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CNN: SPECIAL INVESTIGATIONS UNIT

Encore Presentation: Grady's Anatomy

Aired March 31, 2007 - 15:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


ANNOUNCER: Now, Sanjay Gupta, "GRADY's ANATOMY."
(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: You can get gunshot wounds to the head.

UNIDENTIFIED MALE: He needs to go to the O.R. or he's not going to make it.

UNIDENTIFIED MALE: You get knifings.

UNIDENTIFIED MALE: I mean this is real life.

UNIDENTIFIED FEMALE: At least 10 to 20 percent of the patients are homeless.

UNIDENTIFIED FEMALE: (UNINTELLIGIBLE) to the head. Time of death 10:00 p.m.

UNIDENTIFIED MALE: Any time we hear something on the news, we know they're coming here.

UNIDENTIFIED MALE: Where are you?

NII-DAADKO DARKO, FIRST-YEAR RESIDENT, MOREHOUSE SCHOOL OF MEDICINE: It's a mad dash. It's a chart a trace. Do you know where a chart is for 206? Come here, come here, come here.

ROBIN LOWMAN, FIRST-YEAR RESIDENT, EMORY UNIVERSITY: This is breakfast, lunch, dinner. I just did an intubation. Yes! Oh! I want you like champions over the moon.

ANDREA MEINERZ, FIRST-YEAR RESIDENT, EMORY UNIVERSITY: Most of our days we don't really sit down. It's nice to not be stuck behind a desk.

All in.

LUIS TUMIALAN, FIFTH-YEAR RESIDENT, EMORY UNIVERSITY: We have a chisel and whatnot?

TUMIALAN: I won't be home until late. There are countless nights where I don't get to go home and put my son to bed.

Come on. Come here.

Go home. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Is this maybe one of the biggest changes in medical education we have had in the past few decades, limiting now the number of hours that we can train residents.

TUMIALAN: They're coming through.

UNIDENTIFIED FEMALE: Code red. Code red.

TUMIALAN: How are you doing? Living a dream. I know every Monday, I got my time. I have my O.R. and it's all ready for me to go.

GUPTA: I'm Dr. Sanjay Gupta. I'm an attending physician of neurosurgery at Grady Memorial Hospital. My job is perform surgeries, take care of patients, but simultaneously and I think in some ways equally importantly is to train residents.

Prep and drape, suction, incision.

TUMIALAN: When an attending neurosurgeon hands you the scalpel, you're almost more excited than nervous. My name is Lou Tumialan. I'm a fifth year neurosurgery resident at Grady Memorial Hospital.

Apprehensional (UNINTELLIGIBLE) when I'm doing a (UNINTELLIGIBLE) screw right next to the spinal cord. I don't know if that apprehension will ever go away.

Good God. He's really busted up.

GUPTA: I'm glad to hear that Lou is nervous. I'm nervous. I think everybody should be nervous.

TUMIALAN: We're losing too much blood.

GUPTA: I think if you're not nervous, you might be a little too cocky. And I think that that's the biggest enemy of all.

TUMIALAN: This patient was in a deer stand 15 to 20 feet up in the air and the deer stand must have given way.

And sort of get a sense of all these bones look pretty nice and then all of sudden; this bone is just gone, crushed.

We're bracing ourselves for Pandora's box that we open every time we go into surgery.

Bring the poor machine that way.

We try and position everything perfectly. We try and study all the films perfectly.

It doesn't give me a soft and fussy feeling.

We can't control what variations of anatomy might be.

Give me another weapon. I'll try this one again. We have a cushion? A lot of times no one even has to say a word in that operating room. I know exactly what's going through their minds.

GUPTA: I don't lose feeling at any given moment without him saying a word. I know what's going through his head because I was there.

TUMIALAN: So we weren't not going to put any screws in the (UNINTELLIGIBLE), right?

GUPTA: No, I'm trying to expose through right now.

