"Survivor MD: Second Opinions"PBS Airdate: April 3, 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 that 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. ELLIOTT BENNETT-GUERRERO: It's like a kid going into the candy store. It's overwhelming. There's so much there. And there's just so much 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. 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. PATIENT: I can't breathe this way. NARRATOR: In this hour, the experiences of three of these doctors. JANE LIEBSCHUTZ: You're going to be fine. NARRATOR: Jane Liebschutz practices internal medicine at an inner city hospital in Boston. STAFF: I heard you had some crack. JANE LIEBSCHUTZ: Hi. I'm Dr. Liebschutz. 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. I feel that I have special abilities to give to them, and it makes me feel really good about myself. CHERYL DORSEY: He's a pretty active little guy. Hang on with me. NARRATOR: Next, pediatrician Cheryl Dorsey. 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. And 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. I mean, there are some people who have a real passion. They've wanted to be a doctor their entire lives. That's what they trained for. That's what they've hoped for. But I can honestly say I knew I would never be a great doctor because I didn't love it. NARRATOR: David Friedman is an eye doctor at Johns Hopkins Hospital in Baltimore. DAVID FRIEDMAN: I just thought...well...it's good news. There's nothing worse going on. 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 is in jail for cocaine. I'm taking care of the kid." You get so much and I'm their opthamologist. NARRATOR: 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. JANE LIEBSCHUTZ: 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 fora few minutes before I walk into the room. INSTRUCTOR: It's right in the midline. Keep on dissecting right down here. JANE LIEBSCHUTZ: 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. INSTRUCTOR: This patient had an operation already, and what you see here are the stitches. JANE LIEBSCHUTZ: This is incredible. Oh my god, look at that. Can you see, Tom? DAVID FRIEDMAN: Elliott and I are not only studying anatomy by dissecting cadavers, we're learning it by examining each other in our weekly patient-doctor class. We've been seeing a lot of things on slides, and to see it alive is really nice, especially when it's not fixed. ELLIOTT BENNETT-GUERRERO: We're used to seeing a cadaver, where it's all dead and it doesn't look red and warm and alive. DAVID FRIEDMAN: It's exciting. All this stuff we've seen in books and in everything else. And now we're seeing it where it counts. DR. FINES: You want to do head, ear, nose and mouth with an idea of looking at normal. ELLIOTT BENNETT-GUERRERO: I'm just inspecting. DAVID FRIEDMAN: So I don't feel anything. This is the way my dad always does it. He grabs my neck and...There I got a lymph node. Right there. Both of them. DR. FINES: What you see is a beautiful inferior terminate that kind of just passes right down where it should be. DAVID FRIEDMAN: Great. DR. FINES: Did it hurt? PRODUCER: Not at all. ELLIOTT BENNETT-GUERRERO: Anita you made that seem... DAVID FRIEDMAN: So you kind of start this medial and then go to lateral, essentially. ELLIOTT BENNETT-GUERRERO: How did she hold it? DAVID FRIEDMAN: 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. And I feel like I can try, and not be afraid of hurting somebody. My friend will tell me it hurts. So it's made me feel much more confident about going and seeing real patients. There I see it. ELLIOTT BENNETT-GUERRERO: You see it? DAVID FRIEDMAN: I see it all. ELLIOTT BENNETT-GUERRERO: How does it look? DAVID FRIEDMAN: Beautiful. Reflective triangle. ELLIOTT BENNETT-GUERRERO: Right? DAVID FRIEDMAN: Yep, the little thing on top...that dot that we're supposed to see on top. You've got a beautiful ear, Elliott. This is great, ELLIOTT BENNETT-GUERRERO: Oh, really? DAVID FRIEDMAN: Yes. It's great. Incredible. Oh, I'm sorry. See? You can't go side to side. You can only look at the other side. It's side to side that will kill him. ELLIOTT BENNETT-GUERRERO: There's blood coming out of my ears. JANE LIEBSCHUTZ: 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. And we've gone through part of the body already in just a few weeks, which is incredible. And I've learned so much about the physical part of how we work. It's a woman. If you have a Fallopian tube and 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. We are made for reproduction, the 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? CHERYL DORSEY: I'm surprisingly comfortable being in the anatomy