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.
Right, and here's the ligament right here.
I just want to show you that this is a perfectly normal brain.
Oh man, this needle can be done worse.
David, will you shut up?
I'm sorry.
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.
And 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.
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.
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.
No I can't breathe this way.
In this hour the experiences of three of these doctors.
You're going to be fine.
Jane Leibschutz practices internal medicine at an inner city hospital in Boston.
Hi I'm Dr. Leibschutz.
The work I do is really devoted to people who are on the fringe of society.
I feel that I have patients who really need me, really need me.
You know I feel that I have special abilities to give to them and it makes me feel really
good about myself.
He's a pretty active little guy.
Hang on with me.
First pediatrician Cheryl Dorsey.
He's a good size.
I knew that in whatever profession I chose that I would want to help people and interact
with them constantly so I think I would have been equally happy being a public defender,
being a history professor but just through a matter of circumstances I ended up in medical
school.
Really going there.
Okay come on.
I mean there are some people who have a real passion, they want it to be a doctor their
entire lives, that's what they've trained for, that's what they've hoped for.
Yeah you're awake, look at you.
But I can honestly say I knew I would never be a great doctor because I didn't love it.
David Friedman is an eye doctor at Johns Hopkins Hospital in Baltimore.
As a physician patients come in and I immediately have access to them.
They tell me about their daily lives, who's sick, who's well and then we often lead into
their personal lives and what's going on with their spouse or their son or their wives.
It's incredible the things people will tell you.
I had a patient just yesterday say my daughter's in jail for cocaine, I'm taking care of the
kid and you get so much and I'm their ophthalmologist.
Major funding for NOVA is provided by the Park Foundation, dedicated to education and
quality television.
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Northwestern Mutual Financial Network.
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viewers like you.
Thank you.
I've actually had a real difficult time with gross anatomy and as you know that's opening
and dissecting a cadaver.
I always have to hold my breath and just calm down for a few minutes before I walk into
the room.
It's right in the middle of the line.
Keep on dissecting.
Emotionally I think it's very difficult.
I'm constantly thinking about the person who donated their body, how they lived and what
emotions they had and why they gave up their body.
This patient had had an operation already.
You see here are the stitches.
This is incredible.
Oh my God.
Look at that.
Can you see?
Elliot and I are not only studying anatomy by dissecting cadavers, we're learning it
by examining each other in our weekly patient doctor class.
Hi.
How are you?
We've been seeing a lot of things on slides and to see it alive is really nice.
Especially you know we're used to seeing a cadaver where it's all dead and doesn't look
red and warm and alive.
Right.
It's exciting.
And you know all this stuff we've seen in books and in everything else and now we're
seeing it where it counts.
You want to do head, ear, nose and mouth.
With an idea of looking at normal.
I'm just inspecting.
I don't feel anything.
This is the way my dad always does it.
He grabs my neck and then he slides.
There I got a lymph node.
It's right there.
Right around the thyroid bone.
Both of them.
Yeah.
It's a beautiful inferior terminate that kind of just passes right down where it should
be.
Great.
Did it hurt?
No, I'm all.
Anita, you made that scene.
It did.
Okay, so you kind of start this medial and then go to the laterals and she did it.
How did she?
No, she was way over.
I think that the fact that we've learned these clinical skills gradually and in these little
areas with our friends and people that we know, rather than on patients, is making me
much more confident.
I feel like I can try and not be afraid of hurting somebody.
My friend will tell me it hurts.
It's made me feel much more confident about going and seeing real patients.
There I see it.
You see it?
I see it all.
How does it look?
Beautiful.
Reflective triangle.
Really?
Yep.
The little thing on top, that dot that we were supposed to see on top.
You've got a beautiful ear, Ellie.
Oh, really?
Yeah, it's great.
Incredible.
Oh, I'm sorry.
You see, you can't go side to side.
You can only look at the...
Sorry about that.
It's the side to side that will kill them.
There's blood coming out of my ear.
Even though it's only been six weeks, I've really learned a lot.
We've learned the leg and the chest and the heart.
I mean, we've gone through part of the body already in just a few weeks, which is incredible.
I mean, and I've learned so much about the physical part of how we work.
It's a woman.
If you have the fallopian tube, it's cut out because it's diseased, but the ovary is still
good and left there, and you have another ovary that's diseased, the fallopian tube
from that side will come over and surround the ovary on this side.
Really?
Yeah.
That's pretty amazing.
We are made for reproduction, survival of the species.
I'm going to be 30 when I graduate from medical school.
It's time to start thinking, perhaps, about having children in a few years, and how does
that fit into my career, and what kind of career do I want to choose that will accommodate
that?
