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00:00This time on NOVA, a unique behind-the-scenes look at what it really takes to become your doctor.
00:08A minute or two to figure out how the gown works, but most of them had a chill.
00:12She was way over this way.
00:14It feels like such a costume right now.
00:17Here's the ligament right here.
00:18I just want to show you that this is a perfectly normal brain.
00:21Oh man, this needle can be a normal brain.
00:22David, will you shut up?
00:24I'm sorry.
00:25The story begins in September 1987, as a new class enters Harvard Medical School.
00:33Almost immediately, the students embark on a journey into our bodies and minds.
00:38A process that will change them from ordinary mortals into fully initiated members of the medical tribe.
00:46The first thing I want to do is take your vital signs.
00:50Let me see under your tongue.
00:52For 14 years, our cameras have been there.
00:55From the early days of medical school, through the sleepless nights of internship.
01:00NOVA has followed seven men and women through their grueling medical apprenticeships.
01:06We all did well in school.
01:09And to come in and be given a test where you know nothing, it's really hard.
01:14Last year, I felt I was incredibly ignorant, and I couldn't possibly be in the hospital as such an ignorant person.
01:20This year, I realized I'm still pretty ignorant, but I've gotten used to it.
01:24As soon as he said, I'm having heart problems, my heart just sank, because I said, they tend to be the most difficult cases.
01:32And all these questions that I know I should have asked, I'm sure I didn't.
01:36I 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.
01:43But I sometimes wonder whether it's all worth it.
01:46It's like a kid going into a candy store.
01:49It's overwhelming.
01:50I mean, there's just so much there, and there's just so much that you'd like to do.
01:54What if there's a split-second decision that I have to make, and I don't know what to do?
01:59This ain't no party.
02:00This ain't no disco.
02:01This ain't no fooling around.
02:02This is like the real deal.
02:04People are really sick.
02:05This is the tale of Tom Tartar, one-time bouncer, weightlifter, and mechanic, now transformed into a doctor.
02:18I never thought that I would get to a point where I was comfortable with medicine.
02:21I mean, I can stand alone in an emergency department, and anything that comes through the door, I can handle it.
02:35I was born to be a mechanic.
02:56I was born to be a carpenter.
02:58I was born to be a janitor.
02:59I mean, that's what I was born to do in this society.
03:02We do not have a classless society.
03:03And it's just nice that I've been able to be so, you know, socially mobile.
03:21It's the beginning of the morning.
03:24It's 11.30.
03:26And we're just coming to work.
03:29This is what I do.
03:31I like it.
03:31I like working weekends and nights and all that stuff.
03:33So, I got to go.
03:35I'm going back, see what goes on.
03:44Well, one of the primary mandates of emergency medicine is to ensure the patient's safety immediately, rather than long-term risk and benefit.
03:53We deal with people who are acutely ill, and we want to make sure that everything is done
04:04for them now.
04:05How long ago was it?
04:06How long ago was it you had this problem with jury order?
04:07But then again, the actual management of the problem long-term is up to somebody else.
04:13I've got some concerns about your spleen, which is kind of underneath your...
04:16I love that.
04:17I really do.
04:17Because it's very exciting.
04:18I get to go from case to case.
04:19I get to help each person through a moment of crisis.
04:26Did you get knocked out?
04:27No.
04:28Didn't hit your head, huh?
04:30That could be just some kind of weird spasm, but...
04:33Generally, they're thankful.
04:34Generally, it makes me feel good.
04:36Just cure in the sick.
04:38Yeah, I really like it.
04:39It's very instant gratification, you know.
04:40So, it's definitely the kind of medicine that the TV dinner microwave generation can appreciate.
04:48Her chest x-ray didn't look too remarkable, but I got a CT.
04:52And on the CT, she's got hematoma around her arch.
04:56Would you care to come on in and take a look at her?
05:01I'm certainly not poor anymore.
05:02Thanks very much.
05:03I've got a good future ahead of me, and I enjoy my life every day.
05:10But I actually have nightmares about doing medical school again.
05:14I do.
05:15I sometimes have these nightmares that, for some reason or another, I'm back at my first year,
05:20and I have to complete medical school all over again.
05:23And at this point in my life, at 44, I don't think I could do it.
05:29I mean, I just don't think I could go through that again.
05:33Especially knowing what it was like.
05:35After observation of the holding unit for the remainder of the day,
05:39Mr. Bates is limited to the hospital for the next morning.
05:42Epigastric tenderness has decreased to 461.
05:44It's not just like a little tear.
05:45For me, nothing was as traumatic as the first year of medical school,
05:49because I was just literally a whore in church.
05:52I really was one of the few people there that was from a socioeconomically disadvantaged background.
05:57And believe it or not, this should be self-evident, I guess,
06:02people from that level have a different way of interacting
06:07than people that are middle class and upper middle class and upper class.
06:12And I had to make that adjustment.
06:15I never had to make it before, really.
06:16And I did at Harvard.
06:18We collided.
06:20Stimulate pancreas secretion of bicarbonate, pancreas secretion of enzymes.
06:24My first days at medical school were really tough,
06:26because I felt like I was being assaulted on all sides.
06:29First of all, I hadn't come from a medical family.
06:32I really didn't know anything at all about medicine.
06:36I had this one model of doctors.
06:39To me, doctors knew everything.
06:40Any doctor knew basically anything there was to be known about medicine.
06:44There was this circumscribed body of knowledge that I was going to learn.
06:49But I was in for a surprise.
06:51My class were guinea pigs in an experiment at Harvard.
06:55They were trying to humanize medical education by actually teaching us less.
07:00So when I went into the course of the body,
07:03I thought I was going to, you know, just by magic or some superhuman feat,
07:07learn everything about anatomy and physiology in eight weeks.
07:10That bottom part happens to take the three...
07:12They said, no, you're not going to learn it all.
07:14And I was like, well, then why am I here?
07:16What are you doing?
07:17And what kind of a doctor are you going to make me?
07:22These people were telling me that the emperor had no clothes.
07:25And they really were.
07:26They were saying, no, these great doctors and stuff like that,
07:30they didn't know all this stuff.
07:32They just know little pieces.
07:33This guy knows this one little piece.
07:35That guy knows that one little piece.
07:36Nobody knows all this stuff.
07:37Not only does nobody know this stuff now,
07:40but they never did know it all.
07:42And you're not going to know it all.
07:44So just relax.
07:45That was very, very difficult for me to adjust to.
07:48I mean, I'm not sure what the mechanism is.
07:49I just know empirically that there's a saturation effect.
07:53So as I scrambled to try to learn the actual anatomy on my own
07:57without much guidance at the same time,
07:58I came into a lot of social conflicts with people.
08:01Here, we want more tests.
08:02I just didn't get along very well.
08:06Tutorial was another difficult thing for me
08:10because it was really my first introduction
08:13to the Mutual Masturbation Society.
08:16I mean, that's really what it was.
08:17The idea of that tutorial, to my mind,
08:21was to learn how to sit there and disagree with people
08:24while you're complimenting them.
08:27You know, cliche diagnosis without having to explain
08:30why the guy is wearing a pink shirt or something.
08:33No, but we should.
08:34I mean, one thing that's...
08:34When I worked at a gas station or a bike shop
08:36and somebody did shoddy work,
08:37you'd tell them, hey, that sucks.
