Video: Heroes of Children's Hospital: Watch the show

By Chief medical editor
Dateline NBC
updated 1/31/2010 6:13:15 PM ET 2010-01-31T23:13:15
transcript

This aired on Dateline NBC on Sunday, Jan. 31, 2010. Watch related web-exclusive video here.

Dr. Nancy Snyderman, NBC Chief Medical Correspondent: For me, the trip to Arkansas Childrens Hospital is a personal journey too.  It is here, that fresh out of my residency, I had my first staff job as a surgeon.  And it is where the young doctors you are about to meet will put everything they have learned in medical school and internship to the ultimate test.  It is in residency where their future paths will be determined, and where these men and women will find out if they have what it takes to be a good doctor.

It is one of the most stressful high stakes jobs on the planet. Medical residents--new doctors--who are about to embark on three years of intense and emotional on-the-job training - and sometimes losing lives.

Filmmakers Brent and Craig Renaud take us on an extraordinary journey inside one of the top children's hospitals in the country as we follow a class of residents starting with their first day on the job.

Ryan Wilkes, resident: Has anyone seen Dr. Green? Does anyone know how to page him? This is ridiculous.

Ryan Wilkes (to Dr. Nancy): You're overwhelmed with just the anxiety of doing your job right.

It is a rare behind-the-scenes look at the making of a doctor.

Ryan Wilkes: It's kinda like your first day at school, you know.  You’re excited, but your nervous at the same time.  It's both.

It's week one for the residents at Arkansas Children's Hospital. Every resident must complete monthly shifts or "rotations" in each unit of the hospital.

Zach King: It's pretty nerve-wracking when you first walk into this place.  Um, and you see every, every, bed has somebody really sick.

Ryan Wilkes has his first rotation in the intensive care unit.

Ryan Wilkes: Does your belly hurt at all?

Deeana: No.

One of Ryan's first patients is a little girl named Deeana, who is suffering from leukemia.

Ryan Wilkes: Well, you'll be seeing a lot of me.  If you need anything just holler.

Ryan hopes to specialize in intensive care, so impressing the senior attending physician, who will ultimately write his evaluation, really counts.

Ryan Wilkes: Replacing the Enlodapin with that…(stumbles his words)

Dr. Jerril Green, Attending Physician: Is the Enlodapin - was that started purely for hypertension? 

Ryan Wilkes: I can't answer that for sure.  I'll have to look that up.

Dr. Jerril Green: OK.

Ryan Wilkes: Oh no, I apologize, I'm getting my patients confused here.  That's somebody else.  I apologize.

One of the most stressful first tests for a new resident is leading rounds.  In front of nurses, fellow residents, and sometimes skeptical attending physicians, the young doctor must present a cogent evaluation for each patient on the ward.

Shad Pharaon: Our first patient is Kyler. He's a 3-year-old with 40 percent surface area burns to his trunk, bilateral interior thighs and bilateral hands. And face.  His major issue... uh...has been his respiratory status. Um.  Um.

Dr. William Hickerson, Attending Physician: Any benefit from steroids intense?  Any benefit across the board with giving steroids?

Shad Pharaon: I don't know.

Dr. William Hickerson: You gotta know what to do with these folks; you gotta know what to look for.  And I know it's not fair, it's your first day, but it is fair.  ‘Cause either way you go. I'll make you look bad.

Shad Pharaon: Alright.

Ryan Wilkes: Rounds can be absolutely brutal.  Absolutely brutal.

Zach King: As a new resident it is quite stressful when you come into situations like this. And it is intimidating to think, you know, I might have to be the one that has to get in the room and save that kid’s life.

Trauma in the ER is an intense crash course, and all new residents must take shifts here. Amanda Grueter is one of the few residents who loves the drama, the rush, the unpredictable chaos of the emergency room.

From ambulances to medical choppers, young doctors never know who-or what-- may be coming in next.