TUMIALAN: As a younger surgeon, you want to say OK, what would I do if I didn't have a net? But I can tell you it's nice to have a net because Sanjay will tell you how many jams he's gotten me out of.

GUPTA: The goal is to get him mobilized, get him up to a wheelchair. He's not going to walk again. He is a paraplegic. But we want to get him to a wheelchair. And we want to make sure that he continues to have use of his arms.

TUMIALAN: This is going to work, Sanjay.

That case could not have gone any better. That's what we show up to work for.

I think we're going to be in good shape here.

DARKO: Good morning, my name is Nii Darko. I'm a first-year general surgery resident with the Morehouse School of Medicine. I'm starting my 30-hour shift. My shift doesn't begin until pretty much 6:00 in the morning but I'm here to see my patients. And right now it's around 3:45, 4:00 in the morning.

Hello, I'm sorry. I didn't mean to wake you up. I like to come in earlier during my shift because it's quieter during that time. It's just kind of seems like it's my turf.

How are you doing today?

You know it just feels like the hospital is mine during that time. It's painful sometimes. I'm not going to lie to you. It's painful sometimes. You're just like I really don't want to come in at 4:00 in the morning. I really don't want to come in at 4:00.

My bed talks to me when I get out of it. It's like Nii, come back to bed. Why do you leave me? You can't look at it as a job. You can't look at it as a regular 9:00 to 5:00. It's not. That's why for me I get here so early in the morning so at least I know exactly what's going on with them because for me, you know, I would want the same thing to happen to my mother.

It's OK. I'm glad you're better.

DR. MUSTAFA DAVIS, FIRST-YEAR SURGERY RESIDENT, MOREHOUSE SCHOOL OF MEDICINE: He likes to spend extra time seeing the patients in the morning. I like to come in, get right on the get, and you know, be ready for rounds. I mean, some people kind of need more preparation in order to, you know, feel prepared to present, you know, which is sort of what we do. You know it can be nerve wracking at times.

DARKO: When an attending comes, you know, everybody straightens up. You make sure your white coat is buttoned all the way up, and let them know that you're thinking about everything and anything. And I just -- I don't know. I don't want to look like a fool.

DAVIS: You got a KUB this morning, which I didn't have a chance to (UNINTELLIGIBLE).

UNIDENTIFIED MALE: Please don't write "KUB." We are not all neurologists, OK. KUB is kidney, ureter and bladder. And I'm not interested in looking at kidney, ureter and a bladder.

DARKO: It is 9:05. I've pretty much working for almost six hours, almost a full day. And it's only 9:00 in the morning. We started at 3:45 and probably got another 25 hours to go, 26 hours. So it's not a race, it's a marathon.

MEINERZ: I'm Andrea Meinerz and I'm a first-year neurology resident at Grady.

Sometimes you get hit with everyone just trying to keep everyone healthy.

I'm spending my first year in internal medicine.

How are you this morning? Good. Sometimes, no one's sick and you write the notes and you go home. My day's so boring. I can't believe you're filming it. It's just a lot of writing and walking, and talking because you don't pee all day, you don't eat all day, and you don't sit.

Mr. Thurman, I'm Dr. Meinerz.

This fellow came in two weeks ago with an aortic dissection. It's a very serious condition. The inside of his aorta is actually ripping away from the outside of his aorta. If it continues to dissect, he could die essentially.

UNIDENTIFIED MALE: I got pain in my chest and in my heart.

MEINERZ: He's waiting on a procedure, so he needs to get that repaired.

UNIDENTIFIED MALE: I'm just anxious for it to be over.

MEINERZ: I bet. Well, we're anxious to have you get back out to the real world, OK, for your own good.

The first thing that happens at the end of any day is the first thing when you open that door, there's I'm leaving. I finished for the day, yes. But then as I'm driving home or God, I've been sitting up at night in bed, these patients just run through your mind and you say to yourself, did I do the right thing? Did I give them the right medication? Did I miss something? God forbid, did I miss something? I sit up at night and I wonder are they still going to be here tomorrow?

