"Survivor MD: Tattooed Doctor"PBS Airdate: March 27, 2001 NARRATOR: This time on NOVA, a unique, behind-the-scenes look at what it really takes to become your doctor. ELLIOTT BENNETT-GUERRERO: How did she... DAVID FRIEDMAN: No. She was way over this way. JAY BONNAR: It feels like such a costume right now. STUDENT: Here's the ligament right here. INSTRUCTOR: I just want to show you...this is a perfectly normal brain. DAVID FRIEDMAN: Oh man, this needle could kill a horse. JANE LIEBSCHUTZ: David, will you shut up! NARRATOR: 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. JAY BONNAR: The first thing I want to do is to take your vital signs. JANE LIEBSCHUTZ: Let me see under your tongue. NARRATOR: For fourteen 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. DAVID FRIEDMAN: We all did well in school, and to come in and be given a test where you know nothing, it's really hard. JAY BONNAR: 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. CHERYL DORSEY: As soon as he said I'm having heart problems, my heart just sank because these tend to be the most difficult cases. And all these questions that I know I should've asked, I'm sure I didn't. JANE LIEBSCHUTZ: 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. ELLIOTT BENNETT-GUERRERO: It's like a kid going into the candy store. It's overwhelming. I mean, there's so much there, and there's just so much that you'd like to do. LUANDA GRAZETTE: What if there's a split-second decision that I have to make, and I don't know what to do. TOM TARTER: "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. Let's shock him again at 360. NARRATOR: This is the tale of Tom Tarter, one time bouncer, weight-lifter and mechanic now transformed into a doctor. TOM TARTER: I never thought I'd 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. NARRATOR: Major funding for NOVA is provided by the Park Foundation, dedicated to education and quality television. Scientific achievement is fueled by the simple desire to make things clear. Sprint PCS is proud to support NOVA. This program is funded in part by the Northwestern Mutual Foundation. Some people already know Northwestern Mutual can help plan for your children's education. Are you there yet? Northwestern Mutual Financial Network. And by the Corporation for Public Broadcasting and by contributions to your PBS station from viewers like you. Thank you. TOM TARTER: I was born to be a mechanic. I was born to be a carpenter. I was born to be a janitor. 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've got to 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. I'm Dr. Tarter. Nice to meet you. What brings you in here tonight ma'am? We deal with people who are acutely ill. We want to make sure that everything is done for them now. How long ago was it you had this problem with your aorta? But then again the actual management of the problem long-term is up to somebody else. I've got some concerns about your spleen, which is kind of underneath your rib cage. I love that. I really do, 'cause it's very exciting. I get to go from case to case. Ah...ah. I get to help each person through a moment of crisis. Did you get knocked out? Didn't hit your head? That could be just some kind of weird spasm. Generally, they're thankful. Generally, it makes me feel good. Just curing the sick. Yes, I really like it. It's a very instant gratification. 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. But 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. I enjoy my life everyday. 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. STUDENT: After observation in the holding unit for the remainder of the day... TOM TARTER: For me, nothing was as traumatic as the first year of medical school, 'cause I was just literally a whore in church. I really was one of the few people there that was from a socio-economically-disadvantaged background. And believe it or not, this 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. I had to make that adjustment. I had never had to make it before really. I did at Harvard. We collided. DAN GOODENOUGH: Pancreatic secretions of bicarbonate, pancreatic secretions of enzymes. The whole gut is dancing with itself. TOM TARTER: 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 a circumscribed body of knowledge that I was going to learn. But I was in for a surprise. My class were guinea pigs in an experiment at Harvard. They were trying to humanize medical education by actually teaching us less. So when I went into the course, The Body, I thought I was going to—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 said, "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. 