Front Street Weekly; 718

All of the high technology tools, all of the medical knowledge available today, is meaningless if doctors can't understand their patients. Tonight, Front Street Weekly takes a look at medicine from the other side of the stethoscope. Welcome to Age Wise. Age Wise is a television program for senior citizens which airs on cable TV. What makes this show unique is that it's produced, directed by and stars seniors. Tonight we'll go behind the lights and cameras to see senior citizens in action. Good evening. I'm Jim Swanson. And I'm Gwyneth Gamble Booth. Welcome to Front Street Weekly. All physicians know that before they can help their patients, they must thoroughly

understand the patient's problems. Doctors must be good communicators. In our first story tonight, reporter Hope Robertson examines how four local physicians at times routinely, at times compassionately, and at times decisively, interact with their patients. A few weeks ago, I got a letter from the local medical society asking if I'd want to participate in their many internship program. You see, the medical society likes to give certain people in the community a chance to go behind the scenes with doctors. It's a good public relations move and usually the people that they choose are ones who have some sort of influence in the community. Well, I thought it sounded like an interesting idea, spending half a day with each of four doctors watching what they do each day. What I thought was this. I take a camera crew along and just document what we saw along the way. Somehow I figured we'd get a story out of it. Well, this isn't going to be a typical story. I'm not going to try to make one big point that'll stick in your mind. What I'd

like to do is give you the opportunity to see what we saw on the other side of the steppescope. 7.30 a.m. We had planned to meet Dr. Joanne Jenny in the hospital lobby. Instead, another doctor took us to meet Dr. Jenny in emergency surgery. I was called about 1.30 this morning to attend to this young man who'd been a motor vehicle accident on the coast. We can't show you his face because of patient confidentiality, but chances are even his friends wouldn't recognize him now. Virtually every bone in this man's face has been broken. This is not cosmetic surgery. Without this operation, he couldn't breathe on his own. Now Dr. Jenny breathes for him. She is an anesthesiologist. A career so often misunderstood that Dr. Jenny says a lot of people don't realize she's a physician. What do you think most people think an anesthesiologist is? Knocks people out and wakes them up. In fact, her job is a lot more

complicated than that. And so is this high-tech monitoring equipment all around her. We're watching the heartbeat. We're breathing for the patient. We are providing medications that they may need. We are providing fluid that they may need to be at blood or intravenous fluids. And we're literally keeping the patient in the best physiologic condition they can be in while they're not in control of their own faculties. Compared to the surgeon who's putting this guy's head back together, it doesn't seem Dr. Jenny has a very dynamic job, but she compares herself to an airline pilot. The take-off and the landing are more dramatic than the actual flying. Giving the anesthetic is really sort of like flying because normally your patient is awake and you're going to take them on a trip, a journey, which they have no control over,

and you hope the pilot knows what they're doing and where they're going and how to operate the instruments. For Dr. Jenny, coming in for a landing usually means waking the patient, but it'll be a long time before this man is ready to wake up. In the meantime, she prepares to transfer him to the intensive care unit. Okay, are we ready? Okay, one, two, three. Okay, and do we have a, yeah, a blanket or seat just to go over him because he's going to go by his family out there. Okay, now we can follow us to the intensive care unit. Like a passenger on an airplane, this patient isn't at all aware of his pilot. She's been breathing for him all morning, but when he wakes up, the journey will be forgotten. He's been very stable. Who's in charge? Okay, he's in very stable. He's had three and it's a

blood. There are similar techniques and there are similar procedures, but no two patients are alike and it's wonderful. In the sense that you say, oh, you know, your patients are always asleep, how do you know anything about them? We're in there to communicate with our patients pre-alcutively so we do know something about them, not only the records that we have, but we telephand them the night before if we can and we chat with the family, and we do know something about our patients so we also do follow-ups on them after we've taken care of them. How's the little girl with a thin shot? Well, they're picked up a book of photos. I don't think I've ever seen these people. To a clock, we're in the waiting room of Dr. Norman Eki, Pediatrics. It's a completely different feeling from our morning and surgery. Somehow, there's a little urgency about a two-month-old who spits up his food. As longs sound nice and clear, so... Nothing particularly serious about a little boy recovering