08:38Go do it again.
08:39That's how I learned.
08:40That's how I became a mechanic.
08:42I became a mechanic by telling me,
08:43no, that's wrong.
08:44Do it right.
08:45And I would go to these tutorials
08:47and you'd never tell anybody that they were wrong.
08:50If you thought they were wrong,
08:51if they said that the world was flat,
08:53you know, you would say,
08:54well, that's a very interesting concept.
08:57You know, where'd you get that from?
08:59You know, and I had to learn
09:01to do all that socialization stuff.
09:03And that was what the tough part
09:05of the tutorial was for me.
09:06Might be studying some things too much
09:08and missing important concepts
09:09that someone could just say,
09:11hey, this is really important.
09:12You should know this.
09:13You should examine this.
09:15But nobody tells me that.
09:16I mean, give me a break.
09:17If you don't like it, it's one hour a day.
09:19And if you want to pursue all this stuff on your own,
09:21go pursue it on your own.
09:22That's not really true.
09:23I personally feel that I paid a great deal of money
09:27to consult and to have the expertise
09:30and the expert guidance of people
09:32to point out to me what I should know.
09:35Well, why come to Harvard then
09:36is the big question that would enter my mind.
09:38I'll tell you something.
09:39I'll tell you something.
09:39That's really what was a tough choice.
09:42It was.
09:42And I sometimes wonder if I made the right one.
09:45You know, and well, I do.
09:46And that's why I ask the question,
09:47if you're so unhappy with the past.
09:49This has been the most emotionally trying period of my life.
09:55I've been through a divorce after 10 years of marriage.
10:00I was Olympic gold flu, got knocked out of the Olympics
10:02because of an accident and an injury.
10:06I've had to work for about 14 years
10:09to get into medical school.
10:11And I can't ever remember crying until last week.
10:16Last week, I was just, I just, I had to start crying.
10:20I was talking on the phone to a friend of mine.
10:23And it just happened.
10:33One of the things that made my life possible
10:35was every now and then we'd get a break.
10:38I'd go back to the Bronx, visit my girlfriend Stephanie,
10:41my mother, see the old neighborhood.
10:43And that lifted my spirits up enough to sustain me
10:46till the next break.
10:48That coffee table has a nice little touch with those yellow mats.
10:51Well, it's a little too French provincial.
10:54He was always a little different.
10:57I always used to think he was a little too smart for his own good.
11:00This is what we lived on right here.
11:02Bronx pizza.
11:04Our main staple.
11:05This got us through college.
11:07Hold it straight.
11:08It's not getting us through medical school,
11:09but it got us through college.
11:10Speak for you.
11:11He was always interested in science.
11:14And when he was very young,
11:16his first interest, I think, was in atomic energy.
11:20And he was three or four years old.
11:22He'd have me reading books about atomic energy.
11:25And then when I'd finished,
11:28he would say to me,
11:29Mother, I know you didn't understand that.
11:31Now let me explain it to you.
11:33Do you know what it's like having a three or four year old
11:36explained to you about atomic energy?
11:39Okay, here's the guy you wanted to know about.
11:41This is the guy that married my ex-wife.
11:43The schnoz.
11:44Your ex-wife.
11:46That's my ex.
11:48My ex-wife.
11:49Ex-wife.
11:49Okay, how about this one?
11:51Oh.
11:51This one's my...
11:52You like that one, huh?
11:53No.
11:54No, no.
11:55That looks like Charlie Manson.
11:57It's not Charlie Manson.
12:01It's me and Yosemite, and it was raining.
12:03And I'd ridden for days in the rain.
12:05There we are.
12:08I'm trying to remember where this was.
12:10I think this was in Tennessee.
12:13One of my favorites.
12:15I can't say it's one of mine.
12:17What thought you liked about it, Mother?
12:19I look like the Neanderthal man.
12:22I think he looks like a Renaissance prince.
12:25What's a Neanderthal about it?
12:28Oh, my gosh.
12:29What's Neanderthal about it?
12:32The whole thing.
12:34The flower shirt?
12:35Of course, the old...
12:36Oh, no, no, no.
12:37I wore flower shirts.
12:38No, if you just had a...
12:41Bare skin?
12:42Bare skin.
12:43Oh, a Tarzan suit.
12:45Yes, a Tarzan suit.
12:46I should wear a Tarzan suit.
12:47Right.
12:48And a club.
12:49And a cave.
12:54The thing about the first year was,
12:56after recovering from the initial shock
12:58and all this sociocultural type of dilemmas
13:00that I found myself in,
13:02I finally figured out the system
13:04and figured out how to work through it.
13:06And I ended up learning a lot from my cadaver.
13:08That was probably the most meaningful part
13:11of the first year to me.
13:12It's a state of disarray, you might think.
13:18But it actually makes sense.
13:21It's a train's mind.
13:22That doesn't necessarily mean mind.
13:26And here's our stomach.
13:28This is where the stomach pierces the esophagus.
13:30It's called the cardiac notch.
13:32This is the fundus of the stomach
13:34and the antrum of the stomach
13:35where it goes into the duodenum.
13:36When I first came to school here,
13:39I was in a lecture
13:39and I heard people referred to as lay people
13:42and we were referred to as something else.
13:46There were lay people and there were physicians.
13:48And I thought that was interesting
13:49because that meant to me
13:51that we knew something that other people don't.
13:53Or we looked at things differently,
13:54that we had an alternate perspective.
13:57And now I'm getting to see
13:58what this alternate perspective is.
14:00If I'm writing,
14:01I'm thinking about what muscles are moving,
14:04how they're moving.
14:05I can actually see them in my mind.
14:06I can see the tendons going through their sheaths.
14:09I can see the nerves that are invading them.
14:11Everything.
14:13People now are much more to me
14:16than just their exterior.
14:18They're just their bodies.
14:20When somebody sits down,
14:22I can see what they're sitting on.
14:23I know what they're sitting on.
14:25I know what muscles are being compressed,
14:28what muscles are being relaxed.
14:31It's just an absolutely fascinating way
14:33of looking at people
14:35from a whole other perspective,
14:37from the inside out.
14:38I have a watch that has a stopwatch built into it.
15:08And I spend six hours every day
15:13not looking for books
15:16or walking across the street to the library
15:18or something like that,
15:20but I spend six hours a day
15:21of actively studying,
15:23which means at this desk,
15:25at a book,
15:26or in the library at a videotape.
15:29Six hours.
15:30And if I take a break
15:32to get a cup of coffee
15:33or to go to the bathroom,
15:35I click off the watch.
15:40Part of our first year curriculum
15:42is we go to a private office
15:44that's run by an established physician
15:46here in the community,
15:46and they show us a few tricks
15:49to the physical exam.
15:50We usually try them out
15:51on each other first.
15:52I feel a little depression
15:53just anterior to the ear.
15:57And then if that doctor
16:00can convince one of the patients
16:01to let us try it on them,
16:02we try it on them.
16:03Carlos, right?
16:04Carlos Morales.
16:06And Nathan.
16:07Would you mind seeing
16:08as we're just learning
16:09if we both do this on you?
16:10No.
16:16You have excellent breath sounds.
16:18Really?
16:19Anything interesting?
