Reality TV Bites

It was so early it was still dark out when Chad and Shani Walter woke up on the morning of November 27, 2001, in their three-bedroom home in Humble. They got in their car and drove down Highway 59 South to Houston. The plan was for Chad to drop Shani off at Memorial Hermann Hospital near downtown, and then Chad would continue on to class at the University of Houston's law school.

Just six days earlier -- the happiest day of their lives, they say -- Shani had given birth to premature twin boys. She and Chad named them Grant and Nathan.

The boys had arrived ten weeks early, but doctors told the parents, both 29, that the babies were strong and the prognosis was good. The twins would have to stay in the neonatal intensive care unit for a few weeks, but they would both go home eventually. Shani, a secretary, and Chad, a second-year law student, were concerned that the babies were small. They say all the tubes and NICU equipment frightened them. But they trusted the doctors and they were thrilled to have twins. Both of them wanted a big family -- maybe four or even five kids someday.

"I thought we were off to a really good start," says Shani, who spent each day in the NICU with her boys after they were born.

But soon after Shani got to the hospital that Tuesday morning, things began to fall apart. After Shani arrived she noticed that Nathan, the healthier of the two, had developed a rapid heartbeat. It was around 210 beats per minute. Feeling panicked, Shani asked the hospital staff several times what was wrong. By mid-morning doctors said they suspected some kind of infection and put Nathan on antibiotics. He eventually had to be intubated. Around 10:30 a.m., Shani left the NICU to pump some breast milk for her sons. When she returned, Nathan had been upgraded to Level 3, the area of the NICU reserved for the most critical babies.

"It was chaos; the whole day in my mind was chaotic," says Shani. "I was crying. I was worried all the time."

Still, the hospital staff didn't seem to think the situation was one of life or death. Nathan was passing urine and was responsive. He still looked like he was going to be okay.

After school, Chad joined Shani at the hospital. As required by hospital policy, the couple left the NICU during the shift change. When they walked back in a bit before 7 p.m., they discovered a film crew complete with a producer, two cameramen and a soundman walking around the NICU. Shani noticed that two of the crew members reeked of cigarette smoke.

Shani and Chad say they were approached by a woman holding a clipboard. It was a consent form, the woman explained. She told the young couple that the film crew was following around the physician on duty in the NICU, Terri Major-Kincade, for an ABC documentary about the doctor. Although the couple didn't know it at the time, the crew was collecting footage for what would become ABC's summer reality television show Houston Medical.

Shani and Chad say the woman spent no more than 30 seconds explaining the consent form. In fact, their names were already filled out on the piece of paper and all they had to do was sign it.

"We thought, 'We have to sign this consent because our kid might get in the film because they're filming [Major-Kincade] working on him,' " says Chad. "We thought, 'Maybe he'll be in one or two frames of this and then they'll move on.' We had no idea what it was going to turn into."

And besides, they say, they were exhausted and focused on their sons. They believed that a reputable hospital like Memorial Hermann wouldn't let in just anyone. And although Chad and Shani are quick to praise Major-Kincade's work, they say that at the time they worried that if they didn't consent, the doctor might not spend as much time with their babies as she would with infants whose parents allowed them to be taped.

"We were intimidated," says Shani.

The Walters signed the form. Major-Kincade checked on Nathan, but she still wasn't too concerned. The baby was apparently doing well enough for the doctor to suggest that Chad go home to feed the couple's two dogs and prepare for school the next day, and for Shani to get some much-needed rest. Around 10 p.m., Shani left the NICU to go lie down in a private room. The film crew stayed behind.

"I said, 'He's not going to die on my shift,' and I sent the dad home," remembers Major-Kincade.

But just a few seconds after Shani Walter lay down and closed her eyes, a nurse burst through the door.

Nathan had coded, the nurse said. He was in full arrest.

Shani leaped into the air and went running down the hallway to the NICU, screaming the whole way. At first, the hospital staff would not allow her in to see her son -- they wanted Major-Kincade to be able to focus on Nathan alone. The film crew, however, was permitted to stay inside the NICU and continue taping. Eventually, the nurse let Shani into the room.

