MediVision: March 2007 Archives

I say this in complete seriousness. For some reason, this spectacle of medical fraudery and debauchitude seems to have gained some amount of crazed popularity among the television-watching public. I don't know who this "public" thinks it is, but I have no doubt that it is completely devoid of self-respect.

My friend Tracy and I found ourselves accidentally watching an episode last weekend. In our defense, we had been studying for our upcoming boards exam, and had rewarded ourselves for our hard work by watching a little of the so-called "boob tube." As it turned out, "boob" was right (in the old-timey sense of the word, whereby the term now liberally applied to female mammary anatomy was used to imply "a foolish person." And how.)

Now, Tracy and I are relatively smart gals. Between us we are near to completion of eight years of medical school and have an additional 2 years of a pathology student fellowship under our collective belts. But at one point we turned to eachother while watching House M.D., and exclaimed, "What the hell is going on?" All our years of medical training had left us unprepared to follow the plot line of House, a show based around a jerk-hole "genius" and his rag-tag team of young sexy internal medicine "experts" who together solve really challenging medical cases in a matter of hours, all the while learning valuable lessons about the meaning of friendship. Or something.

The episode Tracy and I watched was the one where Dave Matthews is an idiot savant who has something wrong with his brain. What is it? How can we possibly figure it out? It must be some logic-defying puzzle that can only be unlocked by the brilliant mind of one Doctor House, Medical Doctor.

All I know is that at one point the sexy young medical team was performing a carotid angiogram (something they would not know how to do), and then the next moment they were doing an upper endoscopy on a completely awake Dave Matthews (which is something that only gastroenterologists do - on sedated patients). Ooh! Now they are in the lab diagnosing neurosyphillis. Now they are snooping around somebody's house. And oh, what are they up to now? They are drilling through Dave Matthew's skull to get multiple brain biopsies!! I did not realize that in addition to being board-certified in Internal Medicine, the rag-tag team had also apparently completed a 7-year Neurosurgery residency!

Diagnosis after diagnosis is being spouted, one inappropriate diagnostic test after another is being performed by people who are wholly unqualified to perform them, all seemingly in a matter of hours. Is this entertaining to people who don't understand medicine? Does the fact that things are happening at lightening speed make them interesting, even if they are completely incomprehensible? I have yet to understand the psychologic complexities involved in the popularity of this show.

All I know is that in the end, Dave Matthews ends up with half of his brain removed, and Dr. House is a heartless lecherous jerk who is STILL addicted to pain killers and everyone else is, once again, surprised by it all. Case closed.

I am very aware that this entry reads like a very nerdy joke, in which I rant about televised medical inaccuracies that no-one else can understand, making my ranting more incomprehensible than the show that I am criticizing. But, ladies and gentleman, my life has turned out to be a series of one very nerdy joke after another. And with this I am entirely comfortbale.

(spoiler alert)

It has happened. After years of resistance, of living in the dark, of isolating myself socially and culturally, of misunderstanding my peers, I am finally allowing myself to embark on the spiritual journey that so many before me have undertaken.

I am finally watching Lost.

Right now I am still living in the innocent world of the first season, where polar bears and crazy french ladies and mysterious numbers and terrifyingly creepy people named Ethan live somewhere out in the jungle. The world where the ladies still wears clean clothes. And as much as I am enthralled by the mysteries of the island, I find myself annoyed by the actions of the main characters, who are apparently the only people who know how to do anything, and yet seem to feel the need to do everything in secret. With all of the perpetual character development that is going on, you'd think some of the characters would actually explain some of their actions to other people before they go storming off into the jungle.

But, non-suspension of disbelief aside, what I find most interesting is the medicine of Lost. The good Dr. Jack Shepard, spinal surgeon, has my undivided attention. I just watched the episode where he gives a blood transfusion to a crushed comrade using a sea urchin spine after performing a decompressive needle thoracostomy with a metal spike and instructing the heroin addict on how to instruct someone else on how to deliver a baby and, of course, after curing his arch enemy's headaches. I won't dwell on the fact that he jammed the spike through the chestwall too low (ok, maybe I will... its supposed to go up at the second intercostal space along the midclavicular line so as not to risk puncturing the heart), because what I find more interesting is the role of The Doctor in this little marooned microcosm of society.

The second the plane crash-landed, Dr. Jack emerged as the natural leader of the group. People looked to him for guidance, for answers, for decisions. He seemed, at least for a while, to be the only one who had any rational ideas or actions. Why is that? Is it because doctors traditionally hold a place of power and esteem in our society? Because there is an assumption of trustworthiness based on his profession? Or the idea that doctors are inherently good? [i can tell you right now that this is not true] Or maybe it is because there seems to be a bit of magic involved in knowing how to save a life, and knowing how to heal, and more importantly, knowing how to predict what will happen (prognosis: pro- gnosis, to fore-know or foresee: this was one of Hippocrates' major contributions to medicine). Personally, I think it was because Jack was attractive and manly with well-defined musculature.

I wonder sometimes, whether if I survived a plane crash on a mysterious tropical island, I would be able help people. Sometimes i think that I might have the capacity for leadership, but then I remember how long it took me to decide on what to eat at Typhoon the other night and I am not so sure. I suppose that is why I should probably finish medical school and then go to an emergency medicine residency. To be more like Jack Shepard on Lost. Ha! If only I could have brought this up in my interviews - that really would have wowed 'em.

Over the episodes, there have been many little medical events that have piqued my interest. Like the Post-crash Peritonitis, the Asthma Exacerbation, the Stab Wound, the Poisoning, and the combination of heatstroke, delirium, fatigue, and post-traumatic stress that causes everyone to either charge blindly into the jungle or pull a gun on someone else. But the Delivery of the Baby... this was the impetus for me writing this entry. Not to mention the fact that no-one had once discussed a birth plan with the cute little 9 month pregnant australian girl, or that perhaps she should avoid wandering off alone in the jungle (remember what happened last time?), or the fact that it is apparently possible to deliver a baby without getting a single drop of blood on your clothes... I want to know why television births always ignore the thing that happens right after the baby comes out.

Because there's something else in there that has to come out. What does everyone think the cord is attached to? The placenta! The placenta has to be delivered as well, and this is also accompanied by contractions and sometimes the need to push. It is the 3rd stage of labor, the stage where most complications occur, and the stage that all tv births fail to progress to. Probably because it is very anticlimactic, pretty gross, and raises all sorts of questions like how do you clamp and cut the cord in the middle of the jungle? Dr. Jack neglected to instruct the heroin addict to instruct the murderous bankrobber to clamp the cord after delivery, an action that is important in preventing the flow of deoxygenated blood to the baby from the detaching placenta and in aiding the newborn's circulation to reset itself to get its oxygen from the lungs. Since I'm pretty certain that most people get all of their medical knowledge from television and movies, I'm beginning to wonder if anyone in our society remembers that the placenta even exists.

This is perhaps a minor point in the setting of the beautiful symbolism of new life on the island, and my new life as a member of the Lost-obsessed. But what would be the fun of watching the show that everyone else has already watched without dissecting it a bit? Just don't get me started on House MD.