lab. I thought I'd be a bit squeamish working with the cadaver. But because we've 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. JANE LIEBSCHUTZ: 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 it really made me think that I was holding what used to be a soul. And today when we left, I felt 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. INSTRUCTOR: ...classical scheme. Now, if we take a look at the more detailed scheme that you have, and I'm sure you understand very well... JANE LIEBSCHUTZ: This past block of biochemistry and physiology has been 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. Basically, I've just been a mess. I've had volcanoes of pimples erupting on my forehead and my chin. 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 for air? CHERYL DORSEY: Today's the last day of my introduction to clinical medicine and I'm going to be evaluated by Dr. Alan Gorol, who's the instructor for the course. DR. ALAN GOROL: 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. Your job will be to take a history and do the appropriate physical. CHERYL DORSEY: 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 will be a good learning experience. DR. ALAN GOROL: The second is that 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. CHERYL DORSEY: Okay. DR. ALAN GOROL: And that's it. CHERYL DORSEY: Okay. DR. ALAN GOROL: I'm pretty nervous about what I have. CHERYL DORSEY: Okay. You do seem a little nervous. Can you tell me exactly what brought you in to Mass General today? DR. ALAN GOROL: I've had this feeling here. It's not really a pain sometimes, it's more like a...I guess a tightness, or maybe a pressure. CHERYL DORSEY: Tight, okay. DR. ALAN GOROL: Yeah. And it's all over here. CHERYL DORSEY: All over? Okay. Now we'll listen to your heart in two positions, first you sitting up, and then you 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. DR. ALAN GOROL: Good. Doesn't...nothing sounds bad yet? CHERYL DORSEY: No, no, not at all. DR. ALAN GOROL: It's okay? CHERYL DORSEY: Mm-hmm. I'm just listening for the heart sounds. You have two normal heart sounds, S1 and S2, and they're there, very clear. So I'm just getting a good sense of what's going on. Better to always check. DR. ALAN GOROL: Okay. CHERYL DORSEY: It's fairly stressful actually because you have a...of course, it's a simulated event. But, I mean, 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, as 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 was actually kind of frightening, because I could kind of mentally hear him checking lists, 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. DR. ALAN GOROL: You showed, again, concern for my comfort. I was very comfortable during the entire exam. You did not move me around excessively. CHERYL DORSEY: Okay. DR. ALAN GOROL: 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. CHERYL DORSEY: Oh. Well, thank you very much. DR. ALAN GOROL: So I'm really...I'm really pleased with what you've done. CHERYL DORSEY: Oh. I was so nervous. INSTRUCTOR: I think what we'll do today is—before you try drawing blood on one another—is, we'll just repeat the demonstration. JANE LIEBSCHUTZ: I've never drawn blood before and I'm very nervous. I think drawing blood is the most difficult thing I've had to do in my medical school career. JAY BONNAR: More than the cadaver? JANE LIEBSCHUTZ: No. Yes. No, not more difficult than the cadaver. STUDENT: Give Freddie a break. Yeah... STUDENT: I'll do you or you do me. STUDENT: I don't know how to do this. Am I not going to be able to do it again here? INSTRUCTOR: Can you still feel the vein? STUDENT: Oh. You twist this thing off. Oh man, this needle could kill a horse. JANE LIEBSCHUTZ: David will you shut up. INSTRUCTOR: Try putting your hand behind the syringe, instead of at the top of it. Start at this end. It really doesn't hurt that much. JANE LIEBSCHUTZ: I'm shaking. STUDENT: Okay. That's strike two, man. STUDENT: You got it. That's beautiful. Thanks. DAVID FRIEDMAN: In the third year, we leave the classrooms for the Boston teaching hospitals 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. I mean, 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 a patient the whole time he's here. And it's really a nice feeling. Let me see how this is doing. Mr. Patterson needed to receive chemical therapy, 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 in 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? I'll come back and see you in a little bit, okay? I'll try and get you a pillow, too. So in order to get access to his blood and to give him his chemotherapy for his cancer, we have to put a line in him. And there are big veins that you can get that aren't in this...