UNIDENTIFIED FEMALE: Code red. Code red.

DARKO: A guy got hit by a car.

TUMIALAN: Hey guys, we're coming through. This is what they call the golden hour of trauma.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: Now probably about 10 minutes.

UNIDENTIFIED MALE: OK.

LOWMAN: You tend to see all the problems of the world in the emergency department.

UNIDENTIFIED FEMALE: Somebody please help.

LOWMAN: I wish everybody could train in an environment like this.

UNIDENTIFIED MALE: Sir, do you hurt along the middle here?

LOWMAN: Bottles over the head, gunshot wounds, stabbings. You see everything, especially on a Saturday. And I have my driver's license so this might be a little bumpy, OK? I'm going to do my best.

I'm Robin Lowman, a first-year resident in the E.R. at Grady Hospital.

EKG, Blue Zone, (UNINTELLIGIBLE), EKG, Blue Zone, (UNINTELLIGIBLE).

We have two zones, the red zone is trauma. And here on the blue zone, it's more of a medical side: heart attacks, things of that nature.

DR. DAHLIA HASSANI, ATTENDING PHYSICIAN, GRADY HOSPITAL: It almost looks like chaos from afar, but it's not. It's organized chaos. And it takes a special kind of person to be able to function in an environment why you're constantly interrupted.

LOWMAN: You can't be uptight. And you can't get frazzled easily if you work in emergency rooms. You have to be cool. You have to be confident. I just told the nurse, the guy that just walked by here, to give you some morphine. He's going to put an I.V. in you.

In the emergency room nowadays, you know, it's a lot of people's primary care. So there are definitely patients that we see often.

Hi, Miss Harper, I'm Dr. Lowman again. What brings you to the hospital today?

UNIDENTIFIED FEMALE: Well, I had a head cold for a week and then I started coughing and coughed so bad my chest started hurting.

LOWMAN: Do you do any crack or any cocaine, marijuana?

UNIDENTIFIED MALE: Used to, smoked marijuana.

LOWMAN: OK. And you used to do crack?

UNIDENTIFIED MALE: Yes.

LOWMAN: OK. When was the last time you've done it?

UNIDENTIFIED MALE: Six months ago.

LOWMAN: Six months ago, OK.

You know , when you walk up to a patient, just, you know, laying your hand on their shoulder or, you know, touching them, letting them know that you're not afraid of them, you know, that you don't look down on them, that, you know, you're just like them. I mean it's amazing what a touch on the shoulder can do.

DARKO: I think the biggest inspiration for me to become a doctor was actually "The Cosby Show." So I thought he was great, you know. He had a relationship with his wife. He had a really good relationship with his children. You know, I got a kick out of it. When, you know, I had no idea that, you know, we had to put in 30-hour shifts, you know, as part of the deal. But, you know, you lied to me Dr. Huxtable.

MEINERZ: We're going down to the E.R. to admit my first patient today.

I'm admitting the patient which is like more paper work than anything else I do. I'll write that down. I have a whole history of physical sheets to fill out and then I have like five to seven pages of orders. I have to write my name, time, service on every page.

GUPTA: I mean I felt like a transcriptionist, you know, my first couple of years of residency. It's all I did.

MEINERZ: When I'm no longer an intern, I'll have somebody beneath me who will write the daily notes.

Hi.

UNIDENTIFIED FEMALE: Can you please wait...

MEINERZ: Hi, I can't...

UNIDENTIFIED FEMALE: until I get some rest.

MEINERZ: I got to look at you.

UNIDENTIFIED FEMALE: Could you not put your hands on my body! I'll -- can you give me...

MEINERZ: I'm your doctor and I got to take care of you. That's my job. That's my job. How are you feeling?

You don't have to like all of your patients, but you have to take care of them regardless and you have to treat them like you're aunt or uncle or grandma or grandpa.

