The Doctor Will See You Now Page 4

  But the exploitation is not all one-sided. Health care is also big business. There are hucksters in the pharmaceutical and hospital industries who understand the immense sales potential of television and doctors who, for reasons of greed or vanity, willingly cozy up to the camera. They may exaggerate the benefits or underplay the risks of pharmaceuticals and surgeries. Every medication or surgical procedure carries some risk, and by the same token, any infomercial, press release, or celebrity endorsement may carry a hidden agenda or misrepresentation.

  To a certain extent, the problem is that blurred boundary between medicine and show business. In the 1980s, a cough syrup commercial featured a soap opera actor intoning that now oft-parodied phrase, “I’m not a doctor, but I play one on TV.” That disclaimer was meant to prevent the public from getting the impression they were watching a physician’s endorsement. But television, with its insatiable appetite for content good and bad, has since co-opted the medical profession, with Dr. Oz as the poster boy.

  Moreover, like every successful long-running television show, Dr. Oz ultimately faces the same problem—diminishing quality. (The term jump the shark came from the popular 1970s sitcom Happy Days. After so many years on the air, it became obvious the show had exceeded its shelf life when Fonzie, the show’s star, waterskied over a man-eating shark.)

  Dr. Oz has done hundreds of hours of shows, and there are, after all, only so many ways to dispense reliable advice about scientific medicine and healthy living. Eventually his show must explore the neighborhood where snake oil salesmen reside, and avoiding that neighborhood becomes progressively harder with another show coming up soon.

  There is plenty to be learned about your health from television. But it is not to be confused with reality. Find a trusted physician or health care provider and discuss everything you hear about medicine on television. That’s the best way to get the straight story on treatments that can save your life—and allow you to avoid those that might harm you. It also keeps your doctors on their toes. Keep in mind that when you watch medicine or medical drama on-screen, show business wants to portray real life, but it is perfectly willing to sacrifice real life for the sake of entertainment. Caveat emptor.

  As for Dr. Oz, when he is at his best, he has helped countless people with his medical guidance. He has undoubtedly saved many lives and deserves appropriate credit for that. He remains a brilliant physician and, according to those who work with him, a superb surgeon. He is certainly without peer as a medical communicator. But when he looks in the mirror these days, does Dr. Oz ask himself the eternal biblical question, “For what shall it profit a man, if he shall gain the whole world, and lose his own soul?”

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  PHYSICIAN-JOURNALISTS

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  The first duty of the physician is to educate the masses.

  —SIR WILLIAM OSLER, MD

  MEDICAL STORIES—whether the subject is epidemic outbreaks, celebrity deaths, or the victims of distant wars and disasters—are surefire attention getters. For that reason, most major news organization have a physician-journalist on staff, and some are household names, such as CNN’s Sanjay Gupta, a neurosurgeon, and Richard Besser, a pediatric infectious disease specialist who in 2017 left his position as ABC chief health and medicine editor to become president and CEO of the Robert Wood Johnson Foundation. But when physician-journalists report medical stories, are they primarily reporters or doctors? Can they be both at the same time?

  These ethical questions arose when Dr. Gupta, covering a 2015 earthquake as part of the CNN news team in Nepal, performed an emergency neurosurgical procedure on an eight-year-old girl and then performed brief cardiopulmonary resuscitation on a second patient in a rescue helicopter. Both episodes were shown to audiences on television. At first blush is there anything wrong with showing audiences compelling footage of Dr. Gupta employing his medical skills to help save lives?

  There are two problems, one medical and the other journalistic. From a medical standpoint, showing the patients being treated on international television is technically a violation of medical confidentiality. In neither case was it likely Dr. Gupta obtained consent for filming the patients. According to the Hippocratic oath, “Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.” The principle of medical confidentiality doesn’t change, even if television wasn’t referred to in the ancient Greek oath.

  The second problem is one all journalists, especially those on television, face when covering a story. At what point does the reporter, instead of the subject, become part of the story or even the primary focus of the story? The drama of treating a patient on television is an ever-present temptation for the reporter or the network to use as a promotional vehicle, and the patient becomes nothing more than a prop being exploited (“Breaking news: Tune in at ten to see Dr. Gupta perform brain surgery!”). In the face of such self-promotion, any pretense of objectivity is lost. This doesn’t mean that an audience can’t see a doctor treating a patient or performing surgery. It means the doctor who is treating the patient should not be the same one who reports the story.

  In Nepal Dr. Gupta’s primary job was as a reporter, to describe conditions in the area ravaged by the earthquake. If patients needed emergency medical care that only Dr. Gupta was available to render, his obligation became to treat the patients, and at that point, he gave up being a reporter. But his crew should have turned off their cameras and not aired the footage of the treatment.

  The same issues arose during the 2010 earthquake in Haiti when Dr. Gupta examined and treated a baby with head trauma on camera, and Dr. Besser was filmed caring for a pregnant Haitian woman in labor. In those situations, both doctors came perilously close to becoming the subject of the stories at the expense of patients in extremis.

