How does the lawyer get paid, from the total check or after all the bills are paid the balance will be divided ,minus his 33% ...

Most contingency fee contracts allow for the attorney's fees and his costs to be paid out of the total settlement.  If there are liens or other unpaid medical bills then those are negotiated to try to maximize the amount of the settlement that can be paid to the client.  Your attorney should provide you with a breakdown of all fees and bills that are paid out of the settlement, so that you know where every dollar of the settlement was paid.