Five Things This Is Us Got Right About Medical Care

Usually, when I write these blog post, it’s a scathing review of something a television show or movie got wrong. However, in a recent episode of This Is Us entitled The Waiting Room, there were several things that the show got startlingly right for a change. Chrissy Metz’s character, Kate, was in preterm labor leaving the family to dwell in the waiting room. Here’s what the episode got right.

1.  People use Google all the time to question medical professionals. In the episode, one of the family members pulls up the drug Kate is on to quell her contractions and begins to question its side effects. Listen, I’m all for informed family members, but as many medical professionals know, the information on Google can be less than accurate.

It does become frustrating as a medical person to take Google’s word for a medical treatment over a trained medical professional. I’m also all for questioning a provider in a respectful way. A better way to approach this question with your provider is to ask, “What side effects are common with this medication?” and “Do you feel like those side effects are worth the benefits of the treatment?” Any provider worth their salt should easily be able to answer these questions. If not, then you may have a problem on your hands. This will tell you more than Google will be able to tell you.

2. Often times, people think that waiting equates to poor medical care. In one part of the episode, Kevin begins to question the delay in hearing any news, and openly questions if his sister should be moved to another facility, insinuating that she’s not getting proper care. The truth is, few things are fast in medicine. I think the culture and patient expectations haven’t benefited from these one hour television shows.

Nowadays, everyone wants to be seen within an hour and discharged home shortly after. In reality, especially in units where you don’t have an appointment, triage happens all the time based on how life threatening a patient’s condition is. Also, sometimes patients need to be watched for lengthy periods to see if their condition will resolve to a point where they could go home, or see if they’re appropriate for admission. If needing to be admitted, where to? Does that unit have capacity and staff to take care of the patient? Just because you’re waiting doesn’t mean anything necessarily bad is going on or that your loved one is getting bad medical care. A lot is probably happening behind the scenes that you’re not aware of.

3. Threats to staff happen a lot more than you might think. Maybe a better term for this would be microaggressions. Threatening to leave. Threatening to transfer. Threatening to call the patient care representative to file a complaint. Threatening to sue.  Using profanity directed at the medical staff and not just expressing frustration at the situation. Unfortunately, medical professionals hear variations of these every day and often without merit. They are designed, generally, to force medical care to happen more quickly. Using threats or aggression to speed up medical care is not necessarily wise for a variety of reasons. The largest reason is that stressed out healthcare workers tend to make more mistakes— the one thing you don’t want to have happen.

4. Waiting rooms are pressure cookers. It’s not unusual for arguments and fights to happen in waiting rooms. The waiting room becomes a voluntary prison and all people can do is watch the clock ticking. The more time that goes by— the more frustration builds. We are all more likely to take out frustration on our loved ones most— probably after the staff. That frustration will bleed over into other people and families.

5. Healthcare workers respond to kind and courteous over anger a lot better. In the episode, Kevin and Randall both approach the nurses’ station asking for information. Randall does it with more kindness and respect and gets more of what he’s asking. We are normal humans and it’s true what they say about honey.

This Is Us used truth and reality to make a very effective episode. Well done.

Author Question: Gunshot Wounds and Rib Fractures

Shanda Asks:

I have a scene where (in my mind at least) someone very physically fit is shot in the torso as they dive to save another from being shot. They then land excruciatingly hard on the edge of raised concrete (think like the front of an outside step) and break three ribs but that injury goes unnoticed as a result of the gunshot wound.

human-skeleton-163715_1280So my questions are as follows:

1. Would it be possible for someone to pick up the injured and run say a mile or two to get them to where help is waiting?

2. Could it be possible to have surgery for the gunshot would and the rib injuries be missed and hours later cause internal bleeding?

3. What would be the typical recovery time for the first and the latter?

4. Would it be realistic that after the second surgery (for the internal bleeding) the patient could not wake up for days having had two trauma surgeries so close together?

Jordyn Says:

Thanks so much for sending me your questions.

1.  Can someone carry an injured person one to two miles for treatment? It would depend on the physical characteristics of the character who is lifting the other person. Carrying someone one to two miles is a long way. I could possibly imagine a man doing this for an injured female and possibly a very fit male for another male, but a female doing this for a male might be stretching it. It would have to be a very fit female character.

On the other hand, could a character with these injuries get themselves to the hospital? The three cracked ribs are definitely going to slow them down and it also depends on what the gunshot wound has injured which you’re not clear on here. If the gunshot wound deflated a lung then they are going to have a lot of trouble breathing.

2. Could the broken ribs be missed on the first medical exam? Probably no. Any patient with a gunshot wound to the torso is going to get plain x-rays of the chest and probably a CT scan of the chest as well— both of which would show the rib fractures. So in the setting of modern medical care it would almost rise to the level of negligence to miss the rib fractures with a gunshot wound to the torso. I don’t see that happening.

3. To determine your typical recovery time I really need more information on this gunshot wound. Where was the character shot and what was injured specifically? The rib fractures themselves will take 4-6 weeks to heal. Rib fractures are very painful and could inhibit breathing based on their location. Also, successive ribs that are broken in more than one place can create a free floating segment that can be very detrimental to breathing as well.

4. A patient could still develop internal bleeding and need to go back to surgery even if the rib fractures are found right away. This would not be a rare event. It is reasonable for a patient to not wake up for a couple of days if they suffered a code during the second surgery due to extreme blood loss and had flat lined for a period of time.

Even the stress/shock of the surgeries close together might be enough for the brain to check out for a time. The problem with a comatose patient is they have to be in the ICU, on a vent, with a tube in every orifice as they say. For instance, a patient can’t be out cold and have no way to pee— so a catheter has to be placed so the urine can come out.

Going down that road can get very complicated for a novel depending on whose POV you’re telling it from.

Best of luck with your novel!