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. Any time 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. DOCTOR: You still feel a pulse? DAVID FRIEDMAN: Just lateral to my what? DOCTOR: Middle finger. DAVID FRIEDMAN: When I was going for the vein, I was really afraid I wouldn't get it, and I was just going to sit there and keep stabbing him trying. 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. DOCTOR: Going nice and smooth. DAVID FRIEDMAN: If you can stay still for a few more seconds? We're getting there. DOCTOR: Uh, uh, pull it back. 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. DAVID FRIEDMAN: I don't want to pull it out. DOCTOR: No, you won't pull it out. Promise. How'd it go? DAVID FRIEDMAN: It was great. DOCTOR: What was great about it? DAVID FRIEDMAN: It worked. I was pretty nervous. I didn't get it the first time putting the needle in, and the second time, I got it. That happens. I was really nervous I wasn't going to get it in...poke around forever. I'm sorry. Yeah, he hasn't had one. He needs one post line. PETER: What's exciting about doing things like this? You're smiling. DAVID FRIEDMAN: I don't know what it is. Some people like to do procedures, some people don't. I really like them. I'm not sure why. JANE LIEBSCHUTZ: And 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, you know, interesting disease, interesting this, interesting that. But all of a sudden you realize that's a person on the other end of this discussion. And sometimes I'd feel hypocritical about being excited about a case. I'd feel guilty, almost, because it's somebody, you know? Somebody's illness that I'm excited about. How's it been to be in a relationship when half of the relationship is...has a terminal illness? Is that hard to talk about? PATIENT: 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 until now that we had to deal with it on a day-to-day basis. And now we're having to deal with it a lot more, with this hospital stay. JANE LIEBSCHUTZ: Well that'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. PATIENT: But that's kind of true for all of us. JANE LIEBSCHUTZ: It is true for all of us. PATIENT: But I know I have some different odds. JANE LIEBSCHUTZ: And you also know that it's going to come sooner rather than later. Well... PATIENT: I'm not so sure of that, Jane. You know? PATIENT'S PARTNER: There is a misconception about...just because one is diagnosed with AIDS. Granted, many people do die within a certain time frame, but many, many people have lived a lot longer than that time frame. PATIENT: And I'd like to see it continue for a long time. But if it doesn't, the time I've had has been really, really something. JANE LIEBSCHUTZ: It can be very good with patients, to have the ability to come right out and say incredibly difficult things. PATIENT: You're only a third year medical student, Jane. That's okay. You've got time. JANE LIEBSCHUTZ: I think a lot of patients appreciate somebody who can be direct. 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 when I have time, if I open a can...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 have difficulty with and send them out. I'm learning the difference between the two. MR. COLLINS: ...and I was out walking my wee dog. JANE LIEBSCHUTZ: Your wee dog? MR. COLLINS: The pain came on me, and it gradually got worse and worse and worse. And they put me in the intensive care. JANE LIEBSCHUTZ: How are you feeling right now? MR. COLLINS: I was worried. I'm worried. JANE LIEBSCHUTZ: You're worried? MR. COLLINS: Yeah. But I know I'm in capable hands. JANE LIEBSCHUTZ: What are you worried about? MR. COLLINS: I mean, I've never had a knife put to me before. JANE LIEBSCHUTZ: You never had surgery before. 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... MR. COLLINS: Yeah? As long as I have a good ear and play soccer again. JANE LIEBSCHUTZ: Okay. So that's what we hope. MR. COLLINS: Yeah, I was playing soccer. JANE LIEBSCHUTZ: Until when? MR. COLLINS: Last year. JANE LIEBSCHUTZ: Why did you stop? The chest pain? MR. COLLINS: Yeah. JANE LIEBSCHUTZ: Well, it's a good thing you went to the doctor when you did. MR. COLLINS: Yeah? Well, when I walk out of here, I'll put on my kilt for you. JANE LIEBSCHUTZ: You will? MR. COLLINS: Yes. JANE LIEBSCHUTZ: Okay. I think being in the operating room is one of the most intense experiences one can ever have. And one...and scrubbing in and actually having your hand on a case and actually helping when you feel needed is probably among the top 10 experiences to have in the world. 