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Funding for program by announcer overlay The Eleventh Hour graphic.

Host Robert Lipsyte welcomes viewers and introduces himself.

Pan up on exterior New York Hospital Cornell Medical Center.

Photo snapshot of Libby and newspaper article overlay New York Hospital Cornell Medical Center. Lipsyte narrates that Libby after being admitted to the emergency room for an ear ache died the next morning.

Newspaper headlines overlay photo of doctors looking at X-rays. "Hospital Shakeup Promises to Aid City Interns"; New York Moves to Cut Sharply Interns' Long and Grueling Hours"

Lipsyte narrates that the Grand Jury failed to indict any of the doctors on the case but put forth recommendations. Bullet points overlay newspaper article with the recommendations: More Supervision (by experienced doctors), Reduced Hours (for residents).

INSERT

Robert Lipsyte:
to the proposed law?

Sidney Zion 4:54
It's a disgrace. They should welcome it. This is there for the help of the patients and for the interns and the residents in the medical profession in general, instead, acting out of the arrogance that fuels them, because they don't want anyone else to interfere with their sovereignty. They decide doctor knows best, you don't decide. There's no way to justify these hours, which often run even more 120. it's not the patient, they care, but the patient is out of the equation. This system is abysmal and has been antiquated from the day I began. Do you think it's only there for doctors?

Robert Lipsyte 5:28
Is their reaction to this, out of this arrogance and traditionalist are economics involved as well

Sidney Zion 5:34
they have been paid the $270 million needed? And I don't even know if it's all that needed? I understand Bellevue did it all with a rejiggering of scheduling the biggest hospital of all and added maybe five interns. It's not an economic thing. And it never was. And it's not a question of getting the enough people they can always do that. The thing they have to understand is, no one ever can suggest that this doesn't hurt patients. They can have any kind of cockamamie time schedule system that they want. But they can't give us a child. That is 36 hour workday can operate well. I wouldn't you wouldn't let a guy drive a cab, you wouldn't let him make your malted milk after 36 hours up, and they're going to let them make life and death decisions. If they claim that they have a problem with not enough staff yet, let the doctors who now have privileges in the hospital spend one night a week or one night every two weeks and do it rather than say that there's no alternative to a slave labor system, which is the economics where they say where they pay them, you know, based on a 40 hour week, they can work 120.

Robert Lipsyte 6:35
So let me stop you. What I hear you saying is let these more experienced doctors our age, let them come down,

Sidney Zion 6:43
let them do it. They do it in smaller towns, they've done it before. And and that's why they say they have to go through this rigorous training. So they'll toughen themselves for later. So later, when they get out. They never show up anymore. Then they say you do it, we did it. You do it. Hey, that's parasolid mentality, you said basic training, that mentality has no business when we are the ones that are going to get impacted. We get hurt. That's why my kid dies. Because they say that they want it their way.

Robert Lipsyte 7:10
What are you going to do if the judge throws out this law?

Sidney Zion 7:13
Well, I can't do anything, unfortunately. But I think the state will appeal it immediately. And I'm hoping that the upper courts won't allow this because I don't see anything. I mean, I'm a lawyer, I've looked it over. I don't see why it's like it'd be any constitutional basis to overthrow it. Most many of the hospitals are all set to go on July 1, the city hospitals, the most stretched, they say we can't afford it. We have too many AIDS patients, you know that this house put on health Corporation of New York City came to a city council meeting only two weeks ago and came out 100% for it, they're happy, they say good, we've got more money, we'll add more people. That's wonderful. That's the attitude to take. They're the ones that are really stretched, not these hospitals upstate New York, hiding behind this hospital association in New York, which is a you know, the whole thing is a joke, because the big hospitals down here, I understand, didn't vote on it. But they want the credit. They want they want to knock it out, they're a little embarrassed to say that they're opposed to this. But they've hid behind this Hospital Association, which comes in and acts as if they're saving patients by throwing out this law

Robert Lipsyte 8:16
Sidney This is kind of the feeling to is that if this hadn't happened to your daughter to Sidney Zion, who's kind of plugged into New York, we wouldn't even be here talking about this, nothing would have happened.

Sidney Zion 8:28
That's the worst part of it all to me. I mean, they said, We killed the wrong kid. That's what they really said. That's a terrible thing to say, there. But that's the reason some of them I understand are mad at some of the doctors involved the way you knew he was a big shot. So why didn't you take better care of this? And that's an answer that makes me throw up to tell you the truth. It is probably true. And it aggravates them more, that if it wasn't for my so called connections, nothing like this would have happened if that. So I'm awfully glad I got the connections because we want to something to come out of this. And but I think that's right, and that's awful that they never would have done it themselves at all and having had it done and by great doctors, by the way, that bell commission probably had the most prestigious and best doctors in the state on that commission. Cuomo deserves a lot of credit for that. And Dr. Axelrod, they were great doctors, they against that. You have a bunch of PR men and small time doctors who were yelling against it without wanting to put their faces out there really say why this isn't a great thing and it's going to save lives. That's what they should be worried about

Robert Lipsyte 9:25
Sidney Zion, thank you very much for being with us.