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 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. STUDENT: I mean, I'm not sure what the mechanism is. I just know empirically there's a saturation effect, just one enzyme that breaks down. Think about... TOM TARTER: 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. We get to a point where we can clinch the diagnosis, without having to explain why the guy is wearing a pink shirt or something. When I worked at a gas station or a bike shop, if somebody did shoddy work you'd tell them, "Hey that sucks. Go do it again." That's how I learned. That's how I became a mechanic. I became a mechanic by someone 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 you...if they said that the world was flat, you would say, "Well, that's a very interesting concept. Where'd you get that from?" 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 somebody could just say, "This is really important. You should know this. You should examine this." But nobody tells me that. STUDENT: Hey, 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. TOM TARTER: That's not really true though. I personally feel that I paid a great deal of money to consult and to have the expertise and expert guidance of people to point out to me what I should know. STUDENT: Then why come to Harvard then is the big question that would enter my mind. TOM TARTER: I'll tell you something. That really was a tough choice. It was. And I sometimes wonder if I made the right one. STUDENT: That's why I asked the question. If you're so unhappy with the pathway... TOM TARTER: This has been the most emotionally trying period of my life. I've been through a divorce after ten years of marriage. I was an Olympic hopeful...got knocked out of the Olympics because of an accident and an injury. I 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 had to start crying. I was talking on the phone to a friend of mine, and, bang, 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 and visit my girlfriend, Stephanie, my mother. See the old neighborhood. And that lifted my spirits up enough to sustain me until the next break. That coffee table adds a nice little touch, with yellow mats. STEPHANIE: It's a little too French provincial. RUTH TARTER: He was always a little different. I always used to think he was a little too smart for his own good. TOM TARTER: This is what we lived on—right here—Bronx pizza. STEPHANIE: Our main staple. TOM TARTER: This got us through college. It's not getting us through medical school, but it got us through college. STEPHANIE: Speak for yourself. RUTH TARTER: He was always interested in science. When he was very young, his first interest I think was in atomic energy. When 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." You know what it's like to have a three- or four-year-old explain to you about atomic energy? TOM TARTER: Here's a guy you wanted to know about. This is the guy who married my ex-wife. The schnoz. STEPHANIE: Your ex-wife? TOM TARTER: Ex-wife. STEPHANIE: Ex-wife. Okay, how about this one? TOM TARTER: You like that one? RUTH TARTER: No, that looks like Charlie Manson. TOM TARTER: It's not Charlie Manson. It's me in Yosemite. And it was raining, and I'd ridden for days in the rain. There we are. I'm trying to remember where this was. I think this was in Tennessee. STEPHANIE: One of my favorites. RUTH TARTER: I can't say it's one of mine. TOM TARTER: What don't you like about it? RUTH TARTER: You look like the Neanderthal man. STEPHANIE: I think he looks like a Renaissance prince. TOM TARTER: What's Neanderthal about it? RUTH TARTER: Oh my gosh. TOM TARTER: What's Neanderthal about it? RUTH TARTER: The whole thing. STEPHANIE: The flowered shirt? TOM TARTER: The flowered shirt? Did Neanderthal men wear flowered shirts? RUTH TARTER: No, no, no. If you just had bare skin... TOM TARTER: A Tarzan suit? RUTH TARTER: Yes, a Tarzan suit. TOM TARTER: I should wear a Tarzan suit? RUTH TARTER: Right. And a club...and a cave. TOM TARTER: The thing about the first year was, after recovering from the initial shock of all the social-cultural 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. It actually makes sense to the trained mind. That doesn't necessarily mean mine. 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 antrum of the stomach, where it's going into the duodenum. When I first came to school here, I was in a lecture, and I heard people referred to as lay people, and we were referred to as something else. There were lay people 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. When 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 innervating them. Everything. People now are much more to me than just their exterior...their...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 got 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 video tape. Six hours. And if I take a break to get a cup of coffee or go to the bathroom, I click off the watch. Part of our first year curriculum is we go to a private office. It's run by an established physician here in the community. They show us a few tricks to the physical exam. We usually try them out on each other first. DR. OGUR: Feel a little depression, just anterior to the ear. TOM TARTER: And then if that doctor can convince one of the patients to let us try it on them, we try it on them. Would you mind, seeing as how we just learned it, if we both do this on you? You have excellent breath sounds. 