and we're just coming to work. This is what
I do. I like it. I like working weekends and nights and all that stuff. I gotta go. I'm
going back, see what goes on.
Well one of the primary mandates of emergency medicine is to ensure the patient's safety
immediately rather than long-term risk and benefit.
We deal with people who are acutely ill. We want to make sure that everything is done
for them now. But then again the actual management of the problem long-term is up to somebody
else.
I love that. I really do because it's very exciting. I get to go from case to case. I
get to help each person through a moment of crisis.
Did you get knocked out? Didn't hit your head huh? That could be just some kind of weird
spasm but generally they're thankful. Generally it makes me feel good. Just curing the sick.
Yeah I really like it. It's very instant gratification you know. It's definitely the kind of medicine
that the TV dinner microwave generation can appreciate.
Her chest x-ray didn't look too remarkable but I got a CT and on the CT she's got a
hematoma around her arch. Would you care to come on in and take a look at her?
I'm certainly not poor anymore. I've got a good future ahead of me and I enjoy my life
every day. But I actually have nightmares about doing medical school again. I do. I
sometimes have these nightmares that for some reason or another I'm back at my first year
and I have to complete medical school all over again. And at this point in my life at
44 I don't think I could do it. I mean I just don't think I could go through that again.
Especially knowing what it was like.
For me nothing was as traumatic as the first year of medical school because I was just
literally a whoring church. I really was one of the few people there that was from a socioeconomically
disadvantaged background. And believe it or not, it should be self-evident I guess, people
from that level have a different way of interacting than people that are middle class and upper
middle class and upper class. And I had to make that adjustment. I never had to make
it before really. And I did at Harvard. We collided.
My first days at medical school were really tough because I felt like I was being assaulted
on all sides. First of all, I hadn't come from a medical family. I really didn't know
anything at all about medicine. I had this one model of doctors. To me doctors knew everything.
Any doctor knew basically anything there was to be known about medicine. There was this
circumscribed body of knowledge that I was going to learn. But I was in for a surprise.
My class were guinea pigs and had experimented at Harvard. They were trying to humanize medical
education by actually teaching us less. So when I went into the course of the body, I
thought I was going to, you know, just by magic or some superhuman feat, learn everything
about anatomy and physiology in eight weeks. They said, no, you're not going to learn it
all. And I was like, well then why am I here? What are you doing? What kind of a doctor
are you going to make me? These people were telling me that the emperor had no clothes.
And they really were. They were saying, no, these great doctors and stuff like that, they
didn't know all this stuff. They just know little pieces. This guy knows this one little
piece. That guy knows that one little piece. Nobody knows all this stuff. Not only does
nobody know all this stuff now, but they never did know it all. And you're not going to know
it all. So just relax. That was very, very difficult for me to adjust to.
I mean, I'm not sure what the mechanism is. I just know empirically that there's a saturation
effect. So as I scrambled to try to learn the actual anatomy on my own without much
guidance at the same time, I came into a lot of social conflicts with people. I just didn't
get along very well. Tutorial was another difficult thing for me because it was really
my first introduction to the mutual masturbation society. I mean, that's really what it was.
The idea of that tutorial, to my mind, was to learn how to sit there and disagree with
people while you're complimenting them.
You know, cliche diagnosis without having to explain why the guy is wearing a pink shirt
or something.
No, but we should. I mean, one thing that's-
When I worked in a gas station or a bike shop, if somebody did shoddy work, you'd tell them
to say, hey, that sucks. Go do it again. That's how I learned. That's how I became a mechanic.
I became a mechanic by telling me, no, that's wrong. Do it right. And I would go to these
tutorials and you'd never tell anybody that they were wrong. If you thought they were
wrong, if they said that the world was flat, you would say, well, that's a very interesting
concept. Where'd you get that from? And I had to learn to do all that socialization
stuff and that was what the tough part of the tutorial was for me.
I might be studying some things too much and missing important concepts that someone could
just say, hey, this is really important. You should know this. You should examine this.
But nobody tells me that.
I mean, give me a break. If you don't like it, it's one hour a day. And if you want to
pursue all this stuff on your own, go pursue it on your own.
That's not really true, Loli. I personally feel that I paid a great deal of money to
consult and to have the expertise and the expert guidance of people to point out to
me what I should know.
Well, why come to Harvard then is the big question that would enter my mind.
