"Survivor MD: Hearts & Minds"PBS Airdate: April 10, 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: And 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. There's so much there. And there's just so much you'd like 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. LUANDA GRAZETTE: What if there's a split-second decision that I have to make, and I don't know what to do? NARRATOR: In this hour, the experiences of three of these doctors. First, Luanda Grazette, cardiologist at Mass General Hospital in Boston. Her specialty: people who need heart transplants. LUANDA GRAZETTE: She's actually got pretty reasonable coaptation of her mitral valve. I thought she was going to have a very wide anulus. I'm really just getting out of training. My compatriots who went to law school or business school or whatever else, were full-fledged citizens ten years ago. NARRATOR: Elliott Bennett-Guerrero is an anesthesiologist at New York's Columbia Presbyterian Hospital. At only 35, he's become Director of Cardiac Anesthesiology. ELLIOTT BENNETT-GUERRERO: I work with the surgeons day in and day out. LADY: How many of these surgeries have you done? ELLIOTT BENNETT-GUERRERO: Excuse me? LADY: How many have you done? ELLIOTT BENNETT-GUERRERO: Too many too count. LADY: She's a nurse. ELLIOTT BENNETT-GUERRERO: Here's my card. My goal of wanting to fix people, actually see the results right there in front of me within hours or within days is something I've been able to achieve going into cardiac surgery and anesthesia. NARRATOR: Jay Bonnar is a psychiatrist. He's currently in training to become a psychoanalyst and is in analysis himself. This process has made him very reluctant to be filmed at this point in his life. JAY BONNAR: Actually, it's embarrassing to go back and watch the old tape, as I recently did. I'm just struck by how full of myself I seemed. I guess that goes along with youth, but it's embarrassing. One of the changes that's happening as a result of my psychoanalysis is that I no longer want to be broadcast to the nation. I was a young and vain boy 13 years ago. I'm still vain, but less young. 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. JAY BONNAR: Actually the jacket feels kind of weird, I was commenting. It feels like such a costume right now. I'm trying to get used to it. Just before I met my first patient I was all anxious. I don't know a heck of a lot now, clinically, about what to do when. DOCTOR ONE: I want to introduce you. This is Jay Bonnar. PATIENT: I don't remember good, dear, but hi. DOCTOR ONE: Well, Jay's the one you're mostly going to be talking to. JAY BONNAR: First I'd just like to talk about your cough, and what's brought you into the hospital. And then after we talk for awhile I'd like to do an exam of the back of your chest, to listen to... The patient has been treating you more or less like a doctor, but you're going to fumble. You're going to be a little hesitant. And you're sort of afraid that the patient will look at you and say, "I don't want this person near me. Get this away from me." If you could take off your top and put on the johnny that you have, open in the back. You can leave on your skirt and the rest. And we'll all move over to this half of the room. PATIENT: You mean I got to get nude? DOCTOR ONE: No, we're going to close the curtains. PATIENT: See this body of mine? STUDENT: You did a great job, Jay. JAY BONNAR: I guess the first thing I want to do is take your vital signs, before I forget that. I'm still a little new at this so it may take me a moment to find...if you'll bear with me. Touching patients is not easy, particularly at first. I remember that that was one of the hardest things I did with the first patient. You are worried that they're going to figure out how ignorant you are. The other thing I wanted to know is if you have any questions. If there's anything you'd like to know from me? PATIENT: No, darling. I know just one day you're going to be a great doctor and I'll still be around to see you. JAY BONNAR: I really enjoy seeing patients. I wish I could see them every week. It reminds me of what I'm doing in medical school. INSTRUCTOR ONE: So the knee goes extension, flexion, extension. INSTRUCTOR TWO: This is called the peri-umbilical area. JAY BONNAR: Quite frankly, it's hard. It really is hard to be in medical school. It goes at such a pace. It's so all encompassing of your life. Emotionally, it's a lot of work to keep up that kind of high energy level. Although I enjoy the thrill of pure science, it's not my principal reason for being there. LUANDA GRAZETTE: Facial nerve is a cranial nerve. Seven. It's by itself. When I first got in, I kept wondering if it was a mistake. Somebody's going to pull me aside and go, "Didn't you get that next letter that said we're sorry, but the first one was a mistake?" It was kind of strange. Because even though when I interviewed here and I toured the place I really felt at home, I still, I've never pictured myself in the environment. And I still, when I walk across the quad sometimes, it just kind of ...it hits me. "God, I'm at Harvard." ELLIOTT BENNETT-GUERRERO: This afternoon, in the course where we learn how to examine patients, I'm going to do something which I'm a little bit anxious about. INSTRUCTOR: You have to think about this a little differently if you're woman and if you're a man, in terms of how you touch. You don't want to touch lightly and it feels maybe caressing, but, kind of, firmly. Just say, "If you relax these muscles and can let your legs go a little bit it may be more comfortable for you during the exam." ELLIOTT BENNETT-GUERRERO: I don't