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 to now is if I've had a cold how I felt. But I've never had any real serious illness. Would you swallow for me? So I didn't know what questions to ask. Okay, thanks. Twenty-two-year-old Hispanic male. Presented with acute shortness of breath. 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. DR.OGUR: You didn't get pneumonia. So tell me what you got. STUDENT: Pneumonia? When did he have pneumonia? DR. OGUR: (laughing) A while ago. TOM TARTER: 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. 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 becoming a good doctor, which is the most important thing in my life. INSTRUCTOR: Just remember one thing. Do no harm. That's your greatest gift to mankind. Do no harm when you go through your normal life and as a doctor. TOM TARTER: 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. INSTRUCTOR: ...sort of had a lovulated, fluffy looking mass here. These are something that's abnormal. TOM TARTER: This is where you are supposed to really start learning the difference between sickness and health. INSTRUCTOR: This heart is just about the size of my fist. Beats since the day you're born till the day you die. Responds to every stress... TOM TARTER: With the autopsy that involved in 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 our time is spent with books, we got to see how the stuff we learn in these books becomes real. INSTRUCTOR: 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? Mr. Bronx? What organ is this? TOM TARTER: Looks like a liver to me. Could eat a lot of onions with this. When I got to the hospital, I had no idea what was going on. I didn't know what "call" was, what you do with a beeper. For that matter, I barely knew which end of a stethoscope to use. I started at 6:00 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 it becomes possible. Might be able to get two or three hours sleep, which can really make a big difference. DR. OF NEUROLOGY: I don't know what to make of this numbness around her nose. TOM TARTER: 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 can 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. 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. PREACHER: I, Thomas... TOM TARTER: I, Thomas... PREACHER: Take you, Sharon... TOM TARTER: Take you, Sharon... PREACHER: To be my wife. TOM TARTER: To be my wife. SHARON: 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 why, but I'm very attracted to that guy. And then it was several months later before we started working together. And then I didn't like him at all. TOM TARTER: 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. PREACHER: Thomas, let me caution you. When you blow out your candle, that has a very special meaning. You're saying goodbye to your old flames. SHARON: Well! TOM TARTER: Are we going to light this together or separate? Do we do this together? Together? Right. Together we do this. Sharon and I both have seen some tough times in our life, and I think we share a commonality. She's from a working class family. I'm able to relate my experiences to her, and get some kind of reality testing, some feedback that I trust. I find this very invaluable, especially at a time in my life where things are changing so fast. I love surgery, I love doing surgery. It's a tremendous amount of fun and very gratifying. Thanks. Nice to see you. How's everything going this morning. MRS. KIDDER: Pretty well. Pain is pretty good...under control...and I'm getting anxious to get it over with. TOM TARTER: I bet. MRS. KIDDER: Are you going to be an observer? TOM TARTER: I'm going to be an assistant. I'll probably just be the person standing there handing the Doctor 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 she had cancer, and that it had invaded the bone of her hip. So about five or six months ago, they replaced her hip. Today what we're going to do is, we're going to go in there and put in 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. SURGEON: Here's the patella. Lateral shaft of the femur. Our incision will be coming down this way. TOM TARTER: 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 hold the retractor or just stand there and watch, I would really find it rewarding. 