Doctors' Diaries

PBS Airdate: April 7 and 14, 2009

HOUR 1

INSTRUCTOR 1: Do no harm. That's your greatest gift to mankind.

NARRATOR: Seven doctors, 21 years, and saving lives is only part of the story.

TOM TARTER: Medical school is absolutely something that one cannot be emotionally prepared for.

NARRATOR: Becoming a doctor is an experience that will change students from ordinary mortals into fully initiated members of the medical tribe. Our cameras tracked them from the first days in class...

DAVID FRIEDMAN: She was way over this way, to free herself up.

ELLIOTT BENNETT-GUERRERO: Okay.

NARRATOR: ...to the shock of the teaching hospital;...

JAY BONNAR: Somebody's going to ask me, like, "Quick, Dr. Bonnar, do your stuff." And I'm going to go (makes choking noise).

NARRATOR: ...through heart break...

TOM TARTER: Divorced.

NARRATOR: ...and triumph.

JANE LIEBSCHUTZ: Doctor of Medicine, ad gradum Medicinae Doctoris.

NARRATOR: A unique behind-the-scenes look at the making of a doctor, on Doctors' Diaries , right now, on NOVA.

TOM TARTER: Today should be a very interesting day. I'm going back to Harvard, and I'll be meeting up with the other students who were part of this documentary. I haven't seen many of them for 15 years or so. So it'll be fascinating to see how they've grown as people and matured as physicians.

I'm Tom Tarter. I'm a board-certified emergency physician.

LUANDA GRAZETTE: Good to see you, buddy.

TOM TARTER: Yeah it is. You still working here?

LUANDA GRAZETTE: No, I'm not here, I'm in California.

You've got a little bit of gray.

TOM TARTER: Yeah, I've got gray. Yeah, you bet.

LUANDA GRAZETTE: Yeah, I've got them too.

Hi, I'm Dr. Luanda Grazette, and I'm a cardiologist.

DAVID FRIEDMAN: To me, I kind of like seeing, you know, who they've become and.... We were all just figuring out what we were going to be then.

[I'm] Dr. David Friedman, ophthalmologist and public health researcher.

JANE LIEBSCHUTZ: I'm Dr. Jane Liebschutz. I'm an internal medicine, primary care and preventive medicine physician.

ELLIOTT BENNETT-GUERRERO: Just the sheer sense of history, with these enormous buildings, I think, is really what I remember. I mean, it's almost overwhelming, in a way.

[I'm] Dr. Elliott Bennett-Guerrero, anesthesiologist.

LUANDA GRAZETTE: Look at Elliott.

CHERYL DORSEY: Hi, how are you? I haven't seen you guys in so long. I haven't seen you...my god, how long has it been?

I'm Cheryl Dorsey. I was trained as a pediatrician at Harvard Medical School.

JAY BONNAR: I'm Jay Bonnar, and I'm a psychiatrist.

JANE LIEBSCHUTZ: We graduated 17 years ago, can you imagine? It's like we're old fogies, but I don't feel that. I feel like it was a few months ago.

LUANDA GRAZETTE: Well, when I first got in, I kept wondering if there was a mistake, really, like somebody was 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?'" And it was kind of strange because, even though when I interviewed here and I toured the place, I really felt at home, I still had never really pictured myself in the environment. And I still, when I walk across the quad, sometimes, I just kind of...it hits me sometimes, "God, I'm at Harvard."

LECTURER 1: ...this whole collection of different cells, going through this thing called the thorax.

JAY BONNAR: I knew I couldn't be a businessman. I could never do that because I wouldn't care about any sort of product, I care about people.

INSTRUCTOR 2: ...a renal arteriogram. And you're going to tell me something about the renal vessel.

JANE LIEBSCHUTZ: I'm very interested in working with urban poor. A lot of people don't have advocates for their health. Even though we supposedly have a glut of physicians, there's still a lot of areas which are under-served, and there's a great need for good people to go in and work in those areas.

People had been telling me that—before I came—that it would be hard to do anatomy, but I'd get through it and it would be okay. And then we came in the first day and it was worse then I ever expected it could be. And it looked so, our cadaver looked so lifelike, and so real. It was really difficult. I started crying. I left the room.

STUDENT 1: Here's the ligament right here.

JANE LIEBSCHUTZ: I always have to hold my breath and just calm down for a few minutes before I walk into the room. Emotionally, I think it's very difficult. I'm constantly thinking about the person who donated their body, how they lived and what emotions they had and why they gave up their body.

TOM TARTER: I think your interest kind of overcomes any anxiety, really.

JAY BONNAR: Really?

TOM TARTER: I mean, after reading about it, like, all night in the textbook and everything like that, when you finally get to see it—I mean, all these things are very abstract, and you're trying to figure out, well, this goes here, and this goes there, that goes the other place—and then boom, it's in front of you; you can grab it, you can feel it.

STUDENT 2: Cranial nerve number twelve...no, seven.

LUANDA GRAZETTE: Unh-unh, seven.

STUDENT 2: It's a seven.

LUANDA GRAZETTE: It's by itself.

CHERYL DORSEY: I think, as we begin to work with the head and neck region, when the head will be unveiled from the pouch that it's been kept in, I think I'll be very uncomfortable with that, because for me, the head and the face are really, kind of, the seat of all emotions: the smile, a frown. And that will really bring home to me that this was a human life.

INSTRUCTOR 3: This patient has had an operation already.

TOM TARTER: Up to this point, I've only seen the body from the outside. I've seen people move through space, play sports, I've seen them eat...all natural biological functions that we go through, but I've seen them all from the outside. And what goes on in between the, say, the mouth and the anus has been a mystery.

LECTURER 2: The whole gut is talking to itself along its length about what's going on in other places.

INSTRUCTOR 2: And the sacroiliac joint is here and there.

TOM TARTER: Now I'm learning, actually, what it is that's going on inside. I'm familiar with it, I've seen it. It's now part of my world.

Here's our stomach. This is where the stomach pierces the esophagus. It's called the cardiac notch.

I find this just an immensely satisfying extension of myself and my realm of experience.

DAVID FRIEDMAN: Elliott and I are not only studying anatomy by dissecting cadavers, we're learning it by examining each other in our weekly patient/doctor class.

RECEPTIONIST (Harvard Community Health Plan) : Hi, how are you?

DAVID FRIEDMAN: We've been seeing a lot of things on slides, and to see it alive is really nice.

ELLIOTT BENNETT-GUERRERO: Especially, you know, we're used to seeing the cadaver, it's all dead, and it doesn't look red and warm and alive.

DR. FINES: You want to do head, ear, nose and mouth.

DAVID FRIEDMAN: This is the way my dad always does it. He grabs my next...neck, right there.

ELLIOTT BENNETT-GUERRERO: Right around?

DAVID FRIEDMAN: Both of them, both of them, yeah.

DR. FINES: Okay, you just tilt the nose up a little bit and you go in. What you see is a beautiful inferior terminate that kind of just passes right down where it should be.

DAVID FRIEDMAN: Great.

DR. FINES: Did it hurt?

DAVID FRIEDMAN: Not at all.

ELLIOTT BENNETT-GUERRERO: Anita, you made that seem...

DR. FINES: It is.

DAVID FRIEDMAN: No, she was way over this way,...

ELLIOTT BENNETT-GUERRERO: Okay, right.

DAVID FRIEDMAN: ...to free herself up.

You've got a beautiful ear, Elliott. This is great.

ELLIOTT BENNETT-GUERRERO: Oh, really?

DAVID FRIEDMAN: Yeah. It's great, incredible. Oh, I'm sorry. See? You can't go side to side. You can only look at the other...sorry about that.

It's the side-to-side that will kill him.

ELLIOTT BENNETT-GUERRERO: There's blood coming out of my ears.

JAY BONNAR: You get very nervous before the first time you see a patient.

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.

DOCTOR 1: Ethel Hoffmann, I want to introduce you; this is Jay Bonnar.

ETHEL HOFFMAN : I don't remember good, dear, however, hi.

DOCTOR 1: Well, Jay's the one you're mostly going to be talking to.

JAY BONNAR: I don't know a heck of a lot now, inter...clinically, about what to do when.

DOCTOR 1: ...wanted to talk to you about some of the problems you've had with your cough.

JAY BONNAR: First of all I'd just like to talk about, about your cough and what's brought you into the hospital. And I'd like to do an exam of your, 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'll look at you and say, "I don't want this person near me. Get this incompetent 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.

ETHEL HOFFMAN: You mean I got to get nude?

DOCTOR 1: No, we're going to close the curtains.

ETHEL HOFFMAN: You want to see this body of mine?

DOCTOR 1: You did a great job, Jay. That was very good.

JAY BONNAR: I guess...the first thing I want to do is take your vital signs...

ETHEL HOFFMAN: What's that?

JAY BONNAR: ...before I forget that. I'm still a little new at this, so it may take a moment to find, if you'll bear with me.