All the way down to the breast right.
I'm surprisingly comfortable being in the anatomy lab.
I thought I'd be a bit squeamish working with the cadaver, but because we have been dealing
with organ systems below the neck, I haven't had to deal with seeing the person's face,
so I've been very removed from this cadaver as a person, but I think as we begin to work
with the head and neck region, when the head will be unveiled from the pouch that it's
been kept in, I think I'll be very uncomfortable with that, because for me, the head and the
face are really kind of the seat of all emotions, the smile, a frown, and that will really bring
home to me that this was a human life that is no more, so I think I'll begin to feel
very uncomfortable with that.
Today was the last day of our formal gross anatomy lab.
I expected that I would leave there really feeling happy and relieved of this big burden,
but instead I felt really sad.
I felt very emotionally attached to my cadaver.
When we took out the brain today, I just, it really made me think that I was holding
what used to be a soul, and today when we left, I felt very, as if I was leaving something
very important behind and I wouldn't get it back, so I have a lot of mixed feelings about
the end of this gross anatomy lab.
A classical scheme, and now if we take a look at the more detailed scheme that you have
and I'm sure you understand very well.
This past block of biochemistry and physiology has been really, really draining on me, emotionally
somewhat, but basically I've had so little time to take care of myself.
I'm learning all these biological pathways and physiological systems in our body, and
basically I've just been a mess.
I've had volcanoes of pimples erupting on my forehead and my chin, and I've not had
time to do my laundry in a few weeks, and cooking, well, who has time to cook?
It's been really draining and really engrossing.
I also look around at everybody else who's feeling the same way.
When are we going to come up from air?
Today's the last day of my introduction to clinical medicine, and I'm going to be evaluated
by Dr. Alan Goral, who's the instructor for the course.
I'm going to be simulating a real patient.
The story I'm going to tell you is really a story from an actual patient, and your job
will be to take a history and do the appropriate physical.
It's sort of frightening to think a renowned doctor is going to serve as a patient and
you're going to have to guess his condition, so it's a little unnerving, but I think it'll
be a good learning experience.
The second is I'm going to tell you what it felt like to be examined and getting a real
sense that you actually not only put your hands in the right place, but you felt what
you were supposed to feel.
Okay.
I'm pretty nervous about what I have.
Okay, you do seem a little nervous.
Can you tell me exactly what brought you into Mass General today?
I've had this feeling here.
It's not really a pain sometimes.
It's more like, I guess, a tightness or maybe a pressure.
Tight feeling.
Yeah.
Okay.
And it's all over here.
All over, okay.
Now, listen to your heart in two positions.
First, you're sitting up, and then you're lying down.
That gives me a better sense of what's going on.
So I'll just start and take a listen to your heart.
Okay, very regular.
Nothing in the middle there.
Nothing sounds bad yet?
No, no, not at all.
Just listening for the heart sounds.
You have two normal heart sounds, S1 and S2, and they're there, very clear.
Okay.
So I'm just getting a good sense of what's going on.
Better to always check.
Okay.
It's fairly stressful, actually, because you have a...
Of course, it's a simulated event, but he's, of course, a doctor, so he's a very knowledgeable
patient.
And as soon as he said, I'm having heart problems, my heart just sank because I said they tend
to be the most difficult cases and all these questions that I know I should have asked,
I'm sure I didn't.
So it's actually kind of frightening because I could kind of mentally hear him checking
away, saying, well, she didn't ask me this, she didn't ask me that, and she didn't focus
on this.
So it's very stressful.
You showed, again, concern for my comfort.
I was very comfortable during the entire exam.
You did not move me around excessively.
Okay.
Overall, I think you're exactly where one would expect you to be at this stage of your
training.
You should be proud of yourself.
You are warm.
I felt welcome.
And as you gain a little more confidence, you will do a very nice job and you will be
a superb clinician.
Oh, thank you very much.
So I'm really pleased with what you've done.
Oh, I'm so nervous.
I think what we'll do today is before you try drawing blood on one another is we'll
just repeat the demonstration.
I've never drawn blood before and I'm very nervous.
You want to go into it someplace where you can really see and feel the courses.
I think drawing blood is the most difficult thing I've had to do in my whole medical
school career.
Except, no.
Yes.
No.
No, and not more difficult than the cadaver.
Come on, people.
Give Freddie a break.
Okay.
Yes!
Well, do you or do you do me?
I don't know how to do this.
I don't know how to do this.
Am I not going to be able to do it again here?
What, can you still feel the vein?
Oh, you twist this thing.
Oh man, this needle can kill a horse.
I think so.
David, will you shut up?
I'm sorry.
It still doesn't.
Try putting your hand behind the surgeon's set up on top of it.
