Medical Accuracy in Television

When Carpooling Goes Wrong: Analyzing Dexter S4E2

/ Jordyn Redwood / Leave a comment

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Then comes one of my favorite relics of outdated medical lore: the “Don’t let him sleep” after head injury rule.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?

Reverie: Not so Medically Dreamy

/ Jordyn Redwood / Leave a comment

NBC has launched a new summer show titled Reverie.  In it, Mara (ex traumatized cop, maybe psychologist) is recruited by a company specializing in making-your-dreams-come-true via a hyper advanced virtual reality program. The participants receive an implant that allows them to interact virtually with a program partly of their design.

Problem becomes, some of the clients don’t want to leave. Hence, our heroine, Mara, is recruited to go in after them and pull them back to reality.

In the first episode, it’s noted that the client has been in his dream world for two weeks and it’s commented by the staff that he’s essentially comatose. The man is lying on a bed connected to an ECG monitor and some oxygen via nasal cannula as pictured below. They give the man two days left to live providing a time pressure for the heroine.

However, medically, this man would have already been dead because they are not providing for either hydration or nutrition. This could be solved simply medically by inserting a feeding tube via his nose and providing free water interspersed with bolus liquid feeds. After all, thousands of people live in comatose states for years if their basic medical needs are met such as oxygen (if needed) and nutrition.

The heroine, Mara, is psychologically damaged. She’s had a significant personal trauma she hasn’t quite worked through. There is also a concern expressed by the designers of the program that something might not be quite right with it. When Mara enters the virtual reality program for the first time to retrieve a voluntarily trapped client they run an EEG on her which measures brain waves.

After she successfully retrieves the client, there is a conversation between the designer and lead dream architect that something is wrong with Mara’s EEG— something that indicates she could have a mental illness.

An EEG cannot diagnose a mental health disorder. Its use might be to determine if a patient has a medical cause that may be masked by some psychiatric like complaints such as a seizure disorder or sleep disturbance.

In episode 2, the producers must have gotten some feedback that they needed some actual medical equipment if they were concerned about these clients suffering medical complications. This time, a woman’s heart is going into erratic rhythms, specifically V-tach, because of the stress she’s under in her dream scape. But the medical equipment must make sense. What’s pictured in the photo to the right is what we call a rapid fluid infuser. It delivers IV fluids very quickly. Typically, it would be used in a trauma patient or one who is suffering from overwhelming sepsis where rapid delivery of IV fluids can be lifesaving. It is not appropriate for this patient who is suffering from a heart arrhythmia— much better to park a defibrillator at her bedside.

Have you watched Reverie? What do you think of the show’s premise?

Medical Review of the Movie Flatliners 2/2

/ Jordyn Redwood / 7 Comments

I’m continuing my review of the movie Flatliners that released last year which is a reimagined redux of the original 1990 movie.

In the movie, a group of medical students intentionally put one another into cardiac arrest so they can have a near death experience (NDE). Let’s examine medically whether or not their method would work.

The plan is to anesthetize the inductee with Propofol (which is a short term anesthetic), cool their core body temperature, and then defribillate them with electricity causing them to flatline. Keep in mind, asystole means there is no electrical activity happening in the heart. You can read a post I did here on how electricity or defibrillation really works.  Amazingly, in this medical center’s basement in another fully functional hospital with a very expensive MRI to be used during a disaster.

Issue #1: A medical center has a fully functional part of the hospital with an expensive MRI that is doesn’t use. Any empty, unused space in the hospital is a drain on the budget. Especially an expensive piece of radiology equipment. No sane hospital anywhere would be leaving that piece of equipment unused in a basement.

Issue #2: What they show is not an MRI. MRI scans take a long time and can never be done in 60 seconds.

Issue #3: Trusting a fellow medical student to resusciate you. Need I say more?

Issue #4: Knowing that they are going to put someone in cardiac arrest, no one really bothers to hook up a resuscitation bag.

Issue #5: During one code that begins to run several minutes, one of the students orders another to put the cooling blanket back on because “she’s too warm”. This flies in the face of every resusciation protocol there is. There is a somewhat well used phrase that you must be “warm and dead”. Suboptimal body temperature makes resuscitation more difficult. They are only making their job harder.

Issue #6: Endotracheal tubes have a balloon on the end that must be inflated to stay in place and deflated to take out. No one seems very concerned about this.

Issue #7: You cannot deliver electricity over clothing. Bare skin only. Also, paddles are really not used any more for a variety of reasons. Most hospitals have transitioned to patches. The paddles are used as a back-up.

Issue #8: Propofol is a distinctive milky white substance. Seems easy enough to draw up some milk in your syringe for the movie to simulate this.

Issue #9: You cannot shock a heart that is in asystole into a normal rhythm. You can see my post above for that. Can you shock someone into asystole? There is a rare possibility that you can shock someone and stop their heart. However, the common rhythms a person would go into because of this is V-tach and V-fib and not asystole. The movie depending on this rare event for every flatline is unrealistic.

