Doctors on the cutting edge of reality
By Don Aucoin
Boston Globe
June 13, 2010
In the second episode of “Boston Med,’’ a cardiothoracic surgeon at Children’s Hospital Boston makes this matter-of-fact assertion: “It’s a tough situation, but it’s not hopeless, and if anybody can fix it, we can.’’
He is describing a particular case: a baby born with a rare heart abnormality whose father, a US soldier, has returned from Iraq for the surgery. But his words also reflect the core assumption at the heart of “Boston Med,’’ an eight-part ABC News documentary series that premieres June 24.
The series brings viewers inside high-stakes medical dramas — from a double-lung transplant to a rare face transplant — at Massachusetts General Hospital, Brigham and Women’s Hospital, and Children’s. As physicians and nurses treat patients who are sometimes teetering between life and death, the surgeon’s words echo: If anybody can fix it, they can. Yet as “Boston Med’’ vividly illustrates, there are times when they can’t.
“These are situations that most of us will experience in some form in our lifetimes, either for ourselves or our loved ones, ’’ says David Westin, president of ABC News. “It is important for us all to understand both the possi bilities and the limitations of medical science, and to realize that it’s a complex and subtle ecosystem.’’
Some medical ethicists voice concern about behind-the-scenes documentaries like “Boston Med.’’ They argue that cameras are inherently disruptive to hospital routine and worry about patient privacy and the possible impact on quality of care.
“People don’t expect to be filmed when they go to the hospital,’’ says George Annas, author of “The Rights of Patients’’ and a professor of health law and bioethics at Boston University. “You didn’t come there to get filmed. You came there to get your illness or injury treated, and they’re taking pictures of you and making them public.’’
Arthur L. Caplan, who heads the Center for Bioethics at the University of Pennsylvania, says there is “a certain degree of inevitable exploitation when you’ve got somebody who has just been through a traumatic and unexpected event and you’re there taping.’’
Westin and “Boston Med’’ executive producer Terence Wrong emphasize that only those patients at the three hospitals who signed consent forms are seen on-air. “We had a very strict process of getting informed consent if they are seen on the air in an identifiable fashion,’’ says Wrong. While Annas says many patients may feel pressure to say yes, especially if their doctor consents to the filming, Westin says ABC treads very carefully: “If we feel it’s not a suitable circumstance for somebody to give informed consent, then we don’t ask for it.’’
Wrong insists the ABC videographers were neither a distraction to surgeons nor a temptation for them to showboat. “These are professionals who’ve spent, in some cases, 20 years just to attain the rank of an attending neurosurgeon,’’ he says. “The last thing on their mind is varying any aspect of the care they’re delivering because the camera is there.’’
This is the second time Wrong has trained his cameras on major Boston institutions: He was also the executive producer of “Boston 24/7,’’ a 2002 series about Boston City Hall, police, prosecutors, educators, and firefighters. He won a Peabody award for 2008’s “Hopkins,’’ an inside look at Baltimore’s Johns Hopkins Hospital that was a follow-up to 2000’s “Hopkins 24/7.’’
“Boston was a very natural place to go from Johns Hopkins, because Boston is a citadel of medical excellence,’’ says Wrong, 53, who coordinated the work of a dozen producers and videographers as they shot thousands of hours of footage at the three hospitals, which are all Harvard teaching hospitals.
“The history of American medicine owes a lot to medicine that comes out of Boston and Harvard,’’ he adds. “It’s stunning that a city that is less than half the size of New York or Los Angeles is at least their peer, if not better, when it comes to high-level medicine.’’
But not every medical procedure is flawlessly handled in “Boston Med,’’ and not every patient makes it. There are moments, too, when tragedy mingles with triumph. In a striking coincidence, one crew was following the case of Brookline’s Joseph Helfgot, who died of complications after a heart transplant, while another was tracking a Brigham and Women’s plastic surgeon preparing to do a face transplant on James Perry Maki, whose features had been disfigured by electrical burns. It was the second successful face transplant in the country.
Only later, after it was reported by the Globe, did Wrong and his crew learn that it was Helfgot’s face that had been transplanted to Maki. (In one compelling scene captured on camera, Helfgot’s widow, Susan Whitman Helfgot, meets Maki.)
To Wrong, such twists are what make the genre he calls the “docu-medical’’ — he bristles at the phrase “reality show’’ to describe his work — so compelling.
“Most of network news involves telling stories that have already happened,’’ he says. “But when you’re actually able to live in the moment and not know what’s going to happen in the next moment, you can present the audience with an experience that is very stark and authentic.’’
To capture those experiences, Wrong and his ABC crew lived and breathed the medical life while they were filming “Boston Med.’’ They rented apartments near Mass. General so they could race over at 3 a.m. if necessary. One crew might follow a neurosurgeon; another an orthopedist; and a third an emergency-room physician. One moment they might be filming a patient with a ruptured aortic aneurysm, the next a victim of a motor vehicle accident.
“One night, all five cameras converged at the same moment because all five doctors we were following had come to the emergency department at Mass. General at the same point,’’ says Wrong.
“We explain [to doctors] that we’re going to be there for the good, the bad, the beautiful, and the ugly,’’ he adds. “We promise to be fair. That’s the deal we make. That’s an ethical pact that they understand and can agree with. We’re never going to not show a scene where a doctor has less than an optimal outcome just because it’s less than optimal.’’
Nonetheless, Caplan says that in focusing on top-notch medical institutions and cutting-edge surgeries, “Boston Med’’ may create unrealistic expectations among viewers who, in many cases, have to rely on small community hospitals. “You’re not seeing people waiting 10 hours in the ER and then getting hassled for coming back again and again,’’ he says.
Yet he understands why TV producers are drawn time and again to hospital settings. “Hospitals are places of hope,’’ he says. “And it is a setting in which human virtues and vices are kind of played out, and stories start and end relatively quickly. No one’s ever made a TV show called ‘Nursing Home.’ ’’
“Boston Med’’ unspools in the narration-free style of Cambridge documentarian Frederick Wiseman, whom Wrong cites as an influence. “There are no mediators; there’s nobody saying, ‘It’s OK,’ ’’ says Wrong. “You don’t know what the end is going to be. You don’t know if the patient is going to live or die.’’
Yet “Boston Med’’ also contains touches borrowed from dramatic series. Evocative music punctuates the action, and heart-tugging personal stories are interwoven with medical scenes, such as a sequence about a surgeon at Brigham and Women’s who has to perform a lung transplant the morning of his young daughter’s dance recital. Wrong makes no apologies.
“We don’t have a captive audience in some artsy theater prepared to watch 90 minutes consecutively,’’ he says. “We’re in a multitasking world on a network with five commercial breaks, so we have to supply a tempo and an emotional change of pace that is going to compete with dramas.’’
Indeed, Wrong himself is not immune to the emotional pull of “Boston Med.’’
“The moment that always makes me tear up is when the father of the newborn who has just had heart surgery is at the airport, and he had missed nine months of the pregnancy, and now it is time for him to go back to Iraq and fight, and who knows whether he’ll return uninjured,’’ says Wrong. “Part of you wants to scream, ‘Oh no. Please don’t go.’ ’’
Don Aucoin can be reached at aucoin@globe.com.