16:20So far,
16:21the interesting thing
16:23is you sound perfect.
16:24One of the hard parts
16:26about this course
16:27is that we haven't learned anything
16:29much about how illness works
16:30and what illness is like.
16:31All I've known up till now
16:33is if I've had a cold,
16:35how I felt,
16:36but I never had
16:36any kind of real
16:37serious illness.
16:39Did you swell for me?
16:40So I didn't know
16:40what questions to ask.
16:42Okay, thanks.
16:43Between 22-year-olds,
16:45Hispanic male,
16:47presented with acute...
16:49So we did the history
16:50and physical,
16:51but both of us
16:52being so inexperienced,
16:54completely missed
16:55the larger point,
16:56which was finding out
16:57what was wrong with him.
16:58We just never got to that.
17:00We didn't get that.
17:01You didn't get the pneumonia,
17:02you had it.
17:03You got this.
17:03Well, tell me what you got.
17:04Somebody presented pneumonia.
17:06When did he have pneumonia?
17:08Oh, a while ago.
17:10I didn't get that at all.
17:13At the end of our first year now,
17:15we're having a comprehensive exam,
17:17which is going to cover
17:18a great many subjects,
17:19everything from physiology,
17:20histology,
17:21and probably every other
17:22ology there is.
17:24And passing it
17:25is kind of a landmark.
17:26It makes you feel like
17:27you haven't completely
17:28wasted your time
17:28and that there's some hope
17:30that you're going to make it.
17:31Thank you, sir.
17:31Yes!
17:33So stay there.
17:34All right.
17:34Woo!
17:36It's absolutely fantastic.
17:37Today is the most important day
17:39in my life right now.
17:40I really feel confident
17:42that I can do the work.
17:43I feel confident
17:44that the program
17:46is going to work for me
17:47and that I'm going to become
17:50a good doctor,
17:51which is the most important thing
17:54in my life.
17:56Just remember one thing.
17:58Do no harm.
17:59That's your greatest gift
18:00to mankind.
18:01Do no harm.
18:02Whether you go through
18:03your normal life
18:03and there's a doc.
18:04In the second year,
18:05we're moving on
18:06to what's called
18:06pathophysiology,
18:08which is we've learned enough,
18:10hopefully,
18:11that we know how the body
18:12is supposed to function.
18:14Given that,
18:15we can now look at ways
18:16that the body functions abnormally.
18:18You sort of have a lobulated,
18:20fluffy-looking mass here.
18:21These are something
18:22that's abnormal.
18:24This is where you
18:25are supposed to really
18:26start learning
18:27the difference
18:28between sickness and health.
18:29This heart
18:30is just about
18:33the size of my fist.
18:35Beats
18:36since the day you're born
18:39to the day you die.
18:41Corresponds to every stress.
18:42In the autopsy
18:43that we were involved with
18:44with Dr. Schiller,
18:45we were allowed to see
18:47what a pathologist does.
18:49And although none of us
18:50are pathologists,
18:51and we're not even doctors yet,
18:53we're just students
18:54and most of the time
18:54is spent with books,
18:56we got to see how
18:57the stuff we learn
18:58in these books
18:59becomes real.
19:01This is a perfectly
19:02normal brain.
19:03Probably normal weight
19:03and normal shape.
19:06All right?
19:06Who would like to tell us
19:07what we see here?
19:08Who hasn't spoken?
19:09Ah, Mr. Bronx.
19:10First of all,
19:15what organ is this?
19:16Looks like liver to me.
19:17It sure is.
19:18Okay?
19:19That's liver.
19:20Need a lot of onions for this.
19:21Oh!
19:22When I got to the hospital,
19:34I had no idea
19:35what was going on.
19:36I didn't know
19:37what call was,
19:38what you did with a beeper.
19:40For that matter,
19:41I barely knew
19:41which end of a stethoscope to use.
19:46I started 6 o'clock
19:47yesterday morning.
19:48I'm very tired.
19:50My feet hurt.
19:52It's not too bad
19:53if you can get some sleep.
19:55I didn't.
19:56I usually don't.
19:57But I think
19:58as you get better
19:58at this stuff,
20:00that becomes possible.
20:02You might be able
20:02to get 2 or 3 hours of sleep,
20:03which could really
20:04make a big difference.
20:06I don't know
20:07what to make
20:07of this numbness
20:08around your nose.
20:09The neurology resident
20:10was saying...
20:12As you enter
20:13the medical profession
20:14as a third-year
20:14medical student,
20:15one of the first things
20:17you learn is that
20:18there's a very
20:19rigid hierarchy
20:20of power.
20:23At the top,
20:24you have
20:25the attending physician
20:26who really is
20:27quite powerful,
20:28almost almighty.
20:29You could compare him
20:30to a deity
20:31in some religions.
20:36And then
20:36right next to him
20:38would be
20:39the chief resident
20:40or senior resident
20:41who would be
20:42a high priest.
20:43And he is
20:44the one
20:45who is allowed
20:47direct contact
20:48with this higher power.
20:51A little bit lower
20:52down the line,
20:53you have your
20:54everyday priests,
20:56which would be
20:56your interns.
20:57And they,
20:58although they don't
20:58directly speak
20:59with the almighty,
21:01they do have
21:01the privilege
21:02of contacting
21:03the resident
21:03who instructs them
21:05in the wisdom
21:06of the Lord there.
21:08Beneath your intern,
21:09you have your
21:10third-year medical student
21:11who is,
21:12you know,
21:13at best
21:13a little monk
21:14who trembles
21:15in the wake
21:16of all of these
21:16greater powers
21:17and hopefully
21:18will muddle through
21:19and climb up
21:20the rungs himself.
21:21I, Thomas,
21:30I, Thomas,
21:32take you, Sharon,
21:33take you, Sharon,
21:34to be my wife,
21:36to be my wife.
21:37Actually,
21:37the first time
21:37I saw Tom,
21:38he had held
21:39the door open
21:39for us
21:40and that's when
21:41he was big
21:41and gruff.
21:43And I turned
21:43to my girlfriend
21:44and I said,
21:44I have no idea
21:45but I'm very
21:47attracted to that guy.
21:48And honor you
21:48and honor you.
21:49And then it was
21:50like several months
21:51later before we
21:51started working
21:52together and then
21:53I didn't like him
21:54at all.
21:55Thomas,
21:56as you place this
21:56And I went away
21:57to medical school
21:58and she visited me
21:59during my first
22:00and second year.
22:01She moved up
22:02and now we're
22:04tying the knot.
22:05But, Thomas,
22:06let me caution you.
22:07When you blow out
22:08your candle,
22:09that has a very
22:09special meaning.
22:11You are saying
22:11goodbye to your
22:12old flames.
22:13Are we going to
22:23light this together
22:24or a second?
22:25Can we do this
22:25together?
22:26Together, right?
22:27Together we do this.
22:31I'll blow out
22:32you slowly.
22:33I'm sure you will.
22:35Okay?
22:36Here we go.
22:37Here we go.
22:37Sharon and I
22:43both have
22:44seen some
22:45tough times
22:46in our life
22:46and I think
22:47we share
22:48a commonality.
22:49I mean,
22:50she's from
22:50a working class
22:52family.