from an ear infection. Let's see if I can see your mom from here. And then the routine check-ups are just that, routine. Can he stoop down and come back up? Okay. But that's part of the reason why Dr. Eki likes his work. That's a real rewarding aspect of pediatrics that I've always liked, is that each time they come in, it's not just because they're sick. They come in for good stuff too. All right, bud. Well, you get to go out and enjoy the sun now. It's the unanimous, the real hard thing is all the communication and you have to go through. We're talking to kids that can't really talk back to you or tell you what's wrong. Indeed, yeah, although, you know, sometimes it has an advantage too because they can't lie to you. The physical exam is also pretty easy. I mean, it's pretty accurate in the sense that, for example, you push on the belly and you're wondering about belly pain.

They don't know what an appendix is supposed to feel like. And if they flinch when you get down on that right lower side, that's pretty significant because you know they aren't fated. I've had some adults that come in when I was a med student examining working in clinic, that they'd already come in with a mind made up that they think they might be something wrong with their appendix. They push them. They're already, you need to look there and they're already flinching, you know? And kids, they don't do that. Now, can you show me, Jeffrey, what about your neck hurts? It hurts, it hurts. It hurts right back in here. Yeah, it doesn't hurt. The mobs, they took much Tylenol. Oh, it took Tylenol, something okay. Well, that's good. Okay, can you do this? Can you look way up? Let's see if it might hurt. Good. Okay, look way down here. Way down here. Oh, very good. The nice thing is they get sick fast. If you do the right thing, they get well fast. And adults, adults, I can never stand adults because, you know, you got to say, now, okay, so what's your heart doing now? How's your diabetes doing that? How's your high blood pressure?

Is that okay? Kids, you seldom ever have to worry about multiple complex problems like that. Come in because of a sore ear. You're looking there. Yeah, they've got an ear infection. You can fix that. You know. So this is a, it's a car. The mother's in Dr. Ecky's office weren't at all reluctant to let our camera in while their children were examined. But it was a different situation the next morning in the office of Dr. Kenneth Burry. Hi. How are you? Good. The patients he sees are women wanting to become pregnant. He says half the couples who want to have children can't. And so we found that infertility is a very touchy subject. It does amazing things to self-esteem. It totally deflates people and takes them right down to the basic fragile human being that they are. To be denied a goal and such a basic goal, you know, having babies is something that you assume, you know.

So people are coming to see you in stress. They're stressed. She's on day six. Starter. Sometimes his patients are so nervous that Burry's afraid they don't always tell him everything he should know. So he relies on his nurses to fill in what's missing. And even if I was a female physician, there are things that a patient may tell the nurse that she will not tell the doctor. And many times as assumptions like, well, I don't want to take the doctor's time with this. And, you know, just the seat that doesn't cease to amaze me at the communication gap there is between doctors and patients. She was a patient like six years ago and she can't remember what the story she saw. And, um, her husband had had a vasectomy. I didn't know he had a vasectomy, then had a reversal. Then they had two kids, then he had another vasectomy. Now he doesn't want to go

through another reversal. It's called changing. Right. In this case, Burry will recommend artificial insemination. Some couples he sees have been trying to have children for anywhere from seven to 15 years. Often that means years of fertility drugs, of keeping ovulation charts, even taking sperm samples after sex. Hello. How are you? Now, the thought of having a camera record their session here is simply more stress than most patients feel they can bear. This couple agreed to let us sit in on their consultation, provided we don't show their faces. In reviewing your records, you are definitely candidates for in vitro fertilization. Any questions about this process? How soon can we start? The couple is immediately hopeful about this possibility for pregnancy, but Dr. Burry has seen that look before many times before. I think the biggest problem with in vitro fertilization is the emotional impact. And everybody is always hopeful and when you get

embryos back, everybody is just confident they're going to get pregnant. And our minds set us up for disappointment and still 80% of people go through and don't get pregnant. So you have to always keep that in mind that it is a it's a high-tech option that has success, but it's a limited success. And the risk is mainly the emotional impact. Burry knows that the couple may not really hear his warnings now. They're simply too excited, hoping that within a few weeks, they'll be on their way to becoming parents. This is what we're talking about here. These are the long narrowing there in the colon here. It's 2 p.m. Dr. Craig Fossil studies a group of x-rays for a patient he's about to see. So the intestine is closing off and it's a question of what's causing it to do

