The Specialists

The whiteboard that hangs in David Foster’s office on the Fox lot is, in its own way, a window on two worlds. On it, in black and blue marker, he has written a crowded stack of plot points. Or character arcs. Or medical terms. It’s actually quite hard to tell, given that the words are written in that classically indecipherable physician’s scrawl.

Foster is a co-producer of the medical hit “House.” He is also a doctor, one of a handful of physicians and researchers who straddle the worlds of science and imagination to keep some of the top shows grounded in medical reality while exploiting the dramatic possibilities of a pulmonary embolism or Tourette’s syndrome. On “ER” alone there are six--two doctors who are full-time writers/producers, two who are part-time consultants and two who are technical advisors. “Grey’s Anatomy” on ABC has one MD on staff to make sure the actors talk like doctors, one nurse to show them how to act like surgeons and two full-time medical researchers to help the writers find and flesh out the cases that often mirror each episode’s theme. And in addition to Foster, “House” has four more physicians working as consultants.

It’s as niche as niche gets, and a golden niche it is. “House” and “Grey’s Anatomy” are two of the biggest breakout shows on television, racking up a plethora of awards and nominations for each of their three seasons. Even after 13 years, “ER” remains landmark television.

It’s good to be a Doc Hollywood these days.

“It’s the best of both worlds,” says Lisa Zwerling, a pediatrician who has written for “ER” for four years. “There are days when I cannot believe I get paid to do what I do.”

Time was when medical shows were not this complicated. The doctors on shows such as “Marcus Welby, M.D.” were gods--whatever they said, went, no matter the vagueness of the terminology; it was all in the authoritarian delivery. Even the soap opera “The Doctors” opened with the earnest intonation “Dedicated to the brotherhood of healing.”

Then came NBC’s “St. Elsewhere” and “ER” with their brilliant but flawed doctors. Delving into the gore of the emergency room, “ER” especially put medicine, with its miracles and limitations, front and center as specialists consulted with surgeons and everyone bandied about diagnoses and possible solutions. Suddenly, this was not only drama, it was also public service. One famous “ER” episode, in which a pregnant woman with preeclampsia (which is characterized by high blood pressure) died, continues to haunt women 10 years later. “When I told my ob/gyn I wrote for ‘ER,’ ” says Zwerling, “he said, ‘Do you know you’ve made an entire generation of women paranoid about preeclampsia?’”

As Foster will tell you, the best part about being a doctor has always been the stories. The tales about teachers and patients he and other students swapped to shore themselves up against the pressure of med school; the medical histories and personal narratives his patients told him at the inner-city clinic in Boston where he worked for five years; and the cases he continues to discuss with doctors around the country since he moved to Los Angeles.

“The great thing about being a doctor is that you get to hear stories from people whose lives are so different from your own,” he says. “It’s why I went into medicine. This is a natural extension of my work as a doctor. A chance to tell compelling stories about medicine.”

And the really bad handwriting?

“It’s my secret weapon,” he says. “That way no one has any idea what I’m working on.”

Not that legibility would make a difference. At “House,” which chronicles a premier diagnostician, much of the drama is the medicine, or at least the symptoms, which always look like something else before turning out to be some obscure syndrome or a malady so simple that no one thought of it. Foster is in charge of writing two episodes per season as well as helping the rest of the writers with the medical portion of their plots.

“It’s very tricky because the A story is so complicated,” Foster says. “Each writer will come up with a kernel of an idea--it could be a character or a twist in Act 4. A patient that House respects, so he acts even crazier than usual. One writer saw an image of a fetal surgery in which the fetus’ hand reached out and touched the doctor, and so that became a story. Sometimes you work backward, sometimes forward. Every story is different.”

Like Foster, Zwerling loves stories and wrote her way through high school and college and even into her career as a pediatrician in the Harbor-UCLA emergency room. When a friend told her about a woman working on a medical pilot who was looking for a doctor who could write, Zwerling’s hand shot up. The show was “Presidio Med,” executive produced by John Wells. When “Presidio” got the boot halfway through the first season, Wells, who also is executive producer of “ER,” asked Zwerling if she’d like to join that show. “I jumped at it,” she says.

For the last four years, she has written full-time for “ER” while working part-time in a clinic. Keeping one foot in the field, she says, helps her to come up with good stories; after 13 seasons of “ER,” it becomes more difficult to make recurring cases fresh, so concessions must be made. “We always tweak our stories for confidentiality,” she says, “and also because real life is never as constantly exciting as it is on TV.”

Foster also did time on “ER,” giving uncredited help to his Harvard Medical School mate Neal Baer, who is now the show runner for “Law & Order: Special Victims Unit.”

“I was a fourth year when Neal came out to work on ‘ER,’” Foster says. “He’d bring me out to tell my stories as a med student, then as a resident.”

Even as he established himself as a physician in Boston, Foster came to L.A. several times a year to work the Industry. He went from helping out on “ER” to consulting on “Gideon’s Crossing,” did a few “Hallmark Hall of Fame” gigs and the obligatory slew of pilots that never left the ground. Along the way, Foster decided he could write a few scenes, then a whole script, on his own. So when executive producer David Shore wanted him at “House,” Foster was offered a job as a consultant and the opportunity to write a freelance script that would be made. Even so, he and his family stayed in Boston and he continued to work at the clinic during the show’s first season.

Two years ago, when it was clear that it was a hit, Foster made the leap; he quit his practice and moved his wife and two children to L.A. This year, he’s returning as a co-producer, with six episodes of his own under his belt.

