Most of us who watch television tend to roll our eyes at the absurd depictions of doctors and diseases. Sadly, our patients do not, generating big ratings for shows like Fox's “House,” NBC's “ER,” and ABC's “Grey's Anatomy.” But when viewers come to our offices asking for the new treatment that reverses Alzheimer disease, or are fully convinced they have a brain tumor, it's up to us to debunk myths shaped by national TV.
So I had my doubts when I first heard about “3 LBS.,” a new CBS series so dubbed for the weight of the brain. We've all seen how the media can mislead when it comes to medical themes. And the CNS, both mysterious and misunderstood, is a particularly easy target for creative license. Across the networks, patients wake up from coma, jump out of bed, and blithely ask “what's for lunch?” This may constitute good drama, but is it any wonder that housewives get desperate when after eight years, a husband tries to stop life support? Or that a radio show host can so arrogantly accuse an actor with (real) Parkinson disease of having stopped his meds? Is it the least bit surprising that a profession once so respected has become increasingly marred by suspicion and disdain?
AIMING FOR TRUE-TO-LIFE DEPICTIONS
“When I see doctors on television doing things that are unethical, I am disgusted,” said “3 LBS.” Chief Medical Consultant, James M. Schumacher, MD. “On one show, a patient was intentionally caused by his doctor to worsen, on another, a physician concealed vital information, and for all appearances, it seems customary and usual for attending physicians to sleep with residents”.
“These behaviors are unacceptable and make doctors look bad,” said the Yale fellowship trained functional neurosurgeon. So over two years ago, when he learned there would be to a show about neuroscience, he saw his chance to make a difference. Soon, he and Peter Ocko, the show's executive producer, were sending scripts back and forth and hammering out plots.
“We wanted to keep it true-to-life instead of devolving into science fiction and bad ethics,” said Dr. Schumacher, who serves as Co-director of the Center for Neuroregeneration Research at Harvard. He recently advised against an episode in which the writers wanted gene therapy to cause a patient to deteriorate. “I feel that I have a responsibility to make sure that the medicine is not misrepresented. Politicians and other decision-makers watch television; the repercussions of misinformation could be damaging to science and research.”
PREMIER AT COLUMBIA UNIVERSITY
On November 13th, “3 LBS.” premiered in front of an audience of physicians at Columbia University Medical Center. “I could sense apprehension in the audience,” recalled Dr. Schumacher. “I'm sure that many were thinking: here comes another show that will hurt us.”
As a practicing neurosurgeon he is well aware of the challenges that doctors face. “We keep coming up with new treatments and better technology, but in return, we are being paid less and have more medical malpractice risks,” he explained.
The viewing of the pilot episode, “Lost for Words”, was followed by questions for the cast members and executive co-producer. “I want only hard questions about neuroscience,” began lead actor Mark Feuerstein (formerly of the 2002–2004 television series, “Good Morning, Miami”) who plays the touchy-feely Dr. Jonathan Seger. “It's rare that you get a script on your desk that is really about something…it's not just about people and their egos and neuroses, it's actually about the brain and I found it fascinating,” said Feuerstein, who clearly enjoys his onscreen persona. Feuerstein prepared for his role by observing neurosurgeon Ted Schwartz, MD, excising a brain tumor. “We were just chatting, and he's asking me questions about sports, and high school (we went to the same high school), and our coaches, and he's literally in the center of this person's brain…cutting out a tumor,” said Feuerstein. “And then as I'm watching him standing over a hole in this person's head, in the middle of the brain, he explains that if he is one millimeter off, the patient loses his language, or if he's one millimeter deep, he loses memory…it was just the most amazing experience for me,” he reflected.
THE BRAIN AS ‘WIRES IN A BOX’
Feuerstein seems not unlike Dr. Seger when it comes to earnestness and likeability. According to Dr. Schumacher, the character represents the ‘new-school’ neurosurgeon, having observed, over the years, a transition to a kinder, gentler, physician. When defending his need to get to know his patients, Dr. Seger said, “…I can't screw around in somebody's head and not know whose soul I'm bumping up against.” His character is a sharp contrast to Dr. Doug Hanson (played by Stanley Tucci, of the movie “The Devil Wears Prada”), an impersonal neurosurgeon who views the brain as “wires in a box.”