My family is all working class. My dad was a factory worker. My mom, she was a youth minister. My generation is first generation to have ever gone to college. We're pretty proud of that, I'd say. But my parents kind of say, you know, you did well but maybe you shouldn't think you did well. You can always do better.

So this is my call room. This is where I attempt to sleep. There's a saying in medicine, eat when you can eat and sleep when you can sleep. I had one shift last month that I worked 30 hours sleep without ever going to sleep ever. And I was swerving on the road. It looked like I was probably drunk.

I forgot to eat. If you're working 100 hours a week, your patients would suffer. I totally think the 80-hour work week is wonderful. I don't usually see you this time of night.

UNIDENTIFIED MALE: No.

MEINERZ: So you've been having more pain today?

UNIDENTIFIED MALE: Yes, they changed my prescription.

MEINERZ: Yes. We changed it because the Vicadin was working anymore. Now, have you and the surgeons discussed the other options as far as not having the surgery?

UNIDENTIFIED MALE: No.

MEINERZ: OK, it's a very difficult surgery, you know.

UNIDENTIFIED MALE: And I've been through it.

MEINERZ: Well, you got to understand that this is different than when you were through it before, OK.

Not only do you have the responsibility of weighing the risks and the benefits, but you have the responsibility of presenting those risks and benefits to the patient.

Now, I want to sit down with the surgeons and see exactly how much risk they think there is involved.

UNIDENTIFIED FEMALE: Code red, code red.

DARKO: A guy got hit by a car.

TUMIALAN: He's going to the O.R. or within the hour, he's going to die.

DARKO: He's got a big bleed on his brain.

TUMIALAN: I'm down here in the red zone and there's a guy who needs to go to the O.R. now. He has an epidural hematoma.

I saw that scan and then my entire day just completely shifted.

Jess, open up that other door.

I'm looking at the patient's head and I visualize the blood clot getting bigger.

What are you going to do, Jess?

JESS SCHUETTE, THIRD-YEAR NEUROSURGERY RESIDENT, GRADY HOSPITAL: Drain the epideral and open his airway and give him a subderal.

TUMIALAN: He's going to need DVD.

SCHUETTE: Do you think he's going to be fine?

TUMIALAN: Have you talked to the mom?

SCHUETTE: Yes, I did. I talked to the mom.

TUMIALAN: We know what's going to happen to this guy and so kind we're kind of pushing people out of the way, maybe being a little bit rude. Hey, guys, we're coming through.

If it was a blood clot on my brain and a guy was making a big deal about rushing, I'd appreciate that.

This is what they call the golden hour of trauma.

GUPTA: Trauma's not something you want to make up as you go along.

GUPTA: Give Jess a marking pen. So Jess has already got the head positioned. Lou shaves the head. Jess makes the marks. Jessica is scrubbing his hands already while Lou is finishing up. Then Lou scrubs his hands. It's just an orchestrated dance.

TUMIALAN: I got this.

GUPTA: Jess was here all day yesterday. And we are going to basically let him build the operation, which is a case that he typically will do.

SCHUETTE: Kelly, clamp.

GUPTA: He's got a chief resident joining him in things.

TUMIALAN: Make sure you trick.

GUPTA: I'll show him things as well. And really get down low and let's scrape that.

TUMIALAN: Full power. OK, memorize the look of this.

SCHUETTE: Lou is very intense but he's also -- he's someone openly -- praises you when you do good things. He's a natural leader. SCHUETTE: We're closing.

TUMIALAN: Do you have the (UNINTELLIGIBLE) in?

GUPTA: And how he's going to do, we'll know in the next few days. But the pressure's off his brain and that's key.

TUMIALAN: It's a traumatic brain injury. And so we've given him the best shot that he has to recover.

DARKO: This is the full moon. It's 12:00 at night. And we already had a gunshot wound to the eyeball. Squeeze my hand. So these patients are just one step from expiring.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

TUMIALAN: He's had a good day?

This past weekend we were dealing with a first fear that our 6-month- old had and I think that may have worn my wife out.

