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BMJ. 2007 July 14; 335(7610): 102.
PMCID: PMC1914474
Review of the Week

Getting the inside story

Reviewed by Craig Gerrand, consultant orthopaedic surgeon, Newcastle upon Tyne Hospitals NHS Trust.

Fight for Life. BBC 1 six part series every week from Monday 9 July at 9 pm . Rating: ***.

A prime time series uses computer generated images to illustrate what happens to patients at times of medical crisis—but is it worth the effort asks Craig Gerrand

“Right from the start, we all have one overwhelming instinct.” So say the makers of Fight for Life, a series of six documentaries examining how the instinct for survival makes the body resilient against “incredible” odds. Each programme looks at a different stage in life—birth, childhood, teenage years, prime, middle age, and old age—and the challenges to survival during each. The programmes tell the stories of individuals at times of medical crisis and punctuates them with computer generated images. These images mean that we get to see the story from the inside: City Hospital meets TheMatrix.

The first programme sees Gabriel facing “incredible” danger before birth—meconium is seeping into his lungs—and there it is, black and tarry, squelching blob-like down the bronchi. The dramatic tension is raised. Gabriel's chances of survival are 30%. There is an emergency ambulance transfer. A priest is called; the newborn infant baptised. Without giving too much away, there is ECMO (extracorporeal membrane oxygenation), the risk of intracerebral bleeding, excursions up the nose and into the lungs—and there are tears. The star of this tale is Gabriel's 19 year old mother, Fay, who supports all those around her. Here is a role model for teenage parents.

Among the other stories is that of Arnav, whose medical parents find themselves on the receiving end of care. Arnav is breech and for good measure is being strangled by his umbilical cord. It seems to take an age (try holding your breath) to deliver him by caesarean section. We meet Elijah, in Baltimore, with a sacrococcygeal teratoma, and Lily. Thankfully Lily is delivered fit and well, but even here the narrator doesn't let us off the hook, emphasising that if she gets stuck en route, both baby and mother could die.

The second programme brings us children with asthma, a head injury, and, in the most compelling tale, 9 year old James, who undergoes a heart transplant.

The computer generated images partly enlighten the viewer but are primarily designed to entertain. They are of high quality, and the distinction between real footage and the images is often blurred. Some are more successful than others; the animation of a neonatal head passing through the pelvis is excellent. But to a medical eye, the dividing cells of a tumour and the phagocytes devouring meconium are more comic book than pathology book. The footage of heart transplantation surgery is so graphic that computer images add little.

The programmes are hospital based and it is heartening to see health professionals portrayed as caring, highly skilled individuals. Doctors talk to their patients and are empathetic and compassionate. This footage is real, not computer generated. Some medical staff are heroes. The high drama of the heart transplant requires surgeons to take the high stakes decision to remove the heart before the donated organ arrives in the hospital. Although not exclusively shot in the NHS, the programme is a great advertisement for it. Champions of change take note: we should take care to preserve an environment that allows clinical excellence of the kind shown in this programme to flourish. Viewers who become patients will expect it of us.

The dramatic tone of the narrative is intended to parallel the visual excitement of the images. The dangers lurking at every step are emphasised; every case is potentially a worst case scenario. This may be good therapy for patients and lawyers who expect universally successful outcomes, but it risks inducing early labour in viewers who are in the third trimester. Given the subject matter, this approach is often unnecessary and occasionally irritating. The players speak for themselves.

So why do people at times of crisis agree to take part in these programmes? Could they be harmed? An uncertainty principle applies: observation by camera crew inevitably changes that which is being observed. The camera is at best a distraction. The crying patient or parent is the documentary maker's money shot. Programmes like these are at worst voyeuristic and harmful, but at best can be uplifting, educational, and a force for good. For example, seeing a child in the throes of an asthma attack is better than reading about it in any book, and the candid, patient's eye view of the proceedings may serve as a useful reminder to busy clinicians. Although Fight for Life strikes a reasonable balance, its potential as a force for good is not completely realised. More could have been made of the need for organ donors. No mention is made of how appropriate action might save the life of a head injured child before the ambulance arrives.

On balance, these are enjoyable programmes, although not for medics who are looking for escapism after a day spent working on the front line. For doctors the appeal will be in seeing how others perceive us, and whether you see anyone you know. Further programmes include stabbings, cancer, trauma, and an aneurysm. I for one will be watching.

Notes

Fight for Life

BBC 1 six part series every week from Monday 9 July at 9 pm

Rating: ***


Articles from The BMJ are provided here courtesy of BMJ Publishing Group