On Medical Series, Doctor-Writers Give a Second Opinion Dashboard Dashboard

Drs. Daniela Lamas and David Renaud talk COVID-19, on the frontlines and in the writers' room.

If writers on medical series have to be aware of COVID-19 protocols when approaching storylines and production from now on, how are the doctors who write on these shows approaching scenes and characters?

Dr. Daniela Lamas is a pulmonary and critical care specialist at Brigham and Women’s Hospital in Boston; in her other life, she is a writer. Her book You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and in Between was published in 2018. Lamas is going into her second season as a writer on the Fox medical drama The Resident (created by Amy Holden Jones and Hayley Schore & Roshan Sethi).

As a general physician, Dr. David Renaud has worked in private practice and in clinics around LA, where he also attended UCLA’s film school. He has since joined the staff of ABC’s The Good Doctor (developed by David Shore).

Connect spoke with Lamas and Renaud, at a particularly momentous time for hospital dramas, to get their perspective on production safety, truth vs. fiction during a pandemic, and what changes might come to a prime-time ER.

Daniela Lamas

You’re in the unique position of coming to a writers’ room after spending months on the frontlines of the pandemic. As the writers’ room opens, is there a particular story or theme you want to incorporate into The Resident?

One really surrounds the isolation that this virus requires. As doctors in the hospital we are so used to having families there at the bedside. These are the people through whom we get to meet the patients. And now we’re existing in this world where, we might care for somebody for weeks and never get to talk to [the patient], never really get to talk to somebody who knows them other than on the phone. You develop these very powerful bonds with [patients] that you never really meet. So there’s something very unique and surreal and sad and isolating about that.

Turning to fiction, I’d love to probe what that is like for our fictional doctors taking care of these patients, and also, to whatever extent possible, what that is like for the patients and for the families on the other end of it.

There’s also this feeling of learning as we’re going, of caring for people who have something new. These questions we had at the end of March and in early April—what are the right treatments, how do we manage the ventilator, is this similar to other types of respiratory failure or is it different—this sort of crowd-sourcing type of things that we learn on Twitter, I’ve never had that experience. This feeling of being part of this great, larger team of doctors throughout the country and the world all joined together fighting this one disease has been an immensely powerful experience. Though it’s been awful, it also made us feel really proud to be doing what we’re doing and all working together. Putting aside ego, regardless of your specialty.

You brought up the theme of isolation. Is it your medical opinion—as opposed to your writer’s opinion—that scenes between doctors and loved ones are simply unrealistic for now?

I guess it depends what your mandates of veracity are. If you’re going to tell it like it was, in March and April, and you’re going to try to reproduce that reality of that moment in time, you have somebody dropping off somebody they love in front of an ER and not knowing when they’re going to see this person again. You have a doctor putting an iPad in a biohazard bag and holding that biohazard bag in front of an intubated patient’s face, a doctor or nurse in full PPE in a room. So that a family member on the other end of the line can see the person that they love and say thanks to them.

What is the situation currently at Brigham and Women’s?

Up until actually today, our hospital rules were, visitors only at the end of life. They’ve loosened somewhat. But still, if your doctor didn’t decide that there was a decent chance you were gonna die, you didn’t get anybody. Now patients are allowed one visitor a day. But still, COVID-19 patients aren’t allowed visitors.

What about your doctor characters? What would you say in terms of portraying their interactions?

Our rules in our hospital are that we’re supposed to be six feet away from people. Look, there’s absolutely no way. We have a team of me (I’m the attending), a fellow, residents, interns, nurses, we’re standing on rounds clustered outside a patient’s room. If we were each six feet away from each other we’d have to be at some megaphone, we’d have to be rounding in an auditorium. There’s no way we’re six feet away from each other. When I’m examining a patient with a nurse, we’re in close proximity, we wear surgical masks all the time, except with a patient at COVID-19 risk, in which case we wear N95s.

For the purpose of shooting and logistics, that is definitely some kind of hassle, people are less audible when they’re in masks. In real life they’re less audible, it’s legitimately annoying, you have to tell people to kind of scream.

So where do you come out on how to integrate COVID-19 into The Resident?

As a medical show you lose veracity if you decide to create a world where that devastation did not exist. It’s hard to create and have people believe in medical professionals being heroes if somehow they didn’t experience what it was to care for patients with COVID-19. At the same time, we’re working with a set of unknowns, of when will things be shot, what will the world look like at that point. By definition, if you’re shooting, there has not been a massive second surge that has put things at bay again. I think, looking ahead to saying, alright at some point we will be in a world where COVID-19 existed and likely continues to exist, but is not the main focus of every hospital interaction, and that’s the world that we’re going to want to show, while also doing some acknowledgement of the fact that this happened. I think that is the balance we’re thinking about and I imagine most medical shows are thinking about.

David Renaud

The writers of The Good Doctor came back in April. What were your early thoughts about the way forward?

We didn’t really have any accurate tests to tell our actors—particularly we have some who are little older, in a little more high-risk age groups—how we can tell them, yeah, you can come in here and you’re not going to get this virus. That was a big concern, particularly then. We’ve talked about that since with production, and they have a well-thought-out plan. Our show is shot in Vancouver. Ironically, even though we have all these travel bans, we’re actually the country that people should be travel banning because we have the most cases of anywhere in the world.

Looking back at my experiences as a doctor, I did work in Toronto during the SARS1 outbreak, in the emergency department. What we noticed initially with that virus was that everybody who got infected got really sick. Young people and old people all died around the same rate. It hit everybody. The kill rate on that was, like, 10%—it was very high. So that was a really scary bug.

What made it easier to contain is that everybody got infected. You weren’t shedding the virus when you didn’t have symptoms. If you got it, you got really sick really fast, and you either lived or died, so there weren’t people walking around in the street spreading this thing without knowing it. I promise you there are a lot of people walking around out there right now, on the streets of New York and LA and everywhere across the country, who have active COVID-19 infection, are spreading the virus, and are saying to themselves, “Oh, it’s just my allergies. I get allergies every year.”

David Shore has been candid about how much it feels like writing into this unknown, since new episodes won’t air until the fall.

Some of this came down to creative decisions that David had to make about how much do we want our audience to live in COVID-19 because they just lived through COVID-19. And how much is it just going to look weird if we show doctors behaving in a way that everyone on the planet knows they don’t behave anymore. We’ve always tended to take liberties in that regard. No one wants to watch an amazing guy like Freddie Highmore with a mask on for every scene, because you just lose so much of the emotion in acting. But even myself, just watching shows now that were shot before and seeing how people interact, and how they hug and how they’re really close, it feels weird now even for me.

There has been so much written in the last three months about the heroics and trials of medical professionals on the frontlines of this. Is that a help in terms of story?

Doctors and nurses—forget doctors and nurses, I mean, delivery people and grocery store employees and public servants—they’ve done some really heroic and amazing things. That was the other thing we talked a lot about in the room is, do we have an obligation to celebrate those people and their heroics. I think uniformly we all feel that obligation. So we’re going to try to strike a balance between keeping this respect and presence of something that may just be like a realistic part of our lives alive in the show. We’re going to try to strike a balance, and my role in that regard is to try to help David and the other writers understand what that might look like. If we were writing in real time it would be easy. We’re trying not to be too specific, although I do think even if there’s a vaccine, let’s say by November, early vaccine success, you’ve got to convince people to actually take it, you’ve got to convince me that it’s safe to give to my kids, then you’ve got to distribute, and then it takes time to build up antibodies. So I think it’s a safe bet to say we’re going to be living with the world as it is right now.