Shani approached the isolette that held Nathan, who weighed just less than three pounds. Medical personnel and the film crew surrounded the baby. Major-Kincade told Shani that Nathan had suffered an "acute deterioration" and asked if she wanted to call Chad back to the hospital. Shani nodded yes, then asked the doctor what would happen next.

"If he survives, that means he's going to have some brain damage, but I don't know that he's going to be able to survive, because he's still very unstable," said Major-Kincade, her voice firm but gentle.

Shani stared at the doctor.

"He might not survive, you're saying?" asked Shani. When Major-Kincade nodded yes, Shani began to sink to the floor, only to be caught by two nurses.

"Oh, God, Jesus!" she screamed, holding her left hand to her face as she began to cry. "Why is this happening to me and my baby? It's something I did, I just…There's no reason for this to happen!"

As the hospital staff tried to reassure her, Shani's voice grew louder and her sobbing heavier.

"Don't take my baby, please, take me!" she shrieked, staring at Nathan in the isolette. "Take me! I don't care!"

Some of the nurses surrounding Shani started to cry along with her. Eventually, the doctor started crying, too. Chad returned to the hospital and raced to the NICU. The film crew was still there, hovering in the background with their equipment running, even after Chad asked them for some privacy. But the cameras, say Chad and Shani, were the last thing on their minds. In fact, Shani says she was so distraught that she can't even remember some of the conversations she had that night.

The evening progressed, Nathan's condition grew worse, and doctors finally told the couple that the best thing to do would be to take Nathan off life support and let him go peacefully. In the early hours of November 28, the tiny baby died.

It was the worst night of Chad and Shani Walter's lives, full of private, painful moments they say they never wanted to share with anyone else. But seven months after it happened, 6.2 million Americans sat down on their living room couches and watched the whole thing on TV.

The nursery in Chad and Shani's home still holds the promise of two babies. There are two cribs, both decorated with Noah's ark bedding that the thrifty Shani found on eBay, and there are enough toys and stuffed animals for two children, artfully arranged on shelves and dressers.

Grant, the surviving twin who came home in late January, is in good health. He likes to stick out his tongue and watch Baby Mozart videotapes -- kid-friendly images set to classical music. After their experiences in the NICU, Chad and Shani are very protective of him. When visitors come over, Shani politely asks them not to touch Grant, and they try to keep their two big dogs away from his play area. Since Nathan died, it's been a difficult nine months.

"There are three parts to the loss," says Shani, a Dallas native. "The loss we feel from losing Nathan, the loss we feel from losing twins, and we feel a loss for Grant. Some days, one loss is worse than the other."

But they say the losses were only intensified because of the treatment they received from both Memorial Hermann Hospital and New Screen Concepts, Inc., the Connecticut-based company that produced Houston Medical for ABC. The Walters say they were exploited and taken advantage of not only when New Screen Concepts obtained consent to film them during a time of emotional duress, but after filming as well. According to the Walters, New Screen promised the couple several times that the family would receive all the footage taken of Nathan and Grant before Houston Medical aired. The company never delivered.

"It has hurt us so much, what we went through," says Chad, who often has to stop speaking to fight off tears when he talks about what happened to his family.

Chad and Shani say that shortly after Nathan died they asked Mitchell Horn, a producer for New Screen Concepts, if they could have copies of the footage. They had little record of Nathan's short life, and the film crew had captured the baby's baptism. Plus, the footage just seemed like something very personal, and Chad and Shani thought they had a right to it. Both say that at this time they were still under the impression that the film crew had been focusing on Major-Kincade, and that their son would be shown only in the background.

"I said, 'Mitch, when this is all over can we get the footage?' and he said, 'Yeah, yeah,' " remembers Chad. "They were so nice."

But after Nathan's death, Chad and Shani say, strange things began happening in the NICU. The film crew began stopping by with cameras in tow to check in on Grant, sometimes when Chad and Shani weren't there. Shani says sometimes she would be sitting with Grant in the nursery and the phone would ring. A nurse would answer it, and the person on the other end of the line would ask about Grant Walter's condition.

"The nurse would walk over to me thinking it was Chad or someone who wanted to talk to me," says Shani. "And the person on the phone would start asking questions about Grant, and the nurse would be like, 'Who is this again?' And they didn't even want to talk to me."