Amanda Grueter: Umhmm.  I'm gonna listen to his lungs before I move him.

Zach King: This is about a 2-year-old whose parents thought he was in bed and actually kind of made his way outside and got into a small pool that they had in the back of the house.  They went outside and found him face down in the little pool.

For little Daniel, it's a race against the clock.  The doctors have no idea how long Daniel was underwater. And the longer he is unconscious, the greater the risk of brain damage and death.

Amanda Grueter: Here's the chest X-ray, it's gonna get worse before it gets better.  You just think about, what do I need to do to help this kid.

With his condition deteriorating, doctors work through the night to stabilize Daniel. It has all come down to one anxious moment. Will he wake up?

Zach King: Hey Daniel?

Nurse: Can you wake up, buddy?  Can you open your eyes?  Daniel can you open your eyes?

Mom: Hello little man, Mommy's right here.

Daniel wakes up.

Everyone: Hey!  Good morning.

Mom: Mommy is right here!

Zach King: It does get kind of draining on you physically, emotionally, spiritually.  Uh, but you know you get kids like this that lift you back up.  You know? Somebody who could've easily went down that path of not being able to save.  He'll be fine.

Most of the residents say they chose pediatrics because children, unlike adults, often bounce back from even the most serious illnesses and accidents. Daniel is his own miracle. He has made a complete recovery.

Coming up, the young doctors' skills are tested as a baby's life hangs in the balance and we meet one very special and amazing little girl.

Ryan Wilkes, gesturing to blue bottle: This is my energy drink that looks like it's a bottle of antifreeze.  It's illegal in about 15 states. (takes a sip)  But um, it's the only thing keeping me going.  I think it's just straight caffeine.  Maybe some crack in there, too, I don't know. 

Tonight, Ryan begins his rotation on the night shift, in the neonatal intensive care unit.

Ryan Wilkes: There are 80, 90 babies in here. Um, Unfortunately, I am the only one here, it's what you do when you are the “mole.” You're here at night for 13 hours. The bad thing is, that there is a lot of kids here, and you're the only person here. This one is pretty darn so sick it makes me a little worried, a little nervous, but I don't really sit around thinking about the enormity of the situation.  If you spend a lot of time thinking about the enormity of a situation than this probably isn't what you need to be doing. Looking at a X-ray of a kid that I just intubated.  And I put the tube in, a little too far.  So I need to back off a little bit.  By a little bit, I mean a lot.  Definitely still learning.  You can be doing this job for 30 years and still be learning so, it's just the way it goes.

Ryan's mistake is a common but correctable one, and an attending physician is always nearby if needed to help out. But when a crisis presents itself, the residents are expected to step in, and perform. Without warning, a six-month-old patient suddenly goes into cardiac arrest. She isn't breathing.  And just one week into his residency, Aaron Gardner gets the call.  He must perform careful but calculated chest compressions in the hope that this little baby will begin to breathe.

Doctor: Oh yeah!  Alright, very good.

Aaron's efforts pay off, and her heartbeat returns to normal.

Sarah Weston: Did you like how we were all standing around in case you got tired.  Tap out if you’re tired.  I was watching your thumbs.

Aaron Gardner: You know when you can't do it anymore.

Sarah Weston: Aaron intern of the year Gardner.

Ryan Wilkes: Do you want to suggest some really dramatic background music for when they play this on TV?  And they have you in slow mo?

Aaron Gardner: Faith Hill, "Just Breathe".

A small baby, Quinn, with no feet pushes on a toy to make an electronic sound effect.

Dr. Lisa Buckmiller, Attending Physician: Her name is Quinn and she's from Vietnam.  She's got something called, we abbreviated it "KTS", which is Klypal Trenanay Syndrome.The big surgeries that she had at this point have been on her left foot, which ultimately ended up needing to have a big part of that removed. So...

Dr. Nancy Snyderman: So what's the expectation for today?

Dr. Lisa Buckmiller: We are hoping to see her walk today.