I really enjoy seeing patients. I wish I could see them every week. It reminds me of what I'm doing in medical school.

The other thing I wanted to know is if you have any questions. If there's anything you'd like to know from me?

ETHEL HOFFMAN: No, darling. I, no, darling, I just...one day you're going to be a great doctor, and I'll still be around to see you.

DOCTOR 1: That's right. That is right, you will be.

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. Should I brace the woman? Or, her weight is...?

DOCTOR 2: I'll brace her for you.

INSTRUCTOR 4: Right now he'll hold, right now he'll hold the model, but you don't have to do that. In fact, it's probably advisable for you guys to put your hands as little as possible on the woman, honestly.

DAVID FRIEDMAN: Be as official as possible.

INSTRUCTOR 4: Just do what you have to do, but...okay?

ELLIOTT BENNETT-GUERRERO: I don't want to get to the point where you seem cold and insensitive.

INSTRUCTOR 4: Absolutely, I'm not saying that.

ELLIOTT BENNETT-GUERRERO: I mean you can take it to an extreme.

Do you take a peek until you're going in?

INSTRUCTOR 4: 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 go in. Do you see that?

ELLIOTT BENNETT-GUERRERO: So you can kind of look as you're going in?

INSTRUCTOR 4: Absolutely, with a light over your shoulder.

ELLIOTT BENNETT-GUERRERO: You're not going in blind, then opening it up?

INSTRUCTOR 4: 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 4: Unscrew the screw...other way.

ELLIOTT BENNETT-GUERRERO: I'm trying to.

INSTRUCTOR 4: Oh, you're trying to release it? Goodness. Secret: never do the screw that hard. Then you're really in a bind.

ELLIOTT BENNETT-GUERRERO: Excuse me, ma'am.

INSTRUCTOR 4: My goodness. It would never get out.

LECTURER 3: ...the classical scheme. And now, if we take a look at the more detailed scheme that you have, and I'm sure you understand very well, on page eight...

TOM TARTER: First-year medical school is absolutely something that one cannot be emotionally prepared for. No matter how much you feel that you've reached some kind of equilibrium in your life, I think first-year medical school will upset it.

JANE LIEBSCHUTZ: This past block of biochemistry and physiology has been really draining on me. Basically, I've had so little time to take care of myself. I've had volcanoes of pimples erupting on my forehead and my chin, and I've not had time to do my laundry in a few weeks. And cooking? Well, who has time to cook?

TOM TARTER: I have a watch that has got a stopwatch built into it. And I spend six hours every day not looking for books, or walking across the street to the library, or something like that, but I spend six hours a day of actively studying, which means at this desk, at a book, or in the library at a video tape. Six hours. And if I take a break to get a cup of coffee or to go to the bathroom, I click off the watch.

JAY BONNAR: Being in medical school is a very, very intensive process, and you really need some time where you can just sort of put that aside and really think about other things. Art has been important to me for a very long time and it's, to me, as much as anything, a symbol that I have a life outside of medical school. And I want to keep it alive. It's that piece of me that I will save for myself, and I will not let medical school get to me.

TOM TARTER: I mean, we get to a point where we can clinch the diagnosis without having to explain why the guy is wearing a pink shirt or something.

This has been the most emotionally trying period of my life. I've been through a divorce after 10 years of marriage. I was an Olympic hopeful, got knocked out of the Olympics because of an accident and an injury. I've had to work for about 14 years to get into medical school, and I can't ever remember crying until last week. Last week, I just had to start crying.

Every now and then I go back to the Bronx, visit my girlfriend, Stephanie, my mother, see the old neighborhood.

RUTH TARTER (Tom's mother): He was always a little different. I always used to think he was a little too smart for his own good.

TOM TARTER: This is what we lived on right here, Bronx pizza.

STEPHANIE (Tom's girlfriend): Our main staple.

TOM TARTER: This got us through college. It's not getting us through medical school, but it got us through college.

STEPHANIE: Speak for yourself.

RUTH TARTER: He was always interested in science and when he was very young he'd have me reading books about atomic energy. And then when I'd finished, he would say to me, "Mother, I know you didn't understand that. Now let me explain it to you."

TOM TARTER: Okay, here's a guy you wanted to know about. This is the guy that married my ex-wife: the schnoz.

STEPHANIE: Your ex-wife?

TOM TARTER: That's right, ex, my ex-wife.

STEPHANIE: Ex-wife. Okay, how about this one?

TOM TARTER: I'm trying to remember where this was. I think this was in Tennessee.

STEPHANIE: One of my favorites.

RUTH TARTER: Can't say it's one of mine.

TOM TARTER: What don't you like about it, Mother?

RUTH TARTER: You look like the Neanderthal man.

STEPHANIE: I think he looks like a Renaissance prince.

JANE LIEBSCHUTZ: I've never drawn blood before, and I'm very nervous.

INSTRUCTOR 5: You want to go into it someplace where you can really see and feel the course.

DAVID FRIEDMAN: Oh man, this needle could kill a horse.

JANE LIEBSCHUTZ: David, will you shut up?

DAVID FRIEDMAN: Sorry.

JANE LIEBSCHUTZ: I think drawing blood is the most difficult thing I've had to do in my whole medical school career.

JAY BONNAR: More than the cadaver?

JANE LIEBSCHUTZ: No. Yes. No, not more difficult than the cadaver.

INSTRUCTOR 5: Try putting your hand behind the syringe instead of at the top of it.

JANE LIEBSCHUTZ: Like this?

INSTRUCTOR 5: Yeah, right.

JANE LIEBSCHUTZ: And just go in?

INSTRUCTOR 5: Just right into the vein. Start towards this end.

JANE LIEBSCHUTZ: Like here?

INSTRUCTOR 5: It really doesn't hurt that much if you do it...

JANE LIEBSCHUTZ: I'm shaking.

JAY BONNAR: Sorry about that.

DAVID FRIEDMAN: All right, that's strike two, man.

JAY BONNAR: Strike two; we're even now.

DAVID FRIEDMAN: That's okay, I haven't had pulmonary embolism in a couple of days.

STUDENT 3: You got it. That's beautiful.

JANE LIEBSCHUTZ: I'm just practicing.

INSTRUCTOR 5: It might just have been a little bit off to one side.

DAVID FRIEDMAN: Try my legs.

JAY BONNAR: I'm going to have to go for your neck, Dave.

INSTRUCTOR 1: Just remember one thing. Do no harm. That's your greatest gift to mankind. Do no harm...

TOM TARTER: We're moving on to what's called pathophysiology. We've learned enough that we know how the body is supposed to function. Given that, we can now look at ways that the body functions abnormally.

INSTRUCTOR 1: Now, you sort of have a lovulated fluffy-looking mass here. These are something that's abnormal.

TOM TARTER: This is where you are supposed to really start learning the difference between sickness and health.

INSTRUCTOR 1: Who would like to tell us what we see here? Who hasn't spoken? Ah, Mr. Bronx. First of all, what organ is this?

TOM TARTER: Looks like liver to me. You need a lot of onions for this.

CHERYL DORSEY: Today's the last day of my introduction to clinical medicine, and I'm going to be evaluated by Dr. Alan Gorol, who's the instructor for the course.

DR. ALAN GOROL: I'm going to be simulating a real patient. The story I'm going to tell you is really a story from an actual patient. Your job will be to take a history and do the appropriate physical, and getting a real sense of that, you actually, not only put your hands in the right place, but you felt what you were supposed to feel.

CHERYL DORSEY: Okay, okay.

DR. ALAN GOROL: And that's it.

I've had this feeling here. It's not really a pain; sometimes, it's more like a...I guess a tightness, or maybe a pressure.

CHERYL DORSEY: A tight feeling?

DR. ALAN GOROL: Tight feeling, is that...yeah.

CHERYL DORSEY: Okay, so I'll just start and take a listen to your heart. Okay, very regular.

DR. ALAN GOROL: Good. Doesn't...nothing sounds bad yet?

CHERYL DORSEY: No, no, not at all.

DR. ALAN GOROL: It's okay?

CHERYL DORSEY: Mm-hmm. I'm just listening for the heart sounds. You have two normal heart sounds, S1 and S2, and they're there, very clear. So I'm just getting a good sense of what's going on. Better to always check.

DR. ALAN GOROL: Okay.

CHERYL DORSEY: It's fairly stressful, actually, because you have a...of course, it's a simulated event, but, I mean, he's, of course, a doctor, so he's a very knowledgeable patient. And as soon as he said, "I'm having heart problems," my heart just sank, because, as I said, they tend to be the most difficult cases. And all these questions that I know I should have asked, I'm sure I didn't. So it was actually kind of frightening, because I could kind of mentally hear him checking away, saying, "Well, she didn't ask me this, she didn't ask me that, and she didn't focus on this." So it's very stressful.