Like this?
Yeah, right.
And just go, amen?
Start, you know, toward this end.
Like here?
Yeah.
Don't worry.
I'm shaking.
I'm sorry about that.
Alright, let's try it too, man.
Yep, you got it.
That's beautiful.
I'm just practicing.
Thanks.
Thank you so much.
Aww.
Okay.
I feel better.
In the third year, we leave the classrooms for the Boston Teaching Hospital
so we can see all the different specialties.
When you're at the West Roxbury, it's just very different medicine
from a huge teaching facility with tons of money.
The VA system just doesn't have the same kind of money.
As a medical student, since the staff is so overworked,
you really get a chance to do a lot for your patient.
And it's really the first time in my entire third year
where I felt really needed, like they need me to do things.
If I didn't do them, the patient wouldn't get as much done
because I'm one of five people that's going to take care of that patient
the whole time this year, and it's a really nice feeling.
Let me see how this is doing.
Mr. Patterson needed to receive chemotherapy for a cancer
that he has in his mouth and in his neck.
And in order to get that, he needed to have constant injections of drugs,
and he had really no veins that you could find on his arms.
You're a real challenge.
I don't feel anything.
All right, well, we'll talk it over and see what we're going to do about that, okay?
Come back and see a little bit, okay?
Try to get you a pillow, too.
So in order to get access to his blood to give him this chemotherapy for his cancer,
we have to put a line in him.
And there are big veins that you can get that aren't on the sides, but are in the neck.
And so we're going to put one in his neck, and that'll be through his jugular vein.
Anytime you do a procedure for the first time, your adrenaline goes up,
because you don't know what it's going to be like.
You know that you don't really know what you're doing,
and so you're sort of randomly shooting the needle in.
You still feel the pulse?
To the spiral to my what? Middle fingers.
When I was going through the vein, I was really afraid I wouldn't get it,
and that I was just going to sit there and keep stabbing him, trying to get it.
And that's when you feel bad, because that's when you know
that somebody who knows what they're doing could get that vein on the first try.
If you can just stay still for a few more seconds, we're getting there.
No, no, no. Pull it back.
Okay, now hold the wire at the skin.
You've got to make sure it's coming out the back before you start pushing it through the skin.
I don't want to pull it out.
No, you won't pull it out. I promise.
How'd it go?
It was great.
What's great about it?
Well, it worked.
I was pretty nervous.
I didn't get it the first time, you know, putting the needle in,
and then the second time I got it.
That's actually, that happens, but I was really nervous.
I just wasn't going to get it. I'm poker and I'm pro.
Sorry?
Yeah, he hasn't had one.
Oh, right, he needs one post-line.
What's so exciting about doing things like this?
You're smiling.
I don't know. I don't know what it is.
Some people like due procedures, some people don't.
I really like them. I'm not sure why.
I think one of the strangest things about coming into this institution of medicine
is that human lives and human drama is really an everyday part of your life as a doctor.
And in academic medicine particularly, you know, there's interesting cases,
and you sit and you hear about all the interesting disease, interesting this, interesting that,
and all of a sudden you realize that's a person on the other end of this discussion.
And sometimes I feel hypocritical about being excited about a case.
I feel guilty almost because it's somebody's illness that I'm excited about.
How's it been to be in a relationship when half of the relationship has a terminal illness?
Is that hard to talk about?
Well, it was August in Provincetown and it was a very nice time,
and my disease was not much of an issue at the time.
It wasn't something that we had to deal with on a day-to-day basis,
and now we're having to deal with a lot more with this hospital stay.
But...
It's good for me to hear, you know, your experience as a patient,
because I'm sort of halfway in between the doctor world and the, you know, the outside person world.
And so, I mean, I feel like you've given me a lot by sharing, you know, honestly your experience here.
It's very hard when you're young and alive and you don't know what's going to happen.
But that's kind of true for all of us.
It is true for all of us.
But I know I have some different odds.
Yeah, and you also know that it's going to come sooner rather than later.
Well, you don't know.
I'm not so sure of that, Jane.
I mean, there is a misconception about just because one is diagnosed with AIDS,
granted many people do die within a certain timeframe,
but many, many people have lived a lot longer than that timeframe.
And I'd like to see it, you know, continue for a long time,
but if it doesn't, the time I've had has been really, really something.
It can be very good with patients to have the ability to come right out and say incredibly difficult things.
Well, you're only a third of your medical student, Jane. It's okay, you got time.
I think a lot of patients appreciate somebody who can be directed.
The one thing is that I am learning that not all patients appreciate it.
And what I have got to learn to do is to find, figure out which ones are the ones who are open to it.