When the rep selling surgical toys asks if he'd like to use robots, Dr. Hanson answers, “I think I have surgical robots – they're called interns.” And to a distraught mother, who inquires whether all the MRI images are of her daughter's tumor, Dr. Hanson replies dismissively, “No, these are other patients…a week-at-a-glance.”
The difference between the two neurosurgeons makes for some interesting exchanges. In the first episode Dr. Seger pleads with Dr. Hanson to speak to the mother, explaining, “It's my experience that the emotional state of the family can impact the physiological resilience of the patient.”
To which Dr. Hanson responds, “Yeah, I've always found that taking the tumor out of the skull is fairly effective as well.”
Dr. Adrianne Holland (played by Indira Varma of the HBO series, “Rome”) rounds out the team as a coy neurologist who is reassuring and confident. Disappointingly, her seductive behavior and provocative choice of dress, while sure to bring in viewers, make the role less credible than I'd hoped. Dr. Holland also performs the neuro exam in bare feet, explaining to a patient, “We have as many nerves in our feet as we do in our hands, or lips, but we box them up all day – I think neurologists, of all people, should go barefoot.” Attire preferences notwithstanding, her attitude towards the brain seems more grounded than that of the neurosurgeons. Speaking to a patient who keeps getting lost and has “some mild astereognosis,” she boasts, “I'm a neurologist… we like to try to solve all your problems without actually exposing your brain.” And when Dr. Seger confesses that he meditates before surgery by placing his palm over his heart, she says, “That is such a doofus thing to do.”
DETAILS NOT QUITE RIGHT
Because Dr. Schumacher leaves his practice only twice a month to consult on the technically-intensive scenes, there are niggling details that sneak through to production – Dr. Hanson, without surgical mask or cap, scrubbing his hands before surgery; an MRI machine saleswoman demonstrating her new scanner while seated at its side wearing magnet-attracting gold jewelry. And a violin prodigy with a “tricky little astrocytoma” undergoes a temporal lobe resection in a sitting position. She was posed upright, explained Dr. Schumacher, so that she could develop an embolus from air in her central line. In the pivotal scene, the anesthesiologist alerts Dr. Hanson that he is “sucking air.” The patient is placed in Trendelenburg, bradys down, goes into V-fib, and has a cardiac arrest requiring resuscitation.
In the next scene, Drs. Seger and Hanson, walking in slow motion to the sounds of orchestral jubilation, burst through OR doors, and rip off their masks. The only things missing were the capital N's on their scrub-clad chests. Although the entrance was intended to broadcast surgical triumph, the Columbia audience responded with howls of laughter.
“You have to allow a little bit of artistic license on TV,” explained Dr. Schumacher. “For example, stories have to be resolved within an hour, so sometimes patients improve or deteriorate much more rapidly than in real life.”
But the show does a nice job of demystifying neurological jargon without compromising entertainment. Dr. Seger describes expressive aphasia: “You know when you forget your high school physical education teacher's name, and you can't fall asleep until you remember it… she's got that for every word.” And in a scene illustrating a turf battle between Dr. Hanson and a radio-oncologist, gamma knife therapy is described as “a miracle technology…brain surgery with a beam of radioenergy…bloodless, painless, patients in and out in a few hours.”
“There hasn't been a show like this since Ben Casey,” said Dr. Schumacher, who revealed that his career aspiration took seed in 1965 as he watched Dr. Irving Cooper perform a pallidotomy on television. Dr. Schumacher wants his scenes to be just as realistic and would like neurologists to know that he'll make sure that future shows will be based on solid neurology.
Upcoming story lines focusing on neurology will include a patient with temporal lobe epilepsy who sees God, a patient with synkinesis, and another with prosopagnosia. While it worked for Oliver Sacks, the question remains as to whether it will work on TV. I, for one, want to see more.