feel I can go in any deeper. INSTRUCTOR: No, you can't. This model has a very short vagina. So you're absolutely right. ELLIOTT BENNETT-GUERRERO: Do you take a peek until you're going in? INSTRUCTOR: Imagine this. Make a circle for me. That's the vagina. Elliott, let me show you. You go in like this and then you turn, and then you slowly open it as you're going. Do you see that? ELLIOTT BENNETT-GUERRERO: So you can kind of look as you're going in? INSTRUCTOR: Absolutely. With a light over your shoulder. ELLIOTT BENNETT-GUERRERO: You're not going in blind, then opening it up? INSTRUCTOR: Of course not. You're going in very gradually. You see that? ELLIOTT BENNETT-GUERRERO: I feel uncomfortable doing this and it's just a plastic model. If we had to do this to begin with on a real patient, I don't know if I'd be able to function. INSTRUCTOR: Unscrew the screw. Other way. ELLIOTT BENNETT-GUERRERO: Trying. INSTRUCTOR: Are you trying to release it? Goodness. Secret—never do the screw that hard. Then you're really in a bind. My goodness. It would never get out. EXAMINER: You have 30 minutes in which to finish this test book. Please recall that only... ELLIOTT BENNETT-GUERRERO: The national board is a three-part exam, which we're required to pass in order to become licensed physicians in this country. It's a two-day exam with hundreds of multiple choice questions covering the material we've learned in the first two years of medical school. LUANDA GRAZETTE: I guess it's sort of a contradiction that we spent the first two years sort of learning concepts and how to study and thinking in very broad terms, and then you have to take this test that's really a lot like Trivial Pursuit.® DAVID FRIEDMAN: I didn't know the difference between those things. I forgot it. ELLIOTT BENNETT-GUERRERO: I know. There's niacin and actin, and I don't really know how they interact. JAY BONNAR: It's wonderful. I'm thrilled to be finished, but quite tired. I can look forward now with expectation to my wedding, which is only in a week. You're all invited. KATHERINE: Jay has been quite a bit different than he usually is. He's very tense. Wouldn't you say? JAY BONNAR: It's already been an issue that I'm in medical school because it creates a certain amount of stress. I think we both hear awful things about how little time residents have and things like that. KATHERINE: It's almost fatalistic. In fact people say, "Oh, you're going to marry a doctor." They sort of look at me knowingly. It's hard to anticipate exactly what this is going to mean. I think we're going to have to be in a position where we can work on these things because otherwise I don't think it's going to work. I should be more positive. JAY BONNAR: No, you should be more specific. MINISTER: I now joyfully pronounce them husband and wife. Go in peace. JAY BONNAR: Now that I'm married I think the next major event in my life is going be going into the hospitals. After two years of going to classes, I'm getting really tired of it and I'm ready to go in and start working with patients first-hand. Miss Brown, hi.How are you today? Miss Brown is a patient who was in the hospital, and unfortunately, while there, fell and broke her hand. I was asked to see her and do a neurologic examination to see whether she might be unsteady. MISS BROWN: And I was so happy to get that bible you give me, and I've been praying for you. And I know you've been praying for me 'cause you said you would. And I believe you are a Christian and I know I am. And I pray that God will bless you all. I love you all, and I always say, "Lord, help us to help each other Lord. Each other's cross to bear. Let each a friendly aid afford and feel one another's care." God bless you. JAY BONNAR: I went to see Miss Brown to look into why she fell and talk about some of her recent memory problems. Okay,now touch your nose and my finger back again. Now your nose and my finger. I think this interview was difficult because Miss Brown was not comfortable letting us see those areas where she knew things weren't right. But I, on the other hand, needed to know precisely those things, because I knew that I'd soon be presenting them to my attending, Dr. Poser. Deviation to the tongue to the right. I wasn't sure that that was a significant finding or whether that just happened to be accidental. DR. POSER: Now wait a second. If she has a real deviation of the tongue, what does that mean? JAY BONNAR: It means there's something wrong with her cranial nerve. DR. POSER: On what side? JAY BONNAR: On the right side. The twelfth cranial nerve. DR. POSER: I know, but the tongue deviates to the right, let's say. Where's the lesion? On which side? JAY BONNAR: Left side of the brain. DR. POSER: Left side of who? JAY BONNAR: Left side of the brain. DR. POSER: Of the brain. JAY BONNAR: If it's cortical. But then it could also be the right. DR. POSER: Did you ever see a deviation of the tongue from a cortical lesion? JAY BONNAR: I've never seen a deviation of the tongue from a cortical lesion. DR. POSER: Why's that? JAY BONNAR: Because I've only been in neurology about a week. DR. POSER: Beth, did you ever see a deviation of the tongue from a cortical lesion? BETH: No. DR. POSER: Why not? BETH: The brain stem, many of the nuclei, including the twelfth cranial nerve, are bilaterally innervated. Therefore, you'd have to have bilateral cortical strokes to produce a deviation, in which case it wouldn't go to either side. JAY BONNAR: It feels terrible when you have doctors you're looking up to for guidance and teaching making you feel humiliated. A lot of the experience of being in medicine is feeling