that? It's narrowed there and I think we'll have to go find out what her symptoms are like. Again, the camera is banned from the examination room. Dr. Fossil is in a subspecialty called gastroenterology, GI for short. Mostly he sees older patients, people who have difficulties with their stomachs, intestines, livers, colons, gallbladders or maybe all five. Gil, are you busy? Are you busy? You want tonight? Do you want to see a gift called pollen? Very few cases come straight from the book for Fossil. Often, diagnosing patients is a matter of following clues. Actually, I think you laparoscoker with me. 12-hour days are routine. In early evening, he starts his hospital rounds. Margaret, you never seen any films today on a, you saw them. You saw the films. That's that funny colon. Yeah. If you look over here, we're still seeing some edema. Along here, and we're even seeing some edema here in the hepatic

flexion. In this case, it makes me uncomfortable. Can I understand why? I don't really know what this is. It's a tender. Nothing is tender. No. More clues come from the patient herself. But unlike the kids in Dr. Ecky's office, older patients often guess what may be wrong with them and fear can get in the way of telling the truth. Sometimes when you're saying that, so you can get out of a tube. I'm like, I'm only kidding. Well, it's still the same thing we talked about earlier. There's certainly definitely something going on in the colon. I like the variety that I get between doing procedures, seeing patients being in the office, having very critically ill patients, but having not critically ill patients in the variety that I see. So you're dealing with suddenly sick. So I'm dealing with in part of my practice with suddenly ill, acutely ill, desperately ill patients and have ways of intervening in that. And so we lined up seeing patients at 3 o'clock in

the morning. We didn't stay to see 3 o'clock in the morning with Dr. Fossil. It was time for our crew to wrap up our mini internship with these few insights, mostly about communication. We'd seen a physician whose only chance to talk to her patients is before she puts them to sleep. We met a pediatrician who relies on a physical exam and a parent to tell him what an infant can't. We talked to an infertility doctor who fears his patients may not be telling him everything he needs to know, and patients who often don't want to hear what he has to tell them. Finally, a gastroenterologist whose patients are frequently diagnosing themselves. Monitors x-rays and exams can tell your doctor a lot about what's going on with your body, but so far machines are no replacement for simple talking and listening on both sides of the

stuff of scope. Well, as we've just seen as fragile as communication can be, it is crucial to healing the sick. Jim? Now another aspect of communication, that of self-expression. Thanks to cable access television, Portland Senior Citizens now have a television program produced entirely by senior citizens. Reporter Rod Minot tells us about age-wise. It's a news crew on deadline. Okay, are you ready? But this certainly isn't your typical TV news team. Okay. For one, the 88-year-old host is a retired seamstress. In fact, no one on this production crew is under 60 years of age. Welcome to age-wise. They're a part of a show called Age-wise, which airs by monthly on cable access in the Portland metropolitan area.

The program is produced by and for senior citizens. Associate director Tom Taylor says the idea of age-wise is to show age and action. One of the fundamentals for us behind age-wise is to demonstrate through knowledge production, but the programming that old age is not a disease. It is this part of life and it's a very productive and exciting and significant part of life that for the most part has been downgraded by our so-called youth-oriented culture. Age-wise began airing last July with a help of $163,000 grant from the Fred Meyer Charitable Trust. And all 2001 hour shows will be produced. Segments include health and exercise tips. We've been walking every day. Almost. We've had beautiful weather this year, and I haven't really missed any. Great day. So we kept going.

Every day, how many modes? Oh, my usual sex. There's also information about home safety. When I first came out to meet Gladys in her home, she did not have a rail down her backstep, and that can be a real hazard especially. News about financial and long-term health care planning. Mr. Klammer, how did you first hear about legal services and the help that we could give with making a well? There are stories about special events in the Portland area, and even tips from a Catholic priest on deep breathing to reduce stress. And so there's a word I put into my breathing. Actually, and then my breathing becomes a prayer. I put it in the name of Jesus. I breathe in G. Breathe out, says. There's a wonderful nuance to this little breathing here. Part of the image of aging is I think

