The classic medical story line has a few key ingredients. There is a likable protagonist with a set of perplexing and debilitating symptoms. There are clear stakes. Will the young patient be able to walk down the aisle at her wedding? There is a diagnosishaha777, followed by a high-stakes surgery or a risky medication. And then there is the final act. The bride walks down the aisle. Life returns to how it once was.
I’m in the writers’ room helping to draft the script for a new television medical drama, and we’ve hit a roadblock in the fourth act. We’ve successfully set up the mystery and designed a clever way for our hero — a physician based on the famed neurologist Oliver Sacks — to clinch the diagnosis. But here’s the challenge: Our patient doesn’t get better.
At least, not in the way that we generally define as “better.” We are writing about brain disease, and there’s no cure. The character’s diagnosis is instead the start in a long process of adaptation to a new reality. This is a challenge to portray on network television, for a public that is accustomed to a particular brand of medical heroism.
But this, to me, is a challenge worth undertaking.
In the real world, life after serious illness is often changed forever. Even when a disease is ostensibly treated, symptoms can linger. Millions in this country with long Covid are still dealing with side effects of their initial illness, grappling with chronic fatigue and brain fog for months and years. Sometimes a psychotic break really is the first presentation of schizophrenia, and the first step to learning to manage it for a lifetime. Cancer and heart disease can become chronic conditions. None of these would be satisfactory ends to a traditional medical drama.
As a society, we often define the success of our medical treatments by how much they restore physical abilities. This is not just a television trope — it is also how doctors measure quality of life. A common scale that we use to determine a patient’s well-being, for instance, asks about physical abilities like climbing stairs and carrying groceries. A life with fewer functional abilities and independence is rated a life of lower quality.
These assumptions can affect the care of patients. As a doctor in an intensive-care unit, I often have conversations with patients and families about whether to push forward with interventions that could save a life but leave the patient with significant physical or cognitive deficits. I ask: What abilities are so critical to our patients’ lives that they could not tolerate living without them? Could they tolerate a life on a tracheotomy tube connected to a ventilator? Could they tolerate no longer tasting food but instead receiving it through a tube in their stomach?
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