I love you. So I hope to be able to take the little man off of her hands for a few hours today. Now I'm sneaking home to see my baby and see my wife. I put my baby down to sleep on Sunday and I haven't seen him awake since.

UNIDENTIFIED FEMALE: Hi, Papi.

TUMIALAN: There are countless nights where I don't get to go home and put my son to bed. I just discovered that he can stand up in his crib. And I asked my wife, I said, "Come in here, take a look at this. He's standing up in his crib." She told me he's been doing that all week.

UNIDENTIFIED FEMALE: Would you have pizza this afternoon or what are you doing? I think we very much view our marriage as a team and just being flexible is knowing that might be home for dinner. He might not be home for dinner.

In military life, he was away. And there were weeks on end where I didn't hear from him and I didn't really know his location. And now, he's away sometimes when he's on call or has a really busy day at the hospital. But I know exactly where he is and he's able to come home.

TUMIALAN: This is everything. This is why you wake up in the morning. These little creatures are magical. They're very magical.

MEINERZ: I covet the outside. It generally is very difficult to have a life outside of the hospital. For me, it's easy because a lot of my life is included with my husband.

UNIDENTIFIED MALE: They get a lot of birds out here.

MEINERZ: He like his birds. In college, we took a bird lab course together. We go out for walks.

UNIDENTIFIED MALE: This is one of our ferrets, Penelope.

MEINERZ: We try to go every evening but that doesn't always happen depending on my schedule.

UNIDENTIFIED MALE: There's no routine at all. One day she'll have to go in at 5:00 a.m., another day she'll have to go in at, you know, 5:00 at night. So you never really can get set in your ways. It doesn't leave a whole lot of time for cuddling.

MEINERZ: We like to play poker. All in. Poker is like a release. I can use my abilities that I've learned as a physician to read the other opponents. There are different things about the way the peoples' work, about the way someone's skin will wrinkle, which direction they'll look if they're lying, you know, certain types of nervous habits that they may have. It's just a lot of things that you pick up that you know just because of medicine. I think you have an inside edge.

LOWMAN: Writing music and singing is just a release. It's like catharsis.

(SINGING)

LOWMAN: This song that I'm working on, which is supposed to be the song that these two record companies were waiting on, but I just haven't written it yet. You know what I mean? My manager is getting mad, which I understand. But I don't want to turn in something that's trash, you know. And then I don't have time and you know I'm tired.

(BEGIN VIDEOTAPE)

ROBIN LOWMAN, FIRST-YEAR RESIDENT, EMORY UNIVERSITY: This past week was very, very, very tiring. A couple of days ago, when I'm getting off of my 3 a.m. shift, it's like 4:30. I pull up in my yard. And I try to get my key out of the ignition. It won't come out. So I left it in the ignition. I left my back doors open. So I'm just hoping nobody, no crack head, and no psycho walks in looking.

Somebody stole my radio.

How are you doing?

UNIDENTIFIED MALE: Hi, how are you?

LOWMAN: I don't know when they did this because they took the changer out the back. They used my lotion. It had to be a crack head. I mean you sit to use my lotion? Why are you stealing the radio? But whatever. This is like the only day off. I have to go through this drama.

NII-DAADKO DARKO, FIRST-YEAR RESIDENT, MOREHOUSE SCHOOL OF MEDICINE: It's a full moon. It's 12:00 at night. You know we already had a gunshot wound to the eyeball. We already had a MVC rollover with, you know, multiple injuries. So these patients are just, you know, one step from, you know, expiring.

This person did not wake up, thinking that he was going to get shot in the head two times. So for me, it burdens me. And especially being in this area, you know, with a large minority population, it hits harder because you're like, well, maybe that could have been me.

You know I came from situation like this, and, you know, to treat people who are in a same station as I was growing up, you know, it really means a lot to me. Right now, I'm getting ready to get some shut eye for like a minute or so and then get ready for the next upcoming day. So, this is my white coat, which is also my pillow, which is also my locker room.