Dr. Nancy Snyderman: Really?

Dr. Lisa Buckmiller: This might be the first time we get to actually see her do that.

Baby Quinn was found abandoned on the roadside in Vietnam.  With a rare condition that eventually required the amputation of both her feet, she was brought to Arkansas Children's Hospital, after being adopted by an American family.

Carol Harlan, Quinn's mother: I began calling hospitals all over the country and probably talked to about 150 different hospitals, and then I started reading about Dr. Buckmiller. We just felt like we were being led to come here.

Dr. Nancy Snyderman, watching Quinn try to walk: She's so close.

Evan Moore: I know, if she can just....

Dr. Nancy Snyderman: Yeah.

Quinn climbs up a chair on her own.

Dr. Lisa Buckmiller: That's awesome.  That is awesome.

Everyone applauds; Quinn claps.

Dr. Nancy Snyderman: Good for you.  Yay!

Dr. Nancy Snyderman: (to Evan): I know how tough it is to be a young surgeon, and you see a lot of tough stuff, but this must make your heart sing.

Evan Moore: Yeah, this is really just, I mean, a blessing to be able to be here and see someone doing so well.  She's just doing amazing.

Dr. Nancy Snyderman: She's amazing.  She's just, she's really amazing.

The typical resident will work an 80 hour week, so any social time outside of the hospital is a rare-and welcome-opportunity to unwind.

Ryan Wilkes, over margaritas with fellow residents: A little hair of the dog for you.  This is Sarah's like 8th margarita.  When you work 30 straight hours and you're up all night, you just get brain dead, I mean you can't do anything.

Sarah Weston: It's scary, when you're that tired you're an idiot, anybody is an idiot when your that tired.

Ryan Wilkes: Have you even driven home from work after call and been like, “It is not safe for me to drive right now”?

Other resident: Dawn slept at work, that's how tired she was.  She said she fell asleep while rounding in the ICN, in a rocking chair, during rounds.

Ryan Wilkes: I was in the parking garage, and number one I couldn't find my car, and when I did, I couldn't figure out how to get out of the parking garage, I bet I drove around for like 10 or 15 minutes, just trying to find my way out of the parking garage.

Coming up, the new residents take on one of the most pressure packed rotations in the hospital.

Ryan Wilkes, attempting a spinal tap on an infant: OK, I gotta get a boss just to watch me as ... Has anyone see Dr. Green?

Though the residents are expected to perform the day to day procedures in the hospital, they depend on experienced attending physicians for instruction and mentorship.

Ryan Wilkes talking to Dr. Green: That's it, yeah. Thank you, sir.

Sarah Weston: He says sir, like, about every third word.

Rupal Bhakta, laughing: Whatever... Since when does Ryan say "sir?"

Dr. Green to Ryan: And you've got all the tubes that you need?

Ryan Wilkes: Yes, sir.

Dr. Pam Howard: We're gonna go teach the second-year medical students about burn surgery.

Dr. Pam Howard, a former Air Force burn surgeon, is one of the residents' favorite mentors.

Dr. Pam Howard, talking to resident Joy Acklin: So how are you doing, are you ready?  Basically follow me everywhere.

Joy Acklin: And it's learning trial by fire we go to the OR.

Dr. Pam Howard: I think surgery is the most challenging job of any job. I was in a training program with all men.  There was one woman ahead of me and she quit.

Dr. Nancy Snyderman and Dr. Pam howard prep for surgery.

I scrubbed in with Dr. Howard to see firsthand how she goes about training her new surgical residents.

Dr. Nancy Snyderman: So who's in the OR with you today, resident-wise?

Dr. Pam Howard: Um, Joy is in the OR with me.

Dr. Nancy Snyderman: Hi Joy.

Dr. Pam Howard: She doesn't have booties on with the holes in her shoes, so she needs to go take care of that.

Joy Acklin: Oh, shoot.

Dr. Nancy Snyderman: So you're busted already!

