I have got to give you credit for coming back and sticking with me. Yes, my interview with Mike Wallace really did happen, and yes, today I am going to tell you about it. One of the reasons I have been "stalling" is because I wanted to show you some clips, but I cannot find any. CBS only has clips on its website back to 1993, none before. I know I have a VHS of the program, but: a) I can't find it and b) even if I could find it I wouldn't have a clue how to turn it into a format that I could upload to You Tube and embed in this blog. I know, I am disappointing you by my lack of technical prowess. But for now, you will just have to depend upon my memory. It wasn't totally clear what Mr. Wallace wanted to talk about, but there were several children in my unit on the day of his visit, whose moms had agreed to let me talk about them and their children on camera. All the proper consents were obtained by our media relations people.
One patient was an infant with a condition known as holoprosencephaly.
This is a condition in which the usual separation between the two sides of the brain is missing. While the condition itself can take several forms, this baby had one of the most severe forms I have ever seen. He had mostly cerebral spinal fluid inside his cranial vault, and very little visible brain tissue on his scans. The baby had frequent seizures and was not able to breathe on his own. He had spent most of his short life in the hospital; first in the neonatal intensive care unit (NICU), and then in the pediatric intensive care unit (PICU). He was not growing well, could not eat, so required continuous tube feedings, and required a mechanical ventilator to breathe for him through a tracheostomy (a hole in his neck through which a tube was placed which allowed the machine to deliver oxygen and air about 20 times a minute).
photo credit: pedsradiology.com
I estimated that at the time of the interview this little person had a huge hospital bill, probably at least several hundred thousand dollars, and he had medical assistance. Mike Wallace asked me several questions about the baby's history, and his chances for long-term survival, which were not good. We spoke about the numerous conversations that had been held with the mom to help her understand his condition, and how unlikely it was that he would ever be able to breathe on his own. Would never be able to eat, to talk or walk, to really know her. But the baby's mom had insisted that "everything" possible be done. She wanted to give him a chance, and we were trying everything we could. She had, however, agreed to a "do not resuscitate" order, so that if his heart should stop, we would not try to get it going again. We would not put him through pain and suffering (he did seem to feel pain) of chest compressions. If that happened she felt it would be God's will, and she was ready to accept the end, but did not want the end to come at the hand of a human being. And we were OK with that. By this time I felt the interview was going well. I was relaxed. I might have even let down my guard. I was basically teaching. This was very natural for me. Nothing to fret about. What could happen?
And then IT happened.
The "gotcha" question that had made Mike Wallace so famous. He asked me how much we had spent on medical care for the baby, and I told him. Then he asked me in a tone that sounded a bit like a lawyer for the prosecution in a malpractice case: "Dr. Ackerman, can you tell me, how many immunizations for poor children could you buy with that money?" I made up some reasonable answer, appropriate for the times. He followed up with "How can you justify spending so much of the taxpayers' money on this child, who will never grow up, rather than providing vaccines for thousands of poor children, to keep them healthy?" Ahh, I must have eaten my Wheaties that day, because I actually was able to think up an appropriate retort. No hemming and hawing. No vacant stare, no "umms."
I just looked him in the face and said: "If you could tell me that there is even a 50% chance that money not spent on this infant could be turned into money for vaccinations, then we would have something to talk about. But there is absolutely ZERO chance of that happening. Se we have nothing to discuss." He was silent for a little while, and then we went on to talk about some other issues. The little segment with his ZINGER question was not included in what was shown on TV, and there were no other difficult questions. All in all, a good interview, and a positive outcome. So, do you understand now the power of serendipity? Saying yes to US News and World Report led to a request from Sixty Minutes. Saying yes to Sixty Minutes led to meeting Mike Wallace. And being prepared to think on my feet (probably from years as a pediatric intensivist, having to make rapid decisions with limited information in critically ill children). And serendipity perhaps that I unsettled Mike Wallace with a walk around the PICU, showing him pediatric heart rates that made him think about his own mortality, which may have made him more easy for me to control when he started to approach for the "kill." This story not only shows the power of serendipity, of course, but it has allowed me to present some of the ethical issues seen in pediatrics. Are there any issues you would like to discuss? Please list them in the comments below and we can start a discussion on some of those issues.