22:57I'm able to
22:58relate my
22:59experiences to
23:00her and
23:01get some
23:02kind of
23:02reality testing
23:03and some
23:05feedback that
23:05I trust
23:06and I find
23:07this very
23:07invaluable,
23:08especially at
23:09a time in
23:10my life
23:10where things
23:11are changing
23:11so fast.
23:13That is awesome.
23:18I love
23:22surgery.
23:24I love
23:24doing surgery.
23:25It's a tremendous
23:26amount of fun
23:27and very
23:28gratifying.
23:29Thanks.
23:30Nice to see you.
23:31And you.
23:32How's everything
23:33going this morning?
23:34Pretty well.
23:34Pretty well.
23:35The pain's
23:35pretty good
23:36under control
23:38and I'm
23:38getting anxious
23:39to get it
23:40over with.
23:41I bet.
23:41Are you going
23:42to be an
23:42observer?
23:43Are you going
23:43to...
23:44I'm going
23:45to be an
23:45assistant.
23:46Oh, I see.
23:47I'll probably
23:47just be the
23:48person standing
23:49there handing
23:50Dr.
23:51Do something
23:51or being an
23:52extra hand.
23:53Mrs. Kidder,
23:54who's a 68-year-old
23:56woman, developed
23:57pain in her hip.
23:58While they were
23:59working that up,
23:59they found out
24:00that she had
24:01cancer and
24:02that it had
24:02invaded the
24:03bone of her
24:04hip.
24:04So about
24:05five or six
24:05months ago,
24:06they replaced
24:07her hip.
24:08Today what
24:09we're going
24:09to do is
24:09we're going
24:10to go in
24:10there and
24:10put in
24:11some plates
24:11and some
24:12cement to
24:14prevent her
24:15from actually
24:16breaking her
24:16leg, doing
24:17something maybe
24:18as ordinary as
24:19just getting up
24:20out of a
24:20chair.
24:21Here's the
24:22patella, lateral
24:25shaft of the
24:26femur.
24:27Our incision
24:28is going to be
24:28coming down
24:29this way.
24:31I think it's
24:31a real privilege
24:32just being there
24:33to watch this
24:33stuff.
24:34There's nothing
24:35more dramatic
24:35and more
24:36curative and
24:38more decisive
24:39than surgery.
24:43If I did
24:44nothing but
24:45stand there
24:45and hauled
24:46a retractor
24:47or just stand
24:48there and
24:48watched, I
24:49would really
24:50find it
24:50rewarding.
24:52The harder
24:52the bone
24:53the better
24:53for her.
24:55People
24:56think of
24:57medicine like
24:58to think that
24:58you have to
24:59be exceptionally
25:00smart to do
25:01medicine.
25:02It's really
25:02not the case.
25:03What is the
25:04case is you
25:05can't be stupid
25:06and do medicine.
25:08You can't be a
25:08klutz and be a
25:10surgeon.
25:10But if you're
25:11reasonably well
25:12adept or you're
25:13reasonably bright,
25:14then you can do
25:15either one.
25:17Actual reason
25:17for having medical
25:18students in the
25:19operating room is
25:20so that they can
25:20do this kind of
25:21work.
25:21Tighten the
25:22screws.
25:23It's all
25:23dog work.
25:26Now remember,
25:27this is the
25:27one with the
25:28locking.
25:29Right.
25:29So we don't
25:30want to damage
25:30those threads
25:31going through
25:31there.
25:32So don't
25:32use the
25:32drill guide.
25:33Don't use
25:34the drill guide.
25:38This drill bit
25:39will take
25:40those threads
25:40with it.
25:41Beyond the
25:42shadow of a
25:42dab.
25:44Okay, let's
25:45get the
25:45smaller drill
25:46bit ready.
25:46Meanwhile,
25:47we'll get
25:48that.
25:48That's very
25:48intense work.
25:50Seriously,
25:50you're
25:50concentrating
25:51every single
25:51minute you're
25:52in the
25:52OR.
25:53Unlike in
25:53medicine or
25:54a lot of
25:54other things
25:55where you spend
25:55a lot of time
25:56around the
25:56hospital just
25:57kind of talking
25:58to the nurses,
25:58having a coffee
25:59break.
26:00I mean, when
26:00you're in the
26:00OR, even when
26:01the patient is
26:02fully stable, you
26:03need to be
26:03watching them
26:03on the nerves.
26:04listen, it's
26:05like driving on an
26:07icy road for
26:08five hours.
26:09Absolutely.
26:10Did a good
26:10job, Tom.
26:11Boy, I'll
26:12tell you, now
26:12that we're
26:12fourth years,
26:13we're doing a
26:14lot of stuff.
26:16You were
26:16great, man.
26:17You got that
26:18PA line and
26:19everything like
26:19that.
26:19That's really
26:20good.
26:20That's a
26:20tough.
26:20Who would
26:21have dreamed
26:21last year that
26:24you'd be
26:25closing up and
26:27I'd be able to
26:29do the lines?
26:30That's really
26:31good.
26:31We've come a
26:32long way.
26:33I'll say we
26:34have.
26:35It's a really
26:35good little.
26:35We've had a
26:36lot of help,
26:36too.
26:38My therapist
26:39in medical school
26:40told me medical
26:41training is a
26:42marathon.
26:42I don't have
26:43one.
26:43No, you
26:44don't have
26:44one.
26:44Thanks.
26:45I'm not letting
26:45you graduate.
26:46It's not a
26:47race, it's a
26:47marathon.
26:48You just have
26:49to keep going,
26:50showing up every
26:51day.
26:51As soon as you
26:51get through one
26:52hurdle, there's
26:52another one.
26:53Sparrow
26:54Hospital, Lansing,
26:55Michigan.
26:55Miss Lefebvre,
27:02can you hear
27:02me?
27:04How are you
27:04feeling?
27:06Bad.
27:08In terms of
27:08medicine, I came
27:10out of medical
27:10school knowing
27:11nothing.
27:13She's over
27:13130, I probably
27:14want to hydrate
27:15her, but I'm
27:16just wondering
27:17how you feel
27:17with that on.
27:19People say,
27:19this is your
27:20doctor, and
27:21you are the
27:22patient's doctor.
27:23You shouldn't
27:25be, but you
27:26are, and this
27:27person is going
27:28to tell you all
27:30the things that
27:31should lead you to
27:32understand their
27:33disease, but you
27:34really don't have
27:34a prayer of making
27:35heads or tails of
27:36it.
27:36They might as
27:36well be telling
27:37somebody next to
27:38them in the
27:39subway or
27:39something.
27:40Don't they
27:40clamp down
27:41peripherally?
27:43You think we
27:43could turn down
27:44her W-trex a
27:45little bit?
27:46She's at 10?
27:48My first month
27:49or so back there
27:50at Sparrow
27:51Hospital was just
27:52terrifying for
27:53me.
27:53Now we're on to
27:54our fluid.
27:55I want flush,
27:56right?
27:57You want flush
27:58that's coming out
27:58of this.
27:58I learned most
27:59of it from the
28:00nurses.
28:02I just think the
28:04two hours seem
28:04like too long.
28:06Sounds reasonable
28:06to me.
28:07Okay, we'll try
28:08it.
28:08I think we
28:09have two
28:10ears.
28:10This is the
28:11code beeper.