And which, you know, when I'll have time, if I open a cat of, if I open a bag of worms,
whatever, if I open the Pandora's box, am I going to have time to sit there and help them clean it up?
Or am I just going to open something people, you know, have difficulty with and send them out?
You know, and I'm learning the difference between the two.
Well, I was out walking my wee dog.
Your wee dog?
Aye. And the pain came on me.
Uh-huh.
And it gradually got worse, worse, worse, and they put me into intensive care.
How are you feeling about this?
I was worried. I'm worried.
You're worried?
Yeah, but I know I'm in capable hands.
What are you worried about?
I mean, I've never had a knife put to me before.
You've never had surgery before?
No.
Uh-huh.
The good thing will be that you won't remember what's been going on.
And then when you start to feel better, you'll feel better, and they won't be giving you so much medicine.
So...
Well, as long as I can go out of here and play soccer again.
Okay, that's what we hope.
Yeah, I was playing soccer.
Until when?
Last year.
Uh-huh. Why did you stop? The chest pain?
Yeah.
Well, it's a good thing you went to the doctor when you did.
Yeah, well, when I walk out of here, I'll put on my, I'll put on my coat for you.
You will?
Yes.
Okay.
You have to come over a little to the left one.
I think being in an operating room is one of the most intense experiences one can ever have.
And one, and scrubbing in and actually having your hand on the case and actually helping when you feel needed
is probably among the top ten experiences to have in the world.
Three. Three times.
Now turn around. Yeah, that's it.
Right now there's a coronary artery bypass graft on Mr. Collins.
And what's happening is they're taking some vein from his leg
and then some other vessels that are in the chest wall
and connecting them up to where the coronary arteries are, which give the heart blood.
Thank you. Where would you see the RV from here? I mean...
This is the RV. That's the interior RV.
This is the interior RV? Pickups? Yep.
Wow. That is really cool.
It's just a great place to see anatomy.
Topical cold, please.
Well, I think I feel a little depressed right now because of the fact that he has such diseased vessels
and it's taking a little bit more time than we'd like.
Let's wait and see what happens.
Do you understand what's happening right now? His heart isn't working
and Dr. Johnson is pumping... he's actually pumping the heart himself.
The heart's just failed. It's not working. It's not working.
So that's what's happening right now as we speak.
I can't refuse him.
You're just keeping him alive by pumping his heart
and you're trying to think of something else you might be able to do?
Right.
This is terrible.
I feel like I'm bad luck or something.
I can't believe it. I told this guy he was going to do fine.
Condu, we did okay with not having any condu.
I don't know what more I can do.
Alright.
That's it?
Yeah.
Oh my God.
1137.
Shit.
Alright.
Alright.
Can I stay real quick?
Yeah.
I know. Absolutely.
I'm sorry.
I just never saw him. He was like... right there.
I'm sorry. I know.
The responsibility we have now is to kind of keep a calm head
and help the family understand it.
I feel the way you feel, but I can't go up to them like that.
Well, I wasn't going to go up to them.
It's funny because I've never really had a patient
that I've gotten to know who's died and here it's happened right to here.
And it's like a bad dream or something.
Like, let this be over already.
Who's going to wear his kill... I don't know. I'm sorry.
I shouldn't be...
You're attached in a way that is perfectly appropriate,
but you have to understand all kinds of other things.
Like, from the start of this operation, he could have...
From the aorta, he could have had a stroke
and he never would have worn his kill scan.
It would have been even worse.
I know. And I also know that he wouldn't have lived with his arteries like that anyway.
Oh, no. He couldn't do anything. Absolutely.
I know that. I know that.
But it's so hard to watch it.
That's the physician part. I know.
But you have to be... I understand that.
Thank you. Are you going to go up and talk to them?
Yeah. Yeah.
Do you want me to come to see him?
You're welcome to. Yeah.
I had two patients who died,
and I cried right there.
And now I don't really cry right there, but...
I mean, it definitely affects me.
And when I think about it, like, right now,
it's really obviously upsetting.
And I hope that it'll get to the point where, you know,
I... It doesn't...
Well, it doesn't even now.
I don't even know the way of being able to be the medical student.
But I don't imagine that I'll ever be able to just, you know,
say, oh, yeah, well, you know,
had a patient with pneumonia and had two patients who died
and, you know, played golf.
And, you know, I don't think that...
I don't think that will ever be me.
But I think somehow, in the next years of my life,
I'll be able to process and make sense of some of this stuff.
Jane M. Leibschutz.
Now we have a doctor in the family.
Isn't that fantastic?
Cheryl Lynn Dorsey.
My parents paid for it.
Here it is.
David Steven Friedman.