Chad says he was once in the nursery when a woman he didn't know came in asking about Grant. The nurse told her the baby's father was right over there and pointed to Chad.

"The woman was like, 'Okay,' and you could tell she was not comfortable," says Chad. "She walked over and she said, 'I'm from New Screen Concepts. How's Grant doing?' And I said, 'Fine,' and she turned around and left."

Shani now wonders if New Screen Concepts secretly hoped something bad would happen to Grant that they would be able to capture on film, although she says that at the time she had no reason to believe that. The production company even brought the family peanut brittle for Christmas.

"I really felt obligated to let them film Grant; I was really intimidated," says Shani, who admits it's hard for her to confront people. "They were always really nice, but I was really kind of embarrassed. You could tell some of the nurses felt kind of taken aback by it."

Chad and Shani say they also felt like they should keep cooperating so they could get the promised footage that had been taken on the night of Nathan's death. The couple say they often asked producer Horn about the tapes, and that he told them they were in New York being copied and that the process was being slowed down because of the holidays.

But Chad and Shani say their suspicions grew shortly after Christmas when they discovered a flyer in Grant's chart. The flyer said that if there were any changes in Grant's condition, New Screen Concepts should be contacted. There was also a phone number where the film crew could be reached (Memorial Hermann provided New Screen Concepts with office space inside the hospital).

"We found the flyer; we ripped it out," says Shani. "Somewhere along the way New Screen Concepts found out the flyer was gone, and they came back and put another one in. They're slick."

Shani says she began to feel stupid about what was happening. She says she's the type to take responsibility for her actions, not cry exploitation. Her mother died of lung cancer from smoking, she adds, but she doesn't think her mother had the right to sue a tobacco company.

"I thought, 'I've gotten myself into this, I shouldn't have done it, so now I'm going to have to do what they want to get the tapes,' " she says. "I felt guilty. I thought, 'What have I gotten my little boy into?' "

Chad and Shani say they were so desperate for the tapes they even went so far as to agree to stage a fake going-home celebration for Grant two weeks before he was released from the hospital, because New Screen Concepts said they needed it for the show and were on deadline.

"It was then that they started talking about the decision that we made about turning off [Nathan's] ventilator," says Shani. "We were like, 'Why are you asking us about the decision? This show is about Dr. Kincade, this isn't about our decision to turn off a ventilator.' And we were like, 'What is this story really about?' "

Shani says that New Screen co-founder Chuck Bangert showed up at the staged event. He told Shani and Chad that he didn't think the couple should watch the footage of Nathan's death, then asked them if they knew they were crying in the film. When the couple insisted they wanted the tapes anyway, Bangert told them he wanted to arrange for the couple to watch the tapes at the hospital with a chaplain, a social worker and producers from New Screen.

"He said he'd watch it with us and cry with us," says Chad, his voice brimming with disgust.

Shani says there was no way she wanted to watch the tapes with other people looking at them. It would have been like being raped, she says. When they turned down the offer, Bangert told them he would try to get ABC to allow New Screen to give the Walters the tapes. Chad and Shani said they were under the assumption that New Screen had been trying to get the tapes all along.

Shortly before Grant's release on January 25, Chad and Shani say, Rosa Montes, a manager of patient relations at Memorial Hermann, came by to talk to them. When the Walters explained their situation, she expressed sympathy but didn't offer any help.

"She was like, 'Well, I'm really sad for you guys, but if they don't give it to you, you should at least tape it the night it airs so you have a copy,' " says Chad. "I was shocked."

Once at home, Chad and Shani realized they were never going to get the tapes. Chad contacted Stephen Sheppard, New Screen's attorney in New York City. Sheppard suggested nothing new, just reiterated New Screen's original offer to have the couple watch some of the footage at the hospital with a social worker and a chaplain. Not only did Shani and Chad not want to do that, they told Sheppard they were also unable to do it because they were feeding Grant through a tube every three hours, 24 hours a day.