Issue #10: You can tell when a shock is delivered to a patient because generally they have quite a few muscles contract. Patients never come up off the bed as dramatically as on film or television. In fact, I’ve never seen a patient come up off the bed at all.

Have you seen Flatliners? What did you think of the medical aspects?

 

Medical Review of the Movie Flatliners 1/2

/ Jordyn Redwood / 4 Comments

Flatliners 2.0 released in October, 2017. If you haven’t seen the movie (or the original from 1990) then you may not want to read this post as there will be spoilers involved.

Flatliners centers around a group of medical students who become curious with the phenomenon of near death experiences (NDEs) to the point that they “flatline” one another so that they can purposefully have one.

This first post will deal with a medical scenario that happens in the first ten minutes of the film. We’ll look at two screenshots from the movie.

Here is the conversation among the medical students when their new patient arrives.

Paramedic: “Transfer from Holy Cross. Thirty-eight year old construction worker fell off a beam. Persistent coma. GCS 6.”

Marlo: “Standard procedure for a GCS 6 admit calls for 2 large bore IVs and diazepam on standby.”

Ray: “Seizure meds won’t do any good. Whatever is wrong is in his spinal column and not in his brain.”

Marlo: “And what medical protocol are you citing?”

Ray: “The protocol of actually living in the real world. Where guys with crappy HMO’s go undiagnosed with spinal injuries.”

Marlo: “Actually he’s on seizure meds which is a medical protocol of reading his chart.”

 

At this point an alarm sounds and the students begin to panic. This is the screen shot at the moment of panic. It shows the monitor. The patient’s heart rate is a nice steady 73. His oxygen level is 100%– can’t get any better than that. His respiratory rate is 19– the patient is on a ventilator. I don’t know– things looks pretty good to me for this patient.

An attending doctor arrives.

Attending: “What is it?”

Student: “Respiratory failure.” (Based on the screen shot, there is no basis for this. Also, nothing is quite hooked up correctly at the head of the bed for an ER.)

Attending: “He might be hemorrhaging. Page neurosurgery, call a code, and get CT on standby. Students, clear the room!”

They then show another monitor in the room which appears to show ventricular fibrillation (V-fib) which is a lethal, but shockable rhythm. Yet, no one starts CPR.

End Scene.

Issue #1: I’m not sure how a medical student within the first ten seconds of getting this patient can know if the problem is in the brain or the spinal cord. For me, the problem seems likely to BE in the brain considering his persistent vegetative state.

Issue #2: Because of the patient’s insurance, he didn’t receive an accurate diagnosis. Mmmm . . . I know this myth get’s perpetuated. You don’t necessarily need expensive tests ALL the time to get an accurate diagnosis. CT scans and MRI scans aren’t really seen as extreme measures anymore. Though they are expensive the cost has come down.

Issue #3: Nothing these medical people say makes any sense medically. What evidence is there that the patient is in respiratory failure? The photo of the first monitor doesn’t suggest that. What evidence is there that the patient is hemorrhaging into his brain? Fixed and dilated pupils? Unequal pupils? A worsening coma score? None of that is presented in the scene.

Issue #4: The one medical problem they seemingly show is the V-fib in the second screen shot. Good to call a code, but research has shown that early and effective CPR is the one thing that is best at bringing people back. The next is early defibrillation which no one seems to anxious to accomplish.

Is it that hard to find good medical consultants for movies?

A Real Doctor’s Thoughts on The Resident

/ Jordyn Redwood / 5 Comments

As you know, last week I did a couple of posts on Fox’s new television show The Resident. You can find Part I and Part II by clicking the links. Shortly after this post, I came across a You Tube video by Dr. Zubin Damania who runs a series of entertaining and informative videos on healthcare under the name ZDoggMD.

I’ve found Zubin’s videos fun. Some are satirical in nature, but others tackle very serious healthcare issues. Zubin does for the general public what I try to do for writers. As a note, some of his videos do have some salty language.

So, it was with interest that I viewed his thoughts (serious ones) on The Resident to see if we agreed on the same things. I was somewhat shocked in some of the things he thought were spot on as far as medicine goes and I must say I’m relieved we’ve worked at different hospitals. To be fair, I’ve never worked on a surgical floor or in the OR so my expertise is not in that area. You can view his thoughts in the posted video.

One thing he found more truthful than I did was the cover-up of the doctor who shouldn’t be performing surgery anymore. That something like that wasn’t as blatant as it appeared on television, but was much more subtle— but does happen.

It was interesting to see the differing opinions between a physician and a nurse. The lead female character— I think is a resident because she wears a long, white lab coat. Nurses typically don’t wear this unless they are nurse practitioners. He thinks this same character is a nurse who seemingly works in every unit of the hospital. What’s clear is it’s not clear what her job is. This is also one of my major complaints about medical shows in general— they don’t realistically show the true nature of the job.

I appreciate ZDoggMD— particularly his support of nursing. It has not gone unnoticed by me. Keep up the good fight, my friend!