Joy Acklin: I know, I'm nervous.

Dr. Pam Howard: There's a little mentoring, a little parenting.  You know, there's a lot of that. We're kind of casual here we play more music and more laid back than some of the other surgeons, I think.

Dr. Howard walks through the emergency room.

Dr. Pam Howard: What's happening?  Where's my music?

A nurse pushes play on an iPod.  The Who blasts through the speakers. Dr. Howard sings along.

Dr. Pam Howard: There's too much intensity in this job. You have to bring it down a little bit with the music.

Dr. Nancy Snyderman: And you've educated them for real music.

Dr. Pam Howard: Yes, I'm trying to, it's very difficult.

Today in the OR, dr. Howard is teaching resident Joy Acklin to treat burns on a 2-year-old boy named Korbin.

Dr. Pam Howard: So this baby was walking around and fell into some hot coals. And this baby, you know,. later today will be up and walking around. She's doing pretty good. 

Dr. Nancy Snyderman: What do you expect from them when they come into the OR?

Dr. Pam Howard: I expect them really to have an appreciation for the importance of this, the intensity of it.  It's a little like I feel like sometimes I'm teaching them how to cook, you know? (to Joy) That's good, you might want to clean that up.  So just take a little Actecote and wrap it around the toes.

Joy Acklin: I don't feel like I'm gonna be on the top side of toes if I'm weaving under and over.

Dr. Pam Howard: She's got her own way of doing it and I'm letting her, you know, develop that skill.

Dr. Nancy Snyderman: Nice job, you guys.  Nice job.

It's now six hours after Korbin's surgery, and soon he'll be up and around and home in about 48 hours.  He's sort of the stereotypical patient admitted to the burn center, but because it's the only center in the state, some patients are adults, well into their 80's.

The whirl of helicopters bringing patients into the hospital is nearly constant, and keeps the residents on edge. In this case Shad Pharoan is confronted with a 66-year-old woman severely burned in a house fire.

Staff: She doesn't know this, but her husband died.

Dr. William Hickerson to Shad: Get you a gown and sterile gloves on, and let's do a bronch. You can see some of the black that's down there that's the soot.  And what we're gonna do is just clean all this out.  You ready, Doc?  It's all yours.  Here you go, right there. Show me the soot.  OK.  So if you have any problems, use your common sense.  Alright?  Now clean that out and you're in business. Alright.  Very nice.  You’re through, doc.  Good.

Shad: Thank you.

Dr. William Hickerson: You'll notice that they'll perform, but there's always someone standing right by their side.  Going "No, this is what I really want, this is how you really need to do it." You give them as much lead way as you can.  You let them make decisions that you got control over.  As they get more and more experience they get more and more lead way to do those things.  It's a graded responsibility that goes with learning.

DR. Pam Howard and Joy enter a patient's room.

Dr. Pam Howard: Good morning, hey, I'm Dr. Howard.  What were you doing?

Young patient: Uh, burning brush.

Dr. Pam Howard: Burning brush? What were you at your house?

Patient nods yes.

Dr. Pam Howard: Yeah?  You guys do that a lot?

Patient nods yes.

Dr. Pam Howard: Yeah?  So he's got 2nd degree burn here.  That means the skin came off.  So what we're gonna do, is I'm gonna wrap them up, and I'm gonna try to clean them up to see how they look with him asleep.

One of the most important skills that an attending physician can teach a resident is how to talk to young patients and their parents, putting them at ease.

Dr. Pam Howard: I'm gonna go see your brother. How old are you?

Young patient: Twelve.

Dr. Pam Howard: Twelve, OK. You had the same kind of thing happen, huh?

Patient #2: Yeah.

Dr. Pam Howard: Did you use gasoline?

Patient #2: Umhm.  His idea.

Dr. Pam Howard: Who's idea?

Patient #2: Dad's.

Dr. Pam Howard: (laughing) His idea?