Emotionally exhausted, Chad broke down in the office of one of his law professors and asked for help. The professor put Chad in touch with another law professor, Richard Alderman, who contacted New Screen on the Walters' behalf and arranged for the footage to be delivered to the Walter house by Alderman on February 10 at 9 a.m. The agreement called for Alderman to leave the couple alone with the tape, then return to pick it up and take it back to New Screen's producers.

Although they had been promised their own copy to keep, at this point Chad and Shani were willing to agree to anything because they realized they had no bargaining power. When they got the tape, they were shocked. It was only one hour long, and the footage of Nathan's baptism -- what they had wanted all along -- wasn't on it.

"After we saw the tape, I was floored," says Chad, near tears. "I thought, 'They have left out so much stuff.' "

The day before the couple saw the one-hour tape, Chad wrote a four-page letter to Rosa Montes at Memorial Hermann informing her of what had transpired between New Screen and the family so far and letting her know how upset they were. The next day, Montes responded with a brief three-line e-mail that thanked them for keeping her informed and let them know that her thoughts "are with you both."

After they saw the tape the couple called the hospital's ethicist, Ginny Gremillion, who contacted New Screen on the couple's behalf. She then informed Chad and Shani that the production company and ABC refused to let them watch all four hours of the Walter footage until after all six episodes of Houston Medical were aired. That meant the couple wouldn't see the footage or find out what exactly had been filmed until late July -- five months away. Gremillion told the couple there was nothing else she could do. (The couple finally received all the footage after the last episode aired.)

During the weeks preceding the premiere of the show, the couple saw several promos for it -- the one most frequently aired featured Shani becoming hysterical at Nathan's bedside. Entertainment Tonight even ran a clip of it on its Web site. On the day of the premiere, Good Morning America, which was filming in Houston, invited Major-Kincade to be on the show. While there, the doctor saw some of the footage of the premiere and called the Walters to warn them that the images they would be seeing that night would be especially intense. At this point, the couple was so mistrustful of the production company that they told the doctor they weren't surprised to hear that their dying baby would be one of the main focal points of the first episode.

On the night of June 17, after much hype from ABC's local affiliate (Channel 13) and the Houston Chronicle, the footage New Screen Concepts thought the Walters shouldn't watch alone was finally broadcast all over the United States. Chad and Shani couldn't be together the night it aired; he was on an internship in Dallas and she was in Houston with Grant.

"I cried through most of it," says Chad.

"It was weird, it was embarrassing," says Shani quietly. "It was like watching someone else, but still, it was embarrassing."

The next day, Chad went to a restaurant in Dallas and a few people stared at him. Shani and Chad discovered that the television critic for The Denver Post had called the Walters "oddly exhibitionistic." That afternoon, Shani was in her car when she turned on The Chris Baker Show on KPRC/950 AM. Baker was taking calls about Houston Medical, and Shani listened as people phoned in and said, "I can't believe that woman let them film her!"

The scorn of the critics and the self-righteousness of the viewers hurt. But what really bothered the Walter family was that on June 17 the death of their child became the third most popular television event in the country.

"It's disgusting that that would be entertaining to someone," says Shani. "It makes people feel good to sit around and cry and feel sorry for us. But I don't think it should feel good."

Most of the people the Walters are angry with don't want to talk. Jonathan Lowe of Memorial Hermann's public relations department would say only that Memorial Hermann was "confident that ABC and New Screen Concepts made every step available to work with the Walter family." Because the matter was between the family and the television people, Lowe says, Memorial Hermann is staying out of it. Rosa Montes would not comment, and calls to hospital ethicist Ginny Gremillion were not returned.

Janis Biewend, a producer for New Screen, said that out of respect for the Walters, the company had no comment. ABC echoed that statement.

The only representative of the hospital who would speak was Major-Kincade, a funny, fast-talking mother of two who has also been featured on Lifetime Television's Women Docs. As an African-American woman, Major-Kincade says she wanted to take part in the reality television shows to serve as a role model for other women and people of color who are considering a career in medicine. She stays in touch with the Walter family, and she has regrets about that night.

"I still can't believe I told this family he wasn't going to die," says the doctor, who adds that New Screen "dropped the ball" in their dealings with the family, and that if the couple were promised the footage, they should have gotten it. Major-Kincade does think that "everyone in the NICU knew [the footage taken] was going to be on ABC," but acknowledges that when the couple signed the consent, the doctor had told them the baby would be all right.