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 can do either one. SURGEON: The actual the 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 it. TOM TARTER: We don't want to damage those threads going through there. SURGEON: So don't use the drill guide. TOM TARTER: Don't use the drill guide. This drill bit will take those threads with it beyond a shadow of a doubt. SURGEON: Okay, let's get the smaller drill bit, right? I need retractors times two. ELLIOTT BENNETT-GUERRERO: It'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. When you're in the OR, even if the patient is supposedly stable, you need to be watching the monitors. You know what it's like? It's like driving on an icy road for five hours. TOM TARTER: Absolutely. ELLIOTT BENNETT-GUERRERO: You did a good job, Tomboy. I'll tell you, now that we're fourth year, we're doing a lot of stuff. TOM TARTER: You're great. You got that PA line. That's really great, those are tough. ELLIOTT BENNETT-GUERRERO: Who would've dreamed last year, that you'd be closing up, and I'd be able to do the lines? We've come a long way. TOM TARTER: I'll say we have. We've had a lot of help, too. My therapist in medical school told me medical training is a marathon. It's not a race. It's a marathon. You've just got to keep going. Showing up every day. As soon as you get through one hurdle there's another one. Sparrow hospital, Lansing Michigan. Mr. Lafeb, can you hear me? How are you feeling? Bad? In terms of medicine, I came out of medical school knowing nothing. If she's over 130, I'd probably want to hydrate her. But 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. And this person is going to tell you all the things that should lead you to understand their disease. But you don't have a prayer of making heads or tails of it. They might as well tell somebody next to them in the subway or something. Don't they clamp down peripherally? You think we could turn down her Dobutrex a little bit? She's at 10. My first month or so back there at Sparrow Hospital was just terrifying for me. I won't flush that... But I learned most of it from the nurses. NURSE: I think two hours is too long. TOM TARTER: Sounds reasonable to me. This is the code beeper. If something bad happens to somebody, Dr. Moetz and I are supposed to be the first people to respond. A code gets called. Someone's heart stops. In general, it means someone requires emergent care. Someone is dying. Hi. I'm the code team intern. Who's in charge here? NURSE: 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 2 1/2 miles per hour. She developed some PVCs on the monitor. She then went into this rhythm and I called a code. TOM TARTER: This is what she's doing. Okay. That looks like a wide complex V Tach. Do you have a pulse there? Can you stop CPR for just a second? Check a pulse? I'm using this. "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. And, I mean, if you can't do it on a dummy, you can't do it on a person. Can someone pound on her chest? So today what we had 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 heart beat, so that you can see it on a monitor. And you can apply paddles to it. Then we have dummy that we can put breathing tubes in. DOCTOR: You want to know what her blood pressure is. They might be doing CPR. TOM TARTER: Do I have her pressure? That was a tough intubation. DOCTOR: It's good. Okay. TOM TARTER: Thanks folks. Appreciate it. Should we clean up our mess? DOCTOR: We never have to do that part. TOM TARTER: My mom told me to clean up my mess, but okay. Does that pillow make your neck feel any better? Mrs. Pearson, are you uncomfortable PATIENT: I'm uncomfortable, yes. TOM TARTER: What hurts? PATIENT: Everything. TOM TARTER: Everything hurts? Are you having trouble breathing? PATIENT: No. TOM TARTER: 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. These delays will probably just keep getting longer and longer. Over a gradual period of time...over a gradual period of time. And then one time the delay will last a real long time. FIRST SON: ...took good care of us, didn't you Mom? PATIENT: Well, I tried. FIRST SON: You tried. You did a pretty good job, we think. You're feeling a little rough now though, aren't you? SECOND SON: If we can make her comfortable that's all we can ask. FIRST SON: Tough old bird aren't you? PATIENT: Yeah, I'm a tough old bird, is right. TOM TARTER: Well, quite frankly the lady is trying to die. And there is a "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 shocked. She doesn't want to be intubated. To 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 are you doing? FIRST SON: You've got to speak up. TOM TARTER: So, we're going to give you a little morphine that might make... PATIENT: Beg your pardon? TOM TARTER: 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. PATIENT: I still can't hear. TOM TARTER: We're going to give you a little morphine and that might make you a little bit more comfortable. PATIENT: Yes, it might. Might relax me. SON: Want some? Okay. TOM TARTER: I was a born C-section. And nobody had any problems with helping me come into this world. 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 is being born. 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. 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—is Middle America. I mean, it certainly isn't the cities. It's really nice and it's very affordable, too. I pay half the rent here that I paid in Boston. I live in the nicest place I've ever lived in my life. We have a yard, garage, everything. Everything is easily accessible. No traffic. It's just great. It's like I've 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. I don't have anything against hunters. But owning the guns, buying the guns, having them, playing with the ammunition, and just the excitement of going out to a place where you can shoot up cans or targets—that's what I like. A 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 and 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. 