Dr. Pam Howard: The other issue that comes up sometimes is how to approach the family and how to say you know...this shouldn't happen again.  And give them some safety tips and usually I don't do that right now.  Because they are clearly.

Joy Acklin: Feeling guilty.

Dr. Pam Howard: Freaked out.

Joy Acklin: Uh huh.

Dr. Pam Howard: He feels guilty. He looks like he's gonna cry, and you don't want to make him feel any worse.

Dr. Howard's mentoring is not confined to the hospital. She has started a tradition she affectionately calls "stitch and bitch", where the female residents can get together and speak freely about the pressures of the job.

Female resident: You know, I walk into the OR and I'm the resident for that case.  I'm not the female resident for that case.  I have the skill set that I have regardless of whether I'm a woman or a man.  Now, I have smaller hands so I'm better, but…

Everyone laughs.

Dr. Pam Howard: There is a lot of potential animosity that you may not even know you are going to encounter just because of being a woman and being surrounded by a lot of men.

While half of all medical students are now women, surprisingly, less than 10 percent of them will go on to become surgeons.

Dr. Nancy Snyderman: So is the mentoring aspect of this important to you?

Dr. Pam Howard: I think it's very important.  Some faculty I think like the fact that they could try to make you cry, you know, they wanted to make you cry if you were a woman.  We're better with them, we're kinder than we used to be.

Dr. Nancy Snyderman: So what you are really saying is that the old model is dead?

Dr. Pam Howard: I think that's true.  It's very true.  I think it’s important to be able to show these women how to get through this and stay sane. 

Coming up, learning to juggle the demands of the job with life outside the hospital.

For the new residents of Arkansas Children’s Hospital, 30-hour shifts have become the norm. And in a sense, Rupal Bhakta has been preparing for it her whole life. When her parents came from India, they had just one dream: for her and her two siblings to become doctors.

Dr. Nancy Snyderman: You are one of three kids in your family.

Rupal Bhakta: Yeah, I am. I am.

Dr. Nancy Snyderman: And you're all doctors?

Rupal Bhakta: Yeah.

Dr. Nancy Snyderman: How did that happen?

Rupal Bhakta: Persuasion.  Gentle persuasion from my parents.  My dad said it best.  In India that is one of the most respected demanding fields so when they came here, that is what they wanted.

At the Bhakta household: All of Rupal's family is gathered in the living room dressed nicely.

Rupal Bhakta: Ask him what his American name is and what his real name is.  What is your real name?

Rupal's dad: Mine?

Rupal Bhakta: Yes.

Rupal's dad: Tansukh.

Rupal Bhakta: And what do you go by?

Rupal's dad: Tom. It's easier.

Rupal Bhakta: It is easier.  This is my dad.

Rupal's dad: That's my mom.  I'm ironing my brother’s graduation gown, he officially gets called a doctor tomorrow, he gets his degree tomorrow. Then we force the parents to start retiring.

Rupal's brother: Yeah, stop working.

When the family first arrived in the United States, they bought a hotel in a small rural town in northwest Arkansas. They worked 24 hours a day, 7 days a week, in order to save the money needed to send their three kids to medical school.

Rupal Bhakta (to mom): She was the 24/7 desk clerk.  We used to hide behind the door of the front desk and watch her fight with truck drivers who claim they lost their money in the Coke machine.

Rupal's dad: My last child is coming out of medicine so I'm a happy person.  Happiest person on the earth right here right now.

Graduation Ceremony, University of Arkansas for Medical Sciences.

Speaker: The H. Elvin Sheffield Medical Leadership Award is presented in recognition of promise as a physician.  The winner of this year’s Sheffield Award is Vashall T. Bakhta.

Rupal Bhakta: That's my brother.  You might want to watch my parents - they might start crying and stuff.