"If Nathan had not died, we would not be having this conversation," says Major-Kincade. At the same time, she admits, if Nathan had not died, then Major-Kincade and the Walter family probably wouldn't have been on the show's premiere at all.

According to Major-Kincade, Nathan died of an E. coli infection that is sometimes present in the blood and urine of new mothers and babies. The doctor says the E. coli that killed Nathan was not the same strain that most people think of when they hear E. coli -- it's different from bacteria found in undercooked meat. Major-Kincade says E. coli infections are one of the three most common infections in newborn babies, but Chad and Shani find it odd that even though reality shows like Houston Medical purport to be educational, the producers never mentioned the term E. coli on the episode featuring the Walters.

"We find it very suspicious," says Shani, who adds that it took five months for the couple to get the autopsy report and that they still have not received Nathan's death certificate.

Shani says the experience has left her nervous about germs, and that she was shocked that the hospital let New Screen producers into the NICU without cleaning up and after smoking cigarettes.

"Because Nathan died of an E. coli infection, and the things we witnessed in the hospital -- people not washing their hands, people coming in reeking of smoke -- I was so freaked out I would sit in the shower when I would come home," she says. The couple has not decided whether to take legal action.

While Major-Kincade doesn't think New Screen had anything to do with Nathan's infection, she understands why the Walters are so upset.

"I feel for anyone whose child died and it has to be repeatedly shown on national television," says the doctor.

Major-Kincade admits that even though she supports shows like Houston Medical, she was disappointed that New Screen chose to use the most intense footage of the Walter family for the show's premiere. And while Major-Kincade says tragic events like what happened to the Walters occur every day in the NICU, "I think the same could have been achieved without showing Mom screaming," she says. She also feels producers crossed the line in another episode where they showed a medical student hocking personal items at a pawnshop to pay an electric bill.

Someone who seems unconcerned with the production values of Houston Medical is City Councilmember Michael Berry, who has dubbed himself the chairman of the Save Houston Medical Task Force. When ABC announced in late July that it was not planning to renew the program, Berry created the task force and held a press conference August 8 to unveil the donated Web site savehoustonmedical.com, which Berry says has a market value of $25,000. The flashy site includes a photo of Berry and a letter from him urging Houstonians to sign up for the task force and receive regular e-mail updates (as of press time, ABC has told New Screen to continue shooting at Memorial Hermann, but it has not yet agreed to air more episodes).

"I love the show," says Berry. "For me I feel it's in the realm of things I'm supposed to do for the City Council, which is promote the city. Anytime you can see [trauma surgeon] Red Duke, who is as good as they get, as a Houstonian and get that message out to the world, that's a good thing."

The Walters say they tried numerous times to contact Berry, but he did not call them back. He finally agreed to meet with the couple early this month after Chad informed Berry the family was speaking to the Houston Press.

"I've been told by New Screen Concepts that in the years they've done this, this is the first time anything like this has happened," says Berry. "I feel it would be inappropriate for me to go to this family and say anything other than 'Gosh, I'm sorry.' "

Although New Screen would not speak with the Press, according to interviews given to the Houston Chronicle, the company began scouting locations for a reality television show in March 2001. Producers said they shot so much film at Memorial Hermann that for every minute shown on television, 200 minutes of unused footage remained. New Screen, which has produced shows such as What Every Baby Knows for Lifetime and The Senior Prom for ABC, was given unlimited and unsupervised access to the hospital, and spent about $700,000 on each of the six final episodes. Memorial Hermann was not paid for its participation, but senior vice president and CEO for Memorial Hermann James Eastham was quoted in the Chronicle as saying that "the intent is to showcase the high level of care and compassion that's evident here."

The hospital proudly hung banners all over the building announcing its prime-time debut and participated in countless fluff pieces with both Channel 13 and the Chronicle (although the Walter family tried numerous times to tell their story to Channel 13 and the Chronicle, e-mails and calls the couple made were not answered).