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. Where would you see the RV from here? DR. JOHNSON: This is the RV. That's the anterior RV. JANE LIEBSCHUTZ: This is the anterior RV? DR. JOHNSON: Yup. JANE LIEBSCHUTZ: Wow. That is really cool. DR. JOHNSON: The chest is a great place to see anatomy. JANE LIEBSCHUTZ: 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. DR. JOHNSON: Let's wait and see what happens here. JANE LIEBSCHUTZ: 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. There's no...the heart's failed. It's not...it's not working. It's not...okay. So that's what's happening right now, as we speak. JANE LIEBSCHUTZ: You're just keeping him alive by pumping his heart? DR. JOHNSON: Right. JANE LIEBSCHUTZ: And you're trying to think of something else you might be able to do? Oh god, this is terrible. SURGEON: The heart wasn't doing anything. JANE LIEBSCHUTZ: I feel like I'm bad luck or something. DR. JOHNSON: Oh, come on. JANE LIEBSCHUTZ: I can't believe it. I told this guy he was going to do fine. SURGEON: ...conduit. We did okay with not having any conduit. DR. JOHNSON: I don't know what more we can do. JANE LIEBSCHUTZ: That's it? SURGEON: Yeah. That's it. JANE LIEBSCHUTZ: Oh my God. SURGEON: 11:37 JANE LIEBSCHUTZ: I'm sorry. DR. JOHNSON: I'm going to go up and talk to his family. JANE LIEBSCHUTZ: I never thought that he was... DR. JOHNSON: I know, believe me. Believe me. JANE LIEBSCHUTZ: I'm sorry. DR. JOHNSON: 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. JANE LIEBSCHUTZ: Well, I wasn't going to go up to them. It's funny, I've never really had a patient that I've gotten to know who's died. And here it just happened. DR. JOHNSON: I know, sure. Sure. JANE LIEBSCHUTZ: It's like a bad dream or something. Like let this be over already. He was going to wear his kilt. I don't know. I'm sorry. I shouldn't be... DR. JOHNSON: No. No. No. 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 kilts again. You know, it would have even been worse. JANE LIEBSCHUTZ: I know. And I also know he wouldn't have lived with his arteries like that anyway. DR. JOHNSON: That...oh no, he was...he couldn't do anything. JANE LIEBSCHUTZ: I know that. I know that. But it's so hard to watch. DR. JOHNSON: But see, that's where you...that's the physician part. I know. You have...but we have to be...I understand that. JANE LIEBSCHUTZ: Thank you. Are you going to go up and talk to them now? DR. JOHNSON: Yeah. JANE LIEBSCHUTZ: Do you want me to come? DR. JOHNSON: Yeah. You're welcome to. JANE LIEBSCHUTZ: I remember one of the first patients who died. I cried right there. And now I don't really cry right there, but it definitely affects me. And when I think about it right now it's very obviously upsetting. And I hope that it will get to the point where it doesn't...it doesn't even now get in my way of my being able to be the medical student. But I don't imagine that I'll ever be able to say, "Oh yeah. Well, I had a patient with pneumonia, had two patients who died, and I played golf. 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. GRADUATION ANNOUNCER: Jane M. Liebschutz. JANE LIEBSCHUTZ'S FATHER: Now we have a doctor in the family. JANE LIEBSCHUTZ: Isn't that fantastic? GRADUATION ANNOUNCER: Cheryl Lynn Dorsey CHERYL DORSEY: This is what my parents paid for. Here it is. GRADUATION ANNOUNCER: David Stephen Friedman. JANE LIEBSCHUTZ: Doctor of medicine. Ed gradem medicini Doctorus. DAVID FRIEDMAN'S GRANDMOTHER: David's my youngest grandson. I'm very proud of him. I'm only sorry that my husband isn't here to join me in this wonderful thing. JANE LIEBSCHUTZ'S FRIEND: I am so happy. I can't believe it. DOCTOR: Good morning, doctors. Doesn't that sound good? Welcome to the Deaconess. DAVID FRIEDMAN: 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 opthamology. Today's the first day. This is...everybody's congregating before we all go off to our respective jobs. DOCTOR: I didn't bring a stethoscope. I didn't bring anything. DAVID FRIEDMAN: My girlfriend gave me a button—"Dr. Dave"—and that's what I feel like. Dr. Dave. Nothing more really. I'm David Friedman. NURSE: Oh, you're Dr. Friedman. DAVID FRIEDMAN: There are certain medications that are good for you to be on now. So the first one that we have you on...onIsordil and Nitrate. We'll try to keep you, medically, feeling good. It's the first time where I feel like I have a responsibility, and if I don't do something well, I 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. So that...but that's part of what you have to do to treat somebody. But that's a hard thing to live with. DOCTOR: We're the two residents in the coronary care unit. PATIENT: Where I'm probably going to spend the night? DAVID FRIEDMAN: Where you're definitely going to spend the night. He has an EKG. It looks like