ABC's 'Hopkins': A Routine, Not Incisive, Operation

By David Brown
Washington Post Staff Writer
Thursday, June 26, 2008

If you want a nuanced portrait of 21st-century medicine -- a world dominated by disease prevention, modest improvements in treatment and engineering fixes for making the health-care system safer -- you can find something else to do tonight.

But if you want to see old-fashioned heroic medicine in which the solitary man (who is sometimes a woman) holds the forces of disease, death and tragedy at bay, then by all means tune in to the ABC documentary "Hopkins."

The six-hour film won't disappoint. Unfortunately, it won't educate much either.

"Hopkins," produced by Terence Wrong, is full of stories about the astounding things that human beings can do to fight catastrophic illness and injury. The weapons of choice are scalpel, needle, chest tube and other body-violating modalities. The outcomes are usually clear-cut: life or death, and rarely disability or disappointing improvement.

That is how we like our TV medicine, whether it's "Dr. Kildare," "M*A*S*H" or "ER." That is especially true when the subject is Johns Hopkins Hospital, the Baltimore institution that has been U.S. News & World Report's No. 1 Hospital in America for so many years that the magazine might as well retire the trophy.

In 2000, Wrong produced "Hopkins 24/7," a cinema verite portrait of the hospital. This time it is simply "Hopkins." The name carries the incantatory power of other one-word destinations -- Delphi, Mecca, Lourdes. The unspoken assumption is that if you can drag yourself to Hopkins (figuratively or actually bleeding from the nose and mouth), you will be within shouting distance of cure, and possibly even miracles.

Actually, this is what many Americans expect of modern medicine; Johns Hopkins is the example that stands in for the whole enterprise. The filmmakers do not argue with this expectation. They go to the places where it is most likely to be satisfied -- the surgical suite and the emergency room.

What they find is just one piece of medicine. But nobody can say it isn't a fascinating, harrowing, dramatic and emotional piece inhabited by people of immense skill and seriousness.

"I touch these people's brains, I touch their lives, their emotions, and I can potentially change them at the drop of a pin," Alfredo Quinones-Hinojosa, a neurosurgeon, says in Episode 1 as he is being chased down the hall by the camera crew (a cinematic view repeated endlessly in "Hopkins").

He is about to operate on the brain tumor of a careworn man in his 40s, twice divorced and accompanied only by a female cousin. The man is terrified, and the night before surgery Quinones-Hinojosa is obliged to tell him everything that can go wrong. But then he adds, "Tomorrow, I feel positive."

The next day, Quinones-Hinojosa waits as his patient awakes from anesthesia to reveal what, if any, brain function he has lost. When the man wiggles his toes on command, the surgeon clenches his fists in a gesture of personal triumph one might see in a basketball player sinking a long three-point shot.

Of course, there are costs to these triumphs.

In the most sustained story of the series, "Hopkins" follows the travails of Brian Bethea, who is in his ninth year of training to become a cardiothoracic surgeon. He is married, with three small children, and separates from his wife early in the series.

Bethea is caught in a vise of too many expectations. He ruefully admits: "In order to do a really good job, you have to put the patient first. Which then makes everything else -- your family, yourself, everything else -- by definition second."

In a scene of poignant symbolism, he pays a visit to his children at his old house. Before he leaves, he retrieves a bottle of wine but drops it by accident on the way to the car. As he squats and picks up the shards with his oldest daughter, he says of the separation: "This is a modern situation, you know what I mean? It has nothing to do with you guys."

It's unclear whether Bethea's wife, Amber, works. (She was trained as a physician assistant.) But it's pretty clear why surgery remains a niche market for 1950s-style marriage -- stay-at-home mothers raising children and patiently waiting for endlessly absent husbands.

There are dozens of other stories -- heart transplants, stab wounds, failed resuscitations. There is also a wide, if shallowly portrayed, cast of characters -- the gruff ER attending, the pretty ER resident, the Sikh medical student who is aware he represents all turbaned people. On the patient side, there are the too-cautious father of a boy with a brain tumor, the too-hopeful mother of a comatose drowning victim and a charming run of old people who all bond with their renegade vascular surgeon.

But it's hard not to feel that despite the immense effort that went into "Hopkins," we've somehow seen it all before, from the first race to the airplane with the cooler holding the heart to the last home visit to the flourishing onetime patient.

There is also something oddly anachronistic about the documentary.

"Hopkins 24/7" had a notorious moment when the chairman of surgery remarked that women didn't have "the stamina" for his profession. For the past seven years, the man's successor has been a woman. She doesn't appear in "Hopkins" (or at least not in the first five hours; the sixth wasn't available to reviewers).

The older documentary also had a scene from a mortality-and-morbidity ("M&M") conference, where mistakes are discussed. The new one not only forgoes that, but it also mentions nothing about the national campaign against medical errors, or Hopkins's own efforts to prevent adverse events through checklists, computer prompts and ubiquitous hand-sanitizing stations.

And then there's all the medicine the filmmakers missed.

There is no visit to the ICU and its world of drug- and machine-aided physiology; no listening in while oncologist and patient gauge the risks and benefits of cancer chemotherapy; no sharing of the frustration and joy of treating developmental disabilities; no foray into the vast world of common chronic illness, such as asthma and diabetes.

Medicine is a lot more ambivalent and undramatic -- and also richer and more interesting -- than "Hopkins" shows the viewer or wants to admit.

David Brown is co-teaching a course in medical writing next year at Johns Hopkins University.

Part 1 of Hopkins debuts tonight at 10 on Channel 7.