Doctor of Medicine, Ed Caradam-Medicine-Doctoris.
David is my youngest grandson.
I'm very proud of him.
I'm always sorry that my husband is in here.
Joy meaningless.
What is this?
I am so happy.
I know. Is this fantastic?
I can't believe it.
Good morning, doctors.
Doesn't that sound good?
Welcome to the deaconess.
The back row, could you just...
The next stage is internship,
which is the most grueling part of my training.
After that, I'll do three more years of training
in my specialty, which is ophthalmology.
Today is the first day.
This is everybody's congregating
before we all go off to our respective jobs.
I didn't bring a set of scopes.
I didn't bring any.
We were both on at 8.30 at night.
Yeah.
My girlfriend gave me a button, Dr. Dave,
and that's what I feel like, Dr. Dave.
Nothing more, really.
I'm David Friedman.
Oh, you're Dr. Friedman.
There are certain medications
that are good for you to be on now.
The first one is that we have you on
Isodil, a nitrate.
We'll try and keep you medically feeling good.
Yeah.
It's the first time where I feel like
I have a responsibility, and if I don't do something well,
that could cause my patient harm,
and that would be the worst thing one could do.
And I'm sure that even inadvertently,
like, there are certain things we do every day
that have negative side effects,
and now I'm going to be the one doing those things,
and I'll cause negative side effects to people.
But that's part of what you have to do
to treat somebody,
but that's a hard thing to live with.
We're the two residents in that one air care unit.
We're probably going to spend the night.
That's where we're going to be.
We're definitely going to spend the night.
So this is the EKG.
It looks like he's acutely having a heart attack.
We're just going to ask you a few questions,
very simply.
This is by far the most acute thing I've had to deal with.
In your urine, have you had an E blood?
Absolutely not.
Have you ever had a problem with your heart before?
Have you ever been told you had a heart attack before?
Never.
Okay. It looks like you may have had a heart attack.
But we're going to do it.
We're going to treat you for a heart attack.
Your EKG looks like you're having a heart attack.
You might still be in the process of its evolution,
and when it ends is a debatable type thing.
Do we have IV low pressure now?
I don't know enough about this.
I guess I want to do something.
Push the low pressure.
I want to do something.
We did. We asked Chris to push the low pressure.
So let's start writing up.
An opressor.
I've decided to work in internal medicine.
I'm doing my internship at residency at Boston City Hospital.
It's a public hospital with lots of poor and foreign patients.
So just keep paging me until I'm...
Well, the first couple of days I felt totally overwhelmed.
I have left at midnight every night just getting my work done.
Did it work? Did you get it to work finally, the central line?
No, later on.
But today is like my fourth day, and it's just all of a sudden
things seem to be falling into place a little bit more.
There's a sore spot right there.
Right here?
Yeah, right there.
They really need me, and I have the sense I can make a difference.
They are on the history of non-insulin dependent diabetes,
having fallen and vomited.
Mr. Day is a 65-year-old gentleman.
He had a stroke yesterday and was brought to the hospital.
Initially he was awake and could talk, and then as the day progressed
he got worse and worse.
And then he was brought up to the intensive care unit,
and now it appears that he's had a very large stroke affecting the brain stem.
How are you feeling, Tom? Tom?
What's evident up till now is that he had a major stroke, a big stroke,
and it occurred in a part of his brain, what we call the brain stem.
And a lot of times people have strokes, you think of them becoming paralyzed
or something on one side, but the brain stem, unfortunately,
is the center for a lot of activity.
I don't find it at all difficult to talk to families because I feel that
somebody needs to do that, and it has to be very blunt.
And I feel it's not fair to a patient to have a lot of extraordinary measures taken.
It's very undignified, and I think that if it's not a real quality of life,
a patient is unable to communicate and just sits in bed all day.
You know, I don't personally feel that anybody should have heroic measures
to keep them alive for that quality of life.
I mean, is it possible he can come out of this and be all right?
I think it's a very low possibility.
I think it's a very low possibility that he would have a full recovery.
I mean, I think it's impossible for him to have a full recovery.
I mean, I'm being very blunt.
I mean, I'm not, I'm just not telling you something,
because if you got false hopes, you would be terribly disappointed.
I want you to tell us the truth.
Exactly what's going on. You know, we want to know the truth.
Be as blunt as you can.
They were paging the wrong person for my admissions.
It's like every day has been sort of the sine wave where it's gone sort of way up and down,
where I have moments when, you know, gosh, like I'm really a doctor, you know,
they're really asking me for, you know, I could sign the prescription,
and people call me doctor. That is exciting.
And then there are moments when, I don't know, where I still feel like a medical student.
Okay. Yeah.