humiliated. That's compounded by the fact that you change hospitals every month or nearly every month. You don't know where you are, you don't know any of the people, you don't know the procedures. So you feel ungrounded as it is. And to have people accosting you with "what's this minutiae or what's that minutiae?" You feel bad. I believe it occurs in women more often. DR. POSER: In what kind of women does it occur? JAY BONNAR: Older women? DR. POSER: What kind of women, Beth? BETH: Women who've had a lot of kids. JAY BONNAR: You lose touch with your own strength in a way if you keep staying in that environment and keep questioning yourself for long enough. You begin to think, "I'm the one that's ignorant here. I'm the one that's faulty. Everyone else around me is wise and efficient and powerful and does a great job, and here I am, just a lowly little speck. If only I can be like them." ELLIOTT BENNETT-GUERRERO: This week I work at nights, and then, at least I try to, sleep during the days. I start in the hospital around seven or eight at night, and I go 'til about 10 the next morning. The hardest thing about it is your whole sleeping schedule gets all screwed up. Well, right now we're going to be giving a Cesarean section. It should take about...less than an hour. And what's really nice is that as you get a little bit more experience and as the attendings and the residents get to know you, you get to do more and more at each delivery. I'm thinking a lot about becoming an obstetrician-gynecologist. Because what I think is nice about it is you get to operate and do procedures. It's a happy specialty. With most of the women who come in here, you're almost assured that within 24 hours they'll have a baby. TEAM: It's a boy. Oh my goodness. Eight-and-a-half-pound boy. He's cute. ELLIOTT BENNETT-GUERRERO: It's really nice when...at the end of the delivery and she looks...the baby's already out...it's nice to see how happy she is. I've had a couple of women kiss me after their baby is delivered. It makes your day when that happens. One couple gave me a box of chocolates. It really made me feel special. It made me feel very happy that I'd shared this important moment with them. I was very disappointed when I saw my OB/GYN course evaluation grade. Not only did I think I worked hard during the rotation, I really enjoyed it. And for several months I was actually considering OB/GYN as a career choice. And I think for that reason it particularly hurt me when I didn't do as well as I thought I was going to do. I felt that a lot of the people weren't honest with me. And if they felt I should've been working harder or they didn't like me, nobody ever told me. And for that reason I was particularly disappointed. LUANDA GRAZETTE: Right now I'm doing Cardiology, at New England Deaconess Hospital. I'm really enjoying it a lot. Mr. Burke? Hi. My name is Luanda Grazette. I'm one of the students with Cardiology. We've been asked to come in and take a look at you because we understand that you have a history of some heart disease in the past. Cardiology is a study of the heart and the blood vessels associated with it, which means it's basically hydraulics. You've got a pump, which is the heart, and then you've got all these pipes of varying sizes attached to it. You want to optimize flow through those pipes so that all the organs get enough blood. Would you say you have chest pain once a month or once a year? MR. BURKE: I've had them for the last three weeks. I've had more than I've had in the last two years, see, but not severe. LUANDA GRAZETTE: One of the things that I really like about cardiology is that most of the time you are dealing with an older patient population. I like working with older people. I like to chat with them. I enjoy them a lot. I think they enjoy me. I was raised by my grandmother so I guess I've always had interactions with older folk, and I see that being part of my career. When did you lose your wife? MR. BURKE: A year ago. LUANDA GRAZETTE: Do you have any family here? Any children? MR. BURKE: I have some children, yeah. LUANDA GRAZETTE: Well I'm sure they have a stake in whether or not you're... MR. BURKE: My baby's 38 years old. I don't worry about it. I've been around for a while. I'm useless for anything. LUANDA GRAZETTE: I'm sure you're not useless. I'm sure that if you ask any of them they would tell you that they need you around for counseling and advice and all the things that you probably don't think are important, that are probably quite important to them. MR. BURKE: ...the only way I can get up at the moment. LUANDA GRAZETTE: That's good. That's good. You told me a couple of times that you were afraid that you were going to have one of those attacks. How do you know when they're coming on? How can you tell? Do you just know from experience what brings it on? MR. BURKE: It's starting to work. This is what happens. LUANDA GRAZETTE: You hand starts to shake and then you know? MR. BURKE: I can't explain it to anybody really, 'cause I don't understand enough. LUANDA GRAZETTE: You're doing a great job of explaining. Okay, sir. When we were out in the hall walking, it seems as if he was getting a little dizzy. And I was happy that there were a lot of people around to look out for things like that. But that's actually not that unusual, people getting up after being in bed for a long time will have the same sort of thing happen the first time they get out of bed. ELLIOTT BENNETT-GUERRERO: Okay, I'm just going to put this little sticky thing on your finger. It doesn't hurt. This is just to measure the oxygen in your blood. I promise you it won't hurt you. MRS. KIDDER: I trust you completely. ANESTHESIOLOGIST: Now we'll be putting in a neck line, which requires certain positioning, so we will lower your head and put your head down. ELLIOTT BENNETT-GUERRERO: We're just going to clean off over here, okay? It's going to feel kind of cool. ANESTHESIOLOGIST: Now we will use a finer needle, which is a 32-gauge needle. Now with this hand, hold the syringe and rest your hand against patient's face. Now, insert in the same direction at this point...take the small needle out. ELLIOTT BENNETT-GUERRERO: I felt very comfortable helping to put in the central line because I was being supervised by someone who was very, very skilled—very competent in the placement of these lines. ANESTHESIOLOGIST: In more and out. ELLIOTT BENNETT-GUERRERO: Although I was the one actually doing the actual maneuvers, I knew that he was really the one behind me pushing them in. ANESTHESIOLOGIST: You'll feel a little pressure now. Gently push it in. ELLIOTT BENNETT-GUERRERO: Obviously it bothers me when a patient feels discomfort, especially when I'm doing something to them that's hurting them. But I guess what makes me get through this feeling I have is that I try to think, "Well maybe I'm giving them less discomfort than somebody else would be, and also maybe I can do a good job at trying to comfort them." The worst part's over. There shouldn't be any more pain, any more discomfort. For the past year, I've been taking all these specialties, like radiology, pediatrics, medicine and surgery. Now I'm taking anesthesiology and I really think it's the field for me. Not only do I find it interesting, it pays well and it's got a good lifestyle. Although you get to the hospital very early, you tend to leave earlier. And now that I'm going to begetting married in a few months I really think it's important that I choose a specialty where I'm going to be able to spend time with my family. MELISSA: I had an accident with my toe and I went to the Mass. General Hospital Emergency Room. And Elliott was doing emergency room rotations at the time, and he actually worked on my toe and put the sutures in my toe and ended up giving me his number in case I had any problems afterwards. ELLIOTT BENNETT-GUERRERO: And we went on our first date two months later. MELISSA: I actually called him up to thank him for all the work he did on my toe, and he asked me out and we started dating right after that. ELLIOTT BENNETT-GUERRERO: And it will be a year November 29th. ANNOUNCER: Jay H. Bonnar. JAY BONNAR: At last! ANNOUNCER: Luanda Pampata Grazetta. ANNOUNCER: Elliott Bennett-Guerrero. ELLIOTT BENNETT-GUERRERO: This thing's in Latin. You can't even understand a word of it. LUANDA GRAZETTE: I'm going to miss this. I'm going to miss being so much a part of this Harvard Medical student experience. JAY BONNAR: It's going to be wonderful to finally be Jay Bonnar, M.D., instead of Jay Bonnar, the medical student. RESIDENT: Good to see you. How you doing? Excited? Good. We'll run rounds today, and we'll use the rest of the morning to catch up. LUANDA GRAZETTE: When you start out, you are a doctor. You've been to medical school. Learning to be a doctor is an apprenticeship. That's why people work for hospitals for these ungodly numbers of hours for really minimal salaries. It's because you're serving in an apprenticeship. You will give them a large number of man-hours to take care of their patients at low cost, and in return they will teach you how to be a doctor. How long have you been on the iron? PATIENT: For the last month or so. LUANDA GRAZETTE: Have you had any fevers? PATIENT: No. LUANDA GRAZETTE: Any chills? PATIENT: This morning I had a little chill. LUANDA GRAZETTE: It all seems really cumbersome right now. All these patients, and they all have multiple problems. And they're going for tests and results are coming back from tests and you are making treatment decisions based on tests. And it's sort of...keeping it all straight—who got what, when and how, what they need next—is kind of...can be kind of mind-boggling. It's a lot of information to keep track of. HOSPITAL STAFF: Excuse me, Luanda. There's a call for you on line 10. LUANDA GRAZETTE: I think everybody has that feeling, "Oh, god. What if there's a split second decision that I have to make and I don't know what to do?" DOCTOR ONE: She's a 77-year-old lady with a history of many M.I.s, who's admitted with a chief complaint of abdominal pain. She had deep ST depressions in the anterior leads. Got a KUB. Her PT and OT are up a little bit, and with the TNG, her blood pressure dropped a little bit, but the abdominal pain was unchanged. LUANDA GRAZETTE: Hopefully in a week, I'll sort of have my system together, and that's what I'm really working on tonight. Trying to figure out what's going to be a good system for me, that will keep me from going back to the chart three times to see if I checked X and did Y and so forth. PATIENT: It started out in the back of my legs, this was in September. I had the operation. Now the front of my leg from here down is numb. And every time I take a shower my whole leg gets numb. JAY BONNAR: So when you shower, you take your clothes off? PATIENT: Well I don't take a shower with my clothes on. Of course I do. JAY BONNAR: He says that when he takes a shower it becomes numb up to his waist, the whole leg. Apparently when he says numb, he means no feeling, to the best of my ability to say. I'd like to ask you what exactly it is that you feel, and then come to a... PATIENT: My leg is numb. What else can I say to you? JAY BONNAR: That's fine. It may interest you to know that different people mean