Where are you? What did you say? We need a chest tube. You have a chest tube?

Putting in a chest tube is like a big deal. Right now, my heart is racing because, you know, if you don't fix it, this patient is going to die.

Everybody's looking at me. So it's like, do you really know what you're doing? I mean are you sure you know what you're doing?

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Just about anybody who's a surgery resident of this hospital will tell that when they're suddenly called upon, recruited into duty, asked to put in a chest tube, asked to perform an operation, they get that adrenaline rush that makes them perform.

DARKO: You know everybody's looking at me. So, you know, everyone knows I'm an intern and stuff. And it's just like, well, do you really know what you're doing? Are you sure you know what you're doing? But at the same time, once I look at the skin and once I have the blue towels around it and I have the light there, you know, it kind of seems as though everything behind me just kind of disappears. That was a rush.

Hello, America, I am tired. I am tired. I don't understand how you can live in a hospital or work, you know, greater than 100 hours or greater than 200 hours and really say that you're providing really good patient care when you're tired and exhausted.

UNIDENTIFIED MALE: Hey.

UNIDENTIFIED MALE: We only have 10 1/2 hours left to go.

LOWMAN: If you shoot this, I'm going to hurt you.

This is breakfast, lunch, dinner. It's just a lot of chasing, you know, chasing stuff down. My feet always get swollen like eight hours, maybe like seven to eight hours into the shift.

Because the emergency department is so high strung, our department makes it their business to not schedule us -- they try not to schedule us more r for more than 40 hours a week just because it would just be impossible to do. You know, I'm just tired. My feet are swollen. My knee -- I mean, I'm just zonked. I am wrapping my hair up and I'm getting in the shower and I'm going to bed.

I would have called myself a nerd a couple of years ago going to bed at 10:30. But I'm very thankful for this now. See you all.

ANDREA MEINERZ, FIRST-YEAR RESIDENT, EMORY UNIVERSITY: I'm concerned about will you make it through the surgery, OK, because there's a big risk just being on that table.

UNIDENTIFIED MALE: Yes.

MEINERZ: I think we're too quick to choose intervention sometimes. And sometimes we lead a patient down a path without completely informing him. Hey, if you do this, you could die. I don't know that he should be going to surgery. Maybe he should just deal with the pain.

Of course, we're optimistic, OK. We always want the best for you. But we also want to be realistic, too, OK.

UNIDENTIFIED MALE: Yes.

MEINERZ: We don't want you jumping into something if it's not best for you.

UNIDENTIFIED MALE: I got to be real.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

MEINERZ: I was nervous that whole day during the surgery. I called actually the O.R. I called them four times to see if they were done. And it was like 12 hours later. I was like, oh God, you know, I hope nothing happened.

Hey, can we come on in? You're looking great. How do you feel?

UNIDENTIFIED MALE: I feel great.

MEINERZ: They did a fantastic job. It's rewarding to take care of someone physically. But I think it's even more rewarding to take care of them spiritually and mentally. So many people are so easy to write prescriptions. But there aren't as many people who are willing to just hold their hand, sit with them. And that's what the patients remembered. It's like a miracle.

UNIDENTIFIED MALE: You know what they call me? The miracle patient. MEINERZ: You're the miracle patient? You are. This is one of those moments that I'll remember forever not just during residency, you know. You just have that emotional connection with a patient and to have an outcome that you're not sure what's going to happen and then it comes out beautiful. It's very rewarding. This is why we do what we do.

DARKO: It's 2:15 and I'm just finishing my shift. And based on my calculations, I've been here 34 hours straight without sleep. So the sad part is it's become all too common place now.

I feel like I can feel every bone in my body just tingling right now. And my brain just feels like I took like a 12-hour straight test with no breaks. And it feels like I took the MCAT, the SAT, and the ACT all at once. That's always the case.

OK, you said he was supposed to be admitted to the ICU? I'll come back. All right.