DR. ALAN GOROL: Overall, I think you're exactly where one would expect you to be at this stage of your training. You should be proud of yourself. You are warm. I felt welcome. And as you gain a little more confidence you will do a very nice job and you will be a superb clinician.

CHERYL DORSEY: Oh. Well, thank you very much.

DR. ALAN GOROL: So I'm really, I'm really pleased with what you've done.

CHERYL DORSEY: Oh. I was so nervous.

EXAMINER: You have 30 minutes in which to finish this test book. Please recall that only those responses recorded on your answer sheet will be scored.

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.

JAY BONNAR: It feels like it's such a poor test of what I really know. It's not a great indicator of me as a person or me as a doctor, anything like that.

DAVID FRIEDMAN: Everyone feels like, "I can't believe how little I know." And we're all used to taking tests and knowing...

ELLIOTT BENNETT-GUERRERO: Getting 90 percent.

DAVID FRIEDMAN: Ninety percent. 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: 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.

KATHERINE (Jay's wife) : 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.

KATHERINE: It's almost fatalistic. In fact people say, "Oh, you're going to marry a doctor." And they sort of look at me knowingly. 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 1: I now joyfully pronounce them husband and wife. Go in peace.

DAVID FRIEDMAN: In the third year, we leave the classrooms for the Boston teaching hospitals so we can see all the different specialties.

JANE LIEBSCHUTZ: Since I'm so new to this, I don't really understand what you do in the emergency room, but I think what the idea is is to evaluate how seriously ill somebody is.

TOM TARTER: When I got to the hospital, I had no idea what was going on. I didn't know what call was, what you did with a beeper. For that matter, I barely knew which end of a stethoscope to use.

JANE LIEBSCHUTZ: I felt that, you know, gee, I really learned something in my first two years of medical school, and now here I come to the wards, and I feel like I know nothing. I mean, I feel less than competent. And even when I do know something, if somebody asks me a question, I can't even think of the answer. I mean, it's like I can't even access the information I used to know.

TOM TARTER: I started at 6:00 yesterday morning...very tired. My feet hurt. It's not too bad if you can get some sleep. I didn't; I usually don't. But I think as you get better at this stuff, that becomes possible—might be able to get two or three hours of sleep, which could really make a big difference.

NEUROLOGIST: I don't know what to make of this numbness around her nose.

TOM TARTER: As you enter the medical profession as a third year medical student, one of the first things you learn is that there's a very rigid hierarchy of power. At the top, you have the attending physician who really is quite powerful, almost almighty; you can compare him to a deity in some religions. And then, right next to him, would be the chief resident or senior resident, who would be a high priest, and he is the one who is allowed direct contact with this higher power. A little bit lower down the line you have your everyday priests, which would be your interns. And they, although they don't directly speak with the almighty, they do have the privilege of contacting the resident who instructs them in the wisdom of the lord there. Beneath your intern you have your third year medical student who is, at best, some little monk who trembles in the wake of all of these greater powers and hopefully will muddle through and climb up the rungs himself.

JAY BONNAR: Miss Brown? Miss Brown?

MISS BROWN: Yes?

JAY BONNAR: 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.

MISS BROWN: And I've been praying for you, and I know you've been praying for me 'cause you said you would. God bless you.

JAY BONNAR: Those are very nice thoughts of yours.

MISS BROWN: Thank you.

JAY BONNAR: Okay, now touch your nose. That's good. 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: Well, 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: Yeah, 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, or...

DR. POSER: Left side of who?

JAY BONNAR: Left side of the brain, if it's...

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, no.

DR. POSER: Why's that?

JAY BONNAR: Because I've only been in neurology about a week.

DR. POSER: Did you ever see a deviation of the tongue from a cortical lesion?

RESIDENT 1: No.

DR. POSER: Why not?

RESIDENT 1: The brainstem, many of the nuclei, including the 12th cranial nerve are bilaterally innovated. They...

JAY BONNAR: It feels terrible when you have doctors you're looking up to for guidance and teaching making you feel 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. 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 such a lowly little speck. If only I could be like them.

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, and 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 the 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, and you want to optimize flow through those pipes so that all the organs get enough blood.

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 asked any of them, they would tell you that they need you around for counseling and advice...

One of the things that I really like about cardiology, actually, is that most of the time you are dealing with older patient population. And I like working with older people. I like to chat with them and I enjoy them a lot. I think they enjoy me.

MR. BURKE: I hate to tell you, but I've got to have something to hold on to.

LUANDA GRAZETTE: Is my arm enough?

MR. BURKE: You'll do. Come over here, please.

LUANDA GRAZETTE: I was raised by my grandmother, so I guess I've always had interactions with older folk.

Okay, that's good. That's good. Do you use a walker at home?

MR. BURKE: When you come back in focus, it's great.

LUANDA GRAZETTE: And I see that being part of my career; I like to work with older people a lot.

JANE LIEBSCHUTZ: I think a lot of patients appreciate somebody who can be direct. The one thing is that I am learning that not all patients appreciate it, you know, and I'm learning the difference between the two.

How's it been to be in a relationship where half the relationship has a terminal illness?

PATIENT 1: My disease was not much of an issue at the time. It wasn't until we had to deal with it on a day-to-day basis, and now we're having to deal with it a lot more, with this hospital stay.

JANE LIEBSCHUTZ: It's good for me to hear your experience as a patient, because I'm sort of halfway in between the doctor world and the outside personal world. It's very hard when you're young and alive and you don't know what's going to happen.

PATIENT 1: That's kind of true for all of us.

JANE LIEBSCHUTZ: It is true for all of us...

PATIENT 1: But I know I have some different odds.

JANE LIEBSCHUTZ: ...but you know it's, yeah, and you also know that it's going to come sooner rather than later. Well.

PATIENT 1: I'm not so sure of that, Jane.

PATIENT PARTNER: There is a misconception about, just because one is diagnosed with AIDS...granted, many people do die within a certain time period, but many, many people have lived a lot longer than that timeframe.

PATIENT 1: And I don't know if I'm going to be an old man, but I also know I've had a marvelous life. And at 37, I've had many great experiences, and the quality has really been there. And I'd like to see it continue for a long time, but if doesn't, the time I've had has been really, really something.

JANE LIEBSCHUTZ: I feel like I've got your emotions...don't know if this is professional.

PATIENT'S PARTNER: Well, you're only a third-year medical student, Jane. It's okay, you've got time.

DAVID FRIEDMAN: You're a real challenge.

Any time you do a procedure for the first time, your adrenaline goes up, because you don't know what it's going to be like. You know that you don't really know what you're doing, and so you're sort of randomly shooting the needle in.

DOCTOR 3: You still feel a pulse? Careful, don't stick yourself.

DAVID FRIEDMAN: Just lateral to my what?

DOCTOR 3: Middle finger.

DAVID FRIEDMAN: When I was going for the vein, I was really afraid I wouldn't get it. I was just going to sit there and keep stabbing him, trying. And that's when you feel bad, because that's when you know that somebody who knows what they're doing could get that vein on the first try.

Okay, now I got my finger on the wire.

DOCTOR 3: Slide the thing off. There you go.

DAVID FRIEDMAN: Dilator? Or a little nick, right? If you can stay still for a few more seconds? We're getting there.

DOCTOR 3: When you get that, advance all the way to the skin. Hold the wi...okay, you got to hold the wire. Uh, uh, pull it back. Okay, now hold the wire at the skin. You've got to make sure it's coming out the back before you start pushing it through the skin.

DAVID FRIEDMAN: I don't want to pull it out.

DOCTOR 3: No, you won't pull it out, promise.

DAVID FRIEDMAN: Some people like to do procedures, some people don't. I really like them.

JANE LIEBSCHUTZ: I think one of the strangest things about coming into this institution of medicine is that human lives and human drama is really an everyday part of your life as a doctor. And in academic medicine particularly, there's interesting cases. And you sit and you hear about all the interesting diseases, interesting this, interesting that, and all of a sudden you realize that's a person on the other end of this discussion.

MR. COLLINS: And I was out walking my wee dog.

JANE LIEBSCHUTZ: Your wee dog?

MR. COLLINS: Aye. And the pain came on me, and it gradually got worse and worse and worse. And they put me in the intensive care.

JANE LIEBSCHUTZ: How are you feeling right now?

MR. COLLINS: I was worried. I'm worried.

JANE LIEBSCHUTZ: You're worried?

MR. COLLINS: Yeah, but I know I'm in capable hands.

JANE LIEBSCHUTZ: What are you worried about?

MR. COLLINS: I mean, I've never had a knife put to me before.

JANE LIEBSCHUTZ: You never had surgery before. The good thing will be that you won't remember what's been going on. And then when you start to feel better, you'll feel better, and they won't be giving you so much medicine.

MR. COLLINS: Yeah? Well, when I walk out of here I'll put on my kilt for you.

JANE LIEBSCHUTZ: You will?

MR. COLLINS: Yes.

JANE LIEBSCHUTZ: Okay.

