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Tom Tarter today, in his guise as an emergency-medicine physician in Bloomington, Indiana.

The Producer's Story
by Michael Barnes

One afternoon in 1987 when I began filming NOVA's doctors series, of which "Survivor M.D." is the fourth installment, I found myself standing in a lunch line at a welcoming reception for arriving Harvard Medical School freshmen. As we waited, I struck up a conversation with the man next to me, who introduced himself as Tom Tarter.

I soon learned that Tom was not your typical incoming med student. Hailing from the Bronx in New York City, Tom was 31 years old, recently divorced, and had formerly worked as a bouncer, psychiatric orderly, and auto mechanic. He told me it had taken him 14 long years to get into medical school. With his unconventional background, I knew immediately that he had to be in our film about the training of doctors. I was particularly intrigued to see how Tom would fit into the rather elitist Harvard Medical School community.

I explained to Tom my motivation for making this NOVA series. Doctors have a unique role in many of life's great dramas. They probe our minds and bodies, both figuratively and literally. They help us when we are most in need. Obviously, many rewards come from being a doctor, but the journey to become one can be long and arduous as well as expensive, exhausting, and depressing. Would he be willing to share with us some of his experiences along the way to becoming a doctor? Could he handle being filmed throughout his medical career -- through medical school, hospital clerkships, his internship, and beyond? Fortunately Tom said yes. (Years later he confided to me that he thought being a subject in the film would make it less likely that Harvard would fail him!)

Nearly half the Class of 1991 offered to be in the NOVA film.

Finding a balance
My serendipitous lunchtime encounter with Tom was followed by a more formal session in the school's main amphitheater with all members of the Class of 1991. Tom had been an easy call; he was articulate and passionate about becoming a doctor. But now I had to find a handful of other students willing to be filmed. To my surprise, 70 students, nearly half the class, expressed an interest in participating despite the long-term commitment.

Over the next two days, I conducted interviews. I was looking for a balance of men and women, including some minority and older students. In the end, I didn't bring much science to the interview process but simply relied on my gut instinct to choose good characters.

I was immediately impressed with Jane Liebschutz, for example. She was older than the average student, and she had only started thinking about a career in medicine while working in a health clinic in Taiwan. In her interview, Jane seemed extraordinarily idealistic and had already set her sights on a career helping the urban poor. She also carried her heart on her sleeve, and I felt that she might serve as a bellwether for the emotional mood of the class. In this role she was to prove superlative, alternately overwhelmed and elated as she was by her new experiences.

The Class of 1991 was the first to try out the school's radical "New Pathway" curriculum.

Realizing the difficulty of predicting exactly how people would react to being filmed, and knowing that a few would drop out along the way, I decided to start off with a dozen students, then narrow down from there. At the end of the first year a core group of seven emerged: four men and three women, with representation from the African-American and Hispanic communities. Three of the students had Ivy League backgrounds; two had fathers who were physicians. In short, I feel we had a microcosm of the Class of 1991. [To hear from each of the seven participants, see Meet the Doctors.]

Apart from the convenience of filming just down the road from NOVA's home at WGBH, I had another important reason for asking Harvard to open its doors to us. The medical school was launching a major curriculum reform, which it rather evangelically called the "New Pathway." The class that arrived in September 1987 became guinea pigs in this medical-education experiment, which stressed less information, more self-directed learning, fewer lectures, and more small group tutorials.

The fact that not all of the students were aware of this, and that many faculty members were skeptical of the approach, made for some challenging negotiations for me as a filmmaker. It took many months of talks with various deans, a presentation to the faculty council, and finally the formation of a special committee to get the green light to start filming. And it came just in time for the first rite of passage for the incoming class: gross anatomy.

Witness to a transition
The Anatomy Department was hesitant about letting us film. It had been entrusted with human bodies exclusively for use in medical training, and it was concerned that we not violate that trust. I understood its concern, but I very much wanted to film students dissecting cadavers and talking about what that experience meant to them. It seemed the ideal place to document the start of the students' transition from laypeople to physicians.

And witness that transition I did. "Now I'm beginning to see what this alternative perspective is," Tom enthused after a few weeks with his cadaver. "When I'm writing, I'm thinking about what muscles are moving. I can actually see them in my mind. It's an absolutely fascinating way of looking at people, from a whole other perspective, from the inside out."

In making "Survivor M.D.," Michael Barnes had to strike a delicate balance between his needs as a filmmaker and those of stressed-out medical students.

Although we promised to use "fly-on-the-wall" filming techniques, striving to become more or less invisible to catch the action, at times we did become a distraction to the class. After a few weeks, a group of students complained about our presence. In order to keep the lid on things, we agreed to halt filming for a month. Though disappointing to me as a filmmaker, I sympathized with the complaints. Medical school is a pressure cooker. Students are overloaded with work, and this burden isolates them from the outside world. Occasionally medical students commit suicide because of the stress.

With our camera and microphone constantly lurking around, we became a lightning rod for their collective anxiety. Indeed, we did do a lot of shooting. In making cinema-verité documentaries like "Survivor M.D.," you're looking for those gems that help define the experience and tell the story. As such, you have to keep the cameras rolling longer than usual, gobbling up far more footage than you'll ever be able to use. In our case, we shot about 50 hours of tape, which eventually took three months in the editing room to prune and shape into the series' initial one-hour documentary.

Continue: Into the hospitals

One Night in an E.R. | Meet the Doctors | The Hippocratic Oath Today
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