Vashall Bakhta: So I'd like to thank everyone who made it out here. I wanna thank my parents.  They're in the back.  I'd like everyone to turn around and look at my father back there. Dad, this is the 3rd kid and you’re done and it's time to retire. You need to go travel with mom and just have a nice life. Your kids are finally getting a paycheck, you've done enough and we're forever grateful.

Dr. Nancy Snyderman: And I understand that when your brother graduated from medical school, you and your sister hooded him.

Rupal Bhakta: We did.

Dr. Nancy Snyderman: That must have been an extraordinary event

Rupal Bhakta: It's a milestone for my parents. It's the end of everything they wanted when they came here.

Back inside Children's Hospital, it's a constant struggle to juggle the demands of the job with life outside of work. Zach King and his wife are both resident doctors, they see each other for about three minutes a day in the parking lot of the hospital as they choreograph the handoff of their six-month-old baby girl.

Zach King: That's about the extent of our interactions in the morning.  We don't get to see each other too much.  This is residency life right here.

Zach lifts his baby out of the car, pushes a stroller through the hallway.

Zach King: The life of a resident is a lot different than the life of a doctor.  It's just the grueling hours that you have to work, months at a time, just working nights, and it's the grunt work that kind of makes this hospital run.

Nurse #1: We'll take care of her.  We're not busy.

Dr. Nancy Snyderman to Zach: You're in scrubs.

Zach King: Yeah.

Dr. Nancy Snyderman: We are in an emergency room and a healthy baby has just been put into a stroller. Why is she here?

Zach King: So we have to do a day-care switch.  My wife is a resident as well and so she has to be at work before the day-care is open.

Dr. Nancy Snyderman: So this is the emergency room as day-care.

Zach King: Yes.

Dr. Nancy Snyderman: You know that's not normal.

Zach King: That's very not normal.

Zach's baby is at his side each day as he completes his rounds.

Doctor #1: Watch him drag his baby in.

Zach King: Yeah.  Thanks for the help, guys. Did you look at the X-ray?  I didn't really see much on it.  I mean it looked like there is probably a lot of Atelectasis, They just showed up in the emergency room with decreased mental stats.

Dr. Nancy Snyderman: Can you envision being married as a resident and doing this work?

Ryan Wilkes: I can't envision being married period. But, much less as a resident.

Dr. Nancy Snyderman: Are you a ladies’ man?

Ryan Wilkes: Not at all.  That is not true. 

Dr. Nancy Snyderman: Then why are you blushing?

Ryan laughs.

Ryan Wilkes and Evan Moore have been best friends since attending medical school together in Oklahoma.  They are both single and usually spend their rare days off going out. The teasing they endure for bringing their college lifestyle to their residencies extends all the way to the operating room.

Dr. Buckmiller, Attending Physician, referring to Evan: He's actually one of our junior residents.  Overall good guy but he's a nut.  We like to tease him.

Evan Moore: That's right.  This room is constant teasing. 

Dr. Buckmiller: He's also a ladies’ man. Evan works at three hospitals.  He's got a girl in every hospital.

Everyone laughs.

Dr. Buckmiller: And then Mandy tried to set you up with somebody who was really "hot." And then you screwed that up.

Even for all the teasing, the main focus for these residents and their attending physicians is always the job at hand.

Dr. Buckmiller: And when you hold the scissors, I want you to hold them like this. So your hand isn't in anybody's way, including your own.

Inside Ryan's apartment.

Ryan Wilkes: I don't know how Evan feels but me personally, I wouldn't date a resident in my department.

Evan Moore: See Dr. Buckmiller brought this whole thing up in the OR about...I've dated like two people at Children's and she blew it out of proportion.

Ryan Wilkes: You didn't really have any overlap.

Evan Moore: No, it was like two random people. They were both very nice. They were very nice girls.  Still friends with them.  Very respectable.

Ryan Wilkes: Let me just say this.  Whenever Evan looks at the camera and says something, I guarantee it's horsesh*t, OK?

Everyone laughs.

Coming up, the residents come face-to-face with the intense emotional strains of the job.