Mary Sharkey, who appeared with Berry at the unveiling of the Save Houston Medical Web site and who was profiled on the show fighting pancreatic cancer, says that while she feels for the Walter family, she had a completely different experience with New Screen. After being put in touch with the production company by her doctor at Memorial Hermann, the company came out to her house without cameras and spent time talking to her about taking part in the project. Sharkey says the company was clear that the show would focus on her personal life and her family. They gave her time to think over the project and get her family's input, and they told her that if she ever felt uncomfortable, she could stop taking part in the filming -- something the Walter family says they never heard.

"The producers became like family," says Sharkey, 50, whose cancer is now in remission. "They became my biggest cheerleaders." When the producers came to film a party at her house, Sharkey says, the producers even helped style her daughter's hair. She has been overwhelmed with the cards of support she has received from all over the country, and says she hopes to serve as a sign of hope for others battling cancer.

But while she has nothing but positive things to say about her experience, Sharkey admits she had much more time to mull over being part of a reality show than the Walters did.

"I don't know how I would have reacted in an emergency situation," she says. "My heart goes out to the Walter family."

While Michael Berry has drummed up support for Houston Medical in the Bayou City, reaction nationwide has been more lukewarm. In his review of the show's first episode, TV Guide critic Matt Roush wrote that he was "appalled at the shallow, tasteless exploitation of a mother who is shown weeping over the dying form of one of her prematurely born twins."

Roush says he had to watch only the first two episodes to decide he'd seen enough. The Walter family's story especially bothered him because there was no context applied to the high drama.

"You didn't get to know the family well enough," says Roush. "It looked like they were just using them for dramatic effect."

But Roush thinks that shows like Houston Medical are here to stay -- along with a host of other reality television shows shot in hospitals, including ICU: Arkansas Children's Hospital, also on ABC, and Maternity Ward and Trauma: Life in the ER on The Learning Channel. There's also been a tremendous surge of reality TV shows shot in the courtroom, including State v. and Crime & Punishment, which has been packaged to look exactly like the hit drama Law & Order -- complete with the familiar white lettering on a black background and booming sound effects that introduce each segment.

According to Roush, reality TV and popular programs like NBC's Dateline (which often focuses on actual crimes with a pulp-fiction approach) have taken over our airwaves because they're relatively cheap to make and appeal to the voyeur in all of us. Roush says the networks have been so successful with these shows that they don't worry about showing many movies anymore. In fact, NBC has done away with its Movie of the Week division because it can run a Dateline episode featuring a real event instead.

"Why pay Tori Spelling to play the part of someone when you've got the actual person to walk you through it?" says Roush.

And while Roush doesn't despise all reality TV (he admits MTV's The Osbournes has a certain kind of charm), he feels most of these programs offer a contrived, heightened sense of reality and do little of the educating they claim to do.

That's something that bothers Gregory Larkin, an emergency room physician at Parkland Hospital in Dallas. Larkin, who is so frustrated by much of what's on the air that he doesn't own a television, recently co-authored "Commercial Filming of Patient Care Activities in Hospitals" for the July 17 issue of the Journal of the American Medical Association.

"Just because we can do it doesn't mean we should show it," says Larkin, who adds that he is disgusted with shows like Houston Medical and says hospitals that participate in such programs are doing so for the immense free publicity.

"It's a great opportunity to put their best foot forward," says Larkin. "But it's a complete aberration of their responsibilities."

Joel M. Geiderman, a physician in emergency medicine at Cedars-Sinai in Los Angeles and Larkin's co-author, says Memorial Hermann's treatment of the Walter family is unconscionable.

"It's a ridiculous stance," says Geiderman of the hospital's claim that the troubles are between New Screen and the Walters alone. "The hospital has an obligation to protect the patient. The hospital is private property, and the company was only there because the hospital allowed it." Geiderman adds that patients who are asked to sign consent forms become part of a power play they could never win. Like the Walters, Geiderman says patients often feel compelled to participate in a production so they don't offend the doctor or hospital.

"It's not a level playing field," he says.

In their article for JAMA, Geiderman and Larkin examined the AMA's recommendations for filming in hospitals as well the guidelines set by the Joint Commission on Accreditation of Healthcare Organizations, a voluntary organization that is the country's predominant accrediting body for health-care facilities. Both sets of guidelines call for production companies to get informed consent from patients who are filmed, but neither addresses the fact that patients in hospitals are often emotional wrecks.