different things by that phrase. PATIENT: My leg from here to the tip of my toe is numb. JAY BONNAR: I tried to explain that people have other meanings that sometimes get used with that word, but he was sort of resistant to that. I appreciate that this is something that has you very concerned, and you appear to be a little irritated at some of my questions. PATIENT: I'm not irritated. I'm just tired of not getting any answers. That's what I'm irritated about. JAY BONNAR: I still don't understand exactly what's happening. PATIENT: Well, if you've got my file. All right. You're supposed to have all of this stuff when I get down here so you'll know what the hell you're talking about. Do I have to explain the operation to you? JAY BONNAR: No. I'd like to ask you what exactly it is that you feel and then come to an understanding. PATIENT: My leg is numb, what else can I say to you? JAY BONNAR: Had a bit of difficulty asking him specific questions about the nature of the sensory deficit. He got quite irritated with my questions and felt that I should know the answers already and why wasn't I telling him what was going on? PATIENT: I want to know what the hell is going on with my foot. JAY BONNAR: We'll do everything within our power to come to that decision today. PATIENT: I certainly hope so. I certainly hope so. JAY BONNAR: I tried to reassure him a little bit. I think he got more comfortable once I started examining him. He felt I was actually doing something. I think that was what impressed him. Doing something. Bend your arm. Pull toward yourself. Push toward me. Good. Pull toward yourself and push toward me. Excellent. ELLIOTT BENNETT-GUERRERO: Right now I'm at the Framingham Union Hospital which is outside of Boston. Hi. How are you? I have a list of the medicines you've been taking. Have you been taking... PATIENT: It's quite a list. ELLIOTT BENNETT-GUERRERO: The Cimetadine, Lopressor, Micronase, Procardia, Lasix? Every day you take that in the morning? PATIENT: Yes, in the morning. ELLIOTT BENNETT-GUERRERO: An aspirin a day, and the Prozac and the Captopril and the Isordil? All of that? PATIENT: All that. ELLIOTT BENNETT-GUERRERO: A lot to keep track of. PATIENT: Take them all at once, too. ELLIOTT BENNETT-GUERRERO: What do you need? You practically need like a computer, right, to remind you when to take your pills? PATIENT: I often wonder if they know in which direction to go. ELLIOTT BENNETT-GUERRERO: You think they're giving you pills that send you off in different directions? PATIENT: I wish they'd send me off. Cloud nine. ELLIOTT BENNETT-GUERRERO: You're not walking for me. Does your neck feel stiff at all? Does that hurt at all? Well, right now I'm six months into my internship and I'd say I'm gradually just getting more and more tired. I think in part because I never really get a free weekend the whole year. I get three one-week blocks of vacation, but other than that I never have a whole weekend off. MELISSA: Being married your first year is difficult enough in itself without having your husband work 80 and 90 hours a week, and then come home and be exhausted. It's very sad. It's very hard. I'm very lonely. ELLIOTT BENNETT-GUERRERO: Half the year, I'm on call every third night. And I think what she's realizing is that not only does she not see me when I'm on call the one out of every three nights, but the other two nights, especially the night when I'm post-call, sometimes I go home and I'm just exhausted. JAY BONNAR: Right now, it's January and I'm in medicine, ward medicine, which means that I take care of patients admitted to the hospital with basically any problem that doesn't require them being on a surgical service. It is the rotation, which is, at this hospital, one of the most difficult ones in terms of the workload. Can you call a nurse? She's starting to move. I've gotten to a point, where...it's not that I don't care about patients, but the fact that I care about patients becomes less important than the fact that I am absolutely strung out and absolutely can no longer think any more. I forget simple basic things. People will remind me, "You didn't do this thing on this patient." I'll be like, "Oh, Jesus, I can't believe I forgot that. And that happens a lot. I came into medical training, I think, one of the more sensitive people in the field. I'm going into psychiatry. My whole emphasis is on the emotional and the understanding—the mental aspects of medicine. And yet, for all of that interest on my part, I cannot help but become this person that I don't particularly like even. KATHERINE: Jay doesn't really have very much time to do anything any more. He doesn't really read. He doesn't really get to go out too much. He comes back, and because of the way the schedules work, his time is very segmented and it's erratic. JAY BONNAR: I remember going out shopping for rugs one day after I'd just come back from call, and having very little tolerance for discussion. I really didn't want to get into it too much. KATHERINE: He's really...he's so exhausted. He's actually a pretty hyper person, generally, by nature. And then to see him so worn out, just sort of a shell. I mean, what I get is lousy. The best part of him goes away early in the morning for the whole day, and then when he comes home what do I have? He's this tired, grouchy thing. And he goes straight into bed and he sleeps. And that's where we are. JAY BONNAR: I came in four hours ago. So far I have admitted one patient with fever, probable sepsis; done a lumbar puncture; subsequently disimpacted that patient, which is great fun. What that means is to take all the stool out of that person's