Friday, July 31, 2015

What Writers Can Learn from Bad Medical TV Dramas

Earlier this summer, TV viewers were introduced to two new medical dramas, Complications and Proof. I was eager to watch both shows, but especially Complications because it was set in an ER -- my old stomping grounds before I retired from nursing -- and featured not only a doctor but also a nurse as the lead characters. One seldom seems a realistic representation of nursing on TV, so I settled down to watch the first episode hoping it would meet my high expectations.

It didn't. That first episode was so full of medical errors and impossibilities, that I found myself either laughing at the mistakes or groaning in complete disbelief that the writers could have gotten it so wrong. Obviously, they weren't aiming at reality.

In one scene, ER doc John Ellison finds a man in cardiac arrest after apparently ingesting a large quantity of drugs. Doc Ellison yells "Code Blue!", then reaches for an ambubag to begin administering oxygen to his dead patient. That was mistake #1. CPR protocol used to call for giving two breaths to a pulseless victim before beginning chest compressions. That changed five years ago when the protocol was updated for sound medical reasons from ABC -- airway, breathing, compressions -- to CAB, or compressions, airway, breathing. Cardio-pulmonary resuscitation, or CPR for short, now begins with chest compressions at a rate of 100/minute. 

So the writers were five years behind in the knowledge of CPR. But writers do love to have their TV doctors yelling out orders during a cardiac arrest, so the Complications writers had Dr. Ellison repeatedly calling for atropine, a drug once given during cardiac arrest situations, but also removed from the protocol back in 2010 since it proved useless in reviving a heart rhythm. "Atropine! Give me atropine!" yelled our supposed ER doc while I simply sat and shook my head. If he'd known what he was doing, he would have asked for epinephrine, the first drug of choice for cardiac arrest.

But it got worse. Before you knew it, Doc Ellison had the paddles out and was shocking his vic...I mean, patient...when the cardiac monitor showed asystole, or what writers call a "flat line". 

A defibrillator is used only for shockable rhythms like pulseless V-tac (at right) or V-fib (below) where you're essentially shocking the heart into full stop mode in hopes that the heart's own pacemaker will then restart the heart in a normal sinus rhythm. Asystole means there is no rhythm at all, so there's no reason to shock the heart. It's a dumb mistake that you see committed over and over on TV and in books.

The next impossible feat accomplished by Dr. Ellison involved surreptitiously transferring a child from the pediatric ICU to another hospital. Now this is a young boy who was shot in the chest several hours earlier, saved at the scene by Ellison, and then taken to Ellison's hospital where he underwent cardio-thoracic surgery to save his life. The bad guys are in the ER lobby waiting for their chance to finish off the kid. Instead of calling in the police to arrest the bad guys and guard the child, Ellison sends his sidekick, ER nurse Gretchen, up to what we can only assume is the pediatric surgical ICU (where else would you put a child after such complicated surgery??) where she calmly walks into the sleeping child's room, wheels his bed out into the corridor, and takes him down an elevator to a loading zone where he's put in an ambulance with false paperwork (the paramedics don't check the name on the paperwork against the kid's hospital bracelet) and is whisked off to another hospital. Ellison later goes to that hospital and changes all the paperwork in the kid's chart to reflect his true case and surgical history.

This scene had me screaming at the TV. First of all, the kid nearly bled out at the scene of the shooting, but outside of one clear bag of IV solution, he's getting no IV blood products, no IV antibiotics, he's not hooked up to oxygen or a cardiac monitor, and there are no side rails up on his bed to protect him if he wakes up and moves in the bed. Then there are no staff members to be seen on the pediatric ICU ward, no one to notice that the main nursing station monitor no longer records a heartbeat for the kid or to hear the monitor alarm go off if, as in real life, the child had been connected to a cardiac monitor and Gretchen removed it. 

And let's look at Gretchen. She has patients in the ER, but she can slip away from that unit for a considerable amount of time without anyone missing her. She breaks every rule in the book -- and several laws -- and risks her nursing license to help a doctor who believes he must protect this child without the help of the police. And she does all of this completely unnoticed by anyone.

Oh, please! Give me a break; it ain't gonna happen in real life.

Needless to say, I didn't watch any other episodes of Complications. There were other aspects of this show that bothered me, but the ones I mentioned above were bad enough to make me cancel recording the series.

I'll give you my take on Proof in my next blog post; this one is long enough as it is. The point I want to make, though, is that these same kinds of mistakes are often made in mystery and crime novels. Smart writers would want their work to be as believable as possible. For that reason alone, smart writers would do better research of medical practices before including them in their novels.

WRITING TIP: According to the Chicago Manual of Style and the AP Stylebook, toward, forward, backward, amid, among, and while are the preferred ways to spell these words for American or Canadian readers. In Great Britain, you may see them spelled like this: towards, forwards, backwards, amidst, amongst, and infrequently, whilst