I'll tell you something. I'll tell you something. That's really what was a tough choice. It
was. And I sometimes wonder if I made the right one. You know, in all honesty.
That's why I ask the question if you're so unhappy with the pathway.
This has been the most emotionally trying period of my life. I've been through a divorce
after 10 years of marriage. I was an Olympic-holed fool, got knocked out of the Olympics because
of an accident and an injury. I've had to work for about 14 years to get into medical
school. And I can't ever remember crying until last week. Last week I was just, I just had
to start crying. I was talking on the phone to a friend of mine. And it just happened.
One of the things that made my life possible was every now and then we'd get a break. I'd
go back to the Bronx, visit my girlfriend Stephanie, my mother, see the old neighborhood.
And that lifted my spirits up enough to sustain me till the next break.
Coffee table has a nice little touch with those yellow mats.
Well, it's a little too French provincial.
He was always a little different. I always used to think he was a little too smart for his own good.
This is what we live on right here. Bronx pizza.
Our main staple.
This got us through college. It's not getting us through medical school, but it got us through college.
He was always interested in science. And when he was very young, his first interest I think was in atomic energy.
And he was three or four years old. He'd have me reading books about atomic energy. And then when I'd finished,
he would say to me, Mother, I know you didn't understand that. Now let me explain it to you.
Do you know what it's like having a three or four year old explain to you about atomic energy?
Okay, here's the guy you wanted to know about. This is the guy that married my ex-wife, the Schnaz.
Your ex-wife.
That's right. Ex. My ex-wife.
Ex-wife. Okay, how about this one? This one's my...
You like that one, huh?
No, no, no. That looks like Charlie Manson.
It's not Charlie Manson. It's me and your son, and it was raining. And I'd written for days in the rain.
There we are.
I'm trying to remember where this was. I think this was in Tennessee.
One of my favorites.
I can't say it's one of mine.
What thought you liked about him, Mother?
He looked like the Neanderthal man.
I think he looks like a Renaissance prince.
What's a Neanderthal about it?
Oh, my gosh.
What's Neanderthal about it?
The whole thing.
The flower shirt?
No, no, no. If you just had a...
Bear skin?
Bear skin, whatever.
Oh, a Tarzan suit.
Yes, a Tarzan suit.
I should wear a Tarzan suit.
Right. And a club. And a cave.
The thing about the first year was after recovering from the initial shock and all this sociocultural type of dilemmas that I found myself in,
I finally figured out the system and figured out how to work through it, and I ended up learning a lot from my cadaver.
That was probably the most meaningful part of the first year to me.
State of disarray, you might think.
But it actually makes sense.
It's the train's mind. That doesn't necessarily mean mine.
And here's our stomach. This is where the stomach pierces the esophagus.
It's called the cardiac notch.
This is the fundus of the stomach and the anteroom of the stomach where it goes into the duodenum.
When I first came to school here, I was in a lecture, and I heard people referred to as laypeople, and we were referred to as something else.
There were laypeople and there were physicians, and I thought that was interesting,
because that meant to me that we knew something that other people don't, or we looked at things differently, that we had an alternate perspective.
And now I'm beginning to see what this alternate perspective is.
I think if I'm writing, I'm thinking about what muscles are moving, how they're moving.
I can actually see them in my mind. I can see the tendons going through their sheaths. I can see the nerves that are innervating them. Everything.
People now are much more to me than just their exterior, just their bodies.
When somebody sits down, I can see what they're sitting on. I know what they're sitting on.
I know what muscles are being compressed, what muscles are being relaxed.
It's just an absolutely fascinating way of looking at people from a whole other perspective, from the inside out.
I have a watch that has a stopwatch built into it, and I spend six hours every day,
not looking for books or walking across the street to the library or something like that,
but I spend six hours a day of actively studying, which means at this desk, at a book, or in the library, at a videotape.
Six hours. And if I take a break to get a cup of coffee or to go to the bathroom, I click off the watch.
Part of our first year curriculum is we go to a private office that's run by an established physician here in the community,
and they show us a few tricks to the physical exam. We usually try them out on each other first.
You feel a little depression just anterior to the ear.
And then if that doctor can convince one of the patients to let us try it on them, we try it on them.
Carlos Morales and Beth Davidson.
Would you mind seeing if we're just learning if we both do this on you?
You have excellent breath sounds.
Really? Anything interesting?
So far, the interesting thing is you sound perfect.