DR. FRANK JONES, ATTENDING PHYSICIAN: Had we known he was here for longer than that amount of time, I would have told him to sign out to another resident. The only reason that they leave or have to leave is because of the rule. I think it's very unrealistic. And I think we're setting up a situation where we're not teaching the residents to be concerned about their patients.

LUIS TUMIALAN, FIFTH-YEAR RESIDENT, EMORY UNIVERSITY: We're operating until 1:30 last night, which means Jess has been working very hard. It's time for Jesse to go home.

SCHUETTE: The hours sometimes are a little restricting. You know, I have to go home early on a day. And there might be a case that goes in that day and that experience that I miss.

GUPTA: And we obviously want to follow the law. But we also want to make sure that the residents get the very best training possible.

This is your spinal cord. So this is constant friction between making sure that I have Lou and jess seeing the appropriate number of cases.

We walk back into the room.

Versus making sure they get out of here.

OK, good.

I'm not sure the system works quite in the way they were hoping that it would.

TUMIALAN: Hey, Chris? Chris? Chris, open your eyes. I have almost a contract with the patient.

Not almost a contract, I do have a contract with the patient.

Chris, can you look at me? I said I would care for you. Their family members that have met me and they said, "This is the doctor that's going to be primarily caring for you."

See you.

I would rather be in violation of the hours than I would be in violation of a contract with a patient.

DR. DANIEL BARROW, CHAIRMAN OF THE DEPARTMENT OF NEUROSURGERY, EMORY UNIVERSITY: You know there is an assumption that long work hours and sleep deprivation create more errors. On the other hand, when you limit the hours that a resident can work, you are by definition creating more handoffs of patients from one team to the other.

TUMIALAN: Go home, go. I'm not kidding. I want your coat off. Get your keys.

SCHUETTE: I'm a senior.

TUMIALAN: No, I'll see you tomorrow morning. Get your coat off.

BARROW: And there is evidence that handoffs are also associated with the opportunity to make errors.

TUMIALAN: Glad's in here as my middle reliever. You no longer have the ball.

GUPTA: The group of people that go into neurosurgery and surgery in general work really well under extreme circumstances: little sleep, little food. I wouldn't say they thrive on it, but they almost thrive on it.

TUMIALAN: In an environment where you don't have overachievers, that would be dangerous to patient care. Underachievers need not apply.

LOWMAN: It's starting to go down. It's Saturday night, Grady, red zone.

DR. DEB HOURY, ATTENDING PHYSICIAN: As you can see, we got hit with about five trauma patients all at once. And Robin is one of our interns. Usually, second years are the ones that run traumas, but because we are busy, I asked her to assist.

LOWMAN: Sir, pain?

When I went in there, I was a little shocked at how severely hurt this patient was.

Pupils are equal and reactive to light.

Literally, the foot is almost gone. He has an open fracture on one leg. I mean, he had a lot going on.

UNIDENTIFIED FEMALE: ETA on a 45-year-old female involved in a head- on NBC about 45 miles per hour. She has open head trauma. She is intubated and in traumatic arrest.

HOURY: Oh God.

UNIDENTIFIED FEMALE: No pressure, no pulse.

HOURY: We have no room.

UNIDENTIFIED FEMALE: ETA...

HOURY: We have nothing.

UNIDENTIFIED FEMALE: Stretcher.

UNIDENTIFIED MALE: Coming out, coming out, coming out.

LOWMAN: When we finally get the woman in, they're doing chest compressions. We move her to the bed and get the ultrasound out to see if she has any cardiac activity, to see if we can see the heart moving.

UNIDENTIFIED FEMALE: No cardiac movement.

HOURY: I have no pulse.

UNIDENTIFIED MALE: No pulse.

HOURY: Fatal injury to the head.

UNIDENTIFIED FEMALE: Yes.

HOURY: Time of death, 10:00 p.m., fatal injury to the head.

UNIDENTIFIED MALE: Time of death?