I think being in the operating room is one of the most intense experiences one can ever have. Having your hand on a case and actually helping when you feel needed is probably among the top 10 experiences to have in the world.

What's happening is they're taking some vein from his leg, and then some other vessels that are in the chest wall, and connecting them up to where the coronary arteries are, which give the heart blood.

Where would you see the R.V. from here?

DR. JOHNSON: This is the R.V. That's the anterior R.V.

JANE LIEBSCHUTZ: This is the anterior R.V.?

DR. JOHNSON: Yep.

JANE LIEBSCHUTZ: Wow. That is really cool.

DR. JOHNSON: The chest is a great place to see anatomy. Let's wait and see what happens here.

JANE LIEBSCHUTZ: Do you understand what's happening right now? His heart isn't working, and Dr. Johnson is pumping, he's actually pumping the heart himself. There's no...the heart's failed. It's not, it's not working. So that's what's happening right now, as we speak.

Oh god, this is terrible. I feel like I'm bad luck or something.

DR. JOHNSON: Oh, come on.

JANE LIEBSCHUTZ: I can't believe it. I told this guy he was going to do fine.

SURGEON: ...conduit. We did okay with not having any conduit.

DR. JOHNSON: I don't know what more I can do.

JANE LIEBSCHUTZ: That's it?

DR. JOHNSON: Yeah.

SURGEON: That's it.

JANE LIEBSCHUTZ: Oh, my god.

SURGEON: 11:37.

JANE LIEBSCHUTZ (crying) : I'm sorry. I know, I just...

DR. JOHNSON: The responsibility we have now is to kind of keep a calm head and help the family understand it. I feel the way you feel, but I can't go up to them like that.

JANE LIEBSCHUTZ: Well, I wasn't going to go up to them. It's funny, I've never really had a patient that I've gotten to know who's died. And here it just happened.

DR. JOHNSON: I know. Sure, sure.

JANE LIEBSCHUTZ: It's like a bad dream or something. Like, "Let this be over already." He was going to wear his kilt. I don't know. I'm sorry. I shouldn't be...I don't...

DR. JOHNSON: No, no, no. You're attached in a way that is perfectly appropriate. But you have to understand all kinds of other things. Like, from the start of this operation, he could have, from the aorta, he could have had a stroke, and he never would have worn his kilts again. You know, it would have even been worse.

JANE LIEBSCHUTZ: I know. And I also know he wouldn't have lived with his arteries like that anyway.

DR. JOHNSON: Oh no, he was...he couldn't do anything.

JANE LIEBSCHUTZ: I know that. I'm not...I know that. But it's so hard to watch it.

DR. JOHNSON: But see, that's where you...that's the physician part. I know.

ELLIOTT BENNETT-GUERRERO: This week, I work at nights and then I try, well, at least I try to sleep during the days. I start in the hospital around 7:00 or 8:00 at night and I go to about 10:00 the next morning. And the hardest thing about it is just that your whole sleeping schedule gets all screwed up.

Well, right now we're going to be giving a cesarean section. It should take about, you know, less than an hour. 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. What I think's nice about it is that you get to operate and do procedures, and it's a happy specialty. Most of the women who come in here, you're almost assured that within 24 hours, they'll have a baby.

DOCTOR 4: It's a boy. Oh, my goodness, an eight-and-a-half-pound boy.

ELLIOTT BENNETT-GUERRERO: And it's really nice when, at the end of the delivery, the baby's already out, it's nice to see how happy she is. And I've had a couple of women kiss me after the baby's delivered, and you know, it makes your day when that happens. One couple gave me a box of chocolates, and it really made me feel special. It made me feel very happy that I shared this important moment with them.

I was very disappointed when I saw my ob–gyn course evaluation grade because, 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 a lot of the people weren't honest with me, and if they felt I should have been working harder or if they didn't like me, nobody ever told me. For that reason, I was particularly disappointed.

MELISSA (Elliot's girlfriend): I had an accident with my toe, and I went to the Mass General Hospital emergency room. And Elliott was doing an emergency room rotation 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: Right. I actually called him up to thank him for all the work he'd done 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.

MELISSA: Right.

MINISTER 2: Thomas...

TOM TARTER: I, Thomas...

MINISTER 2: Take you, Sharon...

TOM TARTER: Take you, Sharon...

MINISTER 2: To be my wife.

TOM TARTER: To be my wife.

SHARON (Tom's wife): Actually, the first time I saw Tom, he had held the door open for us, and that's when he was big and gruff, and I turned to my girlfriend and said, "I have no

idea, but I'm very attracted to that guy." And then it was several months later before we started working together, and then I didn't like him at all.

MINISTER 2: Thomas, let me caution you. When you blow out your candle, that has a very special meaning: you're saying goodbye to your old flames.

SHARON: Well?

TOM TARTER: Are we going to light this together or separate? Do we do this together? Together? Right? Together we do this.

SHARON: I'll blow out yours, darling.

TOM TARTER: I'm sure you will. Here we go.

MRS. KIDDER: Good morning.

TOM TARTER: How are you?

MRS. KIDDER: Just fine doctor. Sit down.

TOM TARTER: Thanks. Nice to see you. How is everything going this morning?

MRS. KIDDER: Pretty well, pretty well. Pain's pretty good, under control. And I am getting anxious to get it over with.

TOM TARTER: I bet.

MRS. KIDDER: Yeah. Are you going to be an observer or are you going to do...

TOM TARTER: I am going to be an assistant. I'll probably just be the person standing there handing doctor something or being an extra hand.

Mrs. Kidder, who is a 68-year-old woman, developed pain in her hip. While they were working that up, they found out that she had cancer and that it had invaded the bone of her hip. So about five or six months ago, they replaced her hip. Today, what we are going to do is go in there and put in some plates and some cement to prevent her from actually breaking her leg doing something maybe as ordinary as just getting up out of her chair.

DR. PIERCE: I'm Dr. Pierce, and this is Elliott Bennett.

MRS. KIDDER: Bennett? Are you anesthesiologist, or what are you?

DR. PIERCE: Yes. I am the anesthesiologist and this is the Harvard Medical student you heard about.

MRS. KIDDER: Aha.

ELLIOTT BENNETT-GUERRERO: Hi. Good morning.

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.

DOCTOR 5: At this point, take the small needle out.

TOM TARTER: There is nothing more dramatic and more curative and more decisive than surgery. If I did nothing but stand there and hold the retractor or just stand there and watched, I would really find it rewarding.

DOCTOR 5: The harder the bone, the better for her.

TOM TARTER: People think of medicine...like to think that you have to be exceptionally smart to do medicine. It's really not the case. What is the case is you can't be stupid and do medicine, you can't be a klutz and be a surgeon. But if you are reasonably well-adept or you are reasonably bright, then you could do either one.

DOCTOR 5: Now remember, this is the one with the lock in it.

TOM TARTER: Right, so we don't want to damage those threads going through there.

DOCTOR 5: So don't use the drill guide.

TOM TARTER: Don't use the drill guide. This drill bit will take those threads with it, beyond a shadow of a doubt.

DOCTOR 5: Okay, let's get the smaller drill bit ready. Meanwhile...

ELLIOTT BENNETT-GUERRERO: It's very intense work. I mean, seriously, you are concentrating every single minute you are in the O.R, unlike in medicine, or a lot of other things where you spend a lot of time around the hospital just, kind of, talking to the nurses, having a coffee break. I mean when you are in the O.R., even when the patient is supposedly stable, you need to be watching the monitors. You know what it is like? It is like driving on an icy road for five hours.

TOM TARTER: Absolutely.

ELLIOTT BENNETT-GUERRERO: You did a good job, Tom. Boy, I'll tell you, now that we are fourth-years, we are doing a lot of stuff.

TOM TARTER: You were great, man. You got that P.A. line and everything like that. That's really good. Those are tough.

ELLIOTT BENNETT-GUERRERO: Who would have dreamed, who would have dreamed, last year, that you'd be closing up and I'd be, you know, able to do the lines.

TOM TARTER: It's really good.

ELLIOTT BENNETT-GUERRERO: We've come a long way.

TOM TARTER: I'll say we have. We've had a lot of help, too.

ELLIOTT BENNETT-GUERRERO: Hi, how are you?

JANE LIEBSCHUTZ: I'm going to be doing a residency in internal medicine at Boston City Hospital, Boston, Massachusetts.

TOM TARTER: I don't have one?

ELLIOTT BENNETT-GUERRERO: Not letting you graduate.

TOM TARTER: My therapist in medical school told me medical training is a marathon. Jay, you just have to keep going, showing up every day. As soon as you get through one hurdle there's another one.

Sparrow Hospital, Lansing, Michigan.

ELLIOTT BENNETT-GUERRERO: Duke!

TOM TARTER: Congratulations.

ELLIOTT BENNETT-GUERRERO: Thanks a lot...a big milestone completed.

JAY BONNAR: Finally I get a job. This is my first job.