28:14If something bad
28:15happens to
28:16somebody, Dr.
28:18Motz and I are
28:18supposed to be the
28:19first people to
28:19respond.
28:23code gets
28:24called,
28:24someone's heart
28:25stops.
28:26In general,
28:27it means someone
28:27requires emergent
28:29care.
28:30Someone's dying.
28:31Hi.
28:31Hi, I'm the
28:32code team
28:33intern.
28:34Who's in charge
28:35here?
28:36This is a cardiac
28:37rehabilitation patient.
28:38She's 67 years
28:39old.
28:40She's been in the
28:41rehab program
28:41roughly two weeks.
28:43She was exercising
28:44on the treadmill
28:44about two and a
28:45half miles per hour
28:46and she developed
28:47some PBCs on the
28:48monitor.
28:49She then went
28:51into this rhythm
28:52and I call the
28:53code.
28:53This is what
28:54she's doing?
28:54Yes, that's
28:55what she's doing.
28:55That looks like
28:56a wide-complex VTAC.
28:57Do you have a pulse
28:58there?
28:58Can you stop
28:58for just a second?
29:00Check a pulse?
29:01No pulse.
29:02I'm using this.
29:03There you go.
29:04Okay, can you
29:05read that over?
29:05This ain't no party,
29:06this ain't no disco,
29:07this ain't no fooling
29:08around, this is like
29:09the real deal.
29:10People are really sick
29:11and if you can't do
29:13it on a dummy,
29:15well, you can't do
29:15it on a person.
29:17Can someone pound
29:17on her chest?
29:19Okay?
29:20So today what we
29:21have was a training
29:22exercise where we
29:23responded to the code
29:24and instead of it
29:25being a patient,
29:26it was a special
29:27mannequin that's made
29:28for doing these
29:29resuscitations that
29:30gives you a rhythm,
29:32like a heartbeat,
29:33so that you can see
29:34it on a monitor
29:34and you can apply
29:37paddles to it.
29:38And then we have
29:38a dummy that we
29:39can put breathing
29:40tubes in.
29:41I'd like other
29:42RTS.
29:42Do you want to know
29:43what her blood
29:43pressure is?
29:44Yeah, do I have
29:45a pressure?
29:45Have we got the
29:46Lido drip going?
29:47It's coming.
29:49I thought it was
29:49a tough intubation.
29:50It was.
29:52She's a tough girl.
29:53She's really
29:54wrong with treadmill.
29:55That's good.
29:55Yeah, right?
29:56That's good.
29:58Okay.
29:59Well, thanks, folks.
30:00Yeah.
30:01Appreciate it.
30:02Great.
30:03Should we clean
30:03up our mess?
30:05We never have
30:06to do that part.
30:06My mom told me
30:08to clean up
30:08my mess,
30:08but okay.
30:09does that pill
30:28make your neck
30:29feel any better?
30:32It's Pearson.
30:33Are you comfortable?
30:36My mom is
30:37comfortable, yes.
30:38What hurts?
30:40Everything.
30:41Everything hurts.
30:48Are you having
30:49trouble breathing?
30:51No.
30:51These are the worst
31:03blood gases I've ever
31:04seen.
31:05Maybe other people
31:06have seen worse
31:07ones, but I never
31:08saw a living person
31:09with gases.
31:10That bad.
31:13Yikes.
31:15See this delay?
31:17It's lengthening.
31:18It's getting longer
31:19in between beats.
31:20Look at that delay.
31:22So these delays
31:23will probably just
31:24keep getting longer
31:25and longer,
31:26over a gradual
31:26period of time.
31:28Over a gradual
31:29period of time.
31:30And then one time
31:31the delay will just
31:32last a real long time.
31:36Took good care of us,
31:37didn't you, Ma?
31:38Well, I tried.
31:40Yeah, you tried.
31:41You did a pretty good job,
31:42we think.
31:44You're feeling a little
31:44rough right now,
31:45though, aren't you?
31:45We can make her
31:49comfortable,
31:50that's all we can ask.
31:51Tough old bird,
31:52aren't you?
31:52What?
31:53Said you're a tough
31:53old bird,
31:54aren't you?
31:54Yeah, I'm a tough
31:55old bird,
31:56is right.
31:58Well, quite frankly,
31:59the lady is trying
32:00to die.
32:03But,
32:04and there's a
32:05no,
32:06do not resuscitate
32:07order in the chart,
32:09but my understanding
32:10is that the wishes
32:11of the patient
32:12and the family
32:13were that she'd
32:14get all the medical
32:16treatment available.
32:18She doesn't want
32:19to be shot.
32:21She doesn't want
32:21to be intubated.
32:23Put her on a ventilator
32:25right now,
32:25would keep her alive,
32:27but she'd never come off.
32:29She'd be on a ventilator
32:30forever.
32:31Too accurate.
32:32How you doing?
32:34You gotta speak up.
32:35So we're going to give
32:36you a little bit
32:36of morphine,
32:37and I think that
32:38might make...
32:39Pardon me.
32:40You're very good.
32:41Oh, I'm sorry.
32:41We're going to give
32:42you a little bit
32:42of morphine,
32:43just a little bit,
32:44and it might make
32:45you a little more
32:46comfortable.
32:46I still can't hear them.
32:48I'm going to give
32:48you a little morphine,
32:50and that might make
32:51you a little bit
32:51more comfortable.
32:53Yes, it might.
32:54You want some?
32:55Might very last.
32:56Okay.
32:58I was born C-section,
33:00and nobody had
33:01any problems
33:02helping me come
33:03into this world,
33:04and I don't know
33:05why anybody should
33:05have any problem
33:06helping me leave it
33:07if I need it.
33:08We can use
33:09all this technology
33:10to keep neonates
33:11alive.
33:12As far as I'm
33:13concerned,
33:13dying is just
33:14as big a part
33:14of living
33:15as is being born.
33:17And very often,
33:19just like when
33:19you're at birth,
33:21some of us need
33:21help.
33:22Some of us need
33:23help to die,
33:23and I hope
33:23someone will be
33:24there to give me
33:25that help
33:25when it's my time.
33:28You okay?
33:29One thing
33:29after the other,
33:30huh?
33:32Mrs. Pearson
33:33clearly looked
33:34like she was
33:34going to die
33:35that night.
33:36We gave her
33:36some morphine
33:37to make her
33:37comfortable,
33:38but morphine
33:39is a really
33:39wonderful drug.
33:40It also helps
33:41people that are
33:42in congestive
33:42heart failure.
33:43So it not only
33:44made her comfortable,
33:45but it also cleared
33:46her up a little bit,
33:47and she was able
33:47to hang on
33:48for another month.
33:49I saw her son
33:51about two months
33:53after that night,
33:54and he told me,
33:55and he thanked me
33:56very much,
33:56and said,
33:57gee, isn't it
33:58something we all
33:59thought she was
33:59going to go that
34:00night, but indeed,
34:01it was a month
34:01later until she
34:02finally passed.
34:19I love it here.
34:21And this is
34:22the American dream,
34:23is middle America.
34:25I mean,
34:25it certainly isn't
34:25the cities.
34:28It's really nice,
34:29and it's very
34:31affordable, too.
34:32I mean,
34:33I pay half the rent
34:34here that I paid
34:36in Boston,
34:37and I live in the
34:38nicest place I ever
34:39lived in in my life.
