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'UNDER THE MICROSCOPE'

THE BALTIMORE SUN

As Dr. Christina Catlett leaves the Johns Hopkins Hospital trauma center each evening, she tries to shake the day's searing images - the drug overdoses, gunshot wounds, heart attacks and other heartbreaks.

She wants to be able to sleep.

"As I drive out of Baltimore City to the county, I almost literally let all that emotion drain out of my body, and let my mind go blank," Catlett said recently. As a result, she commonly remembers little about the scenes that stirred her to tears or anger.

In a primetime documentary series due to be broadcast in late August, ABC News will drag Catlett - and the rest of Hopkins - right back to the vortex she seeks to escape each night.

The six-hour series, called "Hopkins 24/7," promises to tell, unflinchingly, about how the medical center works - surgery and treatment, instruction and research.

The effort required three months of reporting and filming by a 25-person ABC News crew last fall, a tremendous investment of time and money for the network. But the series also required a leap of faith by Hopkins' administrators, medical staff and especially by its patients, whose privacy was the most invaded.

"We're hoping they'll capture the essense of the culture here," Ronald Peterson, the hospital's president, said of the documentary-makers. "Part of the objective here is not just to tell the story of Johns Hopkins but to tell folks just what an academic medical center is all about."

An ABC preview tape of the documentary is relentless in pace and emphasizes the gritty nature of Baltimore's mean streets. Its sensibility appears to reflect almost as much of "Homicide" as "ER," the hit medical drama to which the program has been inevitably compared.

Certain people, such as Catlett, became leading characters followed for weeks by the TV crews. The hand-held digital cameras were everywhere, leading to irritating moments, such as frequent collisions with camera-toting reporters; tense ones, as family members of patients bristled at physicians bearing bad news; and light ones, as physicians traded gentle barbs.

Got used to cameras

Most of the Hopkins doctors interviewed for this article said they quickly warmed to the ABC crew and lost the self-consciousness and hyper-vigilance they felt initially while being filmed. "Our job is so stressful as it is that the presence of the cameras wasn't a major problem for me," said Catlett, 30, who was wired for sound and filmed extensively.

Far more unnerving, she found, was being interviewed in her own Ellicott City home and asked to revive the memories of her job. "The interviews were very frank; there were some questions I didn't know how to answer," Catlett recalled. "They were awkward, terrifying. I felt under the microscope."

On one frantic day late last year, Dr. Brett Christiansen, who worked in emergency medicine with Catlett, admitted two ailing patients to the emergency room, one right after another.

Both died. And later, Christiensen, a shy 33-year-old who was somewhat uneasy with the ABC project, remembered he was being filmed for a nationally televised program.

Often teased by colleagues for caring too much for his patients, even ones he met only briefly, Christensen took the deaths hard, his raw emotions spilling out before the camera.

"I looked back afterward. They were very personal moments, and I wonder whether I should have shared them," said Christiansen, who now works at a medical center in St. George, Utah.

Other distinctive figures were also trailed. There's Dr. Michael Ain, once underestimated because of his 4-foo-3 height, who performs elaborate surgery to repair the contorted skeletal structure of children who are also "little people." Dr. Fredrick Montz, a gynecology and obstetrics surgeon with a soothing presence, who sports an earring, ponytail and carefree attitude that stand out in Hopkins' buttoned-up culture. And Dr. Elliot Fishman, the medical imaging wizard who was called by the National Aquarium to determine why a sea tortoise was behaving so peculiarly. (He had swallowed a ball.)

ABC executives pitched their idea more than a year ago in the offices of Dr. Edward Miller, the senior Hopkins official who oversees both the medical school and the hospital. They vowed not to seek out the sensational stories that the network likes to show during its "20/20" newsmagazine show. This is not "gotcha" journalism, the documentary-makers promised. But, they warned the Hopkins officials: You can step in any time and say stop filming, but you won't be allowed to view the final cut before the shows air.

Because of the reputation of the network's news division and the previous work of the senior producers, Hopkins accepted the deal. The medical center agreed to allow largely unhindered access and asked all patients to consider cooperating with the show.

Unusual steps

In reversal of typical procedures, the ABC producers were allowed to film patients who were unconscious or otherwise unable to grant explicit consent to be filmed, as long as the network agreed not to air the footage if the patients later refused permission.

And other sensitive episodes were captured as well. The camera kept filming during an intense debate over whether to find a way to speed the harvesting of a heart from a dying baby for a baby in a nearby ward who desperately needed a new heart.

"There was major pressure to use one for the other, and there were questions about filming that discussion," recalled Dr. John Freeman, a pediatric neurologist. The physicians decided against using the failing baby for the transplant, but the camera stayed for most of the exchange.

The news crew filmed the grueling grind of medical residents and the hospital's ground-breaking surgical procedures, such as Dr. Benjamin Carson's "hemispherectomies," in which large, damaged portions of the brain are removed, often with striking results.

Patients, long a staple of network newsmagazines, were also followed. Some of these patients, however, were not altogether sympathetic characters. "We're trying to save your arm," Dr. Edward Cornwell tells one gunshot victim being wheeled toward an operating room, "so don't give me any attitude here." Cornwell later brings a group of youths from nearby neighborhoods to show them the patient and give a stern lecture about avoiding violence.

According to Hopkins officials, patient care dominated the television reporters' interest, while instruction and research - equally important to Hopkins' record and reputation - appealed far less.

"They were perfectly candid from the very beginning that this is not the public broadcasting company - this is prime-time broadcasting," said Elaine Freeman, Hopkins' executive director of communications. The question ABC producers said they faced, Freeman said, "was how do we put together a six-part series that a network prime-time audience would watch?"

Like many doctors who took part in the project, Christiansen wonders how ABC will perform that balancing act while remaining true to daily life at Hopkins. And as he thinks back on the project and his time here, the young doctor says he's not sorry to have left.

"Sometimes patients [at Hopkins] kept coming back with a gunshot wound," Christiansen said, "and you asked yourself, 'Am I doing the right thing?' "

Catlett, the assistant chief of emergency medicine, recently sought and obtained permission to split her time between the East Baltimore campus and Howard County General Hospital, which Hopkins also runs. She said she was incredibly moved after her first day in Howard; three different patients hugged her in gratitude.

"This is like jumping from an airplane, every day," Catlett said of her work in the Hopkins emergency room, an adrenaline rush that both thrills and exhausts her. "I'm looking forward to my time in Howard County."

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