One of the hard parts about this course is that we haven't learned anything much about how illness works and what illness is like.
All I've known up till now is if I've had a cold, how I felt, but I never had any kind of real serious illness.
So I didn't know what questions to ask.
OK, thanks.
22-year-old Hispanic male presented with acute...
So we did the history and physical, but both of us being so inexperienced completely missed the larger point,
which was finding out what was wrong with him. We just never got to that.
We didn't get that.
You didn't get the pneumonia yet. You got this. Well, tell me what you got. Somebody present.
Pneumonia. When did he have pneumonia? A while ago.
Didn't get that at all.
At the end of our first year now, we're having a comprehensive exam, which is going to cover a great many subjects,
everything from physiology, histology, and probably every other ology there is.
And passing it is kind of a landmark. It makes you feel like you haven't completely wasted your time,
and that there's some hope that you're going to make it.
Thank you. Yes!
So stay there.
It's absolutely fantastic. Today is the most important day in my life right now.
I really feel confident that I can do the work.
I feel confident that the program is going to work for me,
and that I'm going to become a good doctor, which is the most important thing in my life.
Just remember one thing. Do no harm. That's your greatest gift to mankind.
Do no harm, whether you go through your normal life and as a doc.
In the second year, we're moving on to what's called pathophysiology,
which is we've learned enough, hopefully, that we know how the body is supposed to function.
Given that, we can now look at ways that the body functions abnormally.
You sort of have a lobulated, fluffy-looking mass here. These are something that's abnormal.
This is where you are supposed to really start learning the difference between sickness and health.
This heart is just about the size of my fist.
Beats, since the day you're born to the day you die, corresponds to every stress need.
In the autopsy that we were involved with, with Dr. Schiller, we were allowed to see what a pathologist does.
And although none of us are pathologists, and we're not even doctors,
yet we're just students, and most of the time we're spent with books,
we got to see how the stuff we learn in these books becomes real.
This is a perfectly normal brain, probably normal weight and normal shape.
Who would like to tell us what we see here? Who has this book? Ah, Mr. Branks.
First of all, what organ is this?
Looks like liver to me.
Of course, okay. That's liver.
I need a lot of onions for this.
When I got to the hospital, I had no idea what was going on.
I didn't know what qual was, what you did with the beeper.
For that matter, I barely knew which end of a stethoscope to use.
I started at 6 o'clock yesterday morning. Very tired. My feet hurt.
It's not too bad if you can get some sleep. I didn't. I usually don't.
But I think as you get better at this stuff, that becomes possible.
You might be able to get two or three hours of sleep, which could really make a big difference.
I don't know what to make of this numbness around her nose.
The neurology resident was saying...
As you enter the medical profession as a third-year medical student,
one of the first things you learn is that there's a very rigid hierarchy of power.
At the top, you have the attending physician, who really is quite powerful, almost almighty.
You could compare him to a deity in some religions.
And then right next to him would be the chief resident or senior resident, who would be a high priest.
And he is the one who is allowed direct contact with this higher power.
A little bit lower down the line, you have your everyday priests, which would be your interns.
And they, although they don't directly speak with the almighty,
they do have the privilege of contacting the resident, who instructs them in the wisdom of the Lord there.
Beneath your intern, you have your third-year medical student,
who is at best some little monk who trembles in the wake of all of these greater powers
and hopefully will muddle through and climb up the rungs himself.
I, Thomas, take you, Sharon, to be my wife.
Actually, the first time I saw Tom, he had held the door open for us, and that's when he was big and gruff.
And I turned to my girlfriend and said, I have no idea, but I'm very attracted to that guy.
And then it was like several months later before we started working together, and then I didn't like him at all.
And I went away to medical school, and she visited me during my first and second year.
She moved up, and now we're tying the knot.
Thomas, let me caution you. When you blow out your candle, that has a very special meaning.
You are saying goodbye to your old flames.
Well...
Together, right? Together we do this.
I'll blow out yours, then.
I'm sure you will. Okay? Here we go.
Sharon and I both have seen some tough times in our life, and I think we share a commonality.
I mean, she's from a working-class family.
I'm able to relate my experiences to her and get some kind of reality testing and some feedback that I trust.
And I find this very invaluable, especially at a time in life where things are changing so fast.
That is awesome!
I love surgery. I love doing surgery. It's a tremendous amount of fun.
And very gratifying.