In the case where consent is not given until after the film is shot (a common occurrence in shows produced in emergency rooms), the commission insists that the hospital keep the tapes until the production company gets consent. If permission isn't given, the tape should be destroyed (the commission acknowledges that before it updated its guidelines it was common for a production company to leave the hospital with footage that had never been consented to). The commission can cite a hospital for breaking the rules and can even pull the facility's accreditation, but they can't undo what's been done.

The AMA's guidelines suggest that the consent form should be explained by a "disinterested third party" and that the consent procedure should clearly outline the patient's right to see and edit the footage -- something that didn't happen to the Walter family. But the AMA is not a regulatory agency, and it can only offer suggestions.

"There's still a lot of license" afforded the production companies, says Larkin. "The guidelines don't have that much teeth in them."

There is a place for filming in hospitals, say Geiderman and Larkin. Because textbooks are often outdated by the time they're published, it's certainly a good idea to allow medical staff to watch certain filmed surgical procedures to learn new techniques. And Larkin applauds the Nova programs on PBS that are often graphic and compelling but provide real education -- not just melodrama.

But he thinks the only thing that will throw cold water on shows like Houston Medical are disinterested viewers or lawsuits from upset subjects.

"There's a reason we don't make Pipers and Cessnas anymore, and it's because of lawsuits," says Larkin.

But longtime Houston media lawyer Bill Ogden says that unless consent was never obtained for footage that was broadcast anyway, production companies usually win when these cases go to court. While Ogden would not comment specifically on the Walter family's situation, he says if anyone approaches a patient in a hospital and asks to film them, the patient needs to take the time to read the entire consent form.

"The best advice I have is don't do anything in a hurry," says Ogden. "Take the time to ask questions and to understand why someone wants the release. If the circumstances are that you do not have time to give it your full focus, do not agree to it."

It's been more than two months since the first episode of Houston Medical aired. Chad is preparing to go back for his third year of law school. When he's finished, the couple hopes to move back to Dallas, where they first met, and have more children. For now they say they don't go out much -- they'd rather spend time at home with Grant. Shani admits that she's still terrified of germs, although she hopes she's getting better.

"I had a nurse tell me I had to stop," she says. "I was going crazy. It was really hard at first."

Grant is a good baby. He likes to stare at himself in the mirror and laugh. It's an especially poignant pastime for his parents, because Grant and Nathan were identical.

"Some days I cry because I don't have twins anymore," says Shani. "I picture them laying next to one another in their diapers. Or playing soccer or dating or playing tricks because they were identical."

Shani and Chad say they don't know how they will tell Grant about the Houston Medical footage. They do know that they won't give him the option of seeing his brother's final moments until he is at least 18. But Shani worries that the glut of reality shows on TV will desensitize their son to the tragic moments captured on the tapes.

"By the time he grows up, is he not going to care to see a baby die because it's shown so much on TV?" asks Shani.

As for Shani herself, she admits to still tuning in to some of the medical reality programs, although she says it's more like she's policing them.

"If I was a Nielsen family, I wouldn't watch, but I feel so sorry for these people and I wonder what they're telling them," says Shani. "I wonder how they approach these people, and I wonder what they say."

"We're not done with this," adds Chad. "If they renew Houston Medical, what do you think they'll show for old clips? They'll show Shani again."

Why did people watch Houston Medical? Chad and Shani aren't entirely sure. Maybe it was for a good cathartic cry. Maybe it was to have a "thank God that's not me" moment. Sure, a lot of them wiped tears from their eyes when they saw Nathan Walter die. But the Walters were strangers to them, and when the show was done they turned the TV off and the sad feelings passed.

That bothers Chad and Shani. But they don't think about that so much as they think about how people will react if the show airs a second time. Maybe then people will watch it and get upset, but they won't shed any tears. And if they air it a third time, Shani's screams might just become background noise as people do the dinner dishes.

"When people stop crying when they see something like that, whether it's their own child or us, that's bad," says Shani Walter. "I think you should cry every time a person dies. Every time you see it."

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