Doctor on telephone as intern looking on. Dr. says goodbye, hangs up phone and intern follows him out of office.

Two doctors walking down hallway of hospital

Same drs looking at x-rays

two Drs. checking on female patient laying in bed. They ask how her breathing is making her sit up as they both examine her with stethoscope listening to her breathing.

Two Drs. walking into patient's room. Patient in bed is older white male, dr. leaning over asking how patient is doing..

Two doctors examining older white male patient in bed, patient takes deep breath with mouth wide open. Dr. Pochain is narrating about how an intern making decisions about care, but not life and death decisions.

Dr. Pochapin sitting talking with two other doctors in office. Robert Lipsyte is heard narrating about how in New York hospitals, interns report to residents (drs. who are two-three years out of medical school), and residents report to chief residents who are always in the hospital and to attending physicians who are supposed to be able to get to the hospital quickly.

Dr. filmed from behind, quickly walking up staircase. He is heard talking frustratingly about being very overworked and not having time to spend with patients and this makes it seem like you don't care.

Female patient lying in bed appearing to be in pain

Overhead directional sign in hospital hallway, Visitor Elevators, Cafeteria-Exit, N-M Bldgs. Drs are seen entering room

Close up computer screen - yellow highlights across the screen.

Black

INTERVIEW

Robert Lipsyte:
help me if I go to a hospital?

Robert Klitzman
It's an interesting question. I think what it would do is have doctors available who have had a chance to sleep I think that they will be therefore think less uncomfortable as they perform their work. There'll be less fatigued I think they'll be less angry at times that those odd moments but I think that residents and interns find it frustrating being up all night.

Robert Lipsyte
Does that anger and irritation affect the way that you that that residents treat their patients or make diagnoses or make decisions?

Robert Klitzman
One would hope not I think doctors and interns like anyone else are human beings. And in speaking to doctors, particularly after my book came out a number of interns and residents spoke to me about their experiences. And what I found is people would report to me how they had felt quite depressed during their internship quite anxious. quite angry at times residents who've been several years out of their internship would even say to me, they feel they've never quite gotten over internship this several years afterwards. So I think that

Robert Lipsyte
and maybe some of the, the the anger and bitterness that we face in older doctors may still have to do with that period of internship. Marilyn do you think that there's too much responsibility given to interns and residents? Our life in the tape? The the young intern said we don't really make life and death decisions. Is that true?

Marilyn Agin
No, I don't agree. I found when I was an intern that especially at night, when you're on call, there's usually a skeleton staff. I was I was the intern, there was a second year there was a third year. And I remember times where I was all alone taking care of some very, some very sick children. Some of them had cancer, we're on chemotherapeutic drugs, we're on IV drips went into fluid in balance, I had to make decisions. Because often the senior was in the emergency room. The second year was in the delivery room, there was an emergency delivery. And although I could call for help, there were times I had to make certainly spontaneous decisions. And as an intern, you don't even really know all the time when there's an emergency. In terms of you know, electrolyte imbalances, these are things that you learn in the course of the year,

Robert Lipsyte
have you ever did you ever make mistakes?

Marilyn Agin
Well, no, not real. I'm sure I've made mistakes, nothing that was, you know, irrevocable. And I do remember though, being up all night, and kind of in pediatrics, it's very important to know your dosages. Because it's not like an adult where their standard doses you have to base it on weight. I remember kind of calculating, rechecking myself dividing it again, to make sure I was giving the right amount

Robert Lipsyte
to it and making those mathematical calculations tired and yeah, yeah, Joe, you're involved with the committee. One of the things that Sidney Zion said a couple of minutes ago, was that it's not such a big deal to restructure the work practices of interns and residents. Does that make sense to you?