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 I mean, like when I'm not in the hospital, and if I'm standing in line or something or I get a busy signal on the phone, 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've if I had more time and I wasn't doing a residency. This is Karen, the third in the series, and, well, we met about a year ago. KAREN: Almost a year and a half. TOM TARTER: Oh, a year and a half. Time flies when you're having fun. Now I'm two years out of my residency and I'm preparing for the oral boards. 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 or give you any information you need about labs or x-rays or stuff like that. DR. COLEMAN: There's no rash. What would you do next? TOM TARTER: No rash? A neurological exam. Ma'am, we're going to put a monitor on you. I'm going to give you some oxygen. I'd like to give you 4 liters of nasal cana, and I'd like to start an IV. I'd like to look at her. If you can stabilize them successfully, and prepare to hand them off to the appropriate sub-specialist, then you get to be an emergency doctor. Even though I am prepared, better people than me have fallen at this late date. DR. COLEMAN: Well, thank you doctor. Your examination is now over. TOM TARTER: Great. I didn't get labs on a bunch of stuff. Today is the day for the oral boards. Starts in about 45 minutes. Hopefully I won't be late. The one thing they'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 have gone through periods of growth. KAREN: It wasn't long before we knew that we were destined to be together. TOM TARTER: I think we're done. I think we're adults. KAREN: The intelligence...the brilliance is a real turn on. I can't get enough of it. TOM TARTER: What you see is what you get from both of us. KAREN: Sometimes I guess maybe if I were on the outside, looking in, I might think, gee, he seems to be the priority, and Karen is 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. TOM TARTER: All the trappings of civility. Wow. Well I think it will be a lot easier next year. I know what mistakes I made. They were all just stupid mistakes that were either test anxiety or maybe a little residual tiredness or something like that. And 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. This is not strictly a red-neck 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 and stuff. But I see my patients here around town. People go, "Hey doc, thanks for taking care of me." 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. 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. When I was in medical school my therapist advised me against getting tattoos, or growing my hair, or doing anything like that. He thought it would cause 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 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. BOB: There you go man. It's all done. TOM TARTER: Thanks. Appreciate it. You're the man. UNIT COORDINATOR: Dr. Gerard? I don't know where the heck he's at. But it's Sarah, and she slit her wrists. Not side to side, but up and down like she's really trying to do something. TOM TARTER: 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. PARAMEDIC: Here's the scoop. Thirtyfive-year-old female. Found alongside the roadway. Fallen from a vehicle due to a faulty door, approximately 40, 45 miles an hour. TOM TARTER: Hi. I'm Dr. Tarter. How are you? Can you hear me? The first thing I want to know is if they can speak to me. And if they can speak to me I know they have a fairly good airway. And then I assess their breathing. Are they breathing in a labored fashion or a very fast fashion? You can do this by just looking at them. She did walk you say? LITTLE GIRL: First the door went flying open. She went sliding. Hit her head on the concrete. TOM TARTER: Does your neck hurt you? And then usually look at their fingernails and stuff like that when I'm shaking their hand and can assess circulation. Are they pale there? I can do all of that in the first three seconds that I see them. It's basically just hello and a handshake. If there's anything wrong with any of those, then you've got to cut to the chase and fix it before you do anything else. 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, opening her up and potentially saving her life. Would you care to come on in and take a look at her? Thanks very much. Now ma'am, in order to get your lung to reinflate, we're going to have to put a tube in your chest. Now, what I'm going to do is 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 you want to just have done for fun, but when you need it you certainly need it. You might feel a little pressure here. It's going to hurt just a little bit. Are you ready? Here we go. With 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. 