34:40We have a yard.
34:42Garage.
34:42Garage.
34:44Everything.
34:45Everything's easily
34:46accessible,
34:46no traffic.
34:48It's just great.
34:49It's like,
34:50it's like I died
34:51in Guam,
34:51the heaven.
34:52I've been interested
35:01in firearms
35:02all my life.
35:04I'm not a hunter.
35:06I don't really have
35:07anything against hunters,
35:09but owning the guns,
35:11buying the guns,
35:12having them,
35:13and, you know,
35:14playing with the
35:14ammunition,
35:15and just the excitement
35:16of going out to a
35:17place where you can
35:18shoot up cans
35:19or targets,
35:20I mean,
35:20that's what I like.
35:22Safe gun is a gun
35:23pointed in a safe
35:24direction.
35:25Okay.
35:26This is just kind of
35:26something that
35:27everybody should have.
35:29You know,
35:29this is a little
35:30Smith & Wesson 38.
35:32I put some pearl
35:33handles on it
35:34because I thought
35:35Sharon would like that,
35:36and this is really
35:36a good gun,
35:38you know,
35:38for her.
35:39It's her size.
35:40The 38's got
35:41mild recoil.
35:42I think she's more
35:43comfortable shooting
35:43it than the big 45.
35:52I definitely feel
35:56like a doctor
35:57in the sense that
35:58I regularly go
35:59without sleep
35:59for long periods
36:00of time,
36:01and I don't think
36:02anything of it.
36:03Like, it doesn't
36:03hurt me anymore.
36:04I get impatient a lot.
36:06I don't let it out,
36:07but I mean,
36:08like, when I'm not
36:08in the hospital
36:09and I'm, like,
36:10standing in a line
36:10or something,
36:11or, you know,
36:12I get a busy signal
36:13on the phone,
36:14or I want something
36:15done,
36:15and it's like,
36:15I want it now.
36:21Divorced.
36:22Another casualty.
36:24Yeah.
36:25I don't blame
36:25medicine for it.
36:26I think the marriage
36:27probably would have
36:28ended in divorce anyway.
36:31If anything,
36:32I think being in medicine
36:33perhaps prolonged it
36:34because I wasn't
36:35spending a lot of time
36:36with my wife,
36:38so we weren't able
36:39to address problems
36:41as rapidly
36:42as we probably would have
36:43if I had more time
36:44and wasn't doing
36:44your residency.
36:47This is Karen,
36:48the third in series,
36:50and, well,
36:54we met about
36:55a year ago.
36:56A year and a half.
36:57Almost a year and a half.
36:59Oh, a year and a half.
37:00Time flies
37:00when you're having fun.
37:04I'm two years
37:05out of my residency,
37:07and I'm preparing
37:08for the oral boards.
37:11Welcome to this.
37:12Hey.
37:12Hey, Dwight.
37:13How you doing?
37:14How you doing?
37:14Any room, Dwight?
37:15Yeah, how you doing?
37:17Good.
37:17Good.
37:17Good.
37:17Good.
37:19All right.
37:21It's going to be
37:21a couple of hours.
37:22The oral boards
37:23are case-based scenarios
37:25where you can encounter
37:27anywhere from
37:27one to three patients.
37:30We can treat your pain,
37:32sure.
37:32Let me just do
37:33a quick physical exam
37:34on you first.
37:35All right.
37:35The patients are presented
37:36to you by an examiner
37:38who actually will take
37:39on the role of the patient
37:40or give you
37:41any information
37:42that you need
37:43about labs
37:43or x-rays
37:44or stuff like that.
37:45No, there's no rash.
37:46Okay, what would you do next?
37:47No rash.
37:49Neurologic exam.
37:49Ma'am, we're going to
37:50just put a monitor on you.
37:51I'm going to give you
37:52some oxygen.
37:52I'd like to give her
37:53four liters nasal cannula,
37:55and I'd like to start an IV.
37:56I'd like to look at her.
37:57Mrs. White is pretty upset.
38:00He wants to...
38:00If you can stabilize them
38:01successfully and prepare
38:03to hand them off
38:04to the appropriate
38:05subspecialist,
38:06then you get to be
38:07an emergency doctor.
38:08I'd like to ask you,
38:09has she been acting
38:10funny lately?
38:11Even though I am prepared,
38:13better people than me
38:13have fallen at this late date.
38:15Well, thank you, doctor.
38:16Your examination is now over.
38:19Great.
38:20I didn't get labs
38:21on a bunch of stuff.
38:22That's okay.
38:23That's all right.
38:25Today is the day
38:26for the oral boards.
38:27It starts in about
38:2845 minutes.
38:30Hopefully, I won't be late.
38:32And the one thing
38:33they'll say is,
38:34boy, he wasn't too smart,
38:35but he had good hygiene.
38:38Karen and I
38:39are much more similar
38:40than any of my
38:41previous relationships.
38:43Also, I think
38:43Karen and I both
38:45have gone through
38:46periods of growth.
38:48It wasn't long
38:49before we knew
38:49that we were destined
38:50to be together.
38:51I think we're done.
38:52I think we're adults.
38:54The intelligence,
38:55the brilliance
38:56is a real turn-on.
38:58I can't get enough of it.
39:00What you see
39:00is what you get
39:01for both of us.
39:03Sometimes, I guess,
39:04maybe if I were
39:05on the outside
39:05looking,
39:07I might think,
39:09gee,
39:09he seems to be
39:11the priority
39:12and Karen's getting
39:13overshadowed,
39:14but I don't feel
39:16like that right now.
39:17I'm okay with that
39:18because this stuff
39:20is important
39:20and I want to be supportive.
39:22All the trappings
39:22of civility.
39:24Mm-hmm.
39:32Wow.
39:33So how was it?
39:34Well, I think
39:36it'll be a lot easier
39:37next year.
39:40You know?
39:41No, I know
39:42what mistakes I made.
39:43They were all
39:44just stupid mistakes
39:45that were just
39:46either test anxiety
39:48or maybe a little
39:48residual tiredness
39:49or something like that.
39:51It's like I said,
39:52I mean,
39:53they may be enough
39:53to fail me,
39:54but I feel confident
39:55if I took the test again.
39:57If I could take it
39:58all again right now,
39:59I'd do fine.
40:00And I will see.
40:05It's not strictly
40:06a redneck town
40:07or something.
40:08It's a university town.
40:09It's got the best of both.
40:11And, you know,
40:11they're nice to you
40:12even if you didn't
40:12come over on the Mayflower.
40:13A nice thing
40:16about working here
40:17in Bloomington,
40:17in bigger cities,
40:19in the emergency department,
40:21you don't get to know
40:22your patient stuff,
40:23but I see my patients
40:25here around town.
40:26People go,
40:26hi, doc,
40:27thanks for taking care of me,
40:28blah, blah, blah.
40:28And that's real nice.
40:30It really is.
40:31It's very nice.
40:39Living room.
40:41This is my office.
40:43I didn't have this
40:48in medical school.
40:50And that's all
40:51National Forest out there.
40:53That's Hooser National Forest.
40:55So this is going to be here
40:56for a long time
40:57and so am I.
40:59Yep.
