This Is US: Jack’s Needless Death

This television episode caused more people to reach out to me over any other. This Is Us has been building up to Jack’s death for eighteen months. It needed to be big. It needed to be dramatic. Can you tell I’ve been watching the show? It was really none of those and medically— well, just weird to be honest.

If you haven’t watched the episode then don’t read this post because it will reveal his cause of death . . . like right now.

Jack’s ultimate demise? A heart attack called the widow maker caused by the stress of the fire.

Jack is in intense smoke and heat for several minutes. He emerges and is first checked by EMS. He is being given oxygen and a dressing to his arm for “2nd degree burns”. The EMS person says she can’t treat the burn and he is seemingly refusing transport, but she does encourage him to be seen. Also, giving oxygen is correct, but it is not the right type of mask. A note on burns. Burns will evolve over the next several days so you don’t really know how severe a burn will be for a while.

Jack does eventually go to the hospital to get his burns checked. The doctor is initially giving him instructions on burn care.  The doctor says, “I’d like your heart rate to come down.” and glances at the monitor— which doesn’t have any readings on it. No waveforms. No numbers. He then says, “There’s soot in your airway so we’ll have to run some tests. The swelling is minor.”

That’s about it. The doctor tells Jack he basically dodged a bullet and seems none too concerned about his potential airway damage.

Just as I mentioned above, airway burns from smoke inhalation are similar to skin burns in that they evolve over time. Smoke inhalation and the potential for upper airway swelling is taken very seriously. There is a nice overview here. At the very least, there should be discussion of admitting Jack to the hospital. As quoted from the article, “Studies have shown that initial evaluation is not a good predictor of the airway obstruction that may ensue later secondary to rapidly progressing edema.” If there is concern about significant injury to the airway then the patient is electively intubated until the airway injury heals. It’s VERY difficult to intubate someone with a lot of airway swelling.

Shortly after this consultation, Rebecca decides to make a phone call and get a candy bar from the vending machine. In that, perhaps under two-three minutes passage of time, Jack codes and dies. Even though she is just outside the ER nurses station, she never hears a code being called. Doesn’t see the commotion.

The doctor approaches her and says, “One of complications of smoke inhalation is that it puts a terrible stress on the lungs and therefore the heart. Your husband went into cardiac arrest. It was catastrophic and I’m afraid we lost him . . . Mrs. Pearson, your husband has died.”

After a few exchanges she goes to Jack’s room where there is a spotlight shining on his chest with a cursory ambu bag at the head of his bead . . . but no other equipment. I’m telling you in two minutes, a code has barely just begun and is never called so hastily . . . like ever. Later, explaining the event to Miguel, Rebecca says he had a widow maker’s heart attack.

The widow maker is a real term for a heart attack. It generally refers to occlusion of the left main coronary artery that feeds the left side of the heart. It is the same heart attack celebrity trainer Bob Harper had and survived. The reason the widow maker can be so devastating is that the left ventricle is the largest, strongest pumping chamber. If it dies . . . well, you’re hosed.

There would be no realistic way the doctors would know it was specifically this kind of heart attack as shown in the episode without an autopsy. Presumably, Jack went into one of the lethal heart rhythms, v-tach or v-fib, at the time of his code. In the time frame given on the show, the medical team would have barely started CPR and given the first line treatment which is electricity. A 12-lead ECG can be a strong diagnostic tool for this type of heart attack, but they never did one. Had they done that early on, they probably would have seen the changes.

Also, he would likely have some signs and symptoms. Chest pain. Nausea. Left arm pain. Sweating. Demonstrating these might make the scenario seem more believable. Having Rebecca witness the code would have been more dramatic.

Also, it would make more sense that he would suffer this cardiac event while he is actually under duress— such as during the rescue of the children and the dog.

The only way to truly know that this is the type of heart attack Jack suffered as presented in the show would be to conduct an autopsy.

This Is Us— thanks for killing off a beloved character in a totally lame way— at least from a medical standpoint.

Author Beware: This Is Us

Dear This Is Us— please portray nursing accurately. 

Few can argue with the success of the new NBC drama This Is Us. I’m an avid watcher of the show myself. If you like your heartstrings being tugged at every conceivable corner and you’re not watching then you’re missing out on a great opportunity for a good cry. Well, really, several good cries per episode.

nbc-this-is-us-midseason-aboutimage-1920x1080-koThat being said, I was mildly disappointed in a medical scene portrayed in Season 1, Episode 11. If you haven’t seen it, I don’t think I’ll be spoiling much unless you don’t the the fate of Toby post his Christmas collapse. If that statement is true then you should stop reading here.

In episode 11, Toby is getting prepped for heart surgery. He is anxious, but not overly so. It’s a cute and funny scene. There is a flurry of activity as the nursing staff gets ready to take him to pre-op. The conversation goes something like this:

“Name.”

“Toby Damon.”

“Place of birth.”

“Hope Springs.”

At this point, a nurse comes in with a very large needle and makes it noticeable to the patient.

“What is that?” Toby asks. “Holy Cow. Look at the size of that thing! I’m a big guy but geez.”

The nurse then inserts the needle into the IV port and delivers the medication. Another staff member says, “Look this way, we’re getting ready to take you to prep.”

Toby— after the medication takes effect. “What’s in that?”

Nurse replies, “You’re fine. Don’t worry about it.”

Toby asks again. “What was in that needle?”

Nurse responds. “Just medicine.”

Ugh. I mean, really? Let’s take a look at the medical problems with this scene from mild to annoying.

Problem #1: Place of birth is never asked. Although, I do like that they use what is called two patient identifiers— it’s never place of birth. Usually, it’s your birthday. Also, if he’s going to surgery, there should be some communication with the patient about his understanding of the procedure he’s going to have. “Sir, my name’s Jordyn. I’m one of the OR nurses here to take you to the pre-op area. What procedure are you going to have done today?”

Problem #2: It’s called Pre-op. Not prep.

Problem #3: This is getting more egregious. We don’t insert needles into IVs anymore. They are all needleless system. I get that it looks more dramatic to come in wielding a big needle, but it isn’t medically accurate. I haven’t seen an IV system you had to access with a needle in over fifteen years. In fact, in most tubing systems you can’t even insert a needle anymore.

Problem #4: If you are using a needle and the patient is anxious— don’t show them the needle. Obviously, this is one way to increase the patient’s anxiety which is not the direction we want them to go.

Problem #5: The patient asks the nurse twice what he’s being injected with and she doesn’t disclose it. Honestly, this goes against the very fiber of the nursing code. Nursing is about telling your patient the truth and educating them about what’s happening to them medically. Now, in an anxious patient, the explanation doesn’t need to be long. She could have simply stated, “Sir, it’s very common to be anxious before surgery. This medication is called Versed and will help you relax a little bit.”

Just so the staff writers of This Is Us are aware, I am available for medical consultation. Don’t make me hate a show I love by portraying medical people like they don’t care about a patient’s very direct questions. Little is seen in this scene of the medical staff using other methods to calm and relax this patient other than shoving a medicine in his IV and not even educating him about what it is.

That’s not how we take care of patients.