The pediatric intensive care unit is thought by the residents to be the toughest rotation.  It is where the young doctors must learn to deal with the very sickest kids. Ryan Wilkes took us in to see 3-year-old leukemia patient Dominic, who, with his mother at his bedside, is back in the intensive care unit for the third time.

Ryan Wilkes: We have an art line and I believe he has a port from his chemo.

Dr. Nancy Snyderman: So the challenge here is to take care of his infection, boost his white cells, keep him on his chemo, get him back into remission.

Dr. Nancy Snyderman to Dominic’s mom: How are you holding up?

Dominic’s mom: He needs all the support I can give him. So I just deal with it, I mean...There's not much else I can do.

Dr. Nancy Snyderman: Ryan, it can't be easy standing over the bedside of a child who is so ill.  Especially with mom in the room.  Why this work? 

Ryan Wilkes: You give a lot of yourself into it, and it can be emotionally exhausting at times but the reward is well worth it.

Dr. Nancy Snyderman: What is the reward?

Ryan Wilkes: A kid like Dominic, he's gonna get better, he's gonna be in remission and he's gonna be healthy and have, uh what we hope for is that he has a normal life.  And, you get to be a part of that.

Dr. Nancy Snyderman: How do you balance the children like Dominique who are very ill but for whom you have big expectations versus the children who come in here and you know are not going to leave the ICU.

Ryan Wilkes: You can't perform a miracle on everybody and that's just not a reasonable expectation to have. 

But miracles are what the residents are called on to perform every day: In this case, a child who has been rushed into the emergency room after a car accident.

Attending Physician: OK, everybody calm down, OK? Stop compressions.

Doctors working on the boy look up at a monitor, which has flatlined.

AmandaGrueter: No, there's no pulse.

Attending Physician: Does anyone have any suggestions? Calling it.

AmandaGrueter: We're done.

AmandaGrueter to Sarah Weston: God, today sucks.

Sarah Weston: Sorry. What happened?

AmandaGrueter: They lost vital signs in the field like 15 minutes before they came in. He coded for like 15-20 minutes. It was bad.

Sarah Weston: Everytime she's on call, something terrible seems to happen. But she's unlucky right now. Next week it will be somebody else.

Dr. Jerril Green, Attending Physician: When you do this rotation, and by the time you are done with it, some of your patients are going to die. And the residents are not going to be accustomed to that.

Ryan Wilkes: When a kid dies, it weighs on you in a different way. But it's an inevitability that it's going to happen to everybody.

AmandaGrueter: Every death is really difficult. There is no such thing as an easy death to deal with. But when it's just a perfectly healthy child full of life and energy and potential, that's just hard, that's kind of tough.

For the second time in a week, Amanda is faced with a child for whom survival seems unlikely. This time, the baby of teenage parents, born prematurely at just 24 weeks.

AmandaGrueter: And it just, it was clear that this was just a downward spiral and we were not going to save this baby.

Dr. Nancy Snyderman: So you and your Attending decide that this baby girl, with bleeding to her brain, and having several cardiac arrests - this is just not compatible with life.

AmandaGrueter: Right. Talked to the family and confirmed that yes, this is what we want to do and... Um, then just, disconnected everything.  Disconnect the IVs, take the monitors off, and then just, wrapped the baby in a blanket and hand it to the family to hold. The complications that this baby had were very severe and like you can't take it as like, you're a bad doctor because the baby is not going to live. Seems like for every poor outcome there is more good outcomes and so I think it makes it worthwhile.  But you can't really get caught up in the poor outcomes because it can be really sad.

Coming up, as the year comes to an end, things begin to look up for the residents.

At the end of a long year at Arkansas Children's Hospital, the residents, still technically students, are preparing for their end-of-year exams. A year ago, Ryan Wilkes struggled through his presentations during rounds.

Today, he is much more confident in his role as a physician.

