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. [Read an interview with Tom and see video of him on the original "Doctors' Diaries" website.]
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!)
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 slightly 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.
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 felt we had a microcosm of the Class of 1991. [For more on each of these seven people, see Doctors' Lives Videos.]
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 said, 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."
Medicine is only for those who cannot imagine doing anything else.
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 "Doctors' Diaries," 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. (By the fifth installment, we had shot around 250 hours.)
As the new millennium waxed, we decided it was time to make another program in the series, the fourth. Apart from shooting scenes with Tom and Jane, we had not filmed with the other students since 1994. In 2000, they were all fully qualified practitioners working in their chosen specialties—except for Cheryl Dorsey, who was then getting a Ph.D. in history at the University of Pennsylvania.
Jay Bonnar had become a psychiatrist. Despite several attempts to find a way of showing him in action as a psychiatrist, the need to maintain confidentiality with his patients made filming impossible.
Jay told me he was training to become a psychoanalyst. Part of that training required him to undergo his own analysis. The therapy usually involves meeting with an experienced analyst several times a week, during which the analyst-in-training is encouraged to talk about whatever comes to mind.
Even though psychoanalysis is fundamentally a private affair, Jay agreed to let us film the process. Interestingly, his analyst squashed the idea, maintaining that Jay was not in a position to make this decision and that filming him might jeopardize the treatment. So we had to resort to interviewing Jay in his car while en route to his daily session on the couch. Under the circumstances, we felt it was the closest portrayal of his analysis that we could get.
Fortunately, access to the work of the other five doctors in practice proved easier, and it was clear that they had all well and truly hit their stride.
The final chapter
I had left NOVA shortly after completing the fourth installment of the series in 2001 to work in England, and I imagined that would be the end of the project. But a couple of years ago I made a separate film for NOVA, and a conversation with Paula Apsell, NOVA's Executive Producer, at the end of that project led to the idea of one final iteration. I welcomed the idea, and in early spring 2008, I found myself embarking on a whistle-stop tour to meet all the doctors.
I had not been in contact with them since producing the fourth episode. Only Elliott Bennett-Guerrero had occasionally been in touch wondering if there was going to be another show. They had all agreed to meet me, but I was not convinced they would commit to participating before we met in person. In the end they all signed on, but not with equal enthusiasm.
Even more than in the fourth episode, Jay was deeply uncomfortable about the process of being filmed. But in the end he offered, on camera, some very thoughtful and heartfelt insights on his life and his work as a psychiatrist.
Equally uncomfortable with the idea of appearing again was Luanda Grazette. She made it very clear that her personal life was going to remain private and not be part of the film. Her new job at the biotech giant Amgen posed other restrictions. Luanda had left her research and transplant cardiology work at Massachusetts General Hospital to become a clinical scientist helping to develop new drugs to combat heart disease. Amgen is very secretive about its R&D, and Luanda jokingly remarked, "If I really told you what I was doing, I'd have to kill you."
As the pre-production for the film continued, it became clear that there would be very little of the high drama that permeated the earliest episodes. The doctors were seasoned professionals who knew what they were doing. There was none of the tension of performing a procedure for the first time or learning the ropes at a new hospital.
Medicine offers practitioners extraordinary privileges, but it can take a toll on relationships. Both Jane and David Friedman remarked that their tendency at home to treat their spouses like interns had caused problems. David noted, "You can't manage your spouse," suggesting that this was one of the factors that contributed to his separation from his wife Boo.
When I was trying to decide what to do with my life, two passions surfaced almost simultaneously: moviemaking and medicine.
Tom had divorced and was remarried for the fourth time. I had never seen him as happy as he is now with Jennifer. Sadly, Tom's physical health had deteriorated. The prediction he gave me the last time we'd met, that his body was "falling apart like a cheap suit," had proved only too true. He is overweight, smokes, and with high blood pressure is at risk for a heart attack—all problems that Tom acknowledged.
Tom said that it has been difficult for him to get these problems under control because of his lifestyle. Since losing his job at Indiana's Bloomington Hospital emergency department five years ago, he has been an itinerant doctor, working a few weeks at a time in hospitals as distant as Caribou, Maine, Tacoma, Washington, and St. Thomas, Virgin Islands. Tom, as always, is a conundrum—a wonderful doctor to his patients but woefully negligent of his own health.
I was very happy to discover that Cheryl Dorsey had found her calling—not medicine but leading the Echoing Green, a foundation that provides seed money for social entrepreneurs and that, 17 years earlier, had funded her Family Van mobile clinic project at Harvard Medical School. Medicine had made Cheryl's career path a very circuitous route. Thinking about that decade of one's life that medicine requires as the price of admission, I was reminded of Luanda's wise words: Medicine is only for those who cannot imagine doing anything else.
Why I made this series
In my late teens, when I was trying to decide what to do with my life, two passions surfaced almost simultaneously: moviemaking and medicine. In my early 30s, when I hit a particularly bad patch in the film business, I reapplied to medical school. In 2001, when the fourth installment of the doctors series aired, I wrote, "Making this series of films about medical training has made me realize how fortunate I was to be turned down!"
My view has changed. Although the price is high in terms of the time given over to medical training, it is nevertheless an extraordinary journey, and the relationship that it eventually permits physicians to have with patients is the most wonderful gift. When I think about the path not taken in my own life, I'm reminded of what Jay said to me about whether he would choose to go to medical school if he had a chance to do it over again: "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." But if it were possible to press rewind, my medical school application campaign would be a lot more organized than it was 30 years ago.