GRADUATION ANNOUNCER: Jay H. Bonnar.

JAY BONNAR: At last.

GRADUATION ANNOUNCER: Elliott Bennett-Guerrero.

ELLIOTT BENNETT-GUERRERO: This thing's in Latin. You can't even understand a word of it.

JAY BONNAR: It's going to be wonderful to finally be Jay Bonnar, M.D., instead of Jay Bonnar, the medical student.

GRADUATION ANNOUNCER: Jane M Liebschutz.

JANE'S FATHER: Now we have a doctor in the family.

JANE LIEBSCHUTZ: Isn't that fantastic?

GRADUATION ANNOUNCER: Cheryl Lynne Dorsey.

CHERYL DORSEY: It's what my parents paid for. Here it is.

GRADUATION ANNOUNCER: David Steven Friedman.

LUANDA GRAZETTE: I'm going to miss being so much a part of this Harvard medical student experience and...I'm going to miss all of it.

JANE LIEBSCHUTZ: Doctor of medicine: ad gradum Medicinae Doctoris.

DOCTOR 6: Good morning, doctors. Doesn't that sound good?

DAVID FRIEDMAN: This is...everybody's congregating before we go to our respective jobs. My girlfriend gave me a button, "Dr. Dave," and that's what I feel like: Dr. Dave, nothing more really.

RESIDENT 2: We're the two residents in the coronary care unit.

PATIENT 2: Where I'm probably going to spend the night?

DAVID FRIEDMAN: Where you're probably, where you're definitely going to spend the night.

It's the first time where I feel I have responsibility, and if I don't do something well, I could cause my patient harm. And that would be the worst thing one could do.

MEDIC: This gentleman unfortunately was the victim of a beating over in South Boston.

JANE LIEBSCHUTZ: I'm on call tonight in the emergency room, so I'm going to be up all night.

Mr. Lasser? Mr. Lasser?

MR. LASSER: Yeah.

JANE LIEBSCHUTZ: Hi. I'm Dr. Liebschutz. How are you feeling?

MR. LASSER: I'm doing all right, if you untie me.

JANE LIEBSCHUTZ: Where are you, sir?

MR. LASSER: Boston City Hospital.

JANE LIEBSCHUTZ: What brought you in here?

I think that people talk a lot about how stressful it is to work here. I've had a lot of late night discussions, with nurses mostly, about how difficult it is to work in a municipal hospital with fewer and fewer resources and patients who are extremely needy.

All right, I've got a lot of blood here so we won't need any more.

Sometimes I'll dream that I have AIDS, or I'll dream that I have cancer, or I'll dream that I'll have some horrible disease. When I was in medical school, I used to think I had all of these diseases, like, consciously, when I was awake. I'd be worried that I had this horrible thing or that horrible thing. I think, as an intern, I'm very conscious of how healthy I am compared to my patients. I'm conscious of the fact that I don't abuse myself or my body. Well, I mean, being an intern you abuse yourself because you're...

PATIENT 3 [screaming] : I want to get up! I'm going to get up!

JANE LIEBSCHUTZ: This is a young lady who was found outside a, what they call shooting gallery, which is where people shoot intravenous drugs.

PATIENT 3: I can't breathe this way.

JANE LIEBSCHUTZ: You'll be okay.

PATIENT 3: Get out of my way! I cannot breathe this way. Please believe me.

JANE LIEBSCHUTZ: I feel so burned out right now...

PATIENT 3: Put my nose to the air, baby.

JANE LIEBSCHUTZ: ...that the idea of staying in a dysfunctional hospital like this, for years on end, is really not appealing.

DOCTOR 7: Did you have some crack?

PATIENT 3: Yes, I did.

JANE LIEBSCHUTZ: But this is what I've been drawn to, always.

I'm one of the doctors here. I'm going to help you.

PATIENT 3: You going to help me in here?

JANE LIEBSCHUTZ: I'm going to help you, okay? Now, I need you to...

PATIENT 3: I have to go to the bathroom.

JANE LIEBSCHUTZ: You have to go number two?

PATIENT 3: I have to go number two. I promise there will be no problem.

JANE LIEBSCHUTZ: If you have to go, just go. If you have to go, just let it go. We'll clean you up. If you have to go...

All I can say is that I hope life after internship is nothing like life during internship, because this is not why I became a doctor, and I really am not very happy. And it's no one thing in particular, it's just being underpaid labor, spending very little time taking real care of patients, doing everything and anything that's necessary because I'm, you know, the bottom line.

HOUR 2

DOCTOR 1: Do no harm. That's your greatest gift to mankind.

NARRATOR: Seven doctors, 21 years, and saving lives is only part of the story.

TOM TARTER: Medical school is absolutely something that one cannot be emotionally prepared for.

NARRATOR: Becoming a doctor is an experience that will change students from ordinary mortals into fully initiated members of the medical tribe. Our cameras tracked them from the first days of medical school to the sleepless nights of internship,...

JAY BONNAR: It's not that I don't care about patients, but that I am absolutely strung out and absolutely can no longer think anymore.

NARRATOR: ...through heartbreak...

TOM TARTER: Divorced.

NARRATOR: ...and joy. A unique behind the scenes look at the making of a doctor on Doctors' Diaries

right now on NOVA.

TOM TARTER: I'm Tom Tarter. I'm a board-certified emergency physician.

LUANDA GRAZETTE: Hi, I'm Dr. Luanda Grazette, and I'm a cardiologist.

DAVID FRIEDMAN: Dr. David Friedman, ophthalmologist and public health researcher.

JANE LIEBSCHUTZ: I'm Dr. Jane Liebschutz. I'm an internal medicine, primary care and preventive medicine physician.

ELLIOTT BENNETT-GUERRERO: Dr. Elliott Bennett-Guerrero, anesthesiologist and clinical trialist.

CHERYL DORSEY: I'm Cheryl Dorsey. I was trained as a pediatrician at Harvard Medical School.

JAY BONNAR: I'm Jay Bonnar, and I'm a psychiatrist.

GRADUATION ANNOUNCER: Jay H. Bonnar.

JAY BONNAR: At last.

ANNOUNCER: Elliott Bennett-Guerrero.

ELLIOTT BENNETT-GUERRERO: This thing's in Latin. You can't even understand a word of it.

JANE LIEBSCHUTZ: Doctor of medicine. Ad gradam Medicinae Doctoris.

JANE'S FATHER: Now we have a doctor in the family.

CHERYL DORSEY: What my parents paid for. Here it is.

ANNOUNCER: David Steven Friedman.

DEAN TOSTESON: Today you stand before us ready to become a physician.

GRADUATES (In unison) : I will hold in confidence all my patients entrust to me.

JAY BONNAR: It's not over exactly; there is still a lot to come.

GRADUATES (In unison) : I will strive to promote honor in the medical profession.

ELLIOTT BENNETT-GUERRERO: I am very nervous about starting internship, but I feel ready to make the jump.

LUANDA GRAZETTE: I expect I'll look back on it and say, "Boy, my internship years, oh, they were so wonderful," but while I am living through it I think it'll be hell, just like Pietro said, hell, hell and then more hell.

BETH ISRAEL DEACONESS MEDICAL CENTER CHIEF: Good morning, doctors! Doesn't that sound good? Welcome to the Deaconess.

DAVID FRIEDMAN: Today's the first day. This is everybody congregating before we all go off to our respective jobs.

My girlfriend gave me a button, "Dr. Dave," and that's what I feel like, you know: Dr. Dave, nothing more, really.

RESIDENT 1: We're the two residents in the coronary care unit.

PATIENT 1: Where I'm probably going to spend the night.

DAVID FRIEDMAN: Where you're definitely going to spend the night.

It's the first time where I feel I have responsibility, and if I don't do something well, I could cause my patient harm, and that would be the worst thing one could do.

I am sure there are certain things we do every day that have negative side effects, and now I am going to be one of the ones doing those things, and I'll cause negative side effects to people, but that's part of what you have to do to treat somebody. But that's a hard thing to live with.

TOM TARTER: The first few months of internship are very, very difficult. You're constantly in a panic, you're afraid you're going to do something wrong.

How are you feeling? Bad?

In terms of medicine, I came out of medical school knowing nothing.

She's over 130. I probably want to hydrate her, but I'm just wondering, do you think we could turn down her W-tracks a little bit?

People say, "This is your doctor," and you are the patient's doctor. You shouldn't be, but you are. And this person is going to tell you all the things that should lead you to understand their disease, but you really don't have a prayer of making heads or tails of it.

Are you having trouble breathing?

They might as well be telling somebody next to them in the subway or something.

These are the worst blood gases I have ever seen. I never saw a living person with gases that bad. Yikes.

LUANDA GRAZETTE: Learning to be a doctor is 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.

RESIDENT 2: We'll run rounds today, and we'll use the rest of the morning to catch up.

LUANDA GRAZETTE: How long have you been on the iron?