I have a lot to learn for sure, but it's okay, you know. I'll learn it.
I've decided to postpone my internship and residency training in pediatrics
in order to start up a mobile outreach unit serving inner city Boston.
I think that's fine, Chico. We'll have to anchor this side.
I sort of always knew that I wanted to work with the minority community.
The effort was started when people in the city got a look at the 1988 and 1989 infant mortality statistics,
and for a city as large as Boston with the sort of health care and medical care resources that we had,
the numbers were appalling.
The family van is incredibly important to me as a project,
and it really needs my full attention right now as opposed to going off to residency.
Residency will be there. I will do it. But right now I really need to continue the work on this project.
This gentleman unfortunately was in a meeting over in South Boston. They came in and there was a little bit of a...
I'm just about finished with my internship at Boston City Hospital.
I'm on call tonight in the emergency room, so I'm going to be up all night.
Mr. Boxer. Mr. Boxer. Yeah.
Hi. I'm Dr. Leapshoots. How are you feeling?
I'm feeling alright. I'm feeling tired.
Where are you, sir?
I'm trying to see how I feel.
What brought you in here?
I think that people talk a lot about how stressful it is to work here.
I've had a lot of late night discussions with nurses mostly about how difficult it is to work in a municipal hospital
with fewer and fewer resources and patients who are extremely needy.
Alright, I've got a lot of blood here, so we won't need any more.
Sometimes I'll dream that I have AIDS or I'll dream that I have cancer. I'll dream that I have some horrible disease.
When I was in medical school, I used to think I had all of these diseases.
Consciously when I was awake I'd be worried. I had this horrible thing and that horrible thing.
I think as an intern I'm very conscious of how healthy I am compared to my patients.
I'm conscious of the fact that I don't abuse myself or my body.
Well, I mean being an intern you abuse yourself because you're...
This is a young lady who was found outside a what they call shooting gallery, which is where people shoot intravenous drugs.
I can't breathe this way!
You'll be okay.
Get out of the way!
You're going to be fine.
I cannot breathe this way. Please believe.
How can I help you?
Put my nose to the air baby please.
We've got one strap left.
I'll get up. I'll get up. I'm going back.
I heard you had some crack. Did you have some crack?
Yes I did.
Okay. Do you have anything else?
I need some dookie please.
I feel so burnt out right now that the idea of staying in a dysfunctional hospital like this for years on end is really not appealing.
But this is what I've been drawn to always.
I'm one of the doctors here.
That's the doctor right there.
Okay. I'm going to help you.
You want to help me in here?
I'm going to help you. Okay.
Now I need you to...
I need to go to the bathroom and dookie.
You have to go number two?
I have to go number two.
Okay.
If you have to go just go. If you have to go just let it go.
I promise.
If you have to go...
So has this been a still really quiet night?
Very quiet. A little excitement but...
No.
Sweetheart.
I'm so tired.
You're doing great.
We're just going to have to hold up.
Okay.
Two and a half hours until morning.
So you ate one.
One of the best features of this residency training program is that we can do home visits.
You really get a sense of who they are.
They're much more comfortable and they open up a lot more than they might otherwise.
Sometimes.
I think Wenjen cares for you a great deal.
I think.
I think he does.
Nothing better than die.
Because I lost my best friend, my wife.
Nobody cares for me.
Nobody cares for you?
No.
Mr. Nee has two major problems that I'm worried about.
One is difficulty breathing from his heart and his lungs.
And the other major problem is his depression.
And he fits into the category of people who are at risk for suicide.
Okay, I just want to ask you one question.
You talked about suicide. Are you thinking of doing it?
No, I can't do it.
Why not?
I have no pistol.
If you had a pistol, would you do it?
Yes, I do.
I went back a couple of days later to bring him some antidepressant medicine.
And he was having a lot of difficulty breathing.
And so I called his son when his son got home and I told him to bring him into the emergency room.
I agree. I think if your heart should stop, then there's...
Probably that means that there's not much more.
But I think that if you should have breathing difficulties,
I think if you should have breathing difficulties,
then I think you can try the breathing machine.
Iron lung. You could try it.
You talked to the other doctor about it, right?
Right?
You can tell him.
Okay, tell me.
No use. Suppose I'm getting well. What use?
Well, you know what? We're going to work on that. You have a lot of use.
You make me happy to come see you.
Don't waste your time.
I'm not wasting my time.
It's a challenge. And I'm trying to kind of find a way into him,
make a relationship with him, to help him.
You do much better than me, Mr. Lee.
You can do hypers.
He's an incredible man.
And just from my having lived in China and speaking Chinese,
it's a once-in-a-lifetime experience for me.