Joseph Sachter
Absolutely. I think it's been our experience that when different departments try to show some flexibility and innovation, you can substantially comply with many of these regulations, recommendations and regulations. Now, simply by rearranging the schedule of doctors, the doctors work. One example I can give you as a metropolitan hospital where the Department of Medicine has taken positive and excellent steps and in in regulating hours, I think they mentioned on the piece here, that New York hospital voluntarily moved down to an 80 hour limitation. I think that 80 hours is key, because I think what we've been discussing here and what people tend to seize on is this idea of person up to 32 hours, 36 hours and the effects that has, and that's important, but I think what's left behind is what happens chronically, what happens to a doctor when they are working 110 120 hours a week, for weeks on end, three, four or five years. And it's that chronic fatigue, that really exerts a very insidious but very predictable effect on all patients. It's not just the isolated patient, which some mistake could have been made

Robert Lipsyte
What would be an example of that kind of,

Joseph Sachter
it's it's the chronic fatigue, that I'll give you a specific example. It could be when you're, if you've somehow managed to get bed at three, four in the morning, and the four hours that was quoted on by the stock to your hospital, seems optimistic to me, I never had four hours of sleep when I was an intern. So now it's four o'clock in the morning, the beeper goes off, the nurse calls, Mr. Smith, down, the hall can't fall asleep. Okay. Maybe the reason Mr. Smith can fall asleep is because someone else told him that he has an inoperable tumor, I wouldn't be able to fall asleep either. But it's four o'clock in the morning, you haven't gotten any sleep at all. And the response instead of trying to go to Mr. Smith, and see what's going on, is to just let her sleeping pill. And that's that's the effect of the chronic fatigue. It's treating patients like a collection of symptoms and not human beings. I think that's important, I think it's going giving an order over the phone not seeing the patient, which can often have tragic consequences, as we saw earlier. And I think it's in the part responsible for the kinds of things when patients come back and we can complain about doctors being arrogant, insensitive of not taking the time, all those are traced back to the same things. So I think it's really to the credit of the ad hoc committee of Dr. Bell, Dr. Axelrod, that they addressed this not just in terms of limiting 24 hours. In fact, the initial grand jury recommendation was 16 hours but said 24 Yes, but 80 as well. Now, 80 seems like a lot. But I think in terms of the way medicine is practiced today, it's certainly a step in the right direction.

Robert Lipsyte
And beyond even that, the idea that so often the least experienced doctors, were also tired, are being asked to make your phrase was spontaneous decisions. Why in this system Aren't you know, as we've just synchronized doctors, our age, coming back one night, a week, one night a month doing this? Does that would that make sense? Would that have helped you when you weren't intern? Would that have helped those children who needed their doses? modulated

Marilyn Agin
Yeah, I think it would have helped to have more backup. I'm not sure if I would have needed to call a senior attending at three in the morning for something like that. But I just think if there was more staff available, it could even be more senior residents. And as you know, as we just saying, I wasn't so chronically tired. I could possibly deal with this better too

Robert Lipsyte
Robert, you talked about so many doctors who have never gotten over that kind of psychic trauma. Do you think that besides affecting interns and residents care immediately that it will affect care for the rest of that physicians life in their attitude towards patients? Which other doctors?

Robert Klitzman
Well I think to a degree, it may, I think that the internship year in many ways needs to be seen in part as a rite of passage. And I think it's important to realize this importantly, is the context for the bell Commission's findings, as it become instituted. And specifically, I think the rite of passage involves a personal transformation that medical students undergo during the internship and making them into doctors, that has a lot of effects, both positive and have some downside as well. For instance, I think two important ones. I think that people want physicians who are compassionate, but I think that we also want physicians who are familiar with disease with people who are dying, so that when someone dies, and a family is in an acute emotional crisis, that someone in that crisis will be level headed, will be rational, be calm will know what to do. And we look at physicians to do that. I think that that kind of adjustment, that kind of coming to see oneself differently happens during internship. The downside, though, I think, is that interns developing this sense of becoming familiar with disease and with dying, can become perhaps hardened or numb to and I think that's the danger that needs to be sort of talked about more, I think, I think that interns and residents need to have a context in which to view their experiences. And I think the other thing that internship does, though, in terms of being a personal transformation, is that it empowers doctors we give in society, society gives doctors tremendous power. In this country, doctors determine what kind of foods we should eat, they determine what kind of sex we should have, what kind of exercise we should do. And similar when someone goes into a hospital patient, an intern, we let intern come and put needles in us put tubes in various parts of our bodies, wake us up at all hours. And the kind of confidence that's involved in the kind of empowering that goes on, I think happens during internship. I think that the internship years in many ways, a kind of personal transformation, which ones comes to see oneself differently, on which one goes through a kind of trauma coming out, in some ways a different person

Robert Lipsyte
but we have to find some way to keep the humanity within that year, doctors, thank you very much for being with us.

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Host Lipsyte introduces Kenneth Raske, President of the Greater New York Hospital Association a challenger to the new law and Bertram Bell, MD Albert Einstein College of Medicine and Chairmand of the committee that made the recommendations for the proposed new law.

Interview concludes, Lipsyte announces the show and introduces himself. Show Ends.

Funding by announcer and overlay the Eleventh Hour graphic.