TNT
Paging fans of ER, Grey’s Anatomy, and House: a new medical drama is coming to a TV set near you. Monday Mornings, premiering tonight at 10 pm on TNT, revolves around morbidity-and-mortality meetings at the fictional Chelsea General hospital. These so-called M&Ms, an important part of most large medical practices, give doctors the opportunity to review possible lapses in patient care: they learn from their mistakes (even as some are haunted by them). Here, it’s Chelsea’s chief of surgery Dr. Harding Hooten, played by Alfred Molina, who leads these meetings.
The show is based on the recent novel of the same name, written by Dr. Sanjay Gupta, Emmy-winning CNN medical correspondent and practicing neurosurgeon. Gupta, one of Monday Mornings’ executive producers, talks to TIME about creating a medical drama that explores a little-known but very significant part of a doctor’s life.
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Why focus on this particular meeting? Why is it so important?
I’ve been fascinated by how doctors learn for a long time. If you are constantly discussing your mistakes, how much of an impact does that make on your learning? At these meetings, which I’ve been attending for 20 years now, everyone keeps their notes because they’re designed for everyone else to learn from [doctors’] unexpected outcomes or complications.
How do you decide what medical conditions to feature?
These are all very authentic things that could actually, and probably have, happened in hospitals. You can have an episode in which you’re talking about whether a transplant patient is actually brain dead—how do you determine brain death? Or if someone is on a ventilator — who has the authority to make medical decisions if there’s nothing written? Who owns your organs after you donate them? If you donate your organs, and then let’s say the person dies in the interim. Who owns the organs then? There are questions that come up in medicine, and we don’t always know the answers.
In one episode, the hospital’s Chief of Transplantation Dr. Buck Tierney (Bill Irwin) is eager to declare a patient brain dead so that he can harvest his organs. Is that a common phenomenon?
Most of the things that get presented in these very secretive meetings thankfully don’t happen a lot. It can be a gray line when someone is actually considered an organ donor and when they’re not. That was something we wanted to get at with this particular [scene]. As a neurosurgeon, I’ve been fascinated by this idea of brain death and how people determine it differently in different hospitals and in different countries. A lot of these story lines come from things I’ve seen or questioned or written about.
And then there are cases in the TV show that aren’t in the novel, such as the 13-year-old patient with a brain tumor who does not want to have surgery.
That was an episode I helped write. I was fascinated by this case because I had read an article [examining] when judgment develops in a human being. This gets to the story of Trisha Miller, the 13-year-old. We say people can drive at age 16. The reason we can drive at age 16 is because that’s when you can get a work permit—and historically, parents didn’t want to drive their kids around anymore. Sixteen became an arbitrary age. Eighteen became the voting age because we figured if people can fight, they can vote. None of this has any specific root in science. It’s more part of pragmatic social considerations. And if you look at Trisha Miller, she’s 13 years old but probably has more judgment than most of the adults that we know. So is it a question of judgment or is it a question of age? I was fascinated by that topic, and that’s the genesis of this particular story line. It’s fun when you get to take interesting areas of medicine and turn them into a TV show.
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Who are the show’s characters based on?
They’re all just amalgamations of people I’ve met—some in medicine and some outside of medicine. Tina Ridgeway [Jennifer Finnigan] is someone who is preordained to be a doctor. She has some misgivings about traditional medicine and the competing interests in hospitals and their politics. Alfred Molina’s character, Harding Hooten, is the chairman who is the reason people come to this hospital. He’s that legendary person who trains people to become leaders in neurosurgery. He holds everybody accountable, so they respect him and are terrified of him at the same time. Dr. Jorge Villanueva [Ving Rhames] is a trauma surgeon who is also a very senior person like Hooten, and sometimes when you have two very strong department heads, they butt heads over how they want to take care of a patient.
Are any of the characters supposed to be you?
None of them are based on me, but I think I relate to all of them in a way. For instance, there was a woman I trained with who never left the hospital. She essentially just lived in the hospital for seven years. She was always there, and that can be a very good thing because she was so dedicated. But she had no life at all. Is she happy? Do I want my doctors to have a life outside the hospital, or would I prefer they’re in the hospital all of the time? Sydney Napur [Sarayu Rao], one of the characters in the book and the TV show, that was a little bit [based on her]. She’s really, really good, but at what cost?
One of the things I was really trying to get into the character of Sung Park [Keong Sim], the Korean neurosurgeon, was something my parents experienced as immigrants. [My parents] weren’t doctors, but his immigrant story was based in part on things that I saw in my own family. For Park to become chairman one day, he is going to have to improve his English. He’s a really talented neurosurgeon, but [his English is] potentially a stumbling block. And that’s something immigrants always talk about, the impact of language on their careers.
In the show, the young, star neurosurgeon Tyler Wilson (Jamie Bamber) keeps making the same mistake: performing life-threatening operations without consulting his colleagues. Are doctors really so afraid to talk to one another?
There is an arrogance sometimes. His whole life is dedicated to being a surgeon, similar to Sydney. He does not have relationships or friends outside the hospital. He lives by himself. So when something like a mistake happens with him, just from a psychological perspective, it’s so challenging. He doesn’t always consult with his colleagues because he thinks he’s the guy who is supposed to know it all; he preps constantly for this stuff. How can somebody know something that I didn’t? It just doesn’t seem possible. That’s where he gets called out a bit by Alfred Molina’s character.
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What are the biggest, preventable mistakes that doctors make?
The more common ones are things that are small but can have a more significant effect—like giving antibiotics at the wrong time, not following up on exams, and ordering blood tests and not evaluating them.
What mistakes have you made as a doctor that still stick with you?
Everybody has been at the lectern at one point or another. I was in my fifth year of training as a neurosurgery resident, and there was a situation where there was an infection in one of our post-operative patients. An infection in someone who’s had surgery can potentially be a big deal. They may need treatment with antibiotics, and sometimes they need to go to the hospital. But we found out that the sterilization times of our instruments were off; we were using instruments that hadn’t been in the autoclave machine long enough. That stuck with me because you spend decades training to do this stuff and learning to do the operations, but something really simple like that—an extra 30 seconds or 15 seconds in the machine—can make a huge difference in terms of the outcome.
How does Monday Mornings fit into the world of medical dramas like ER, House, and Grey’s Anatomy.
It’s very different. There have been a lot of cop shows, legal shows, medical shows over the years, but when I started writing this book, it became clear that this topic—in the way that I was writing about it—took people inside a place that they didn’t know about.
Through the show, do you hope to convey any lessons about how doctors can better communicate with patients or how doctors can be better doctors?
The show is primarily a scripted drama, so hopefully it will be engaging and entertaining for people. But I’ve always seen my role as an educator as well as a journalist and a doctor. As surgeons, we spend a lot of our time educating patients. If the show is authentic, then people may learn stuff from it and become more empowered patients. They may see what happens after something goes wrong and how the hospital and the doctors deal with it. It can be very humanizing. Often times when something goes awry in a hospital, the communication completely breaks down. This show is the rest of that story.
Do you think the Monday morning meetings are effective?
I do. I think they could have a real role outside of medicine. I think any institution could benefit from holding a weekly meeting on a regular basis that’s not designed to be punitive, but where you are evaluated and held accountable by your peers. First of all, you learn from it. And a lot of times, mistakes are things that just aren’t being done in the best way, and people don’t recognize it because they don’t talk about it. So I think the actual act of just talking about these things in a candid, closed-door session makes a big difference.