rectum by hand. I have visited all of my own patients in the hospital. Wrote notes on several of them. Checked their labs. Drawn some blood tests on patients that needed them to be done. I've just now wheeled up my second admission for the night and will be going shortly to examine her. I'm taking a short food break because I'm getting a little hypoglycemic here. LUANDA GRAZETTE: I'll be a lot happier tomorrow, I think, about being a doctor, than I am today. I still have my last call night ahead of me and I'm still kind of grumpy about that. Do you do your own cooking? PATIENT: Mostly sandwiches. LUANDA GRAZETTE: Sandwiches are good. PATIENT: No pots and pans to wash. LUANDA GRAZETTE: And are you allergic to anything? PATIENT: I'm allergic to tape. LUANDA GRAZETTE: Adhesive tape? I wrote that down. We won't put any adhesive tape on you. We'll put you on a strict no-adhesive tape diet. I want you to follow my finger with your eyes. I don't have any regrets about coming down this path. There are lots of rewards. This is one of the professions where you actually can see that you have a direct and hopefully beneficial effect on somebody's life, and that's a wonderful thing. PATIENT: You're not going to put me in restraints? LUANDA GRAZETTE: We're not trying to kick you out. PATIENT: But you're not going to put me in restraints? That's all I want to know. LUANDA GRAZETTE: If you can't follow the rules, then you'll have to be restrained. I think I have gotten a lot tougher. I was sort of shy at the beginning of this process. And you really can't afford to be. I don't miss it at all. Actually, it's much more fun to be ferocious. Mr. Battersby, our little 90-year-old demented man that came in yesterday with COPD and a history of AF, and tracheal bronchitis and horrible lungs. At this point, I'm a doctor. I'm Dr. Grazette. That is who I am in this hospital and in my clinic, Dr. Grazette. I'm not the Dr. Grazette that I'll be in ten years. Hopefully I'll have learned a lot more, I'll have grown a lot more, and I'll be a better Dr. Grazette. But I'm Dr. Grazette now. ELLIOTT BENNETT-GUERRERO: We're going to come and get you and bring you on a stretcher. Mr. Rogers is a 74-year-old gentleman who is going to be having bypass surgery on his heart tomorrow. Go ahead and put a breathing tube down. That goes... It's very delicate discussing the risks of procedures and anesthesia with patients. Because on the one hand you want there to be a full disclosure and informed consent, and you want them to know what they're getting themselves into, knowing the risks. On the other hand you don't want to take someone and make them very, very anxious. If they have a bad heart, anxiety is very bad. It's nice meeting you, sir. MR. ROGERS: Nice meeting you. ELLIOTT BENNETT-GUERRERO: We'll take real good care of you. MR. ROGERS: I know you will. I'll put my dependence in you. ELLIOTT BENNETT-GUERRERO: Mr. Rogers, I'll take you into the operating room now, okay? All ready to go? After doing anesthesia for a year and a half, I think I take for granted now, because I've done it so often, just how incredible it is when you give somebody a general anesthetic. Can you just tilt your head back a little? That's wonderful. Oftentimes you paralyze them. They can't move. You're totally scrambling their brain. I want you to think about some nice place that you like being. They can't breathe. They can't protect their airway. You're doing fine. We're going to take real good care of you. I think Melissa was very unhappy with the amount of time that I spent at the hospital. And the fact that I'd come home from work and I'd be emotionally exhausted, especially after, say, a 36-hour shift. MELISSA: It's hard to spend the time you need to work on a marriage when you have a husband who's working 100, 120 hours a week. And whenever he's at home, either his mind is at work or he's so emotionally drained from work that he has no energy left for you or the relationship. ELLIOTT BENNETT-GUERRERO: The fire was a really terrible thing. I think one of the things that really disappointed me was that instead of it bringing us closer together, I think it drove Melissa and I further apart. Because we got separated about two weeks after the fire. MELISSA: There wasn't really anything to keep us together. Because our home was burned. We had nothing. Nothing was left after that fire, and it was sort of easy for us to pick up and go and establish our own new lives independent of each other after that fire. ELLIOTT BENNETT-GUERRERO: If you're a very, very needy person and you always need a lot of attention and support from your spouse, you're probably not going to be happy being married to a doctor. MELISSA: I guess we've been separated for close to a year and a half now, and it still makes me very sad when I think about it. Not that I don't think it was for the best, but it still makes me sad. I think it always will. PRODUCER: And it all started with your toe? MELISSA: It all started a tragedy and it ended a tragedy. ELLIOTT BENNETT-GUERRERO: How much of this stuff do you have to put on? Number four step.We don't want Tina to burn. I'd say this is a very happy time in my life. Personally, I think things are going well. Professionally, things are going great. I really like what I'm doing. I like medicine. Anesthesiology is a lot of fun. I hope medicine is this much fun for the rest of my life. JAY BONNAR: Being a psychiatrist is a wonderful career. And I appreciate having the medical background as well because it helps me understand not only the mind but also the brain. So here we are. Here's my office. Let's see, what have