The surgeon is scrubbed and ready. He calls for a “ten-blade” and the nurse slaps the scalpel into his hand. He nods, unwavering, and runs the sharp edge against plastic skin. And then —
A different kind of cut. The surgeon relaxes and now he is an actor waiting for a touch-up of his powder. The director makes a suggestion and he nods. He’s game. The patient sips from her water bottle. And in this world of seemingly unlimited takes, we are ready to go again.
My love for medical television has long felt like an embarrassing secret. I’m one of the few doctors I know who has watched all of “E.R.,” twice, and is fully up-to-date on “Grey’s Anatomy” characters and plot lines. So when I learned that doctors like myself regularly work for medical TV shows, I started to imagine the possibilities.
Which is how I recently left an overnight shift in the intensive care unit, signed out my pager and boarded a plane from Boston to Los Angeles. For the next two months, the writer’s room would be my workplace.
I arrived with a new pair of high-top Converse and a set of lofty goals. I would pitch ideas that revealed medicine as it truly is. Of course there would be medical mysteries and great diagnoses. But there would also be doctors rounding endlessly on patients who neither got better nor worse, amid suffering, drudgery and sadness.
A few days after my arrival, I learned that I would be a co-writer of an episode. The premise: a snowstorm has surprised Atlanta and the hospital staff is snowed in. I live in Boston. I’m all too familiar with snow. The assignment seemed perfect; I must have a wealth of charming snowy night hospital stories and compelling weather-based medical crises.
I remembered a time, some years back, being on call overnight as a storm raged outside. A hospital administrator handed out “care packages,” which were biohazard bags stocked with patient underwear, hospital socks and a few single serving packages of peanut butter. I ate the peanut butter right away but was paged to some sort of emergency before I could try on the socks or underwear.
Another winter. A different storm. I cared for a dying man whose daughter was flying in from somewhere far away, overseas. Ice coated the runways in Boston and no flights could land. The father died while his daughter was still in the air. The way I remember it, she learned that he had died over Delta’s spotty wireless internet service.
But these are not television stories. I worked on the Fox medical drama “The Resident” which, in striking contrast to the doctor-as-hero medical genre, offers a more complex view of medicine. The plot lines are bold and often dark. A patient survives a cardiac arrest — but the time without oxygen leaves her brain-dead. Financial incentives corrupt. Patients die. Doctors are human and imperfect, sometimes prioritizing profit over patient care.
Even with this unflinching focus on the harsh realities of today’s medical system, pitches in the writer’s room often begin with this question: “Is there a world where…?” What freedom! Maybe there is a world where I used the hospital care packages to help a patient or solve a diagnostic dilemma. So too could there be a world where my patient’s daughter raced through the airport and made it onto the last flight to land in Boston before they closed the runways. Maybe she was able to give her father a final hug and say goodbye after all. There is a world where all of this is possible.
A few weeks before I flew to Los Angeles to dream of that world, I found myself part of a real-world conversation about which of two patients should be placed on a machine called extracorporeal membrane oxygenation, or ECMO. The machine works as an artificial lung, circulating blood outside the body, and it is increasingly used to help patients whose lungs are so damaged that the ventilator is not enough to support them. We have a handful of such machines in our hospital and all but one was in use. On that night, two patients could potentially benefit. Who would get the machine?
Turned out the writers liked this idea. As they built the stories and as I offered my opinion on medical details and dialogue, I continued to follow my actual patients in the online medical record. At first fiction and reality unfolded as if in parallel. But then they diverged. I learned that in nonfiction life, the patient who was placed on ECMO grew sicker and ultimately died, while on TV we are allowed to hope that both patients lived.
At first I worried that made the televised version misleading. But the authentic core of uncertainty — how we balance risk and benefit and the great complexity in making decisions about allocating a limited resource — is still there. And I like believing in an alternate reality where my patient might have lived. This was the world we had hoped for. And in the writer’s room we were able to make that world come to life.
Maybe this is the power of the medical dramas I love. As a nonfiction writer, I am used to relaying the truth as it occurs. But television finds a way to offer enough reality to teach and to provoke, but also offer a balance. Viewers can come close to the fire but they are not scorched. That is not the same truth as nonfiction. But it is a kind of truth-telling nonetheless, one I am still learning to navigate.
Toward the end of my time in the writer’s room, I flew from the on-set hospital back to Boston for a weekend in the intensive care unit. “Is there a world,” I found myself thinking in a windowless family meeting room, where I told a wife that her husband would not live to leave the hospital. “Is there a world,” I thought again as I examined a woman whose lung transplant had failed, leaving her dependent on a ventilator for every breath. “Is there a world,” I murmured as I listened to the moans of a man who had been healthy until a disseminated staph infection cascaded through his bloodstream.
When I left the hospital that night, I passed the clerk who sits at the entrance to the I.C.U. Her job is to answer the main phone line, which rings frequently, often from panicked family members. She had just settled in for the evening, and I noticed that she was watching something on her tablet. Curious, I approached.
“What are you watching?” I asked her.
She smiled at me before responding: “General Hospital.”
Daniela Lamas is a doctor at Brigham and Women’s Hospital in Boston and the author of “You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and in Between.”
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