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On Call

The Journey Begins | Dear Film Crew: Help! | On Call | Alex's Case

Saturday, August 24, 1996
The "Medical Tower" Apartments next to New York Hospital
Room 1021

At 6:00 a.m. this past Thursday, Dr. Ghajar began a period on call. And so did the NOVA COMA crew. Team 1 members are posted at Jamaica; Team 2 members are here at New York Hospital.

Around 10:00 p.m., Team 1 gets beeped. After 10 minutes, as rehearsed, they call me on the cell phone code. It looks like a real case of head trauma. Highway traffic at night The patient was in a motorcycle accident. The crew has used two rolls of film already and is eager to continue filming. But it's my job to play the role of dispassionate observer. I need to ask some cool-headed questions: Was the patient wearing a helmet? The crew had not yet gotten that information and proceeds to investigate. The answer comes back: yes. Was the helmet scratched or dented. Were there any signs on the helmet that might lead you to believe this patient received a severe head trauma? Again, the team goes back to investigate. The answer: no. I ask the team to stand by, rather than rolling more film. This doesn't sound like severe head trauma to me at all—it sounds like the patient might be unconscious due to a pre-existing seizure condition, or something. Initially, the crew is frustrated with me, certain that we're going to miss critical steps of a real case; but ten minutes later, the police and medical personnel piece together this story: There was no accident. The patient does indeed have a pre-existing seizure condition and had pulled over his bike, and was found, lying next to it, unconscious. This is a false start.

For a moment I feel like Oliver Sacks, having made the right call. Meanwhile, the film crew at Jamaica is frustrated. How are they supposed to ask these sorts of questions in the heat of battle—when a case is unfolding? The trauma team is focusing on basic resuscitation—the ABCs, for airway, breathing and circulation. They don't have time to answer crew questions about helmets and so on.

The experience suggests that the split crews may be a mistake—that it's asking too much of a two-person crew to film and make medical assessments at the same time. But we all decide to give it one more day in the current arrangement.

Sunday, August 25, 1996
Team 2 post, Helmsley Medical Tower Apartments
(next door to New York Hospital)

Just 24 hours ago, both teams were rolling on minor concussions, or cases that involved no head trauma. And we didn't know what questions to ask. Now, we're bandying about terms such as p.l.o.c., for positive loss of consciousness, epidural hematoma, and "intubated at scene." [See Chicago Hope: Reading Between the Lines.]

With each false start, we learn something useful about what might happen when we begin documenting a real head trauma case. We're all much more confident about keeping the teams split and about our ability to respond to such a case.

Friday, August 30, 1996
Team 2 post, New York Hospital

But no severe head trauma cases come—to New York or Jamaica Hospital—despite the fact that we've been on call for eight days.

Life "on call" has had a number of mind-bending factors. First, there are no regular rhythms to the day. Just as you start to relax around 6:00 or 7:00 p.m., the usual end to a workday, just as you start to forget the 24-hour nature of this gig, the beepers go off! (Between our two closeup of surgical instruments locations, we have been beeped and have raced to the emergency rooms about 16 times for false starts.) The only consistently quiet time thus far is between about 4:00 a.m. and 10:00 a.m.

Second, there is the confinement. We are all tethered to an emergency room, beyond which we cannot stray further than three minutes, the time between when beepers will first alert us, and when the ambulance pulls in.

As a measure of how psychologically odd the confinement is making all of us, we quiz Peter, the sound person, about a recent dental appointment. He replaced himself with another sound person to cover his post for an emergency office visit. And we all want to hear, in real time, what it was like to "go out." A dental appointment is now a coveted activity.

At the post for Team B, Jeffrey, the assistant camera person, and I simply have not gotten the knack of having someone else supply us with all the groceries we need. Specifically, we have, for the last eight days, repeatedly forgotten to have the production assistant buy us salt. Today, we convert a piece of NOVA stationary into a make-shift sieve, by punching holes, and up-end a bag of pretzels, sifting for the desired seasoning.

I had imagined that after the first couple of days on call, after we perfectly set up our posts, we could retire to our living quarters to read great books in between the beepers going off. But there's an endless stream of adjustments in the logistics of this shoot. And even when there are apparent "down" moments, it's hard to concentrate on a book or movie—or to sleep—when you know that the beeper can go off at any second.

After days of this, I turn to Dr. Ghajar in exasperation: How do you do this? Is this really how you live?

Early on in his career, he confessed, it was very difficult for him to do any other activity. When he swam, he would have to check to see if his pager had gone off at the end of every lap. And even now, when he's on call, he still avoids leaving his neighborhood on the East Side, which is better positioned for darting over to Jamaica Hospital than, say, mid-town.

But even more psychologically difficult on this project than the confinement is the dreadful reality that the very event we are waiting to document will be the worst moment in someone else's life. We are poised and ready and rehearsed—for some family's worst nightmare. The longer we wait, the harder it is to face this aspect of the project.

I am honestly beginning to think that this idea is a mistake. Team members encourage me to wait until after the Labor Day weekend. They are confident that we will begin documenting a case then—and that this will bring back the sense of purpose I had when the project began.