Thanks. Nice to see you.
And you.
How's everything going this morning?
Pretty well, pretty well. The pain's pretty good, under control, and I'm getting anxious to get it over with.
I bet.
Are you going to be an observer? Are you going to...
I'm going to be an assistant.
Oh, I see.
I'll probably just be the person standing there, handing Dr. Huss something, or being an extra hand.
Mrs. Kidder, who's a 68-year-old woman, developed pain in her hip.
While they were working that up, they found out that she had cancer, and that it had invaded the bone of her hip.
So about five or six months ago, they replaced her hip.
And what we're going to do is we're going to go in there and put in some plates and some cement to prevent her from actually breaking her leg, doing something maybe as ordinary as just getting up out of a chair.
Here's the patella, lateral shaft of the femur. Our incision is going to be coming down this way.
I think it's a real privilege just being there to watch this stuff.
There's nothing more dramatic and more curative and more decisive than surgery.
If I did nothing but stand there and haul the retractor or just stand there and watched, I would really find it rewarding.
The harder the bone, the better for her.
People think of medicine like this, think that you have to be exceptionally smart to do medicine.
It's really not the case. What is the case is you can't be stupid and do medicine.
You can't be a klutz and be a surgeon.
But if you're reasonably well adept or you're reasonably bright, then you could do either one.
Actual reason for having medical students in the operating room is so that they can do this kind of work, tighten screws, do all the dog work.
Now remember, this is the one with the lock in.
So we don't want to damage those threads going through there.
So don't use the drill guy.
Don't use the drill guy.
This drill bit will take those threads with it beyond the shadow of a depth.
Okay, let's get the smaller drill bit ready.
Meanwhile, we'll get that other one.
That's very intense work.
I mean, seriously, you're concentrating every single minute you're in the OR, unlike in medicine or a lot of other things where you spend a lot of time around the hospital
just kind of talking to the nurses, having a coffee break.
I mean, when you're in the OR, even when the patient supposedly is stable, you need to be watching them on Earth.
It's like driving on an icy road for five hours.
Absolutely.
Did a good job, Tom.
Boy, I'll tell you, now that we're fourth years, we're doing a lot of stuff.
You were great, man.
You got that PA line and everything like that.
That's really good.
That's tough.
Who would have dreamed last year that you'd be closing up and I'd be able to do the lines?
That's really good.
We've come a long way.
I'll say we have.
It's really good.
We've had a lot of help, too.
My therapist in medical school told me medical training is a marathon.
I don't have one?
No, you don't have one.
Thanks.
I'm not letting you graduate.
It's not a race.
It's a marathon.
You just have to keep going, showing up every day.
As soon as you get through one hurdle, there's another one.
Sparrow Hospital, Lansing, Michigan.
Mrs. Lefebvre, can you hear me?
How are you feeling?
Bad.
In terms of medicine, I came out of medical school knowing nothing.
She's over 130.
I probably want to hydrate her.
I'm just wondering how you feel with that on.
People say, this is your doctor, and you are the patient's doctor.
You shouldn't be, but you are.
This person is going to tell you all the things that should lead you to understand their disease,
but you really don't have a prayer of making heads or tails of it.
They might as well be telling somebody next to them in the subway or something.
Don't they clamp down peripherally?
You think we could turn down her W-tracks a little bit?
She's at 10?
My first month or so back there at Sparrow Hospital was just terrifying for me.
Now we're on to our fluid.
I want flush, right?
You want flush, that's coming out of this.
I learned most of it from the nurses.
Coming out of this line.
I just think the two hours seem like too long.
Sounds reasonable to me.
Okay, let's try it.
This is a code beeper.
If something bad happens to somebody, Dr. Motz and I are supposed to be the first people to respond.
Code gets called, someone's heart stops.
In general, it means someone requires emergent care, someone's dying.
Hi, I'm the code team intern.
Who's in charge here?
This is a cardiac rehabilitation patient.
She's 67 years old.
She's been in the rehab program roughly two weeks.
She was exercising on the treadmill about two and a half miles per hour, and she developed some TBCs on the monitor.
She then went into this rhythm, and I called the code.
This is what she's doing?
Yes, that's what she's doing.
That looks like a Y-complex V-tach.
Do you have a pulse there?
Can you stop for just a second?
Check a pulse?
No pulse.
I'm using this.
Here you go.
Okay, can you read that over?