41:05When I was in medical school,
41:07my therapist advised me
41:08against getting tattoos
41:09or growing your hair
41:10or doing anything like that.
41:11He thought it would cause
41:14me too much anxiety.
41:15Probably right.
41:17Now that I'm no longer
41:18so concerned about being
41:20the good resident
41:20or the intern
41:21or the physician,
41:22I can be myself.
41:23I can just be Tom
41:24and I happen to be
41:26a physician too.
41:26You know,
41:29doctors hate tattoos.
41:32That's one of the things
41:33I like about them.
41:35They hate them.
41:35They hate patients
41:36that are tattoos.
41:37They have something
41:38called the tattoo-to-tooth ratio
41:40where if you have
41:41more tattoos
41:42than you have teeth,
41:44you probably can't kill them.
41:45There you go, man.
41:51It's all done.
41:51All right.
41:52Hey, thanks.
41:54Appreciate it.
41:55You're the man.
41:57Yeah.
42:02Dr. Gerard,
42:03I don't know
42:04where the heck he's at,
42:05but it's Sarah
42:06and she's slit her wrists,
42:08not side to side,
42:09but up and down.
42:10You know,
42:11like she's really trying
42:12to do something.
42:12It's the beginning
42:15of the morning.
42:17It's 11.30.
42:21And we're just
42:22coming to work.
42:25In my years of practice now,
42:27I've seen all the ranges
42:28of extreme tragedy,
42:30extreme joy.
42:32It's been my privilege
42:33to have had a life
42:35that's allowed me
42:36to experience
42:36all these wonderful aspects
42:38of being alive
42:40and being human.
42:41and I can't think
42:42of anything more beautiful
42:43or anything that's grounded
42:44me so much in my life
42:46as being a doctor.
42:52Dr. Turner,
42:52we're not real sure on you.
42:55Here's the scoop.
42:56A 35-year-old female
42:58found alongside the roadway
43:00following in front
43:01of a vehicle
43:02due to a faulty door
43:03approximately 40 to 45 miles
43:05an hour.
43:06Hi, ma'am.
43:07I'm Dr. Turner.
43:07How are you?
43:08Yes.
43:09Can you hear me?
43:10One IV established
43:11the first thing
43:12I always want to know
43:13is can they speak to me
43:14and if they can speak to me
43:15I know they have
43:15a fairly good airway.
43:17And then I assess
43:18their breathing,
43:19you know,
43:19are they breathing
43:20in a labored fashion
43:21or in a very fast fashion.
43:23You know,
43:23you can do this
43:24just looking at them.
43:25She did walk.
43:26What's that?
43:27First,
43:27her door went
43:28flying open
43:29and she went sliding
43:31hit her head
43:33on the concrete.
43:34Does your neck hurt you?
43:36Yes?
43:38Oh, my back.
43:39Sorry.
43:42And then you usually
43:43look at their fingernails
43:45and stuff like that
43:46when I'm shaking their hand
43:46and I can assess circulation
43:48or are they really pale there?
43:50You know,
43:51I can do all that
43:51in the first three seconds
43:52that I see them.
43:53That's basically just
43:54hello and a handshake.
43:55Do you take any medicine?
43:56If there's anything wrong
43:57with any of those,
43:57you've got to cut to the chase
43:59and fix that
44:00before you do anything else.
44:04CAT scan revealed
44:05some fairly extensive injuries.
44:07It showed that she had
44:08developed a blood clot
44:09around her aorta,
44:10one of the big arteries
44:12that leads straight
44:12out of the heart
44:13and pumps blood
44:14to everything.
44:15And if your aorta blows,
44:17your chances of surviving
44:18are just about zero.
44:22We're going to get
44:22a cardiothoracic surgeon
44:24in here so that
44:24if she suddenly
44:25goes down the tubes,
44:27we have a chance
44:28of performing
44:28an emergency chest surgery.
44:30Do you care to come on in
44:31and take a look at her?
44:32Opening her up
44:33and potentially
44:34saving her life.
44:35Thanks very much.
44:40Now, ma'am,
44:41in order to get your lung
44:42to reinflate,
44:43we're going to have
44:44to put a tube
44:45in your chest, okay?
44:46Now, what I'm going to do
44:47is I'm going to put
44:48a lot of numbing medicine
44:49in there,
44:49but we're going to need
44:50to do that
44:51because your lung
44:51is collapsed
44:52and it's probably
44:53what's causing
44:54your blood pressure
44:55to go kind of low,
44:56all right?
44:57Okay.
44:57It's not a pleasant
44:59procedure.
45:00It's not something
45:00that you, you know,
45:01want to just have
45:02done for fun,
45:03but when you need it,
45:05you certainly need it.
45:08Might feel
45:09a little pressure here now.
45:10This is going to hurt
45:10just a little bit,
45:11okay?
45:11Ready?
45:12Here we go.
45:14Sorry.
45:14Oh, my God.
45:15In a patient like this,
45:17if she was to go
45:18downhill
45:19and we needed
45:20to put her on a ventilator
45:21to breathe for her,
45:23if we did that
45:24without putting
45:24in a chest tube,
45:25it would probably
45:27kill her.
45:28Please stop.
45:29Oh, my God.
45:33Oh, my God.
45:34You can hook this up.
45:35Oh, my God.
45:36Right here.
45:37Oh.
45:38She's got it.
45:39The chest tube
45:40in this lady
45:41and her hemoglobin
45:42and vital signs
45:43at least temporarily
45:44stabilized,
45:45the only thing to do
45:46is really watchful
45:47waiting until
45:48the angiography team
45:49and the surgeon
45:50get here.
45:51So I'm going to go
45:52take care of some
45:53of the other patients
45:53who are clearly
45:54less urgent than she is.
45:56Ah.
45:57Ah.
45:58Good.
45:58Yeah, it looks
45:58a little red back there,
45:59but there's no pus.
46:00That's a real good thing.
46:01Yeah.
46:02No pus.
46:03She's got conjunctivitis there.
46:06Pink eye.
46:07Oh, that's good.
46:08Close up.
46:09Oh, that's good.
46:09Okay.
46:13It looks like
46:14you got some swelling here.
46:15Has anybody ever figured out
46:16what this swelling's from?
46:16Uh, I've got
46:19What have you got?
46:25Uh, see
46:26Uh, see
46:29cirrhosis.
46:34Blood pressure is
46:35134 over 70.
46:37When was your last drink?
46:39I'll go ahead
46:40and try to draw.
46:40About two,
46:41two hour,
46:42how much do you drink a day?
46:45Do you drink
46:46a couple of six packs
46:47a day?
46:48Yeah.
46:48Okay.
46:50Okay.
46:52Mm-hmm.
46:53Hi there.
46:54I'm Dr. Tartar.
46:55How are you?
46:57Can I take a peek
46:58at your fingers?
46:58I love this.
46:58This is great.
47:00I want some water.
47:01Okay.
47:02Can I just take a peek
47:02at this, though?
47:03I'm the doc.
47:04Let me see
47:04if I can help you.
47:06You don't have to.
47:07Don't look.
47:07Close your eyes.
47:09Okay.
47:10Do we have the other piece?
47:11Yes.
47:11Uh, yes.
47:12Got a glove on?
47:13Grab that.
47:14Are you in a lot of pain?