he's acutely having a heart attack. DOCTOR: We're just going to ask you a few questions. DAVID FRIEDMAN: This is by far the most acute thing I've had to deal with. In your urine...have you had any blood? DOCTOR: Have you ever had a problem with your heart before? Have you ever been told you had a heart attack before? It looks like you may have had a heart attack. What we're going to do...we're going to treat you for a heart attack. PATIENT: As if I had one. DOCTOR: Your EKG looks like you're having a heart attack. PATIENT: Having or had? DAVID FRIEDMAN: You might still be in the process of...it's an evolution, and when it ends is a debatable type thing. I don't know enough about this. I guess I want to do something. I want to do something. We pushed the Lopressor. DOCTOR: We asked Chris to push the Lopressor. DAVID FRIEDMAN: So I'll start writing up this guy. DOCTOR: Okay, Lopressor. JANE LIEBSCHUTZ: I've decided to work in internal medicine. I'm doing my internship and residency at Boston City Hospital. It's a public hospital with lots of poor and foreign patients. Well the first couple of days I felt totally overwhelmed. I have left at midnight every night, just getting my work done. Did you get it to work, finally? The central line? But today's, like, my fourth day. And it just...all of a sudden things seem to be falling into place a little bit more. PATIENT: There's a sore spot right there. JANE LIEBSCHUTZ: They really need me and I have a sense like I can make a difference. DOCTOR: ...now in the history of non-insulin-dependent diabetes. Having fallen and vomited... JANE LIEBSCHUTZ: Mr. Days 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 to the intensive care unit. And now it appears that he's had a very large stroke affecting the brain stem. FAMILY MEMBER: How are you doing, Tom? Tom, this is Margie. JANE LIEBSCHUTZ: What's evident up 'til now is that he had a major stroke, a big stroke. And it occurred in a part of his brain...what we call a brain stem. And a lot of times when people have strokes, you think of them becoming paralyzed or something on one side, but the brain stem, unfortunately, is a 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 that are...it's very undignified. And I think that if it's not a real quality of life, if a patient is unable to communicate and just sits in bed all day, that...that, you know, I don't...I don't personally feel that anybody should have heroic measures to keep them alive for that quality of life. FAMILY MEMBER: I mean, is there a possibility he can come out of this and be all right, or is...? JANE LIEBSCHUTZ: I think it's a very low possibility. FAMILY MEMBER: Very low. JANE LIEBSCHUTZ: 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'm being very blunt. I mean, I'm not. I'm just not telling you something... FAMILY MEMBER: No, I'm very glad. JANE LIEBSCHUTZ: Because if you've got false hopes, you would be terribly disappointed. FAMILY MEMBER: No. I want you...I want you to tell us the truth. FAMILY MEMBER: We want to know exactly what's going on, you know? We want to know the truth. FAMILY MEMBER: Yes. FAMILY MEMBER: Be as blunt as you can. JANE LIEBSCHUTZ: They were paging the wrong person for my admissions. It's like every day has been sort of the sign wave where it's gone, sort of way up and down. where I have moments, when like, "Gosh, I'm really a doctor. They're really asking me for...I can sign a prescription." People call me "Doctor." That is exciting. And then there are moments when I still feel like a medical student. I have a lot to learn for sure, but it's okay. I'll learn it. CHERYL DORSEY: 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 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 have, 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 to work on this project. PARAMEDIC: This gentleman, unfortunately,is a victim of a beating in South Boston that came in... JANE LIEBSCHUTZ: 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. Lasser? Mr. Lasser? PATIENT: Yeah. JANE LIEBSCHUTZ: Hi. I'm Dr. Liebschutz. How are you feeling? PATIENT: I'm doing all right if you untie me. JANE LIEBSCHUTZ: Where are you, sir? What brought you in here? I think 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. 