This ain't no party, this ain't no disco.
This ain't no fooling around.
This is like the real deal.
People are really sick.
Clear, clear, please.
And if you can't do it on a dummy, well, you can't do it on a person.
Can someone pound on her chest?
Okay.
So today what we have was a training exercise where we responded to the code, and instead of it being a patient,
it was a special mannequin that's made for doing these resuscitations.
It gives you a rhythm, like a heartbeat, so that you can see it on a monitor, and you can apply paddles to it.
Then we have a dummy that we can put breathing tubes in.
I like other art tests.
Do you want an audible?
That pressure is saying might be...
Yeah, do I have a pressure?
We got the lino drip going.
Coming.
That was a tough intubation.
It was.
She's a tough girl.
She took a lady on the train.
That's good.
Yeah, right.
That's good.
Okay.
Well, thanks folks.
Appreciate it.
Great.
Should we clean up our mess?
Mm-mm.
We never have to do that part.
My mom told me to clean up my mess, but okay.
Does that pillow make your neck feel any better?
Is it piercing?
Are you comfortable?
My mom is comfortable, yes.
What hurts?
Everything.
Everything hurts?
Are you having trouble breathing?
No.
Oh.
Okay.
She's awful.
Okay.
These are the worst blood gases I've ever seen.
Maybe other people have seen worse ones, but I never saw a living person with gases that bad.
Yikes.
See this delay?
It's lengthening.
It's getting longer in between beats.
Look at that delay.
So that these delays will probably just keep getting longer and longer.
Over a gradual period of time.
And then one time delay will just last a real long time.
Took good care of us, didn't you, Ma?
Well, I tried.
Yeah, you tried.
You did a pretty good job, we think.
You're feeling a little rough right now, though, aren't you?
Yeah.
If we can make her comfortable, that's all we can ask.
Tough old bird, aren't you?
What?
Said you're a tough old bird, aren't you?
Yeah, I'm a tough old bird, that's right.
Well, quite frankly, the lady is trying to die.
But, and there's a no, do not resuscitate order in the chart,
but my understanding is that the wishes of the patient and the family
were that she get all the medical treatment available.
She doesn't want to be shot.
She doesn't want to be intubated.
Put her on a ventilator right now would keep her alive,
but she'd never come off.
She'd be on a ventilator forever.
How you doing?
Got to speak up.
So we're going to give you a little bit of morphine,
and I think that might make...
Pardon me.
Oh, I'm sorry.
We're going to give you a little bit of morphine, just a little bit,
and it might make you a little more comfortable.
I still can't hear him.
We're going to give you a little morphine,
and that might make you a little bit more comfortable.
Yes, it might.
You want some?
It might relax me.
Okay.
I was born C-section,
and nobody had any problems with helping me come into this world,
and I don't know why anybody should have any problem
helping me leave it if I need it.
We can use all this technology to keep neonates alive.
As far as I'm concerned,
dying is just as big a part of living as being born.
And very often, just like when you're at birth,
some of us need help.
Some of us need help to die,
and I hope someone will be there to give me that help when it's my time.
You okay?
One thing after the other, huh?
Mrs. Pearson clearly looked like she was going to die that night.
We gave her some morphine to make her comfortable,
but morphine is a really wonderful drug.
It also helps people that are in congestive heart failure.
So it not only made her comfortable,
but it also cleared her up a little bit,
and she was able to hang on for another month.
I saw her son about two months after that night,
and he told me, and he thanked me very much and said,
gee, isn't it something?
We all thought she was going to go that night,
but indeed it was a month later until she finally passed.
I love it here.
This is the American dream, it's middle America.
I mean, it certainly isn't the city's.
It's really nice, and it's very affordable, too.
I mean, I pay half the rent here that I paid in Boston,
and I live in the nicest place I ever lived in in my life.
We have a yard, garage, everything.
Everything is easily accessible, no traffic.
It's just great.
It's like I died and gone to heaven.
I've been interested in firearms all my life.
I'm not a hunter.
I don't really have anything against hunters,
but owning the guns, buying the guns, having them,
and playing with the ammunition,
and just the excitement of going out to a place
where you can shoot up cans or targets,
I mean, that's what I like.
Safe gun is a gun pointed in a safe direction.
This is just kind of something that everybody should have.
This is a little Smith & Wesson.38.
I put some pearl handles on it
because I thought Sharon would like that,
and this is really a good gun for her.