Many of the cases on the show mirror cases Foster has known--he blended one patient who had died from receiving too much chemotherapy with another whose staph infection had been misdiagnosed to create the woman Dr. Foreman “killed” last season. Foster knew of some revered researchers whose testing standards during the 1960s were less than ethical, and he used that material to create an eminent though unscrupulous researcher (played by Joel Grey) who refuses to be part of a treatment trial because he knows researchers can be unethical. “It’s still all about sitting around with writers telling stories,” Foster says, although he has to reel it in when those stories break the last strand tethering them to the real world.

“All the time,” he says when asked how often he has to say, “No, that would never happen.” “All the time. Look, the point of House is he deals with the one-in-a-million case. So that’s my rule; if it’s happened once, I’m comfortable with it. But I like it so much better when it’s been documented. Fortunately, doctors like to write these things down.”

Like “House,” “Grey’s Anatomy” has structural limitations. It follows surgical residents, so all the cases must be surgical, which means the show cannot deal with hot topics such as obesity. “For obesity to be surgical it would have to get really ugly,” says Elizabeth Klaviter, director of research for the show. “That’s one reason they opened the clinic [on the show]. So we could show a broader range of cases and a broader range of people.”

Klaviter has a theatrical rather than a medical background. She also grew up with show runner Shonda Rhimes; after Klaviter finished graduate school she began working as Rhimes’ assistant on feature film projects. What she brought to “Grey’s” when she started three years ago was not so much expertise in medicine but expertise in Rhimes.

Since then, Klaviter has learned to read her writers--one likes broad, sweeping events such as a ferry accident; another likes characters to make dramatic choices. Klaviter, who will also head medical research for Rhimes’ new show, “Private Practice,” spends her days combing through medical journals, newspapers and the Internet, compiling a file inches thick of possible cases that will answer a variety of needs. “There are a lot of organizations that will make experts available,” she says. “Because they all know how important it is that the medicine be as accurate as possible.”

Her rule of thumb: If the situation exists, the medicine that follows must be plausible if not actually documented. “We try to make sure that if it hasn’t actually happened, it could happen.”

As with “House,” the “Grey’s” story lines evolve in every way imaginable. Rhimes wanted a coma patient opening his eyes, his gaze connecting with lead character Meredith Grey’s, or a man who seems to be pregnant. A writer who rock climbs wonders what would happen if, on falling, one climber stuck his pick in someone else’s back; another wants hiccups to kill a patient.

This last served as the penultimate episode for last season; the person who hiccuped to death was Meredith’s stepmother.

“We had been wanting to kill a person with hiccups for a while,” Klaviter says. “Just to show how something simple, something you experience every day, can be fatal. Having it be Meredith’s stepmother just happened to fit the characters’ stories.”

“ER” follows a similar arc when breaking stories--the characters come first.

“We figure out what journey we want them to go on in their personal and professional life,” says Zwerling. “Then we find a story to communicate it.” Sometimes the cases come out in the writers’ room--Zwerling and Joe Sachs, a doctor who has been with “ER” since almost the beginning, often dredge up cases or stories from memory. But sometimes the two go off by themselves, call friends and contacts to come up with just the write, er, right medicine.

The medical community has, of course, long recognized television dramas as the ultimate public service venues. Real doctors are the ones who suffer when people come to them with heads filled with misinformation. Not surprisingly, a Los Angeles group, Hollywood, Health & Society, part of the USC Annenberg’s Norman Lear Center, exists precisely to fill this need. Funded by big guns, including the Centers for Disease Control and Prevention and the National Institutes of Health, HH&S; is proactive, offering presentations and panels on hot health topics for writers and producers; its website currently features a brief called “Motivating Television Viewers to Become Organ Donors.”

“We all saw the same briefing on organ transplant,” says Zwerling, “so there were a few of those [episodes]. Which is great since it is a worthy subject.” (Does this also explain the new TNT show “Heartland,” which follows an organ transplant team?)

Although the writers are happy to provide a service, they all are firm in their commitment to story over cause du jour. Still, it’s not unusual to have Dr. House bust a patient for not using contraception.

Because the writers all use the same resources, there is occasional overlap, and the really strange cases stand out for everyone.

“I was so proud when I found cases of Hmong people who had to reconnect their souls before an operation,” Klaviter says. So proud, she mentioned it to Linda Klein, a nurse who advises actors on how to “perform” surgeries. “She said, ‘Oh yeah, the Hmong.’ She had done it on ‘Chicago Hope,’ she had done it on ‘Doogie Howser.’ ‘Doogie Howser’--that’s the one that killed me.”

Like all writers, they are concerned with viewer reaction, but Foster and Zwerling must face their peers in the medical world who will take a show to task if they find the medicine questionable. But envy, they say, trumps self-righteousness most of the time. “Most of them are jealous,” says Foster. “It’s such a great job.”

Sometimes, he says, friends will give him a hard time, but mostly “they find the show rejuvenating. Real doctors are pulled in so many directions--dealing with understaffing, insurance, malpractice, cost-cutting. The show is just about practicing medicine. And it’s good to remember why we all wanted to be doctors in the first place.”

Still, for all his love of medicine, Foster doesn’t want to go back even though he misses his patients and their stories. Although Zwerling could envision returning to medicine, she is very happy with the job she has now. “As a part-time doctor, I miss being an integral part of the clinic,” she says with a laugh, “but medicine is so high pressure. We have pressure too, but nothing like medicine.”