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Dr. Michael Rich

Talk about life in the movies.
I was a film and English major in college, focused on making the great American film. I first worked as an assistant director making B-movies in Hollywood, getting experience in the trenches. I made connections in Japan and got a scholarship to go to Asia.

Didn't you end up working with Akira Kurosawa?
In Japan, I worked on a famous film comedy series with a very commercial and powerful director. He introduced me to another director I worked with who was a close friend of Kurosawa's. At the end of the job, he asked me what I wanted to do, and I said my fantasy was to work with Kurosawa. He had been my favorite director because of his combination of brilliant visuals and truly human content. At the time, he was starting Kagemusha. I was one of four assistant directors. I directed battle scenes, did second-unit photography, was on location every day. Later, I didn't have a hugely successful Hollywood career. I alternated working on things I didn't feel very good about and doing stuff like rewriting other people's scripts and trying to sell my own.

How did you go from movies to medicine?
What always interested me about movies and narrative was the vagaries of the human condition: What is it that makes us human? What makes us tick? I wanted to use this powerful medium to change hearts and minds, to make the world a better place. And that's what interested me in medicine. It's that simple.

How are you using film now?
When we gave up the house call, we gave up much more than an opportunity to have a warm connection with our patients; we gave up a huge data-collection opportunity. We have lost touch with the ability to really understand what is going on with the patient from the inside out, what the experience of illness is. What I am seeking to do with video is to ask patients to teach their physicians everything they know about the illness experience. [Rich is director of Video Intervention/Prevention Assessment at Children's Hospital.] You can imagine the look on the face of a 14-year-old when I hand him a camcorder and say, "Teach me about asthma." He's the expert; he lives it 24/7. I can only tell him what the textbooks say.

What are you discovering?
That 95 percent of the patients had elements in their environments that were precipitating asthma that they recorded but didn't mention in the office. So our medical history was almost 100 percent wrong in terms of its sensitivity. And it wasn't because people were lying: It was because memory is revisionist, particularly with children who have no ability to control their environments. What is the point of mentioning something you can't change?

Why does asthma especially afflict minorities?
It is generally felt to be an economic issue, but it's so complex that it is impossible to rule out issues like, are certain ethnicities more prone to asthma or not? When people ask me, "Is there going to be a cure for asthma?" my first response is "When there's a cure for poverty." Many of the clear problems for kids with asthma are elements that you cannot control if you have no money. Like the ability to live in a home without forced-air heating or in an area where you're not breathing industrial fumes all the time. If we could fix society, I would fix the quality of housing first.

If you could make one change in medicine, what would it be?
From the first day, I would teach medical students, nursing students, and social work students the primacy of the patient. I would focus on what the body and mind and spirit need rather than teaching the technical aspects. The technical aspects will come. They're not about healing. One of my guiding lights as a physician was something taught to me by an 11-year-old boy as he was dying, whom I took care of when he was going through chemotherapy for leukemia and through his bone marrow transplant. I was sad and frustrated and feeling completely ineffectual. Late one night, we were talking, and he said, "I'm going to die, aren't I?" I thought about it, and I said, "Yeah, and I can't tell you how much that hurts me and how much I want that not to happen and how hard I've worked for that not to happen." And he said to me - and I can't say this without getting emotional - "You can't always cure, but you can always heal." I wondered, where did that come from, that wisdom? I realized what he was telling me was that I had healed him in some way and that couldn't have happened without our relationship, but that I still hadn't cured him, but that dying was OK, because he had made his journey from life to the threshold. The simple act of being there with him during some of the journey had made the journey possible for him, and therein lay the healing. It felt like when you lie down next to a young child who's falling asleep, and it makes it OK for them to let go and fall asleep. It's very easy in medicine to get seduced into me-against-death; I have all this technology and medicine and knowledge, and I'm going to throw myself into the breach and I'm going to save this kid, and I was caught up in that seduction. What he taught me was that what's really important is the human connection, the relationship. That everybody had made their best effort, and that in that best effort healing had gone on.