we got? We've got the chairs for psychotherapy face to face, and the sofa for psychoanalysis. This is where I see my patients. Oh, a wall full of diplomas, yes. That has some impact as well. I don't spend much time with the diplomas these days, though it represented a lot of work certainly. I've decided to become a psychoanalyst, and that means that,amongst other things, I participate in psychoanalysis myself. So for the past three years I've driven across town to see my analyst four times a week, and I'll probably be doing that for another few years. Psychoanalysis is a treatment that is based on free association, which means that the person in treatment is given the task of saying everything that comes to mind. And that isn't something we ordinarily do in public or even private life for the most part. If we were to say everything that came to mind we'd be arrested or put in the hospital. Psychoanalysis is fundamentally a private thing and has to be. Because when you start talking about what's on your mind, it's the whole range of human emotion including love, disappointment, anger, sex, lust. It's all in there. Like most people in analysis, I'm hoping that what I get out of it is that I'll be happier. I hope for relationships that are more stable. I hope for greater satisfaction in my work and with myself as a person. Had this been an actual analytic session I would have continued to lay here and talk about whatever came to mind. And the analyst would have been sitting, much as I do when I'm doing the treatments here, in this role. Listening, largely, taking notes, thinking about it, reflecting on those thoughts. I think that for many people including myself psychoanalysis is a lot about getting to be kinder to yourself, to help people lighten up a bit on themselves. And what people find is that they also then are more generous to the people around them, which is nice, too. Having been married and then having the experience of that falling apart, and getting divorced, has been enormously impacting on who I am and how I feel about myself and about other people, about stability, connectedness. So here we are in my apartment. And this is a painting by Aiyae, who had a show at the Boston Psychoanalytic Institute, which is where I saw it first and fell in love with it and subsequently with the painter. Do you catch the ants? Come here. AIYAE: When I first met him, it was at the opening, but we only spoke for about one minute. It was really crowded, and I was already—after opening...post-opening fatigue. So we sort of got to know each other through communicating about this particular piece, because he was interested in it. And it was very refreshing for me to hear insight from someone outside...who's outside of the art world. JAY BONNAR: This is as deep an exploration of the mind as my work. AIYAE: He's a psychiatrist. And his insight from his experience was very inspirational for me, actually. JAMES BONNAR: I think that's part of the thing about being in analysis, and being a psychiatrist. You get incredibly self-conscious. How are people going to see you professionally? And what are people going to think? Most psychiatrists don't do movies. Don't go on television. It's a field where you tend to be fairly self-conscious. Part of the work is understanding your own stuff. It's very, very important to understand yourself when you're interacting with other people so that you don't have your own stuff get in the way of the other person's healing. DEANNE BONNAR: I mean,I think self-reflective is a better word than self-conscious about that. That's what I hear you doing, too, is reflecting on what are your motivations for getting into this. JAY BONNAR: I mean, you're also talking to me at a time when I'm in the middle of an analysis. One is very much focused on the internal. A lot of focus goes too, to the things that have not worked well in life. And so, it's real easy to portray yourself as being fairly pathological, which is another concern of mine, too. And another reason for not particularly wanting to do this filming right now. ELLIOTT BENNETT-GUERRERO: So what we're going to do is we're going to bring you into the operating room and put an IV in. Then I'll start giving you some medicine to make you pretty relaxed. Then, we'll put you off to sleep. Give you some oxygen to breathe through a mask. Then we'll give you some medicines in through your IV. How are you feeling? Okay? Nice big breath. Mr. Grant is 40 years old and unfortunately at a pretty young age, he's got pretty bad heart disease. He's got blockages of a lot of the arteries that feed the heart and it's these blockages that can lead to a heart attack if they're not treated. When I did this I really didn't feel much. When you first start out people are feeling a lot, but basically when you become very experienced doing this, you just kind of have a sense for where it is. My temperament is well-suited for anesthesiology. I'm really very compulsive. I'm a real worrier. I hate it, I really hate it if I'm working with a trainee and I don't get the sense that they're really anxious, that they're really on edge waiting for something bad to happen, because that's really,I think, part of doing a good job. DR. MEHMET OZ: I'm giving you some heavy silk. The first time I met Elliott is when I was asked to interview him. And he was considering coming over as an extraordinarily young chairman of the division of cardiac anesthesia, which is for many of us the most powerful position on the anesthesia side of the fence. And we went to the faculty club together, and I was immediately impressed by Elliott. But I was even