because people feel trapped. They retire. What do I do with myself? And what we're trying to do is give people insights and portray the various activities that you can engage in and show the possibilities and potentials that each person has. It's television not only geared to help seniors, but also to show social service agencies the value of cable access as a way to reach viewers. To organizers of age-wise, there's also the matter of TV democracy. One of the things that is I think vital to people is that they know that they have control over what's said about them rather than turning that control over to the commercial media which puts people in the position of being a subject and they might have something very interesting that they want to get out to the community. But they don't have any control over the way it's done, whereas with our programming and public access in general, the people that have something to say

have control over what is said. H.Y. is a new special program that we know you'll enjoy. Control over the show's quality may seem a little shaky sometimes, but organizers say they're constantly improving and point out that their staff is made up almost entirely of volunteers. Most of them with no previous television experience. In video, you might take four or five shots and then put them together like you put together words in the sentence. Volunteers are recruited from orientation classes like this one. From here, they go on to take more intensive courses on using a camera and audio recorder, how to write a script, and edit video tape. Now this thing is very difficult to see, but I always think one too. That's the one we want to plug into. The real training begins out in the field. We followed one H.Y.'s crew on a story about a model railroad club in Portland. Until Joe Bogel joined H.Y.'s, the 64-year-old

retired sales engineer, had only picked up a home video cam quarter. Now he's one of the show's veteran TV cameramen, volunteering 10 to 15 hours a week. Work he gladly says keeps him active. If you'd stop learning, you start getting old, you know, and it's just fascinating to be able to shoot something and look at it right back. If you goof, then you shoot it again. And instead of waiting three or four days or a week, or the film to be developed, you see. It's getting easier all the time. How was it in the beginning? Oh, it was finally a bite in time. Lewis Simpson recently retired from the Postal Service. I had to find something to do, and I found this to be something that's interesting and exciting in itself, and something that's contributing to the community. Yes, it is hard work. It is hard work. I mean, with the amount of equipment that is there, and we do every part of it. Now again, there are some of the persons here not physically able to do it, and they do the

lighter things, but as far as wherever setting up lights or whether it's there in the activities of carrying the equipment around in itself, you're just like a pack horse, you might say. I'm having a lot of fun. Yes, I really am. Retired schoolteacher, Kate Boylan, is one of age-wise's original producers and hosts. Did you get nervous in front of the camera? I used to. When I first started, it was so new to me, and I never thought of myself as being in front of the camera, and when I remarked about that at home, one of my daughters said to me, oh, mom, forget it. Probably nobody's watching you anyway. And after that, I was never nervous again. I just happened to like people, and I always have believed in communication. As a teacher, I've believed in that. People need to talk to each other and be involved, and be aware of what's going on around them, and particularly I think retired people need to keep doing that. But ironically, many seniors aren't aware of what's going on,

partly because they can't afford the cable fee to watch programs like age-wise. Television is not an necessity like a phone or electricity, so you're talking $15, $16 a month, living on a fixed income, if you're single and have only social securities and income, it's cost prohibitive. Age-wise has about 40 volunteers. Show organizers say they need more. And if you're under 60, they add, sorry, that's just too young. And just remember, if you need a friend, here at age-wise are lots of friends for you. Goodbye. Organizers of age-wise are optimistic about getting continued funding, to find out when the program errors on your local cable channel in the Portland area consult your TV listings. And those people interested in becoming volunteers can call age-wise

at the Center for Urban Education, 231-1285. Coming up next week, a report on one of the state's most controversial issues, organ transplants. Advanced medical technology is keeping patients alive, but the costs can be very high. The key question is what priority should transplant candidates get when it comes to allocating limited state funds? That question has caused sharp debate among state lawmakers and the public. I said at that time that the legislature was doing something very stupid, that they were kidding themselves, that this wasn't going to backfire, that you couldn't allow these people just to die and not have some incredible amount of public concern and controversy. The question is how to allocate those limited dollars. And it seems to me that as a baseline, we should extend sound basic health care services, including preventive care to all Oregonians, as a first order of business. And after that, look at the amount of money

that is left and talk about how to allocate high-tech services. That report next week on Front Street Weekly. And finally tonight, last January, photographer Todd Sonfleeth and Sound Recorder's Greg Bond decided to spend a day up at Mount Hood. We're going to close our show with a look at what they found. Till next week, good night. Good night.