Ryan Wilkes: So this is Joshua.  He is our 15 year old.  He is adequately sedated.  He was previously on muscular blockers and those were discontinued earlier this morning.

Dr. Jerril Green: Electrolytes OK?

Ryan Wilkes: Electrolytes have been OK.

Dr. Nancy Snyderman: A year ago, when you started here, would you have been able to give such a fluid presentation?

Ryan Wilkes: No.  Not a chance.  I don't think so.

Dr. Nancy Snyderman: How has it changed?

Ryan Wilkes: A lot of it is just experience and you become more comfortable.  You know, you get thrown out in a residency and I guess the system works where they stress that you pick it up as you go and you pick it up quickly because you have to pick it up quickly.

Rupal Bhakta: I got here at 6 a.m. yesterday morning, and it is 12:41 p.m. the following day. But you have to stay here for 30 hours.

Amanda Grueter: Yup.

Rupal Bhakta: It's just tiring. But I think the awards eventually come in later.  So I think it's worth it.  For the cost of your youth.

The drama and intensity of residency bonds this group of young doctors.  Many of the relationships here will be lifelong.

Amanda Grueter: When you get a run of really sick kids with bad outcomes that die-

Sarah Weston: You beat yourself up.

Amanda Grueter: It’s good to get a good one in there every now and then.

Dr. Nancy Snyderman: What is it about this friendship that makes you guys better for it?

Amanda Grueter: I mean, a lot of people you know, outside of residency--non-medical people--wouldn't be able to relate at all to like, you know, what goes on here.  The things that stress us out.  And, you know when we have a bad day. We keep each other sane.

Sarah Weston: Yeah.

Amanda Grueter: Definitely.

All of the residents are preparing a party.  Amanda sticks her finger in the punch.

Sarah Weston: We are planning a birthday party for Rupal.  We are wrapping presents at the last minute. 

Elizabeth: I got off at 5:30. And now I'm trying to put makeup on so I can pretend to have a life.

Sarah Weston: We have a stack of cards in case people forgot to bring cards.

Amanda Grueter: We're like a little family.

Sarah Weston: We really are.

Elizabeth: This is all we have is each other.

Sarah Weston: When you go through all of this stuff and you spend 80 hours a week, you have to get closer.

Elizabeth (to Rupal): How does it feel to be 30?

Rupal Bhakta: Shut up!

Dr. Nancy Snyderman: Do you ever worry that the world is passing you by?

Rupal Bhakta: Kind of, yeah.  Because you kinda put your life on pause while you're going through this and yes, when I finish I'll be in my 30's. But that's fine, that's fine.

As the residents hit their stride, the impossibly hard times give way to more and more better days.

Amanda extends her hand out to the child.

Amanda Grueter: Can you give me five?

The child slaps her hand.

Amanda Grueter: Alright.  I think we got you fixed up.

Amanda Grueter: Today was a good day.  You know, kids like that, that just kinda makes your day and kinda reminds me of why I'm doing it and things like that. Like whenever you do a procedure really well, have like your own little end zone dance.  Like...

Amanda dances.

Dr. Nancy Snyderman: If I gave you a form tonight where you can just sign it anonymously, I'm a fair doctor, poor doctor, good doctor, what would you anonymously say about yourself?

Amanda Grueter: I'd like to think that I was a good doctor. But you kind of have to be careful because you can't be too confident.  There is so much that I still don't know.  I just know that it is going to be OK.  If you make a mistake, you'll deal with it, and move on, and you'll be OK.

Ryan Wilkes is examining a young boy.

RyanWilkes: Open up and say “ahh” for me.  Buddy I think you are doing just fine, I don't think you need to worry.

Boy's mother: Yes, please let him know.

RyanWilkes: Yeah, you're fit as a fiddle.

RyanWilkes (to Dr. Nancy Snyderman): It only takes one.  You can have a horrible, horrible day if at one point in the day you have one mom who's nice or appreciates what you do it's all OK.  All you need is one, one family to make it worth it.

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