Q: Are any of the human-interest cases on TV medical shows realistic?

A: Absolutely. Although many are realistic, on the TV shows these kinds of cases seem to come one right after another, but in real life they are not so frequent.

With that said, there is much more to the practice of medicine than just evaluating all the data and facts and determining the best treatment plan. The interactions between patients, their loved ones and clinicians is a two-way street, with the specific aspects of the patient’s life and their wishes the vital part of the decision-making process. To illustrate this, I thought I would write about a “TV show”-like case I saw many years ago.

When we breathe, we create a low pressure inside our chest — a negative pressure compared to the air pressure around us — by expanding the chest cavity, and hence the lungs, using the muscles in the chest wall and the diaphragm in order to “suck” air in. Some sick patients are not able to do this sufficiently on their own, and hence we use certain devices to help them. Most people are familiar with a patient “being intubated,” where a tube is placed into their breathing pipe (trachea) and air is “pushed” into the lungs. “Pushing” air in, rather than “sucking” air in, changes the pressures and other physical parameters inside the chest cavity. Another way a patient’s breathing can be assisted is by applying a negative pressure outside the patient’s chest to “pull” on their chest cavity in order to expand it to create a negative pressure inside to “suck” air in. The device that does this is called an iron lung, invented in 1920 by Philip Drinker, although there are now more modern versions/approaches to achieving similar results.

Some readers may know that my Ph.D. is in theoretical physics, and I changed careers to medicine after my father got cancer; hence a “physics” patient was determined by the chief of the ICU to be a good “fit” for me. That’s how I ended up taking care of a patient in the ICU that was being treated with an iron lung, but whose condition was decompensating.

This patient had a degenerative disease that compromised her ability to breath, although her thinking abilities were completely intact — people familiar with the story of Dr. Stephen Hawking will understand how this can be the case. Unfortunately, her condition had been worsening, and it had gotten to a critical point where nothing more could be done.

This is where the “TV show” side of things came into play. Her first grandchild had been born prematurely a couple of months earlier, and was finally to be released from the NICU a few states away and able to travel to meet grandma. My patient and her family knew she was about to die, and they all had made their peace with the inevitable. Grandma had one last wish, and that was to see her granddaughter — and namesake, the baby’s middle name was grandma’s name — just once before she died.

We — medicine is absolutely a team effort, and nothing would have been possible without the entire team of caregivers working in concert — had to take her off her iron lung and intubate her to support her breathing. This is where the “physics” came into play. When we changed the pressure in her chest from a “negative” pressure to a “positive” pressure — pushing air in instead of sucking it in — there were many other changes that occurred. Specifically, the “pull” of blood back to her heart — from the negative pressure in her chest — was now more of a “push away” of blood returning to her heart. That night in the ICU was a careful balancing of how much air to “push” into her lungs and how much fluid and support to give to maintain her blood pressure. We were able to keep her alive and mentating through the hectic 12 hours that ensued.

Just after her granddaughter got to the ICU we took out her breathing tube and restarted her “iron lung.” She was able to smile and even mouth words to her granddaughter, spending her last minutes as she had hoped. I sat with her daughter and granddaughter for a few minutes after she passed away, and as her daughter got up to leave she gave me a warm hug and a kiss on the cheek and told me she could not have been more grateful for what we had done for her mom.

I had bagels and coffee delivered to thank the team for all the work they had done; it had been a frantic night. I look back on this as one of the best days of my medical career, even though my patient died.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.