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 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. Let's take a look. Say, "Ah." Looks a little red back there, but there's no pus. That's a real good thing. She's got conjunctivitis there. Pink eye. Put drops in both eyes. Looks like you've got some swelling here. Anyone ever figured out what this swelling is from? PATIENT: I've got cirr...cirr...cirr... TOM TARTER: What have you got? PATIENT: Cirr...I've had it for... TOM TARTER: Cirrhosis? NURSE: Blood pressure is 134 over 70. TOM TARTER: When was your last drink? PATIENT: About two hours ago. TOM TARTER: How much do you drink a day? Do you drink a couple of six packs a day? PATIENT: Yeah. TOM TARTER: Hi there. I'm Dr. Tarter. How are you? Can I take a peek at your finger? FLO: This is great. I want some water. TOM TARTER: Okay. Can I just take a peek at this? I'm a doc. Let me see so I can help you. You don't have to. Do we have the other piece? Are you in a lot of pain? FLO: Yeah, I mean...yeah. PLASTIC SURGEON: What did she catch it on? TOM TARTER: Fell down and there was a wooden spool down there, one of the big cable spools, and somehow when she came up, that was off. There was a little ethanol going on there so we're not exactly clear on how it happened, but that's as good as we can figure. Ah ha. You broke one of your ribs, and that's probably what's hurting you real bad...is your rib's 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. Cause they're going to get over that minor ailment. If you come in with sprained ankle, there's very little I can do to stop that from getting better. It hurts there? That's where it hurts the most, up in there? More than over here? 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 everyday for two weeks, and two weeks from now your ankle would be better. And we could say it was because of the mask and the rattle. A lot of this stuff really is 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 weight lifter. I feel like I'm falling apart like a cheap suit. I had this knee replaced, and I had that one replaced at the same time as this one. I had two discectomies there when I blew two discs from weightlifting, and I've just torn and broken all kinds of things. I broke my neck once in a bike wreck. And I broke my leg, and have rod in my whole leg from kick-starting my bike. Tore my biceps pretty good from when I was a power lifter. I'm an old dilapidated wreck. There's very little that still works. So this lady fell out of the car, and 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. Fortunately 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. DR. ONEILL: Arch is clean. TOM TARTER: Good. Everything else okay? DR. ONEILL: She doesn't have much of an air leak. Did she ever? TOM TARTER: 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. 'Cause that's what we do. That's what we do best. This shouldn't hurt any more after that. Sorry. I think you've been through it all now. Which was worse, that or that chest tube? I like that...keep forgetting about it. Let me just sew your head up and then you'll be free of me, anyway. I just did the first stitch and you didn't even feel it. Being a patient so many times has really allowed me to connect with my patients. Just use the regular stuff that you take out, less chance of infection. When one of my patients is hurting I know first-hand how that feels. Does this hurt you? 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. And believe it or not, I'm kind of ok with that. I'm not suicidal. I don't want to die, I want to live forever. But that's not the way it is. I'm okay with it. But I'm not going to be a person who says, "I wish I'd done this." I've done a lot and I'm real happy. JANE LIEBSCHUTZ: It's what I've been working for, for years, but now I'm actually doing it. But I can honestly say I knew that I would never be a great doctor, because I didn't love it. I'm 38 and I'm still not married. I don't have children. A lot of the physicians aren't totally happy with what they're doing. NARRATOR: Next time on Survivor M.D.: Second Opinions. NOVA Producer Michael Barnes has chronicled the lives of these doctors for 14 years. How did he choose them? What challenges did he face 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 M.D. 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. Major funding for NOVA is provided by the Park Foundation, dedicated to education and quality television. This program is funded in part by the Northwestern Mutual Foundation. Some people already know Northwestern Mutual can help plan for your children's education. Are you there yet? Northwestern Mutual Financial Network. Scientific achievement is fueled by the simple desire to make things clear. Sprint PCS is proud to support NOVA. And by the Corporation for Public Broadcasting and by contributions to your PBS station from viewers like you. Thank you. PRODUCTION CREDITSSurvivor M.D.
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