HOURY: 10:00 p.m.

LOWMAN: That is hard to deal with. I tend to pray. I'll just grab my cross just to make sure that it's there. It's just comforting for me. And that's been hard for me to understand that there's nothing we can do.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

HOURY: Time of death 10 p.m., fatal injury to the head.

UNIDENTIFIED MALE: Time of death?

HOURY: Ten p.m.

LOWMAN: You have to have a coping mechanism. Mine is spiritual. My bible always sits here. "Praise ye the lord, oh, give thanks unto the lord for He is good, for His mercy endureth forever." This basically tells me that, you know, God is in control.

GUPTA: It's a huge burden to carry around that you're always imagining the troubles of your patients. And the troubles of the world are on your shoulders. It's OK to have those emotional attachments. That's not abnormal. I think what's abnormal is not to feel, you know, for what your patients are going through.

LOWMAN: It's cold. I'm going to my brother's house.

Hi, this is my mom, the best mommy ever.

UNIDENTIFIED FEMALE: Hey, how are you?

LOWMAN: Mom, you look cute.

UNIDENTIFIED FEMALE: Thank you, thank you.

LOWMAN: It was so good to see them up waiting for me to get off work at 12:00 at night, you know. I mean that's priceless.

Even though it was hard, my dad always said, "You'll never forget this experience and you'll always remember residency."

DARKO: This is the only opportunity I really get to relax, is the drive home. It is 4:54, almost 5:00. It is 36 hours plus that I've been up. I'm on my way home. I'm looking forward to taking a nap. And I'm looking forward to kicking it with some of my compadres out on Midtown Atlanta.

The most important thing is that I'm home. I'm just looking forward to hitting the sack for a little bit. And then I'm going to get up and get into town and have a good time tonight.

You know the big thing is everybody says, you know, "When are you going to have time to go out? When do you have time to go out?" And the key answer is you never have time to go out. So you have to make time. I only slept for about an hour and a half. I was just, you know; complete, you know, non-interrupted sleep. I'm tired right now but I got a couple more hours left in me before I really completely pass out. And, you know, I go into my hibernation.

For me what it comes down is the love. If this is what you want to do, if you have the love to be doctor, if you want to help people, then this is not a big deal to do a 30-hour shift. It's a sacrifice. It's tough. This is what it boils down to. This is what makes me happy, at least.

MEINERZ: I just enjoy my days off. It doesn't make a difference what I do with them anymore.

UNIDENTIFIED MALE: Yes, and the last day off you had, you slept until 5:00 in the evening.

MEINERZ: What time did I go do bed?

UNIDENTIFIED MALE: Well, you know, but... MEINERZ: Five in the morning.

UNIDENTIFIED MALE: Yes, still -- but that was the last time you had a day off. And that's what you did. You slept all day long.

MEINERZ: Yes. The toughest thing is managing your life, managing your time.

UNIDENTIFIED MALE: Last month was really difficult. There were some days where the only I would only get to see her was 20 minutes when I would come home for lunch.

MEINERZ: I thought after medical school, it would get a little easier. Now it's -- I actually realized that it gets worse rather than better.

TUMIALAN: After the week I've had, I need a good lift. This workout will be like having four or five hours of sleep.

People are driven for reasons. And in my case, it was sense of powerless that I had when my younger brother suffered from a condition called Barter's Syndrome. Downtown Chicago, 26-year-old male comes in on a Friday evening. He's got a Hispanic last name. It's probably a drug overdose or something related to that. And my younger sister was trying to explain to them exactly what his disease process was and no one would listen. My mother gave me the information, "Your brother has died."

I was overseas at the time. But if I was there, perhaps, things would have been different. If doctors had listened, perhaps, I would not have lost my brother.

Let's just go, go. Hours have nothing to do with me as a physician. I want every surgery that I do, every interaction I have with a patient to be a manifestation of the memory that I honor. That's it. I'm on a mission.

(END VIDEOTAPE)

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