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. Or I'll dream that I'll have some horrible disease. When I was in medical school I used to think I had all of these diseases, like consciously, when I was awake, I'd be worried that I had this horrible thing or 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... PATIENT: I want to get up. JANE LIEBSCHUTZ: This is a young lady who was found outside a...what they call a "shooting gallery," which is where people shoot intravenous drugs. PATIENT: I can't breath this way. JANE LIEBSCHUTZ: You'll be okay. PATIENT: Get out of my way.I cannot breath this way. Please believe me. JANE LIEBSCHUTZ: How can I help you? PATIENT: Put my nose to the air, baby. DOCTOR: I heard you had some crack. Did you have some crack? PATIENT: Yes, I did. DOCTOR: Okay. Did you have anything else? JANE LIEBSCHUTZ: I feel so burned 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. I'm going to help you. PATIENT: I have to go to the bathroom. JANE LIEBSCHUTZ: You have to go number two? If you have to go, just go. If you have to go, just let it go. We'll help clean you up. If you have to go... PRODUCER: So has this been a quiet night? JANE LIEBSCHUTZ: Pretty quiet. A little excitement. But I'm so tired. You're doing great. Two and a half hours 'til morning. 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 a lot more than they might otherwise. I think Wen Jan cares for you a great deal. I think he does. MR. NEI: Nothing better than dying because I lost my best friend, my wife. Nobody cares for me. JANE LIEBSCHUTZ: Nobody cares for you? MR. NEI: No. JANE LIEBSCHUTZ: Mr. Nei 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 I'm...he fits into the category of people who are at risk for suicide. Okay, I just want to ask you one question. Are you...you talked about suicide. Are you thinking of doing that? MR. NEI: No. I can't do it. JANE LIEBSCHUTZ: Why not? MR. NEI: I have no pistol. JANE LIEBSCHUTZ: If you had a pistol, would you do it? MR. NEI: Yes, I'd do. JANE LIEBSCHUTZ: 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 in to 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. Chinese: Tie Fei (iron lung) iron lung, you could try it. You talked to the other doctor about it, right? MR. NEI: Yeah. JANE LIEBSCHUTZ: Chinese, Ni gen jiang ta ma? Shi ma? Gen wenzhen hao ma? (Have you talked with him? How was it? Was it ok with Wenzhen?) MR. NEI: No use. Suppose I am getting well? JANE LIEBSCHUTZ: Yeah? MR. NEI: What use? JANE LIEBSCHUTZ: Well, you know what? We're going to work on that. You have a lot of use. MR. NEI: Nobody needs me. JANE LIEBSCHUTZ: It makes me happy to come see you. MR. NEI: Don't waste your time. JANE LIEBSCHUTZ: I'm not wasting my time. It's a challenge, trying to find a way in to him...make a relationship with him. To help him. You do much better than me, Mr. Nei. MR. NEI: High position you can do, like this here. JANE LIEBSCHUTZ: He's an incredible man. I mean, 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's something about him that took the 60 years difference between us and the gender difference and the cultural difference and we were really able to become quite intimate in a way that I haven't experienced with almost any other patients. Mr. Nei 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. Nei Xu Ping was not just any patient or any man. Mr. Nei's name actually means "autumn peace," and I hope that he's achieved it. CHERYL DORSEY: 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 had always wanted to lay that issue to rest. So about 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. MRS. DORSEY: 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, bouncing around. That was so funny. But she wanted to try that. Of course, she always loved the swimming, so she had to do the swimming. She enjoyed the horseback riding. 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. CHERYL DORSEY: 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 Danya 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. Ken, give the update, 'cause I don't know...especially you, Rich, because you were busy with ATTC stuff. The products that they develop...from educational brochures to training manuals...web sites 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 agreed yesterday. 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. 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 an ebb and flow of life, and at this particular point I don't need to work those kind of hours. JANE LIEBSCHUTZ: 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, under-served patients. It's really, really hard to stop drinking if you've been drinking for 40 years. It's really hard to do it sort of on your own like that. PATIENT: At this point, my old man told me he would never let me drink again. JANE LIEBSCHUTZ: But I'm thinking you probably need other support as well. You get so frustrated with what people are doing to themselves that you say, "God damn it, would 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, 'cause you know this, that the drinking... I can't do it by passing judgment or just telling them to stop using. The power of nicotine, the power of heroin, the power of alcohol is way too strong. But the power of a 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. 