It's her size.
The.38's got mild recoil.
I think she's more comfortable shooting it than the big.45.
I definitely feel like a doctor
in the sense that I regularly go without sleep
for long periods of time,
and I don't think anything of it.
It doesn't hurt me anymore.
I get impatient a lot.
I don't let it out,
but when I'm not in the hospital
and I'm standing in a line or something,
or I get a busy signal on the phone,
or I want something done,
it's like, I want it now.
Divorced.
Another casualty.
I don't blame medicine for it.
I think the marriage probably would have ended in divorce anyway.
If anything, I think being in medicine perhaps prolonged it
because I wasn't spending a lot of time with my wife,
so we weren't able to address problems as rapidly
as we probably would have if I had more time
and wasn't doing a residency.
This is Karen, the third in series.
And, well, we met about a year ago.
A year and a half.
Almost a year and a half.
Oh, a year and a half.
Time flies when you're having fun.
I'm two years out of my residency,
and I'm preparing for the oral boards.
Hey.
Hey, Dwight.
How you doing?
How you doing, Dwight?
Yeah, how you doing?
Good.
Karen?
These are going to be a couple of them.
The oral boards are case-based scenarios
where you can encounter anywhere from one to three patients.
We can treat your pain, sure.
Let me just do a quick physical exam on you first.
The patients are presented to you by an examiner
who actually will take on the role of the patient
and give you any information that you need about labs
or x-rays or stuff like that.
There's no rash.
Okay, what would you do next?
No rash.
Neurological exam.
Okay, so we're going to just put a monitor on you.
I'm going to give you some oxygen.
I'd like you to have four liters nasal cannula,
and I'd like to start an IV.
I'd like to look at her.
Mrs. White is pretty upset.
If you can stabilize them successfully
and prepare to hand them off to the appropriate subspecialist,
then you get to be an emergency doctor.
I'd like to ask you, has she been acting funny lately?
Even though I am prepared,
better people than me have fallen at this late day.
Well, thank you, doctor. Your examination is now over.
Thank you.
Great.
I didn't get labs on a bunch of stuff.
That's okay.
Today is the day for the oral boards.
It starts in about 45 minutes.
Hopefully, I won't be late.
And the one thing I'll say is, boy, he wasn't too smart,
but he had good hygiene.
Karen and I are much more similar
than any of my previous relationships.
Also, I think Karen and I both have gone through periods of growth.
It wasn't long before we knew that we were destined to be together.
I think we're done. I think we're adults.
The intelligence, the brilliance is a real turn-on.
I can't get enough of it.
What you see is what you get for both of us.
Sometimes, I guess maybe if I were on the outside looking,
I might think, gee, he seems to be the priority
and Karen's getting overshadowed,
but I don't feel like that right now.
I'm okay with that because this stuff is important
and I want to be supportive.
All the trappings of civility.
Wow.
So how was it?
Well, I think it will be a lot easier next year.
I know what mistakes I made.
They were all just stupid mistakes.
They were either test anxiety or maybe a little residual tiredness
or something like that.
It's like I said, they may be enough to fail me,
but I feel confident if I took the test again.
If I could take it all again right now, I'd do fine.
We'll see.
It's not strictly a redneck town or something.
It's a university town. It's got the best of both.
They're nice to you even if you didn't come over on the Mayflower.
The nice thing about working here in Bloomington,
in bigger cities, in the emergency department,
you don't get to know your patients' stuff,
but I see my patients here around town.
People go, hi, doc, thanks for taking care of me, blah, blah, blah.
And that's real nice. It really is. It's very nice.
Living room. This is my office.
I didn't have this in medical school.
And that's all National Forest out there.
That's Hoosier National Forest.
So this is going to be here for a long time, and so am I.
Yep.
When I was in medical school, my therapist advised me
against getting tattoos or growing your hair,
doing anything like that.
He thought it would cause me too much anxiety.
Probably right.
Now that I'm no longer so concerned about being the good resident
or the intern or the physician, I can be myself.
I can just be Tom, and I happen to be a physician too.
You know, doctors hate tattoos.
That's one of the things I like about them.
They hate them. They hate patients that are tattooed.
They have something called a tattoo-to-tooth ratio,
where if you have more tattoos than you have teeth,
you probably can't kill them.
There you go, man. It's all done.
All right. Hey, thanks. Appreciate it.
