Anatomy

Ah, Dexter. Few shows juggle serial killing, dark humor, and wildly inaccurate hospital scenes quite like you. In Season 4, Episode 2, our favorite blood-spatter analyst wrecks his van—with a dead body conveniently riding shotgun in the back—and winds up in the ER. What follows is a crash course in how not to portray medicine on television.

Let’s dissect, shall we? (Pun very much intended.)

The ER doctor shines a light into Dexter’s eyes. Normal practice? Sure. But then we’re treated to the statement that his pupils dilate. Pupils constrict when you shine a light into them. They dilate in darkness. This is how the human body properly works.

Next, the doctor looks at Dexter’s CT scan and announces, “You’ve sustained a concussion.” implying that concussions are diagnosed this way. Concussions can be clinically diagnosed, based on symptoms like headache, confusion, dizziness, and loss of consciousness. You don’t need a CT scan to tell you that, and a CT isn’t going to show a concussion anyway. If it does, congratulations—you’re likely now dealing with a bleed, not a simple concussion.

But hey, why rely on pesky medical standards when you can dramatically gesture at a glowing scan instead?

Then comes one of my favorite relics of outdated medical lore: the “Don’t let him sleep” after head injury rule. Dexter is told not to sleep for twelve hours, as if a good nap might somehow erase him from existence.

In reality? We don’t keep people awake anymore after they’ve suffered a head injury if they feel like they need to sleep. That advice has gone the way of lobotomies. Any injured body part needs rest to heal. The brain rests by sleeping. Sleep is good and beneficial for the head injured patient. The guidance is: let the patient rest, check in periodically if symptoms worsen, and maybe—just maybe—don’t torture the poor guy who just got his bell rung trying to hide his crimes.

Ultimate lesson– don’t get into a car accident with a body in the back of your van that the police are going to tow.

Which show do you think butchers medical accuracy the most and which on gets it right?

Let’s answer the medical question posed in the last post. How do you keep an intubated patient from extubating themselves? There are a couple of options.

One is to sedate them. Sometimes sedation is necessary because the patient is so ill that we need to have total control over the patient’s breathing and we don’t want them “bucking” the ventilator. Bucking is medical lingo for the patient fighting what the ventilator is trying to do. It’s very hard to breathe on a ventilator because the machine is forcing air into the lungs. It’s unnatural in comparison to normal breathing.

skeleton-1243818_1280 Two is to restrain them. Typically a patient on a ventilator is restrained at the wrists and these are secured to the bed. Even a sedated patient can have these applied. This is for safety. Lastly, in a highly cooperative, ventilator dependent patient who has grown accustomed to living with the ventilator, they may neither be restrained or sedated. This tends to be more rare.

Let’s move on…

Note to authors everywhere: Know your anatomy. Gray’s Anatomy. The book . . . not the show.

Here’s a paraphrased example I read in a published novel. I’m not going to name the novel or author to protect the innocent. The purpose is to educate.

John Doe looked at the scar that ran along his right rib line, where a splenectomy incision might be.

Did you catch the problem? Your spleen is on your left side. Anatomy questions should be the easiest to research on Google University. Simply type in “what side is the spleen”. Go ahead . . . try it now. What I got was the “left” side in the first four of five options without even going to a web site.

Take the extra time to be sure the easy things are correct.

Medical question for you: What does it mean if you have dextrocardia?