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. So I'm trying to figure out how can I make my work so that it could sustain those kinds of relationships and connections. And 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, what would come in its place? That, kind of, over-achieving has been there for so long, that it's hard to know what it would be like not to be in that mode. So that's an interesting kind of struggle. DAVID FRIEDMAN: Now I'm working in the opthamology department at Johns Hopkins Hospital in Baltimore. Whenever I walk to my office I get to see all the incredibly famous people in opthamology, 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 were chairpeople all over the world. So it's really 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, but I've been lucky. I divide my time between the clinic, research, teaching and surgery. Mr. Weber's coming in this morning because his pressure has been much too high in that eye and 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 needle. 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. The optic nerve gets damaged from glaucoma, and 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. I make sure not to pick up a lot of heavy things. No coffee. How are you doing Mr. Weber? MR. WEBER: Do me a favor. Call me Hank. Mr. Weber was my father. DAVID FRIEDMAN: The eye is incredible. It's amazing that we see up close, far away for as long as we see. We see until old age, in general, with good vision. 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. 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 will leak and stay underneath this outer tissue that I'm dissecting out and making sure it doesn't have any 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. I'd barely touch it. And the guy with me would be like, "Cut deeper." And I'd be like scratching down. Because you're cutting into the eyeball. 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. I need another needle. I just reattached his own natural outside membrane. Opthamology is one of the fields where you really feel that you 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 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. It went perfectly. I'm optimistic. No, he's done, he can get up. He shouldn't do any heavy lifting. Hey, want to come on out. Where's that go? The gray ones. Oh it goes in there, you're right. What's that? My wife is a librarian, but she's only working part time right now so she can spend more time with our kids. I used to 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. BOO: Because when he was waiting to work later in the evening then that was the time that he and I would have had. DAVID FRIEDMAN: So now I sleep less. BOO: Now he goes to work at 6:00 in the morning, and it doesn't affect my schedule. DAVID FRIEDMAN: I feel like I've really stepped into a great situation. I'm particularly lucky. It's been 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 for 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. I feel like I've been given a privilege to take care of people. Any pain? Any discomfort? 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. MR. WEBER: I can open it, but I see an orange color. DAVID FRIEDMAN: What other job would let me do this stuff? And that to me, that's the big benefit. I put in all the time, and that's the payoff. JAY BONNAR: I guess the first thing I want to do is to take your vital signs. CHERYL DORSEY: It's kind of a rush. This is what I came to med school for. ELLIOTT BENNETT-GUERRERO: The worst part's over. JAY BONNAR: You change hospitals every month. You don't know where you are, and you don't know the procedures. ELLIOTT BENNETT-GUERRERO: Does that hurt at all? JAY BONNAR: I no longer want to be broadcast to the nation. NARRATOR: Next time on Survivor M.D.: Hearts and Minds. 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 Web site 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. 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. This is PBS. What is science? Science is really just an explanation of why things are the way they are. In other words, science is a story. And for more than 25 years one program has been telling the best science stories on television. NOVA is living, breathing proof that turning your brain on at the end of the day is actually more rejuvenating than turning it off. NOVA. Mind-altering TV. PRODUCTION CREDITSSurvivor M.D. Second Opinions
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