You the man. Yeah.
Dr. Gerard, I don't know where the heck he's at,
but it's Sarah, and she's slit her wrists,
not side to side, but up and down.
You know, like she's really trying to do something.
It's the beginning of the morning.
It's 11.30.
And we're just coming to work.
In my years of practice now, I've seen all the ranges
of extreme tragedy, extreme joy.
It's been my privilege to have had a life
that's allowed me to experience all these wonderful aspects
of being alive and being human.
I can't think of anything more beautiful
or anything that's grounded me so much in my life
as being a doctor.
We're not real sure on her.
Here's the scoop.
35-year-old female found alongside the roadway,
falling from a vehicle due to a faulty door,
approximately 40 to 45 miles an hour.
Hi, ma'am, I'm Dr. Turner. How are you?
Yes. Can you hear me?
The first thing I always want to know is,
can they speak to me?
And if they can speak to me,
I know they have a fairly good airway.
And then I assess their breathing, you know,
are they breathing in a labored fashion
or in a very fast fashion?
You know, you can do this just looking at them.
She did walk, you see.
First her door went flying open and she went sliding,
hit her head on the concrete.
Did your neck hurt you? Yes?
Oh, my back.
Sorry.
And then you usually look at their fingernails
and stuff like that when I'm shaking their hand,
and I can assess circulation, are they really pale there?
You know, I can do all that in the first three seconds
that I see them.
That's basically just hello and a handshake.
If there's anything wrong with any of those,
you've got to cut to the chase and fix that
before you do anything else.
Oh, my God.
CAT scan revealed some fairly extensive injuries.
It showed that she had developed a blood clot
around her aorta, one of the big arteries
that leads straight out of the heart
and pumps blood to everything.
And if your aorta blows,
your chances of surviving are just about zero.
We're going to get a cardiothoracic surgeon in here
so that if she suddenly goes down the tubes,
we have a chance of performing an emergency chest surgery...
Would you care to come on in and take a look at her?
...opening her up and potentially saving her life.
Thanks very much.
Now, ma'am, in order to get your lung to re-inflate,
we're going to have to put a tube in your chest, okay?
Now, what I'm going to do is I'm going to put
a lot of numbing medicine in there,
but we're going to need to do that,
because your lung is collapsed,
and it's probably what's causing your blood pressure
to go kind of low, all right?
Okay.
It's not a pleasant procedure.
It's not something that you, you know,
want to just have done for fun.
But when you need it, you certainly need it.
You might feel a little pressure here now.
This is going to hurt just a little bit, okay?
Ready? Here we go.
Sorry.
In a patient like this, if she was to go downhill
and we needed to put her on a ventilator
to breathe for her,
if we did that without putting in a chest tube,
it would probably kill her.
Ma'am, stop. Oh, God.
Oh, God.
You can hook this up.
Right here.
She's got it.
The chest tube in this lady and her hemoglobin
and vital signs at least temporarily stabilized,
the only thing to do is really watchful waiting
until the angiography team and the surgeon get here.
So I'm going to go take care of some of the other patients
who are clearly less urgent than she is.
Ah. Ah.
Good. Yeah, looks a little red back there,
but there's no pus. That's a real good thing.
No pus.
She's got conjunctivitis there.
Pink eye.
Oh, that's good.
It looks like you got some swelling here.
Has anybody ever figured out what this swelling's from?
Uh, I've got...
Sy...
What have you got?
Uh...sy...
Uh...
Se...
Syrosis?
Blood pressure's 134 over 70.
When was your last drink?
I'll go ahead and try and draw it.
About two...
How much do you drink a day?
Do you drink a couple of six-packers a day?
Yeah.
Okay.
Mm-hmm.
Hi there.
Look at that.
I'm Dr. Tartter.
How are you?
Can I take a peek at your finger?
I love this.
This is great.
I want some water.
Okay, can I just take a peek at this though?
I'm the doc.
Let me see.
I don't want to look.
If I can help you.
You don't have to.
Don't look.
Close your eyes.
Okay.
Do we have the other piece?
Yes.
We got it.
Got a glove on?
Grab that.
Are you in a lot of pain?
Yeah, not, I mean I...
Okay.
Yeah, I'm...
Okay.
What did you do there?
What did you catch it in?
She fell down and there was a wooden spool down there, one of those big cable spools,
and somehow when she came up, that was off.
All right.
