I Am Caught Between The Two Worlds Of The ICU And TV

Daniela J Lamas NYT WHEN it is quiet in the intensive care unit, I escape into one of the call rooms. The air is stale and dry, the bed unmade. I take off ...

Daniela J LamasNYTWHEN it is quiet in the intensive care unit, I escape into one of the call rooms. The air is stale and dry, the bed unmade. I take off my mask, angle the computer away from the tousled sheets, and log onto Zoom, where a group of writers and producers is discussing another medical emergency. A young man’s heart has just stopped. The resident rushes to get the defibrillator, but before he can, someone objects.It’s a producer noting that the scene feels too predictable. We need something more, he says, maybe a medical mislead or an escalation to hook the viewers before the commercial break. He looks to me for guidance. We can do that, I reply, before the alarm of my pager calls me back to the unit once again. We can do anything. This is television.When I started to write for a television medical drama a few years ago, I embraced the job as a salve for the burnout that so many doctors face. It offered me a release from the unyielding sadness of intensive care, a way to turn tragedy into something more hopeful and to control how the story ends.But in straddling these two worlds, I have realized that television drama is not just about escapism. On the contrary, I believe that medical fiction can also be a powerful tool for countering misinformation and changing minds.I leave the call room and return to the unit, where we are caring for an older woman with Covid-19 whose pastor had advised the congregation not to get vaccinated. She followed those instructions and now, though her lungs are slowly improving, her kidneys are worsening, and she is profoundly delirious, not waking up. When we stand at her bedside and call her name, her eyelids flutter. Down the hall, we titrate drips and manage vent settings for a man whose stem cell transplant cured his leukemia but ravaged the rest of his organs. His wife would be at his bedside, but she is at her father’s funeral.I used to want to show the hospital as it truly exists, to reveal the humor and tragedy and grace that characterize my world. I could tell you about the time a family came to say goodbye to a dying woman. A misplaced identification card had led them to believe, wrongly, that she was their mother. I could tell you about a patient’s brother, a hulking man with skull tattoos on his shaved head, who told us that he could not stand to be in the room when we took his brother off the ventilator. When he left, we thought we would never see him again, so we were surprised when he returned minutes later — not to sit vigil at the bedside, but to collect his brother’s prosthetic leg. He spent the rest of the day in the hospital chapel with the leg beside him. I could tell so many stories about the forms that love takes.But when I recounted these types of stories in the writers’ room, I learned that much of what I see is simply too grim. The public does not need to be reminded of how quickly things can go bad, how protracted illness can lead a family to disintegrate, how doctors can try their very best and yet people will still die. Audiences want to see their heroes succeed. And when life is uncertain, as it is now, the predictably optimistic formula of network television is more reassuring than ever.During my first experience on the set, walking through our fictional hospital, I learned that when things went wrong — when an inaccurate image was displayed on a CT scanner or a medical word was mispronounced — we could fix it later in postproduction. “Don’t worry,” the producers told me. “We can fix it in post.”How I loved that phrase the first time I heard it. That was all I wanted for so many of my patients: to be able to have another chance, to treat the sepsis earlier, to stop the pastor from advising against vaccination. To fix it in post.During the pandemic, I have found my roles as a critical care doctor and television writer increasingly in conflict. I want to memorialize and honor every tragic death, but I also yearn to tell stories that are hopeful, to immerse myself in a world where there is always the chance for recovery, no matter how dire the diagnosis.It is a tension I am still learning to navigate. How do we tell stories that feel true while also keeping viewers engaged? What kind of cheats are acceptable, and which are irresponsible? Television characters survive cardiac arrests far more often than people do in real life. But if we showed all codes as they really are, all the ribs breaking and limbs flailing and the nurse left alone to clean up after the death, our viewers would change the channel. I struggle to define the line between my responsibility to reality and to entertainment.Finding this line matters now more than ever. Here in the intensive care unit, where we meet patients at their sickest, there is so much that we cannot fix. But in the writers’ room, we have a chance to start again, to offer a different ending to the story. And in doing so, we can sneak in potentially lifesaving education — about early warning signs of certain illnesses, the dangers of overtreatment or the impact of inequities in access to care. For better or worse, people often do believe what they watch on television. With millions of viewers of all political leanings, television dramas have an unparalleled opportunity to educate and even to change behavior. I once thought that my role was to tell the unvarnished truth about medicine. But I have come to believe that it is worth glossing over the facts if we can weave a story that encourages viewers to trust science, to get vaccinated, to look differently at disease. When I find myself fact-checking what I see on the television monitors, I remind myself of this more important goal.On rounds one recent morning, I stopped in to examine a man with a complex history of congenital heart disease. After I muted his television so that I could listen to his heart and lungs, he asked me if I might be able to step out of the way of the screen. He was watching a medical show; it was an episode he had never seen before, and he was just getting to the good part. He noted my surprise. Through all the surgeries over the years, he explained, medical television dramas have been his one constant. He knew the schedules of each show by heart. Something about these plots reassured him, teaching him what might be ahead while helping him to feel less alone in his own medical odyssey. “They really hit a note,” he said, and I told him that I understood.