Tuesday, September 3, 1996
A pedestrian walkway that hangs over FDR Drive—
and provides good views of the East River,
three minutes run from New York Hospital

Jeffrey, my team partner at New York Hospital, loaded himself up with his camera equipment one day and set out to find us a spot to sit outdoors, NY Hospital entrance which would still be within three minutes of the emergency room. On an exit road to FDR Drive, which winds along the East River, he discovered a pedestrian overpass. From this vantage, we can get some fresh air and watch the strange tug boats that go up and down the river everyday. Also from this spot, if we're beeped, we can race right through an open parking garage to the e.r. within the three-minute safety period.

When the walls of our post are closing in, Jeffrey and I suit up with our camera and sound equipment and take to this perch. This is where I begin the day, after the holiday weekend.

I'm bracing for a talk with the home office. I pretty much led them to believe that we could count on Labor Day weekend for a more active emergency room. But it turned out to be the quietest weekend on record at both hospitals! We still have no case. Now we have to decide whether to stop the project or go forward. I find myself concocting superstitious games—such as, if the next tug boat that passes by has blue lettering on it, we'll stop the project. This sort of thing.

Jeffrey agrees to take the equipment to the e.r. and stand watch, so that I can walk just one more block away to Dr. Ghajar's office. It's slightly out of the three-minute range to New York Hospital, but I need his advice. (This is how Jeffrey and I have conducted business over the last nine days, dragging equipment back and forth, one person standing watch, while the other takes a risk and ventures just one or two minutes further than the outer boundary of the quick-response zone. I admit, one day, we broke down and ventured beyond the quick zone to buy salt.)

Dr. Ghajar's mission is in part for the public to recognize that it doesn't take a miracle for patients to come out of a coma and do well—it takes the application of good science. I need this sort of rational thinking at this point.

"You look really depressed," Dr. Ghajar says when I walk into his office.

I'm about to earn the dubious distinction of being the first producer in NOVA history to walk away from a 10-day shoot with absolutely no film in the can. I think I have good reason to look depressed.

I explain to Dr. Ghajar that it's time to make a critical decision. If I don't want to assume any further financial risk, I can advise that we cut our losses and bail out of the project. Or, I can lead my bosses further down this risky path, knowing that we could wait another two weeks, and come out empty-handed. The next time Dr. Ghajar goes on call is September 20th, at summer's end, when cases of severe head trauma are expected to dwindle anyway.

But Dr. Ghajar suggests that I consider the "reversion to the mean." He usually averages one to two cases of severe head trauma a week, and the past month has been unusually slow. But sooner or later, the law of averages will kick in, he says.

Then, I feel guilty again that we're waiting for something that will be one of the most terrible events in the life of some as yet unknown family. Dr. Ghajar reminds me that our waiting to document a case doesn't make the case happen.

I return to the FDR overpass and watch the tug boats. I think of all the fantastic team members on this project. I think of Peter, the primary sound person, trying to boil pasta with a hot plate over a bathroom sink at Jamaica Hospital, night after night, never complaining. I think of how he and Dyanna Taylor (who filled in for camera person Tom Hurwitz in the critical first few days) devised a "quick-response cart" to help get the crew's equipment from the trauma room to the CT scan and back again, after the first couple of false starts. I think of how cool-headed Tom has remained in the face of some horrific false-start cases—multiple gun-shot wounds, injured infants where abuse is suspected—that sort of thing.

I think of Jeffrey, the assistant camera person, having set up our Team 2 post at New York Hospital and how every morning he goes to the e.r. to change the film loaded in the camera from nighttime to daytime stock, and then back again when it gets dark. We will have the job of filming Dr. Ghajar in his car en route to Jamaica if a case starts there. If we need to film the drive in the daylight, that requires one sort of stock; in the nighttime, it will require another sort of stock. So Jeffrey has to keep downloading and reloading the film in the camera, depending on what time of day it is!

Everyone has scouted, produced and directed their own posts. They've learned, on their own, when to roll and not to roll film, and what needs to Ambulance being unloaded be done in between to remain prepared. They talk about cases now as if they've been to med school. It's so affirming how committed they are to the project.

On top of that, two hospital administrations, dozens of paramedics, dozens of trauma team members, and Dr. Ghajar—all had said, okay, you can come along on this emotional journey. We might be able to witness, alongside a family, a loved one emerge from a deep state of unconsciousness, after days or weeks in a coma. We might be able to witness first-hand the treatments that Ghajar and colleagues are trying to establish as standards in their field. We might be able to discover why many hospitals have not adopted these standards, despite the building scientific evidence to support them. What if we do document a case, and it helps to bring the problem of head trauma—the number one cause of death and disability in the age group one to 44—to the public's attention? What if our audience comes to realize that outcome in such cases is shaped not only by severity of injury, but also by where the accident happens? What if this, in some small way, helps to change practice?

I don't want to miss this journey. I leave the tug boat perch to go back to my post and call the home office. I will recommend that we stay the course and go back "on call" again.

The Journey Begins | Dear Film Crew: Help! | On Call | Alex's Case

Photos: (1-4) NOVA/WGBH Educational Foundation.

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