By Allan J. Hamilton, MD
Professor of Neurosurgery, University of Arizona Health Sciences Center
As a real-life brain surgeon, I feel it’s important to recognize a bit of historic neurosurgical history being made: Thursday night the fifth season finale of “Grey’s Anatomy” is here. I, for one, am grateful that neurosurgeon Dr. Derek Shepherd (played by heart-throb Patrick Dempsey) continues to maintain a busy and demanding clinical practice every Thursday night. That’s because, each week at 8 p.m., I have to keep a close eye on Derek, to be — figuratively — at his side, supporting him through each episode. I have to look on sympathetically as each week the show’s writers expect him to perform case after case of the most daunting, dangerous, and demanding neurosurgical procedures ever undertaken in the history of TV. And Shepherd was doing well. Well respected. Making a name for himself. Up until recently.
A few weeks back, Derek lost a patient. It was a tough case. Believe me, I know because she’d been my patient once in real life. And, after that, his confidence was shot. He stopped shaving. Didn’t bother to show up at the hospital. He started drinking. His hair was mussed. And not just once or for a single episode either. I became worried that Derek couldn’t pull himself together. He might lose his privileges at the fictional Seattle Grace Hospital. I’d also heard a rumor that Patrick might be focusing more on movies. There might be new contract negotiations with the show’s producers. If those failed, well, who knew what could happen to Derek’s character? Drinking could spiral out of control. Depression. He’d already thrown Meredith’s engagement ring into the woods. Next, he might try to kill himself and, well, if Derek went, then I’d have to go too.
That’s because I work part-time as the neurosurgical script consultant for “Grey’s Anatomy.”
As long as Derek keeps operating, the writers want my advice about neurosurgical cases and procedures. Without him, I’m useless. So Derek and I were arriving at one of those existential crossroads. Life–his, mine–were edging precariously towards a season finale. We might recover. Or we could perish. And we were also facing sweeps month in May. This is when TV shows have to have put on their most riveting dramas to attract as many viewers as possible so advertisers will look at the audience numbers and then clamor to buy commercial spots for the next season. Our fates lay in the hands of writers. Like gods, huddled behind closed doors, they would decide in a writer’s conference whether we lived or died. It all depended on the story arc, they told me. Yeah, but what’s the arc? Where’s it supposed to go? What’s going to happen? You’re the writers. You know what’s going to occur. It’s already written, isn’t it?
That’s when I was struck by how life can imitate art. That patients have the same questions when they face the real challenges of severe illness or major surgery. They’re begging to know what their story arc will be. Will it be a glorious? Uplifting? A happy crescendo of recovery? Or is it going to take a sudden, unexpected turn for the worse? An irresistible, insurmountable death spiral. What’s been written for each of us, the mortal character in our play? What’s already scripted to happen to us?
Many of the patients that Dr. Derek Shepherd operates on are drawn from my own neurosurgical experiences. When the writers ask for a case that will fit this need or that, where else am I going to look but my own experiences? So the characters in the script can possess elements of my own failures and successes as a surgeon. When Derek reaches that critical moment–right before a commercial break–when he’s got to save the patient, my heart stops. But it’s because I remember the real patient–the real-life mother or son–who was lying on the operating table once. I no longer see the actor pretending to be sick. Instead I recall the alarms of real monitors going off. The anxious anesthesiologist telling me the heart rate is plummeting and we’re losing the patient. For real. And praying to God to help me so I don’t lose this patient. Sometimes, I watch Derek pull off a great save; but there’s no sense of relief or salvation for me. Instead, tears run down my cheeks because, in real life, it wasn’t written that way. In the real script, I lost them. In the real OR, their precious life slipped through my fingers. When it looked like everything was going to work out fine, something went terribly wrong. Something we just didn’t anticipate. Those moments are hard to relive, to talk about.
As a surgeon, you are haunted for life by every patient you lose. Sometimes, an experimental procedure failed. Sometimes, your skill or your judgment were not up to the task and couldn’t surmount the disease. And luck has a lot to do with it, too. Occasionally, something on a scan might look like an ominous cancer that causes you to worry about how bad the prognosis might be. But then there’s a surprise! You get to go out to the waiting room and tell the family: “Good news! It wasn’t a tumor after all. It was an abscess. We took it out. Six weeks of antibiotics and they’re cured!” Happy endings.
Patrick Dempsey is a very hard-working actor. He cares intensely about his craft and labors to portray Derek’s emotions with a poignant, meaningful realism. He once called me to talk about one patient that the writers had him losing on the table. The script called for Derek to be unwilling to accept losing the patient’s brain function. That Derek would keep operating long after all hope for survival was lost. Patrick wanted to know the surgeon’s state of mind in a situation like that. I told him that, in those desperate moments, as the surgeon, you find yourself in two places at once. One part of you is in the dark–the loneliest, blackest place you can imagine. That human side of you is screaming to get out of there. To escape from the terrible events unfolding in front of you. Another part of you is resolutely technical. That surgical half is telling you to remain steady. You can do this. Don’t give up now. You’re the only one who can save them. And you know no one else in that OR can feel the desperation tearing at your heart.
Recently. my 83-year-old mother had a heart attack. She had a cardiac arrest in the ICU. They did CPR on her, and rushed her down to the operating room. As I waited to hear from the surgeons about her fate, my hands shook so badly I couldn’t dial my brother’s phone number to let him know our mom might be dying. I had to give my cell phone to a nurse to dial the number for me. But Mom came out of surgery, and the next day she opened her eyes. Against all odds, she’s now doing well. That wasn’t how I thought the story would end. But that’s what hope is about. It is about wishing with all your heart that the script might not be in its final form. That there still might be some revisions that can be made before the scene is shot. That a new twist can be added to the story so the character can continue till the next episode. Or, maybe, next season.
Allan J. Hamilton, MD, is a script consultant in neurosurgery for ABC’s Grey’s Anatomy and author of “The Scalpel and the Soul: Encounters with Surgery, the Supernatural, and the Healing Power of Hope” (Tarcher/Penguin).