more impressed when I told him about this wonderful study I had just seen in one of the biggest journals that we have in this country, and I said, "I just wish we could reproduce that." And he said, "Well, I wrote that paper." ELLIOTT BENNETT-GUERRERO: Instead of putting the person on a heart-lung machine, you actually put a little device to kind of hold the heart a little bit still. And the surgeon actually sews these blood vessels onto the heart while it's beating. DR. MEHMET OZ: There's a dance that occurs and that has to be a well-choreographed affair. And if you have a team that works well—and you have to build that team, it doesn't come naturally, it really is a marriage—then you have a whole that is greater than the sum of the parts. ELLIOTT BENNETT-GUERRERO: And when it's working well, there's silence. I know what he's doing. I'm taking care of what I need to get done. We don't need to...it's like with dancing. You don't need to say, "Go left, go right, one two three." You just know what to do. KAREN: I think that I felt very comfortable marrying a doctor because my father is a doctor and I grew up with a lot of doctors in my family. Oh, look at the geese. ELLIOTT BENNETT-GUERRERO: Look at the little pretty ducks. KAREN: Aren't those geese? ELLIOTT BENNETT-GUERRERO: I guess so. I don't know. Ducks, geese, what's the difference? I'm not Mr. Nature Boy. Are any of these ripe? KAREN: They all look ripe. ELLIOTT BENNETT-GUERRERO: One thing that works in our relationship is that we both have high standards for what we do, even though we have different kinds of professions. And so I think that Karen can appreciate and respect the fact that I'm really so dedicated to my profession. And I also...I respect the fact that Karen really takes the work that she does very seriously. I remember when I was a kid you could buy a whole watermelon like this for a dollar. And now it's 50 cents a pound. KAREN: That's what you keep telling me. I don't think this was ever a dollar. ELLIOTT BENNETT-GUERRERO: It was in upstate New York when I was a kid. When I was 10 years old you could buy a whole one for a dollar. And now things are getting so expensive. And I think also we're basically both very good-hearted, traditional people who basically want to have a stable, happy family life. LUANDA GRAZETTE: She wants you to know everything that's going on because you guys are a team. I thought I was going to do general cardiology, and as it turns out I ended up in probably the most sub-specialized area imaginable, in transplant. This patient is a middle-aged woman who has had a diagnosis of cardiomyopathy. Our task is to try to figure out why all of a sudden her heart failure is so much worse. Oh, there it is. That's it. You don't get much better than that. We're going to need to look at the echo in a little bit more detail and see whether or not there's some options, short of transplantation, that might be helpful for you. So her numbers are actually not particularly bad. CVP is still in the teens. I'm still excited about medicine. I think it's very difficult not to be excited because it's constantly changing. Consider her for a mitral replacement and anular plasty. I've been around long enough to be able to say, "Well I've seen things evolve, and diseases that there weren't good approaches for when I started medical school, there are now rational therapies for." Hello there. You're sort of dressed as if you're ready to leave here. I don't think there's anything we could tell you that would make you stay. One of the things that is attractive about transplant medicine is that it is a very intimate relationship between the cardiologist and the patient. PATIENT: You've been wonderful. You did a good job, both of you. LUANDA GRAZETTE: That's actually a joy. That's one of the great parts of the job, is that you do get to have this ongoing very rich and deep relationship with the patients. PATIENT: I know you stopped me from going home, but it was worth it. LUANDA GRAZETTE: It was necessary. PATIENT: I know, I understand. LUANDA GRAZETTE: All right. Good to see you. PATIENT: Good to see you. I'll see you again. Bless you. LUANDA GRAZETTE: This is still pretty time-intensive. And I think I take the time that I do have with family and friends, or sort of doing things that I enjoy, much less for granted than I did when I was in internship and residency. I'm sort of at that stage in life where you start to...like you see that point approaching where you have just as many years ahead of you as you have behind you. And I think that that makes you stop and reflect and think about. "Am I doing things that I really enjoy and that I find fulfilling?" I think that this is a field to go into because you can't imagine not doing it. It was definitely worth it for me. 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 American 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. Next time on NOVA: the race to unravel a three-billion-letter mystery. "This is the ultimate imaginable thing that one could do scientifically, is to go and look at our own instruction book and then try to figure out what it's telling us." Cracking the Code of Life. 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. 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. TRIVIAL PURSUIT®, is a trademark of Horn Abbot Ltd. and Horn Abbot International Ltd. for the games distributed and sold worldwide under exclusive license to Hasbro, Inc. ©1999 Horn Abbot Ltd. and ©1999 Horn Abbot International Ltd. All Rights Reserved. PRODUCTION CREDITSSurvivor MD: Hearts & Minds
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