47:15Yeah,
47:16not,
47:17I mean,
47:17I've,
47:18Okay.
47:19Yeah,
47:20I'm,
47:20but I can,
47:22Okay.
47:22What'd you do there?
47:23What'd you catch it?
47:24She fell down
47:25and there was a wooden
47:26spool down there,
47:27one of those big cable spools,
47:28and somehow,
47:29when she came up,
47:30that was off.
47:31I relate with you.
47:32Your son,
47:33there's a little ethanol
47:33going on,
47:34so we're not exactly clear
47:35on how it happened,
47:36but that's as good
47:37as we can figure.
47:38You broke one of your ribs,
47:54okay,
47:54and that's probably
47:55what's hurting you real bad,
47:56is your ribs broken.
47:58When people come in
47:59with minor ailments,
48:00most of the time,
48:01it doesn't really matter
48:02what the physician does.
48:04That hurts right there a lot,
48:05because they're going to get over
48:07that minor ailment.
48:08You know,
48:08if you come in
48:09with a sprained ankle,
48:11there's very little
48:12that I can do
48:14to stop that
48:15from getting better.
48:16Hurts there?
48:17Yeah,
48:17that's where it hurts
48:18the most up in here,
48:19more than over here.
48:21I mean,
48:21it would be hard
48:22for me to make it
48:23turn into a chronic condition
48:24or something like that.
48:25I'd really have to give you
48:26some seriously bad advice.
48:28So,
48:29the fact is
48:30that this sprained ankle
48:31is going to get better.
48:32Now,
48:32I can put you in a splint
48:35and give you crutches,
48:35and give you some Motrin
48:37or something,
48:39and then when you get better,
48:40you can tell everybody
48:41what a wonderful doctor I am
48:43and how good medicine is.
48:44Or,
48:45I could not do those things
48:48and dance around you
48:49with a mask and a rattle
48:50and do that every day
48:52for two weeks.
48:54And two weeks from now,
48:55your ankle will be better.
48:56And we can say
48:57it's because of the mask
48:58and the rattle,
48:58you know.
49:01You know,
49:01a lot of this stuff
49:02really is
49:03just people healing themselves.
49:05It's just the body
49:06doing what it does.
49:09I wish my body
49:10would heal itself.
49:11I'm really paying
49:12for all those years
49:13as a competitive weightlifter.
49:15I feel like I'm falling apart
49:16like a cheap suit.
49:18I had this knee replaced.
49:20I had that one replaced
49:21at the same time
49:22as this one.
49:23I had two discectomies
49:25right there
49:26where I blew two discs
49:27from weightlifting.
49:28And then I've,
49:29you know,
49:29just torn and broke
49:31all kinds of things.
49:31I broke my neck once
49:32in a bike wreck
49:33and I broke my leg
49:34and have a rod
49:36in my whole leg
49:36from kickstarting my bike.
49:38I tore my bicep
49:39pretty good
49:40from when I was
49:41a powerlifter.
49:42I'm an old
49:43dilapidated wreck.
49:46There's very little
49:46that still works.
49:47This whole thing here
49:48is pneumo-mediastatic.
49:49It's pneumo-peracar.
49:50So this lady
49:51fell out of the car.
49:53So what we have to do
49:54at this point
49:55is we have to further study
49:57the nature
49:57of her aortic injury.
49:59How are you doing?
50:01Now the question is
50:02is that blood clot
50:03sealed off
50:03or is it bleeding?
50:04And in order to do that
50:05we need to really
50:06take a look
50:06at a flow
50:07or dynamic type study
50:09where we put some dye
50:10in the aorta,
50:11let the dye flow through
50:12and see if it leaks
50:13out into the chest.
50:18Fortunately in this case
50:19her aorta's okay.
50:23One of the things
50:24that we really have to do
50:25in the emergency department
50:26is play patient advocate
50:27and simply act as a liaison
50:30between the various specialists
50:31who sometimes see things
50:33just in terms of
50:34one organ system
50:35or another.
50:37Then when we talk
50:38to these people
50:38in consultation
50:39very often
50:40they treat us
50:42with some amount
50:42of disdain
50:43because you know
50:44we don't know
50:45what they know.
50:47Arch is clean.
50:48Good.
50:49Is everything else okay?
50:50Yeah.
50:52Great.
50:52She doesn't have
50:53much of an ear leak
50:53did she ever?
50:54No.
50:57However
50:58when things go wrong
51:00when the patient
51:01starts to get sick
51:01and starts to die
51:02who does every
51:03specialist want
51:04around an emergency doc
51:05because that's
51:06what we do.
51:07That's what we do best.
51:10It doesn't hurt
51:10anymore after that.
51:12Oh man.
51:13Sorry.
51:13I think you've been
51:14through it all now.
51:17It's hard.
51:17You just want to...
51:18Which one's worse
51:18that or that chest tube?
51:21I forgot about
51:24the chest tube.
51:25You did?
51:25Good.
51:25I like that.
51:26Keep forgetting about it.
51:27I see.
51:28Let me just sew your head up.
51:29I'll have it sewed up
51:30and then you'll be free
51:31of me anyway.
51:34I just did the first
51:36stitch and didn't even
51:36feel it.
51:38Being a patient
51:39so many times
51:40has really allowed me
51:41to connect with my
51:42patients.
51:43You just use the
51:44regular stuff that
51:45you take out
51:45less chance of infection.
51:48When one of my
51:48patients is hurting
51:49I really know firsthand
51:50how that feels.
51:51Okay.
51:53Sure.
51:54Does it hurt you much
51:55in here?
51:57Yeah.
52:05I enjoy a cup of coffee.
52:08I enjoy sitting here.
52:09I enjoy the cool breeze.
52:10I enjoy my comfort.
52:11I enjoy the fact that
52:13right now I'm not hot,
52:14I'm not cold,
52:14and nothing hurts.
52:16These things are
52:17wonderful luxuries
52:18that I definitely
52:20wouldn't enjoy
52:21if I wasn't
52:22constantly exposed
52:23to people who
52:24didn't have this.
52:25or I wasn't
52:25exposed to
52:26the person whose
52:27health is wonderful
52:29and they have
52:29the big aneurysm
52:30and they keel over
52:31and that's the
52:32end of their life.
52:32I mean,
52:33I could die
52:33right now.
52:35This could be
52:35my last sentence.
52:36And believe it or not,
52:38I'm kind of okay
52:39with that.
52:39I mean,
52:40I'm not suicidal.
52:41I don't want to die.
52:41I want to live forever.
52:43But hey,
52:45I mean,
52:45that's not the way
52:46it is and I'm okay
52:47with it.
52:48I am not going
52:49to be a person
52:50who says,
52:50gee,
52:50I wish I had done
52:51this.
52:52I've done a lot
52:53and I'm real happy.
52:55I'm real happy.
53:10Nova producer Michael Barnes
53:16has chronicled the lives of these doctors
53:18for 14 years
53:19how did he choose them
53:21what challenges did he face along the way
53:23go behind the scenes on Nova's website
53:26at pbs.org
53:28or America Online keyword
53:30PBS
53:40to order the three-hour Survivor MD special
53:52for $29.95 plus shipping and handling
53:55please call WGBH Boston Video
53:58at 1-800-255-9424
54:10Nova is a production of WGBH Boston