- BIOETHICS FORUM ESSAY
An Insider’s View of Boston Med
How many television shows have been about hospitals? How often have they rendered the complexity and drama at all accurately?
This summer that may almost have happened. Boston Med, an eight-week show that ended last month, used an up-close documentary format to feature footage from three of America’s top hospitals: Children’s Hospital Boston, Brigham and Women’s, and Massachusetts General. In each episode, the lives of patients, doctors, and nurses converged, and the vast complexities of the health care world came to life. To my surprise, the show actually helped clarify what goes on inside a tertiary care hospital.
As a nurse who cares for newborns in the NICU, I was particularly struck by the depictions of various medical diagnoses, patient situations, and health care team dynamics, especially those taking place in the newborn intensive care unit. The series’ second episode told the story of Sam, who had the grave prenatal diagnosis of hypoplastic left heart syndrome, a congenital cardiac defect that causes an underdevelopment of the heart’s left side. Following birth, Sam needed to undergo a series of surgeries to facilitate proper blood flow. Without these surgeries, Sam would not survive.
The news of Sam’s diagnosis was devastating for his mother, Renee, and it was all the more difficult to hear because Sam’s father, Jake, was deployed to Iraq. In fact, he arrived back in Boston after a nine-month leave, just in time for Sam’s birth, and then only for a short stay.
At the beginning of the episode, Renee communicated with Jake via e-mail and telephone, including her news from the 18-week prenatal appointment, where she learned of Sam’s congenital anomaly. When Jake returned home, he was eager to understand Sam’s diagnosis and the events surrounding Sam’s birth and surgeries. Jake seemed hopeful about his son’s future. Perhaps receiving the report of Sam’s condition early in Renee’s pregnancy allowed Jake to cope more optimistically compared with many other NICU fathers that I have known.
Fathers often cope with a child’s illness in a different way than mothers do. They may become more withdrawn, removed, and uncommunicative as time goes on. Jake remained physically and emotionally present, supportive toward Renee, and engaged while receiving the periodic updates from Sam’s health care team.
The producers of Boston Med portrayed Sam’s situation both accurately and movingly, but what may not have come across was the emphasis on careful, family-centered care given by the medical team. On the one hand, some of the extensive measures used to facilitate communication, like holding special meetings with Jake when he returned from Iraq to get him up to speed, seemed overdone and unrealistic. It was almost as if this scene was staged for the rolling cameras.
More typically in situations like Sam’s, fathers are pushed to the sidelines and the health care team continues to direct questions and information toward the mother, especially if the father is perceived to be sporadically involved or he has difficulty expressing his desire for participation in his child’s care. On the other hand, when health care teams in the NICU encounter a very complex case and parents who are as amicable as Jake and Renee, it is not unusual for extra care and attention to be given to both parents and baby. So when Jake returned home and was treated as if he was never absent – meeting Sam’s doctors, getting a tour of the hospital, and receiving the latest updates alongside Renee – one can be sure that this type of treatment does not happen with every father, but that it might be reality in this case.
Sam was born with good tone, pink color, and a lusty cry, belying the seriousness of his condition but allowing the medical entourage to stand by as Sam transitioned to life in the arms of his parents. Although impending heart surgery loomed in the background, Sam’s health care team had a celebratory tone in the delivery room. This is unusual because many times, with a high-risk delivery like Sam’s, congratulatory remarks to the parents are forgotten while the health care team focuses on the delivery and stabilization of the baby.
After Sam was transferred to the newborn intensive care unit, the health care team spoke frankly about growing concerns and uncertainty with regard to Sam’s heart condition. Diagnostic test results done in preparation for Sam’s first surgery showed that Sam’s defect was more complicated than originally thought. Surgeons said that they wouldn’t know what kind of surgery Sam needed until they were in the operating room.
When Sam’s parents responded with questions about their infant’s chances for survival, the team expressed honest apprehension. This is laudable and rare in practice, because in situations like this, medical personnel often use confusing or ambiguous language in order to soften difficult news. But instead of being vague, overly rosy, or pessimistic, Sam’s doctors took a wait-and-see approach, and promised to give each step of the journey their best effort.
To be sure, both Renee and Jake experienced a roller coaster ride of emotions. Because of Sam’s uncertain chances for survival, Renee expressed difficulty with maternal bonding. She verbalized a desire to set up boundaries, not wanting to get too close, just in case Sam didn’t make it. One wondered how events would unfold, but as subsequent scenes revealed, both Renee and Jake remained at Sam’s bedside and both seemed to continue to engage with their son as he underwent surgery and then recuperated. The episode ended with the happy events of Sam’s hospital discharge and a quick flash-forward showing Sam in his mother’s arms as a thriving, if still delicate, one-year-old.
Boston Med, and particularly the episode about Sam, might not have been must-see TV, but it was valuable, as long as the viewer understood that she was getting edited versions of stories from some of the best hospitals in the country. Although some events were portrayed fairly realistically, many others were left out. Many challenges that frequently occur in the NICU environment – social, medical, financial, and ethical in nature – were not part of Sam’s story. For example, we did not see the team deliberate a case where the discontinuation of life-sustaining treatment or the continuation of care is in question. That said, though, the show came much closer to reality than drama.
Melissa Kurtz is a registered nurse in the NICU at Yale-New Haven Hospital and a joint master’s degree candidate in nursing and ethics at Yale University.