Well, I don't know. Once-in-a-residency experience for me, at least,
to be able to have this kind of relationship with somebody.
I wish I could do more for him.
There was something about him that took the 60 years difference between us
and the gender difference and the culture difference
and really able to become quite intimate in a way
that I haven't experienced with almost any other patients.
I was able to get to know him.
I was able to get to know him.
I was able to get to know him.
I was able to get to know him.
Mr. Lee looked to death as a solace
as a time when he could meet his maker and his wife.
However, he greatly feared becoming disabled
and losing his independence in that process towards death.
In spite of my sadness now, his spirit is with me strongly,
and will be so.
I realize that it is somewhat unusual for a doctor
to have this type of relationship with a patient,
but Mr. Nhi Chiu Ping was not just any patient or any man.
Mr. Nhi's name actually means autumn peace,
and I hope that he's achieved it.
After medical school and after the family van,
I left Boston and came to Children's National Medical Center
for my three-year pediatric residency.
For a long time, I was torn between the idea
of a medical career versus an academic career,
and I'd always wanted to lay that issue to rest,
so about a year ago, I enrolled in a Ph.D. program
in history, and I was a very successful doctor.
I was a very successful doctor.
A year ago, I enrolled in a Ph.D. program in history
at the University of Pennsylvania.
My parents are incredibly supportive.
With that said, my mother thinks I'm ridiculous.
She thinks I'm nuts.
We went through being the majorette.
We did the ballet, and we were terrible parents
at the ballet recital because I think we both had to laugh
to see this little fat thing in her little tutu.
And bouncing around, that was so funny.
But she wanted to try that.
She wanted, well, of course, she always loved the swimming,
so she had to do the swimming,
and she enjoyed the horseback riding,
but she always, you know, everything that came up,
she wanted to try, and we were suckers for it,
and we just let her try everything
that she was interested in.
You know, I was really excited about going back
to graduate school, but with the wisdom of age comes
the realization that if you don't like it,
if it's not the right fit, you get out of it.
There was no sense in delaying the inevitable,
so after the first year, I decided that I wanted to come home
and sort of figure out the next step.
I never imagined myself in the corporate world,
but I currently work for Donnie International,
which is a health communications firm.
I'm here as their new director of public health initiatives,
and my responsibilities include everything from project management
to new business development.
You know, Ken, give the update, because I don't know,
especially you, Rich, because you were busy with ATTC stuff
on the whole Mary's House.
The products that they develop from educational brochures
to training manuals, websites that are designed
for practitioners as well as children.
So the work that they're doing was a good fit for me.
Put a marketing bid together where we agree just...
I have no regrets about not being a practicing doctor,
and I'm not disparaging the people who work 70 to 90 hours per week
if they feel that's their mission.
And I'm sure at some point in my life, I'll be so energized
by something that it will be important to work that hard,
but it's sort of like ebb and a flow of life,
and at this particular point, I don't need to work those kind of hours.
MUSIC
I'm not surprised that I'm still at the same hospital
where I did my internship and residency.
I've always wanted to do what I'm doing,
which is working with urban, poor, underserved patients.
It's really, really hard to stop drinking
if you've been drinking for, like, 40 years.
It's really hard to do it sort of on your own like that.
At this point, my old man told me he would never let me drink again.
So...
But I'm thinking you probably need other support as well.
No.
You get so frustrated with what people are doing to themselves
that you sort of say,
God damn it! Can you stop doing that?
But then, you know, I sit back and I realize that these are people
who do the best that they can.
I don't have to tell you that, because you know this, that the drinking is...
I can't do it by passing judgment or just telling them to stop using it.
I mean, the power of nicotine, the power of heroin, the power of alcohol
is way too strong, but the power of relationship is very, very strong.
...we could support you and you could stop drinking.
Over time, I have had a number of serious addicts
get off of their substance of choice,
and I know that I have played a role in that.
It's not all me, I mean, they have to do it themselves,
but I know, I know that that long-term relationship really makes a difference.
Does anybody... We should be in contact with this program right now.
I'm 38 and I'm still not married, I don't have children.
I think it's something that I would like,
in terms of finding a life-love partner and thinking about having kids.
And I realize that the biological clock is ticking,
there's all these other pressures.
Do you see how her veins are kind of dilating?
You know, so trying to figure out how can I make my work
so that it could sustain those kind of relationships and connections.
So that's, I think, a challenge that I'm dealing with.
Do I choose the ambition to fill a void?
And if I let go of some of the ambition, let go of some of the compulsiveness,
if I let go of some of that, you know, what would come in its place?
And that that kind of overachieving has been there for so long,
that it's hard to know what it would be like not to be in that mode.