  Following the Haiti earthquake, Tom Linden, a physician and professor of medical journalism in the School of Journalism and Mass Communication at the University of North Carolina, proposed guidelines for physician-journalists. His first rule was that when there is no alternative in a life-threatening medical emergency, physician-journalists should act as doctors and treat the patient; their responsibility as reporters is secondary. When they do treat a patient, it should not be featured on television. In all situations any identifiable patient should give consent before appearing on television (and in the case of children, consent should be obtained from a parent or guardian). And there is a general presumption that any treatment by the physician should never be contingent on having the person consent to being on television.

  Dr. Linden’s rules are a sensible attempt to establish boundaries between the two roles of physician-journalists. Sometimes the line between those roles is not a bright one, and it is not always easy to see. In this respect, I am not beyond reproach. I regret I may have occasionally crossed the line at a patient’s expense in my writings and interviews. It is admittedly difficult to maintain the boundaries between the role as a physician and as a journalist. But it is incumbent on physician-journalists to recognize how important the separation is. Otherwise they put at risk their two most valuable assets—their integrity as physicians and their credibility as journalists.

  II

  HEROES AND VILLAINS

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  IN PRAISE OF FIRST-RATE MEDICINE

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  At a given instant everything the surgeon knows suddenly becomes important to the solution of the problem. You can’t do it an hour later, or tomorrow. Nor can you go to the library and look it up.

  —JOHN KIRKLIN, MD

  LET US NOW PRAISE FAMOUS MEN AND WOMEN: the paramedics and medical professionals who performed heroically after the 2013 Boston Marathon bombings. Despite the efforts of cold-blooded killers who constructed antipersonnel devices packed with ball bearings and nails designed for maximum lethality, there were only three deaths from the bombings among more than
260 victims. That is amazing.

  How did the Boston medical community achieve such remarkable results? It began with the coordination between first responders and hospitals, working with lessons learned from military medicine. The treatment of hemorrhage and shock has been refined incrementally from World War II to Korea, Vietnam, and finally the Gulf Wars. Military surgeons have observed that rather than immediate wound repair in the field, more lives are saved by emphasizing rapid control of bleeding at the site followed by stabilization and transport for definitive surgery. This was the primary focus at the marathon site.

  Next, the triage at the medical centers was excellent. It is an underappreciated skill to rapidly sort out the seriously wounded requiring immediate surgery from those who need urgent but nonsurgical attention from the less urgent walking wounded. The doctors and nurses in the emergency departments performing triage must think fast and use quick judgment; errors at that stage are frequently fatal. When the marathon casualties arrived, the medical teams performed superbly.

  The small number of deaths also speaks to the quality of surgery performed on those who survived the explosions. In the case of bombs like those detonated at the Boston Marathon, blast injuries are a frightening amalgam of blunt and penetrating trauma, burns, and wounds from shrapnel composed of dirt, metal, nails, and ball bearings, along with clothing and bone (sometimes from other victims). The three unfortunate marathon fatalities were in the early period, and the fact that the subsequent fatality count did not rise means there were no delayed, fatal surgical misadventures or infections. Remember, all this occurred amid the confusion of hospital mass disaster responses.

  Having participated in and coordinated hospital mass disaster responses in Chicago, I can testify that the best of these are often little more than controlled chaos. It is always extremely difficult to account for large numbers of unanticipated admissions. Many victims are admitted without identification, and because of injuries are unable to identify themselves. Patient charts often get misplaced, and keeping track of everyone involved is difficult. (One of the young women who died in the marathon bombing was initially misidentified to her family as being alive.) These problems become exponentially more difficult with investigating law enforcement officials, hordes of reporters, worried family members, and curious onlookers besieging the hospital.

  Finally, no experienced medical professional with humility would discount the role of serendipity when lives are saved. Since the marathon is a significant civic event in Boston, there were extra first aid stations, less vehicular traffic, and more medical personnel available than on a normal day. Most of the victims were young and thus better able to withstand serious injuries than those at the extremes of age. Finally, the nature of the explosions was such that the force was concentrated low to the ground. The blast injuries were primarily to lower extremities, devastating to be sure but not as prone to inflicting life-threatening damage as those to the torso, chest, or head.

  Unfortunately, the blast injuries to the lower extremities resulted in extensive limb damage, in many cases necessitating amputation. Here again the knowledge gained and techniques perfected in battlefield care have spread to civilian medicine. Limb injury and amputation have been one of the most common results of the use of the improvised explosive device (IED) by the enemy in Iraq and Afghanistan. However, the same human ingenuity that creates weapons of combat and the capacity to kill also discovers ways to heal and save lives. Now amputees can be fitted with state-of-the-art prosthetics made from high-tech plastics and metal alloys. Using microprocessors and hydraulics, these sophisticated prosthetics employ sensors that react to electronic impulses from intact muscles. One day soon, amputees may be able to move a prosthetic limb simply by concentrating on the movements.

