'Nova' updates its study of medical students


October 08, 1991|By Michael Hill

There in front of you on this TV screen a hand is holding a human heart, pumping it, keeping its owner alive. The patient had been in the midst of a bypass operation when his cholesterol-clogged heart stopped beating.

Narrating all this is a third-year medical student who has been in the operating room observing. You've been following this student's progress through med school for more than an hour of this special two-hour season-opener of PBS' science series "Nova." "So You Want to be a Doctor?" will air tomorrow night at 9 o'clock on Maryland Public Television. It's hosted by Neil Patrick Harris and will run opposite his ABC show, "Doogie Howser, M.D."

This is the second of a series of documentaries that are part of a 10-year project that follows a few members of a class at Harvard Medical School. The first ran in 1988 and introduced viewers to the participants, the initial Harvard students to follow a new curriculum.

The idea behind the New Pathway approach, as it's called, was to put a human face on patients right from the start. So, instead of starting off neck-deep in textbooks, with a preserved cadaver the closest thing to a person they encounter, these students were interviewing patients in their first year.

Tomorrow night's documentary focuses on their second, third and fourth years in school. The third installment, currently in production, will follow these fledgling doctors during their internships.

The New Pathway seems to end when the third year begins and the medical school turns the students over to hospitals for apprentice-like training in various medical disciplines.

Suddenly, the imperious, arrogant physician who deems it his duty to humiliate medical students, and undoubtedly a few quizzical patients as well, shows up. The term God-like is no misnomer. Indeed one of the med students does an entire explanation of the professional hierarchy in the teaching hospital using a religious order as his model.

The ridiculous, through-the-wringer long hours appear as the medical establishment continues to assume that students must be exhausted to learn, doing its best to ensure that doctors themselves live unhealthful lifestyles.

But actually getting in the hospitals -- not in the carefully monitored interview situations, but in the midst of actual medical procedures and emergencies -- does bring a certain urgency to these students' education that had been lacking during hour after hour of studying.

So you've seen this young woman putting into practice the various skills she has learned as she sits with a spry Scotsman who fears his upcoming bypass operation. She reassures him that all will be fine, and he seems certain that he is in the best of hands. He just wants to play soccer again, a recreation his chest pains had stopped.

And now that man is alive only because a doctor is manually beating his heart. As the med student asks the surgeon questions, he admits that he's basically trying to think of something else to do. A slightly frantic look comes into the student's eyes, visible above her mask.

Then suddenly, with no fanfare, the doctor says that's it. He stops pumping the heart. Someone notes the time. The patient is dead.

And the med student steps away from the operating table and cries and cries and cries, uncontrollably. Most people in the room ignore her. The surgeon does come over and say a few awkward words of comfort and understanding.

And the student feels compelled to apologize for her tears. But you want her to be proud of them. Because you know that instead of one of those cold, imperious, God-like types, you would rather have a doctor who would shed tears over your death. Those tears are a sign that the New Pathway is headed in the right direction.

During "So You Want to be A Doctor?" you get to know several of these students, not intimately, but well enough to observe their development.

A gruff, cynical first-year student seems to grow younger and more enthusiastic. A sensitive student thinks he's found his specialty in psychiatry. An earnest fellow whose enthusiasm seemed deflated after bad marks on his obstetrics rotation chooses anesthesiology because the money and hours are good.

Others take time off for further studies, to expand their worlds beyond the stifling pressure of med school, one working with a Johns Hopkins program in Indonesia.

So much of their education seems designed to squeeze the tears from their bodies. "So You Want to be a Doctor?" reminds you that behind the rushed appointments and cold stethoscopes and bad handwriting and jargon-filled answers are people, not gods.

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