PATIENT 1: For the last...about a month or so.

LUANDA GRAZETTE: It all seems really cumbersome right now. There's, like, all these patients, and they all have multiple problems, and they're going for tests, and results are coming back from tests, and you're making treatment decisions based on tests and, sort of, keeping it all straight: who got what, when and how. What they need next just can be kind of mind-boggling. That's a lot of information to keep track of.

DOCTOR 2: 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 S.T. depressions in the anterior leads, got a K.U.B., and with the T.N.G., her blood pressure dropped a little bit.

LUANDA GRAZETTE: Hopefully, in a week, I'll sort of have my system together. And that's what I am 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.

JAY BONNAR: Right now it's January, and I am in 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 the surgical service. It is the rotation, which is, at this hospital, one of the most difficult ones in terms of the workload. I've gotten to a point where it's not that I don't care about patients, but that 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 anymore.

Can you call a nurse? She's starting to move.

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.

KATHRYN POTTS (Jay's wife) : Jay doesn't really have very much time to do anything anymore. He doesn't really read; he doesn't really get to go out too much. 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.

JAY BONNAR: I came in four hours ago. So far I have admitted one patient with fever, probable sepsis, and 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 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, and I've just now wheeled up my second admission for the night and will be going shortly to examine her. I am taking a short food break because I'm getting a little hypoglycemic here.

PATIENT 2: It started out in the back of my leg, 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 2: Well, I don't take a shower with my clothes on. Of course I do.

JAY BONNAR: I'd like to ask you what exactly it is that you feel and then come to a...

PATIENT 2: 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 2: My leg, from here to the tip of my toe, is numb.

JAY BONNAR: I appreciate that this is something that has you very concerned, and you appear to be a little irritated at some of my questions.

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.

ELLIOTT BENNETT-GUERRERO: Right now I'm at the Framingham Union Hospital, which is outside of Boston.

Mrs. Cari?

MRS. CARI: Mm-hmm.

ELLIOTT BENNETT-GUERRERO: Hi, how are you?

MRS. CARI: Good.

ELLIOTT BENNETT-GUERRERO: I have a list of the medicines you've been taking. Have you been taking...

MRS. CARI: That's quite a list, yeah.

ELLIOTT BENNETT-GUERRERO: Yeah, the cimetidine and lopressor, and the micronase?

MRS. CARI: Right.

ELLIOTT BENNETT-GUERRERO: Procardia? Lasix?

MRS. CARI: I often wonder if they know in which direction to go.

ELLIOTT BENNETT-GUERRERO: You think they are giving you pills that are... send you off in different directions?

MRS. CARI: I wish they'd send me off.

ELLIOTT BENNETT-GUERRERO: He's not walking for me.

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, you know, I never really get a free weekend the whole year.

MELISSA (Elliot's wife) : Being married your first year is difficult enough, in and of itself, without your husband working 80 or 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 three nights, but the other two nights, especially the night when I'm post-call, as soon as I go home I'm just exhausted.

Mr. Rogers, we're going to take you into the operating room now, okay?

If you are 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.

JANE LIEBSCHUTZ: I've decided to work in internal medicine at Boston City Hospital. One of the best features of this residency training program is that we can do home visits.

Mr. Nei has two major problems that I'm worried about. One is difficulty breathing from his heart and his lungs, and the other major problem is his depression.

MR. NEI CHU PING: ...nothing better than dying, because I lost my best friend, my wife. Nobody cares for me.

JANE LIEBSCHUTZ: Nobody cares for you?

MR. NEI CHU PING: No.

JANE LIEBSCHUTZ: It's a challenge. And trying to kind of find a way into him, make a relationship with him, to help him...

You talked about suicide, are you thinking of doing that?

MR. NEI CHU PING: No. I can't do it.

JANE LIEBSCHUTZ: Why not?

MR. NEI CHU PING: I have no pistol.

JANE LIEBSCHUTZ: I went back a couple of days later to bring him some antidepressant medicine, and he was having a lot of difficulty breathing. And so I called his son, when his son got home, and I told him to bring him in to the emergency room.

Ni gen jiang ta ma? Shi ma? Gen wenzhen hao ma? (Have you talked with him? How was it? Was it okay with Wenzhen?)

MR. NEI CHU PING: No use. Suppose I am getting well?

JANE LIEBSCHUTZ: Yeah?

MR. NEI CHU PING: What use?

JANE LIEBSCHUTZ: Well, you know what? We're going to work on that. You have a lot of use.

MR. NEI CHU PING: Nobody needs me.

JANE LIEBSCHUTZ: It makes me happy to come see you.

MR. NEI CHU PING: Don't waste your time.

JANE LIEBSCHUTZ: I'm not wasting my time.

Mr. Nei looked to death as a solace, as a time when he could meet his maker and his wife. However, he greatly feared becoming disabled and losing his independence in that process towards death. In spite of my sadness now, his spirit is with me strongly and will be so. I realize it is somewhat unusual for a doctor to have this type of

relationship with a patient, but Mr. Nie Chu Ping was not just any patient or any man. Mr. Nei's name actually means autumn peace, and I hope that he's achieved it.

LUANDA GRAZETTE: I'm Dr. Grazette, I'm one of the doctors up on Ellison 11, and I understand you are going to come and spend a day with us at least,...

MR. RIZZO: Yes.

LUANDA GRAZETTE: ...maybe a little longer. How are you feeling?

MR. RIZZO: I don't feel too good, I feel very, very weak and tired.

LUANDA GRAZETTE: Mr. Rizzo, he came in for heart failure; he's been in and out of failure for quite some time now and he had problems with his lungs, as well.

Have you had any fevers?

MR. RIZZO: No, I don't think so, didn't feel any.

LUANDA GRAZETTE: It was quite clear that things weren't getting any better, and that they were actually getting worse.

That's your pacer?

MR. RIZZO: Yeah.

LUANDA GRAZETTE: Is your belly usually this big?

MR. RIZZO: No.

LUANDA GRAZETTE: Is that tender when I press on it like that?

MR. RIZZO: Oh, your hands are cold.

LUANDA GRAZETTE: My hands are cold, warm heart.

I remember him as being very, very sweet and being much more concerned about how his family was doing and how the nursing staff was doing, much more so than he was concerned about how he himself was doing. It was sad. It was sad when Mr. Rizzo died. He was a very sweet old gentleman, and I was sorry to see him go. But I don't have any expectation that people should live forever. I'm not, you're not; nobody is. And at a certain point I see our job and the job of the nurses and everybody involved to help people have the most painless, graceful death possible.

CHERYL DORSEY: No, I think he's okay, should have plenty of room.

CHERYL DORSEY: I've decided to postpone my internship and residency training in pediatrics in order to start up a mobile outreach unit serving inner-city Boston.

I think that's fine, Hugo. We'll have to anchor this side now.

I sort of always knew that I wanted to work with the minority community.

There you go. Okay, little guy, hang on, hang on with me. Hang on. Look at that guy.

After the Family Van, I left Boston and came to Children's National Medical Center for my 3-year pediatric residency. For a long time I was torn between the idea of a medical career versus an academic career, so I enrolled in a Ph.D. program in history at the University of Pennsylvania. My mother thinks I'm ridiculous. She thinks I'm nuts.

CHERYL'S MOTHER: We went through being the majorette. We did the ballet –I think we both had to laugh to see this little fat thing in her little tutu, and bouncing around. That was so funny. Everything that came up, she wanted to try. And we were suckers for it, and we just let her try everything that she was interested in.

JAY BONNER: Being a psychiatrist is a wonderful career.

So, here were 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.

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 was a young and vain boy 13 years ago. I'm still vain, but less young.

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 Ayae, 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.

AYAE (Jay's girlfriend) : 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 who's outside of the art world. His insight from his experience was very inspirational for me, actually.

JAY BONNER: This is as deep an exploration of the mind as my work.

I've decided to become a psychoanalyst, and that means that, amongst other things, I participate in a psychoanalysis myself. So for the past 3 years, I've driven across town, to see my analyst, four times a week.

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.

I have a number of different facets to my career, currently. Mostly, I work in private practice and see patients, for the majority, in psychotherapy. I really enjoy the teaching that I do, which is increasingly part of my work now. And I'm very happy to be at a part in my career where I can do that. It's a lot of fun, I really enjoy it.

We've been talking today about parallels between patient therapeutic process and our own process. And I think one of the ways in which that's true is around self-forgiveness.

As is true for many people going into intensive therapy, there's a painful moment of realization when you understand that you're still going to be yourself when you come out of it. Because I, like many people, I think, had a fantasy that I was going to be a new person, a different person. And I think that coming to acceptance of that, coming to acceptance that I am still the person I am, and I still have so many of the frailties and hang-ups that I've always had and it's...you know, life remains a challenge.

All I can say about the question of whether I would do it all again is I'm glad I don't have to consider that. I mean, one can't live one's life over, it's just not done. So I am here, and it's a better place than where I've been. And I'm glad I don't have to do it again.