  To paraphrase Winston Churchill, for the medical victims of the marathon bombing, this is not the end or even the beginning of the end, merely the end of the beginning. They and their families will forever live with devastating physical damage and psychological trauma. As a society, we must offer these people our ongoing care, compassion, counseling, opportunities for employment, and most important our understanding. For the first responders and medical personnel who did such a magnificent job treating the casualties on Patriots’ Day, the appreciation and gratitude owed to them is immeasurable.

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  THE GHOSTS OF COOK COUNTY

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  The lawn

  Is pressed by unseen feet, and ghosts return

  Gently at twilight, gently go at dawn,

  The sad intangible who grieve and yearn. . . .

  —T. S. ELIOT

  THE OLD COOK COUNTY HOSPITAL BUILDING, built in 1914, stands partially torn down, but there are plans to reconfigure it for office and residential use sometime in the future. I worked there for three decades and knew people who worked there as far back as the 1930s. I took the news of the new plans with mixed emotions—any plan to revitalize the beautiful facade is better than how it sits now amid garbage, weeds, and graffiti.

  But something bothered me. While there are plans for a hotel, shops, and apartments, no provisions have been made for the thousands of ghosts living there. Many of those ghosts of the past I knew personally; others I learned about from my predecessors. They all exist as memories and markers of a crucial Chicago institution.

  The emaciated old men dying of tuberculosis. The emaciated young men dying of AIDS. The young women who died of uterine infections after illegal abortions. The young unwed mothers, barely out of grade school. The heroin addicts dying of overdoses. The patients from the Madison Street flophouses who went into delirium tremens when they couldn’t buy alcohol.

  The trauma patients with the type of wounds that doctors rarely saw outside the battlefield. The patients from foreign countries with exotic infections none of us had seen before. The patients who died of heat stroke when there was no air-conditioning on the open wards and the windows could not be opened. The people who wanted to kill themselves by jumping out of the building. The few who succeeded.

  The doctors who saved patients with their brilliance and their daring. The doctors who killed patients with their arrogance and stupidity. The physicians who became nationally renowned and the ones who took kickbacks. The surgeons who invented new surgical techniques and the ones who operated drunk. The doctor who invented the blood bank and the doctors who charged patients for blood transfusions. The doctors who smoked cigarettes while they made rounds on the large, open wards. The intern who was stabbed to death by a patient.

  The nurses who selflessly volunteered to come in whenever there was an emergency. The nurses who were so talented they could place intravenous lines in any patient and the medical students who couldn’t put them in anyone. The overworked but always well-intentioned social workers. The unsung patient transporters, the radiology technicians, and the therapists. The electricians, maintenance men, buildings and grounds men, custodians, and cooks. The elevator operators who got Election Day off to get out the vote but kept their jobs even after the elevators became push button.

  The staffers who cheated on their overtime. The chaplains. The county board presidents. The security guard who denied a county board president entry to the hospital because he didn’t have identification. The crooked politicians—and the occasional honest one. The county commissioners who went to jail. The hospital administrators who were glorified political hacks. The union stooges and management flunkies. The anarchists, communists, left-wingers, and right-wingers. The doctor who serendipitously discovered the identity of mass murderer Richard Speck when Speck came to the emergency room during a nationwide manhunt. Richard Speck, twenty years later a jailhouse prostitute. The gangbangers, numbers runners, and Syndicate killers. The patients who sold drugs in the stairwells. The hookers who plied their trade in the stairwells. The doctors on call who made love with nurses in vacant offices at night.

  The brave policemen who died in the trauma unit, killed in the line of duty. The courageous
firemen who died of smoke inhalation and burns. The cops on the take and those who worked covertly for the Outfit. The newspaper and television reporters who came to the hospital but never stayed long enough to get the facts right.

  The famous visitors like Princess Diana, Mr. T, Harrison Ford, then state senator Barack Obama, and Dan Rostenkowski—when he was the most powerful man in the US House of Representatives. Linda Darnell, dying in the burn unit twenty years removed from being the most beautiful woman in Hollywood. Major Lance, thirty years after he had the number-one R&B hit in the country.

  The forgotten jazz musicians. The Negro League ballplayers who played with Satchel Paige. The babies who grew up to be Harold Washington, Herbie Hancock, Curtis Mayfield, Bernie Mac, and Phil Everly (of the Everly Brothers).

  The great-grandmothers. The great-grandchildren. The premature infants who died, never having come off the ventilator. And the ones who miraculously survived to grow up healthy and have families.

  Now with the new plan for the building, those ghosts will have to move. For a time, they can reside in my memory and that of those who came before me. But at some unspecified future date, those memories are also scheduled for demolition.

  When that happens, where will all those ghosts live?

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