Looking Inward

I was brought into this world by a jack-of-all-trades. The physician who delivered my siblings and me wasn't skilled merely in obstetrics; he was a talented surgeon, had a flair for pediatrics and was accomplished at setting broken bones. And yet whenever the occasion demanded, he'd pack his little black bag and make house calls. Unique? Not in those times. But his multifaceted practice gradually gave way to the system of medical specialties and subspecialties that we now know, one where a jammed thumb is treated not just by an orthopedic specialist, but by an orthopedist who specializes in hand injuries.

There are an awful lot of highly focused subspecialties in our business, too. Take, for example, the uncanny ability to follow a two-inch golf ball on a quarter-mile arc across an overcast sky; the grace required to coax a slightly buoyant underwater camera housing through a hatch on a shipwreck; or the saintly patience required to capture surreptitious shots of endangered wildlife nosing around the savannah. As in medicine, the highly focused television specialist lives and works at the pinnacle of his or her art.

So what could be more exciting than when specialist meets specialist?


When television cameras were first invited into the operating room, skill was presumably not an issue. The sheer bulk of the early cameras, even those designed for use outside the studio, was inherently at odds with the high-precision choreography of the OR, and the rough, industrial construction of those behemoths did little to advance antiseptic conditions. Nor was the space required for vacuum tube CCUs, king-sized audio mixers and transmission equipment likely to be found within the OR suites.

But as cameras grew smaller and became more self-contained, television coverage of medical procedures became more commonplace, even if only for closed-circuit relay to teaching institutions or taped for later analysis of surgical technique. It was in this environment that I learned about surgical shooting, starting with the surgeons' own inviolable laws concerning the sanctity of "the sterile field," the theoretical zone above the patient where sterility is required. Still, no matter how hard we tried, how well we behaved, we couldn't escape the annoyed glances and pointed barbs of the surgical team; we were mere civilians in an alien world, and our presence was just barely tolerated.


Time, as they say, heals all wounds, and the same emerging TV trends that taught viewers about chroma-key and digital effects quickly turned surgeons into media-savvy collaborators. No longer seen as enemies, our specialty was acknowledged, and we were invited to bring in jib arms and cranes to get a bird's-eye view of a deep incision, or to dress in full sterile garb in order to belly-up to the table for a closer look. Surgeons' icy conceit would melt visibly before the lens, as they graciously allowed their colleagues a peek at the master at work. Most often, we'd plead our case for a second camera, one for the procedure and another to capture the sights and sounds-the human angle-of the OR team at work.

It was hard to envision that a new surgical technique was about to revolutionize our specialty as much as it would those of the surgeons. Endoscopy was originally used to view the inside of a patient's stomach, for example, by passing a fiber optic tube down the esophagus. When we first saw the endoscope used, with prototype instruments, to actually enter the body through an incision, we were confused; how could long-handled forceps and scissors, worked in the blind, possibly be considered an advance?

Today, of course, "band-aid surgery" is revered for its low rate of complications and speedy recovery times, but nonetheless poses some significant challenges to the task of visualizing a surgical procedure. Since the main event takes place on the inside, we're at the mercy of the camera mounted at the end of the endoscope, and that's not always a good thing. For starters, the outputs available for hookup to an external recorder are usually NTSC-not a fatal flaw, but not a strong foundation. Systems integrators sometimes scrimp on the electronics, and the results can be poor handling of high-contrast scenes, which is basically everything, and marginal performance on highly saturated chroma; like red, of which there's a lot.

There are profound advantages to today's well-equipped endoscopy suite, too. Most obvious is the amazing scenery, the ability to see things in a way never before possible. In addition to the actual 'scope camera, these suites often include other points of view, such as a headband camera worn by the surgeon, or a remote zoom/focus lipstick cam mounted in the center handle of that big light centered over the operating table. That's a camera position you'll never duplicate, since it lies within the "sterile field" and is off-limits to foreign objects.


As a result of all these advances, the shooter or producer is usually left with far less control over the pictures gathered during surgery. The endoscope is placed literally in the hands of the doctors; some even control the auxiliary cameras with the same voice recognition systems used to control robotic surgical devices.

These changes point to new roles for those of us who claim minor specialties in medical shooting. We've got to learn a new role, a consultative one, in which we take the figurative "larger view" of the procedure's visualization, coaching the surgical team-our shooters-to get the right coverage. And, much as we did several years ago, we've got to advocate for enough additional resources-conventional cameras, extra mics and supplemental lighting-to ensure that a story is told, that a complete picture is painted, no matter how limited the topic may be.

In other words, the process has come full-circle: our "general practitioner" role was honed to that of a hyper-focused specialist, but must now widen once more to encompass storytelling, interpersonal relations and project management, and we must demonstrate skill and sensitivity in each.

Maybe my old family physician had the right idea.

Walter Schoenknecht can be reached via e-mail at walter@mmgi.tv.