TOM TARTER: Divorced; another casualty. I don't blame medicine for it. I think the marriage probably would have ended in divorce anyway. If anything, I think being in medicine, perhaps, prolonged it, because I wasn't spending a lot of time with my wife, so we weren't able to address problems as rapidly as we probably would've if I had more time and I wasn't doing a residency.

This is Karen, the third in the series. And, well, we met about a year ago.

KAREN (Tom's wife) : Year and a half, almost a year and a half.

TOM TARTER: Oh, a year and a half. Time flies when you're having fun.

KAREN: It wasn't long before we knew that we were destined to be together.

TOM TARTER: I think we're done; I think we're adults.

KAREN: The intelligence, the brilliance is a real turn on. I can't get enough of it.

TOM TARTER: It's the beginning of the morning; it's 11:30, and we are just coming to work.

E.R. STAFF MEMBER: Yeah, but it's Sarah, and she's slit her wrist, not side to side, but up and down.

TOM TARTER: I love emergency medicine because it's very exciting. I get to go from case to case; I get to help each person through a moment of crisis. It's a very instant gratification, you know? It's definitely the kind of medicine that the TV-dinner-microwave generation can appreciate. This is what I do. I like it, I like working weekends and nights and all that stuff. I got to go. I'm going back, see what goes on.

EMERGENCY MEDICAL TECHNICIAN: Here's the scoop: 35-year-old female, found alongside the roadway, fallen from a vehicle due to a faulty door...approximately 40 to 45 miles per hour.

TOM TARTER: Hi, ma'am, I'm Dr. Tarter. How are you? Can you hear me?

In my years of practice, now, I have seen all the ranges of extreme tragedy, extreme joy. I can't think of anything that's grounded me so much in my life as being a doctor.

TOM TARTER: I'm Doctor Tarter, nice to meet you. And looks like we got some swelling here, has anyone ever figured out what this swelling's from?

PATIENT 3: I've got cirr...

TOM TARTER: What have you got?

PATIENT 3: Cirr, uhh, cirr, ur, uh...

TOM TARTER: Cirrhosis? When was your last drink?

PATIENT 3: About two hours ago.

TOM TARTER: How much do you drink a day? Do you drink a couple of six packs a day?

PATIENT 3: Yeah.

TOM TARTER: Since I've started working in the emergency department, I have never seen anything come close to alcohol as a cause of injury and death, not cancer, not gun violence, nothing.

A little ethanol going on, so we're not exactly clear on how it happened, but that's as good as we can figure.

I've seen people come in, their skin is the color of a Chiquita banana, and you take one look at them, and you know they have absolutely no liver left. And they killed themselves with alcohol, perfectly legally, too. Car accidents, where people are busted up into all kinds of pieces that you wouldn't want to even think about because someone was drunk and driving, and that just blows my mind; I've seen nothing make as much misery as alcohol.

The nice thing about working here in Bloomington, in bigger cities in the Emergency Department you don't get to know your patients and stuff, but I see my patients here around town. People go, "Hey, doc, thanks for taking care of me, blah, blah, blah." And that's real nice. It really is. It's very nice.

...living room. This is my office. I didn't have this in medical school. And that's all National Forest out there; that's Hoosier National Forest. So this is going to be here for a long time and so am I, yeah.

DAVID FRIEDMAN: Ophthalmology is one of the fields where you really feel that you made a concrete difference for your patients. It's an immediate gratification, as a surgeon, to be able to do this for somebody.

How are you doing Mr. Weber?

MR. WEBER: Do me a favor, call me Hank.

DAVID FRIEDMAN: Okay.

MR. WEBER: ...everybody else. Mr. Weber was my father.

DAVID FRIEDMAN: I'm going to give him an injection to numb his eye, behind the eye. It's a big needle; you don't put it all the way in, but it goes back into the space behind the eye.

I remember the first few times when I had to cut on the eye, and I'd make these little scratches. I'd barely touch it. And the guy with me would be like, "Cut deeper!" And I'd be, like, scratching down, because you're cutting into the eyeball. You're cutting into an eyeball. It's incredible.

I feel like I've really stepped into a great situation. I'm particularly lucky. It's a long haul, and I'm very happy because I enjoyed the whole process and I made it here in good shape. But I think a lot of people...it's really a long grueling process, and, in the end, a lot of physicians aren't totally happy with what they do.

My wife's a librarian, but she's only working part-time right now, so she can spend more time with our kids.

I used to bring work home. I'd wait and wait to get the kids to sleep so I could do my work. And then I decided I'd just go in very early in the mornings and get the extra work done I needed done, and when I came home I was done, and I was just here for the family.

ELIZABETH (David's wife) : Because when he was waiting to work later in the evening, then that was the time that he and I would have had, so there was none.

DAVID FRIEDMAN: So now I sleep less.

ELIZABETH: Now he goes to work at 6:00 in the morning, and it doesn't affect my schedule.

DAVID FRIEDMAN: You go through this phase of learning as you move up and you have people working for you, how to manage them, and suddenly you apply those skills in the wrong places. Like, I would act like, you know, how come you haven't finished the tasks I set aside for you at home? And you can't be like that with somebody you're married to; you can't treat people that way. And if it doesn't get done, you can't get angry that it didn't get done. You can't manage your friends; you can't manage your spouse. You have to still just be those things to them.

This is the Hopkins dome which is one of the really beautiful old buildings at Johns Hopkins, and this is just an amazing statue. It draws people all the time. It's a real energy point for a lot of people who are undergoing serious illnesses here. And then they have...on the sides, they keep these books, and people will write, "Dear heavenly father, please guide us and direct us as to the right decisions to make for our precious little baby." It's just...these books are loaded with human life and emotion, and it's just a, it's a fantastic space.

As you move up, you get more and more responsibility. You have a series of hats that you wear, and each of them you want to do properly.

Miss Bossler came to me about four or five years ago, and she only had one eye.

MISS BOSSLER: I was insured up until I got divorced, and then that was part of the divorce settlement, I guess: my children are insured and I'm not.

DAVID FRIEDMAN: So we've always had to have a little bit of a deal going.

MISS BOSSLER: Your deal's outside.

DAVID FRIEDMAN: My deal's outside; I get cookies and she gets a discounted fee.

Go ahead.

Healthcare and health insurance? Either you believe it's a right of everyone, and it's a way to level the playing field and guarantee even the most down and out and sad cases should be given the best healthcare they can get, or you don't. And if you believe they should, then it's not a business model, because, if you take care of those people, you're going to lose money on them. And so it's an insurance pool where we all agree that we're taxed to help everybody.

Now I have almost, like, five different jobs that I do. I'm a clinician and I take care of patients; I have my research effort here; last year I probably published 20 manuscripts; I teach; part of my salary is paid for by a non-profit, and I travel overseas for them, and I help them with eye-care development projects.

One-hundred-sixty-two-million people are thought to have low vision because they don't have glasses. And that's the only reason they walk around with bad vision. And so how do you fix that problem? How do you get glasses to people effectively, efficiently and cheaply?

What we're trying to do is develop a pair of glasses that are very simple: somebody could carry them in a backpack, test vision quickly, and then you would just try them on, take that pair and walk away. And if you can do that in a poor village in rural China, suddenly you have a distribution system.

A lot of these people are so poor and so remote that if we could develop this easy distribution system, it would almost be the only way they could get glasses.

Once my children grow up, I really...I plan on, or I hope I will, maybe help found a hospital or work in an area to help their eye-care and really live there and do the work. And that would make a huge impact on a whole group of people all at once. You could do that in your older years.

I think the thing that really strikes me, as I get older, is how alone we are, at some level. Like, I have these great relationships with friends, and I have great relationships with my patients and my kids, but at some level you try to create these intimate relationships, but ultimately I start realizing you feel a little more alone. And I think, to me, that's the one realization that's been a little hard, as I age.

JANE LIEBSCHUTZ: Is Roger here yet?

JANE'S FRIEND: I think I saw him coming in, yeah.

JANE LIEBSCHUTZ: Roger and I met at the synagogue. I cannot tell you how happy I am to have a stepson. I love Eli, and I just felt like I've wanted a family for so long and now I have one.

I love you.

The thing I like about Roger is that he grounds me. And he's very connected, and his home and family...and, sort of, pulls me into reality from my work and my life out—always out of the house—and he brings me back home. And so, and I feel very connected to him. And I love him, so...

I'm not surprised that I'm still at the same hospital where I did my internship and residency. I've always wanted to do what I'm doing, which is working with urban, poor, under-served patients.

In the population that I work with, 80 percent have had severe trauma in their lives at least once, and most of the people who've had trauma have had multiple traumas in their life. One out of every seven patients in our practice had a family member die by violent means: suicide, murder.

One of the biggest challenges to being a primary care doctor is that it's not well compensated for the work that we do, which I find incredible.