But that's, so that's an interesting kind of struggle.
Now I'm working in the ophthalmology department of Johns Hopkins Hospital in Baltimore.
Whenever I walk to my office, I get to see all the incredibly famous people in ophthalmology,
because so many of them trained here or were chief residents here,
you see people who were heads of departments, the head of the National Eye Institute,
people who are chair people all over the world.
So it's really, it's impressive.
I remember the first time I came here, I thought,
there's no way I'm going to stay here because these are the people who are here.
I've been lucky.
I divide my time between the clinic, research, teaching and surgery.
Mr. Weber is coming in this morning because his pressure has been much too high in that eye.
He has glaucoma.
In order to lower his pressure, we've used medicines and they haven't worked.
So I'm going to do an operation to lower his eye pressure.
I'm going to give him an injection to numb his eye behind the eye.
It's a big deal.
You don't put it all the way in, but it goes back into the space behind the eye.
If his pressure remains high, he's very likely to lose vision in that eye.
If his optic nerves get damaged from glaucoma,
he could end up losing all vision with a very high pressure.
This is the only way I can see of safely preserving his vision.
You want to stay calm. You don't want to have a tremor or anything like that.
I don't do squash before. I don't play a sport before. I don't lift weights before.
Make sure not to pick up a lot of heavy things.
No coffee.
How are you doing, Mr. Weber?
Fine.
Okay.
Do me a favor. Call me Andy.
Okay.
Everybody else saw Mr. Weber was my father.
The eye is incredible. It's amazing that we see up close, far away, for as long as we see.
I mean, we see until old age in general with good vision.
I mean, how do you do that? How do you build a living structure like that?
I'm not very religious, but I've thought of the eye as almost the perfect creation in some ways.
And how do you explain it?
This couldn't have come out pre-made.
There's something behind the fact that we can see so well.
I'm making a hole in the eye here, a permanent hole that's meant to leak just a little bit to let fluid out.
And it'll leak and stay underneath this outer tissue that I'm dissecting out and making sure there's not many holes in it or anything like that.
I remember the first few times when I had to cut on the eye.
And I'd make these little scratches. Like, I'd barely touch it.
And the guy with me would be like, cut deeper!
And I'd be, you know, scratching down because you're cutting into the eyeball.
I mean, you're cutting into an eyeball. It's incredible.
I'm putting in a tiny suture. It's probably about as thin as a human hair.
I can only see it when I'm doing this. If we drop the needle or something, it's almost impossible to find.
I need another needle driver, another needle.
I just reattached his own natural outside membrane.
Ophthalmology is one of the fields where you really feel that you've made a concrete difference for your patients.
They come in visually impaired. You give them a new pair of glasses. They suddenly can read.
You do cataract surgery. They suddenly can see well.
I've had patients just, you know, smiling and laughing and hugging me because of it.
It's an immediate gratification as a surgeon to be able to do this for somebody.
Hank, you did great. You went perfectly, okay?
Fine.
I'm optimistic. What?
No, he's done. He can get up. You shouldn't do any heavy lifting.
Okay.
Come on out. Where's that going? All the gray ones? Those are quarters and nickels and diamonds.
Oh, it goes in there. You're right. You're right.
What's that?
My wife's a librarian, but she's only working part-time right now so she can spend more time with our kids.
I used to, you know, bring work home. I'd wait and wait to get the kids to sleep so I could do my work.
And then I decided I'd just go in very early in the mornings and get the extra work done I needed done.
And when I came home, I was done and I was just here for the family.
Because when he was waiting to work later in the evening, then that was the time that he and I would have had.
So there was none.
So now I sleep less.
Now he goes to work at 6 o'clock in the morning and it doesn't affect my schedule.
You ready, Isaac? I feel like I've really stepped into a great situation. I'm particularly lucky.
It's a long haul. And I'm very happy because I enjoyed the whole process and I made it here in good shape.
But I think a lot of people, it's really a long grueling process.
And in the end, a lot of physicians aren't totally happy with what they do.
Thank you.
You ready, Isaac?
I feel like I've been given a privilege to take care of people.
Any pain, any discomfort?
No, it's just like...
Society lets me have incredibly close contact with individuals that I could never get otherwise.
And the vision may be down the first day or two.
Try to open your eye a little bit.
I can open it, but I see like a large cut.
What other job would let me do this stuff?
And that to me is, you know, that's the big benefit.
I put in all the time and that's the payoff.
I guess the first thing I want to do is take your vital signs.
It's kind of a rush. This is what I came to med school for.
The workshop part's over.
You change hospitals every month. You don't know where you are. You don't know the procedures.
Does that hurt at all?
I no longer want to be broadcast to the nation.
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