There's a little ethanol going on, so we're not exactly clear on how it happened, but
that's as good as we can figure either.
Okay.
Aha!
You broke one of your ribs, okay?
And that's probably what's hurting you real bad is your ribs broken.
When people come in with minor ailments, most of the time it doesn't really matter what
the physician does.
That hurts right there a lot, huh?
Yeah.
Because they're going to get over that minor ailment.
You know, if you come in with a sprained ankle, there's very little that I can do to stop
that from getting better.
It hurts there?
Yeah.
That's where it hurts the most up here?
Yeah.
More than over here?
Uh-huh.
I mean, it would be hard for me to make it turn into a chronic condition or something
like that.
I'd really have to give you some seriously bad advice.
So the fact is that this sprained ankle is going to get better.
I can put you in a splint and give you crutches and give you some motrin or something.
And then when you get better, you can tell everybody what a wonderful doctor I am and
how good medicine is.
Or I could not do those things and dance around you with a mask and a rattle and do that every
day for two weeks.
Two weeks from now, your ankle will be better.
And we can say it's because of the mask and the rattle, you know?
A lot of this stuff really is just people healing themselves, just the body doing what
it does.
I wish my body would heal itself.
I'm really paying for all those years as a competitive weightlifter.
I feel like I'm falling apart like a cheap suit.
I had this knee replaced.
I had that one replaced at the same time as this one.
I had two discectomies right there where I blew two discs from weightlifting.
And then I've just torn and broke all kinds of things.
I broke my neck once in a bike wreck.
I broke my leg and have a rot in my whole leg from kickstarting my bike.
I tore my bicep pretty good from when I was a powerlifter.
I'm an old dilapidated wreck.
Very little that still works.
So this lady fell out of the car.
So what we have to do at this point is we have to further study the nature of her aortic
injury.
Now the question is, is that blood clot sealed off or is it bleeding?
And in order to do that, we need to really take a look at a flow or dynamic type study
where we put some dye in the aorta, let the dye flow through and see if it leaks out into
the chest.
Unfortunately in this case, her aorta is okay.
One of the things that we really have to do in the emergency department is play patient
advocate and simply act as a liaison between the various specialists who sometimes see
things just in terms of one organ system or another.
Then when we talk to these people in consultation, very often they treat us with some amount
of disdain because we don't know what they know.
Her arch is clean.
Good.
Everything else okay?
Yeah.
Great.
She doesn't have much of an air leak, did she ever?
No.
However, when things go wrong, when the patient starts to get sick and starts to die, who
does every specialist want around an emergency doc?
Because that's what we do.
That's what we do best.
Ow!
It shouldn't hurt anymore after that.
Oh man.
Sorry.
I think you've been through it all now.
Sorry you just went.
Which was worse, that or that chest tube?
I don't know about the chest tube.
You did?
Good.
I like that.
Keep forgetting about it.
Let me just sew your head up.
I'll have it sewn up and then you'll be free of me anyway.
I just did the first stitch and didn't even feel it.
Being a patient so many times has really allowed me to connect with my patients.
You just use the regular stuff that you take out, less chance of infection.
When one of my patients is hurting, I really know firsthand how that feels.
Thank you.
Sure.
Does this hurt any much in here?
No.
Yeah.
I enjoy a cup of coffee.
I enjoy sitting here.
I enjoy the cool breeze.
I enjoy my comfort.
I enjoy the fact that right now I'm not hot, I'm not cold and nothing hurts.
These things are wonderful luxuries that I definitely wouldn't enjoy if I wasn't constantly
exposed to people who didn't have this or I wasn't exposed to the person whose health
is wonderful and they have the big aneurysm and they keel over and that's the end of their
life.
I could die right now.
This could be my last sentence.
Believe it or not, I'm kind of okay with that.
I'm not suicidal.
I don't want to die.
I want to live forever.
But hey, that's not the way it is and I'm okay with it.
I am not going to be a person who says, gee, I wish I had done this.
I've done a lot and I'm real happy.
Nova producer Michael Barnes has chronicled the lives of these doctors for 14 years.
How did he choose them?
What challenges that he faced along the way?
Go behind the scenes on Nova's website at PBS.org or America Online keyword PBS.
To order the three hour Survivor MD special for $29.95 plus shipping and handling, please
call WGBH Boston Video at 1-800-255-9424.
Nova is a production of WGBH Boston.