Over and over, the evidence is that if patients have good primary care, they're less likely to use expensive procedures, they're less likely to use the emergency room, et cetera. And so why don't we compensate doctors who do primary care more and attract more people into the field? People are leaving the field; it's burdensome.

I don't know why there's so many divorces and doctors. I mean, maybe it's that relationships are a lot harder than this profession. My husband says to me, "Now remember, I'm not one of your interns," because you get into this mode of giving orders and being in charge, and it's really different in a relationship.

Maya, that's really, really noisy.

You know, I have a really demanding job, which requires me to stay late, work hard, work—often I'm on the computer from 10 'til midnight—and so the burden falls much more to Roger for picking up the kids at daycare, dropping off.

My three-year-old sometimes says, "I want to be a mommy and a doctor." And I have mixed feelings about it, knowing how hard it was for me and how strenuous it is and how much you sacrifice. On the other hand, it's just an incredible gift, being a physician and so, if that's her path, I'll support her on it.

LUANDA GRAZETTE: I work for a pharmaceutical company called Amgen. I'm one of a small handful of cardiologists there. I have always been interested in science and was doing, actually, quite a bit of research as a cardiologist at Mass General, and had been primarily focused on how drugs, when they don't work or when there are unexpected side-effects, what the impact is on the heart.

But in my current position, instead of being in a lab with a couple of other people helping me and a few pieces of equipment studying a problem, there's enormous resources and lots of expertise to think about these same sorts of issues. So the impact is huge, compared to the type of impact that I could have on the process as a bench scientist. Although that was a heck of a lot of fun, and I enjoyed every minute of it, this seemed to be an option that I could take and make sure that I would have a well-funded retirement and not be in the cath lab until I am 80.

I definitely did not anticipate liking California. It was kind of a necessary part of taking the job, but it's really pleasant to live here.

I do miss patient care. That is the one area that's unresolved for me.

PATIENT 4 (Film Clip) : You did a good job, both of you. Thank you.

LUANDA GRAZETTE: Direct patient care and interacting with patients, and participating in their lives is a privilege, and I enjoyed it a great deal.

It's always sort of, like, a few of my patients that my mind sort of drifts to, like, "Hmm hmm, maybe that's what I should be doing."

TOM TARTER: Oh, now we're all locked up, huh? Great.

Unbelievable. My third marriage did not work out. It was probably just a very poorly advised thing for the two of us to get married to start with. When I first started at Bloomington I thought things were great. It seemed like the staff really liked me, the patients loved me.

Hi, ma'am, I'm Doctor Tarter. How are you?

I felt like I was doing a really good job, and I think I did deliver excellent patient care. The problem was I seemed to have a slightly different model of healthcare delivery than the people that ran the place. My charts were habitually late because I was habitually spending more time with patients.

You broke one of your ribs, okay?

Something had to give, and, of course, it wasn't going to be the corporation, it was going to be me. So they terminated my contract, without prejudice. I didn't actually get fired; I just didn't get my contract renewed.

People will look at me by my tattoos, by the way I wear my hair, by the way that I may speak, and they'll rush to judgment by that. But by the same token, these people

have access to my C.V. They see that I graduated Harvard; I've been working for 15 years as a board-certified, high trauma, high volume emergency doctor; I've never been sued, never been named in a case. It's just me.

JENNIFER (Tom's wife) : You know, sleepy man, I looked at your schedule, and you are stuck up there, because of those extra days, until about the middle of June.

TOM TARTER: Currently I'm taking planes, working anywhere from Seattle, Washington to St Thomas, Virgin Islands just to find work.

JENNIFER: Love you.

TOM TARTER: Happy Mother's Day.

JENNIFER: Oh, thank you. Have a nice flight.

You know, if I could, I'd go with him everywhere he goes, but that's not very feasible.

TOM TARTER: It's hell being away from my family. I don't know what I'm going to do about this. I'm trying to get a job closer to home, but I just can't find a job locally.

I need a room. (Quiet, you). This is where I live. It's not quite as big as my house in Indiana, but it has a bed and a TV.

ELLIOTT BENNETT-GUERRERO: I spend about two days a week working in the operating room, and then I spend the rest of my time working here, at the Duke Clinical Research Institute, which is part of Duke University. And it's a place where we are involved in coordinating big, multi-center clinical trials.

I'm interested in rupturing the abnormal cells.

I love research, but I think it's really nice to take care of patients and stay connected with that part of medicine.

My temperament is well-suited for anesthesiology. I'm really very compulsive, I'm a real worrier. And I hate it, I really hate it, if I am 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.

All the medical students are very interested in continuity of care and specialties where you get to know patients over many weeks or months or years.

So do you have any last minute questions?

PATIENT 5: No, I think I'm good.

ELLIOTT BENNETT-GUERRERO: Okay. We're going to take real good care of you.

You know, it's really a double-edged sword, because, with continuity of care, yes, you get that special relationship with the patient and a family member, on the other hand, there are obligations with that.

Let us know if anything bothers you, okay?

And so, if you're trying to leave the hospital at 6:00 to go to your son's baseball game and your patient has deteriorated and has gotten very sick, you know, there's a strong sense of obligation and guilt about, well, should you do something with your son or should you stay in the hospital and deal with the patient who's sick?

I play with my left hand.

I mean, I know I have a lot more balanced outlook of life now, than I did. Part of that's maturity, but also part of that is not having to work 90 hours a week anymore. It makes it a lot easier to have a family and have interests outside of medicine.

Oh, I hit it thin, but it's on the green. They say, you know, "thin to win."

KARIN (Elliot's wife) : I thought it would be nice for him to have a hobby and go meet people, but then it took over.

I always knew I wanted to have children and stay home with them, so I just feel really lucky that I have a husband who does get up and go to a job and doesn't care if I work or not.

ELLIOTT BENNETT-GUERRERO: I think I got kind of lucky in that way, because I don't think I was always of that mindset.

KARIN: Really? Well, since you met me you were.

ELLIOTT BENNETT-GUERRERO: Yeah. What I'm just saying is that I think it, I think that I, like many, many other people was thinking, oh, you know, I'm more likely to maybe get along with somebody who's a doctor or somebody in my same field because they can understand what I'm going through and I can understand what they're going through. I mean, I think that's a very pervasive thing that a lot of people think about. But in retrospect, I think the reality of it is that it's really nice having somebody who kind of can focus on the kids and the home, so at times when I'm working very hard, I can focus on my job.

CHERYL DORSEY: I now serve as president of Echoing Green, a non-profit organization.

As the president of Echoing Green, my job, mainly, is to be a spokesperson for the organization and to fundraise for the organization. That requires a lot of schmoozing, a lot of public appearances.

I have to say now, that I'm sort of the bad investment from Harvard Medical School, because I'm the only one who's not practicing medicine.

As a pediatrician in a large tertiary-care hospital, one of my great frustrations was you'd see a kid in the emergency room and you might patch him or her up, but you'd send them out, back to the same circumstances that led him or her to the emergency room in the first place. And there was a great sense that you could really actually change that child's life by working on, you know, a broken education system or a broken socio-economic system in that particular neighborhood. And I thought I could do that better outside of a medical setting than I could within one.

ECHOING GREEN EVENT ATENDEE: Three weeks ago, my friend Dona Maria used this bucket to draw water from a shallow well in her Bolivian village. I founded Terra because humanitarian aid is failing to help rural and impoverished Bolivian communities develop vital drinking and irrigation water.

CHERYL DORSEY: Echoing Green is not in the business of charity, it's in the business of change, and the whole idea that these people are digging deep to the root causes of these tough social problems and not putting a BAND-AID on these problems, but actually trying to dismantle the structures that keep poverty in place and educational inequity in place. That's how you get to change; that's the only way we can do it.

The issue of work-life balance, again, is not unique to medicine. You know, the work that I do now, I actually don't have a work-life balance; I work all the time. But it's been a labor of love for me, and I couldn't imagine doing anything else. And I get such joy out of the work that I do that I happily put in those hours. But I would say it's to the detriment of my personal life. I mean, I essentially work, and that's what I do, and that's who I have come to be defined as. And I think that's a problem.

I think it would have been easier if I'd had a family, because that's, sort of, the pull that gets you out of the office, and it stops you from checking that e-mail at one in the morning. I haven't quite cracked that code yet.

TOM TARTER: Hi there, sir, I'm Doctor Tarter. Feeling kind of awful, huh?

PATIENT 6: Yeah.

TOM TARTER: I'm really sorry to hear that. What happened? You woke up and started throwing up?

If I knew what I know now about emergency medicine, you bet I'd do it all over again. I love emergency medicine. I love it. I wouldn't want to do anything else. No matter what's wrong, I know that when somebody walks into my emergency department, I can give them their best shot at getting better, no matter what it is. And that feels really good, to be able to offer that to somebody. It really does. You know, to say, "You're going to be okay. We're going to take of you, and you're going to be all right." That's great. I wouldn't trade that for the world.