Thursday, October 1, 2015

“Code Black” should be pronounced dead

A new television series called “Code Black” debuted last night on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a "Code Black."

There is the usual array of standard medical characters—the inexperienced new residents on their first day at work, the savvy nurses, and the cocky, overconfident attendings. This one has a few twists. The world-weary head nurse is a Hispanic man, and the headstrong know-it-all attending is a woman, Dr. Leanne Rorish. She has early conflict with the handsome, more cautious Dr. Neal Hudson, but I see romance in the future should this show manage to stay on the air.

It takes 5 people to push an empty gurney at Angels Memorial
The show started off with a gunshot wound to the neck that the docs had to retrieve from a car which had been abandoned in the hospital parking lot. Although no one had been putting pressure on the damaged carotid artery for an undetermined period of time and blood was visibly spurting out of the wound, the patient pulled through the resuscitation thanks to Dr. Rorish who replaced all his blood with cold IV fluid. She spiced up the resuscitation by asking the new residents questions about what she was doing.

A man with head trauma and a Glascow Coma Score of 3 was brought in and declared brain-dead on the spot. The transplant team was on its way in. Apparently Angels Memorial Hospital has no brain death protocol.

Another man came in with expressive aphasia due to a stroke, received tPA, and promptly woke up and told his wife he loved her. That’s not the way it works.

My favorite vignette was the arrival of a young boy who was short of breath. Learning that he was Norwegian, Dr. Rorish immediately diagnosed a pneumothorax and assigned an unsupervised new resident to insert a chest tube. He of course was a bit nervous. It was touch and go for a while, but he eventually got the job done. The patient was remarkably calm despite not receiving any local anesthesia which, by the way doesn’t work too well for chest tube insertions anyway.

In the midst of all the chaos, Dr. Rorish fired one of the new residents, a woman who disobeyed her by ordering a urine toxicology screen on a patient who was discharged and later determined to be suffering from carbon monoxide poisoning.

I won’t bore you with the details but the fired resident somehow ended up going in an ambulance to get the patient at her home. On the way back to the hospital, they got stuck in traffic. Drs. Rorish and Hudson talked the resident through a cesarean section which she performed in the ambulance without any assistance.

Did I mention that Dr. Rorish was doing a burr hole on a patient with an epidural hematoma while all this was going on? This scenario was plausible since it can often be difficult to get a neurosurgeon to come to the hospital.

At this point, I'd had enough.

Here’s an idea that I’d like to pitch to the networks. It’s a show about the fast-paced world of nursing homes, and it’s called “Code Brown.” For those of you who don’t know, a Code Brown is called whenever a patient poops so much that it takes four people to clean up.

ADDENDUM: I had heard about more crazy stuff in the second episode of Code Black. Against my better judgment, I watched it. To read my review of that one, click here.

36 comments:

Joe Niemczura, RN, MS said...

Thanks. I missed the show and plan to always miss the show. I totally hate it when the medical details are not letter perfect. There's no excuse.

artiger said...

Medical shows don't need to be letter perfect, but I wish they would at least slightly resemble real life.

Aside from that, I'm with you Joe, I plan to continue missing this one.

Anonymous said...

Anonymous Europe: I was just about to stream this show.... It is 21.36 here in Europe and usually streaming sites get a 24h delay... Thanks for warning me. I am at the fifth minute, the guy's carotid has been spurting blood like a fountain for about 3 minutes and he is still alive...
I guess I will be better off with Mardi Gras Spring Break...:) Marvel's Agents of Shield still beats all the other series out there for me , except for Vikings...:)

William Reichert said...

I can imagine how difficult it will be today for all the doctors on the show
to correctly code all the illnesses they treated last night when they have to use all the new ICD 10 codes that will have to be dredged up to maximize hospital revenue for Angels Memorial Hospital.

steve said...

When I compare these new EM dramas to "ER" there are the same themes- dramatic procedures working way more often than they should, a career's worth of bizarre stuff in one shift, wildly inaccurate medicine etc. I think the thing about these new shows is that the dialogue is just so over the top and overly dramatic that it's laughable even to someone not in medicine.

Skeptical Scalpel said...

Yes, I don't think they have to be perfect, and I recognize that their has to be some drama. But a c-section in an ambulance by an ED resident with no help? Ich don't think so.

Yes, the themes are recurring. Code Black one-upped the show "ER" which once had a segment where an ED doc delivered a baby with forceps that he had obtained from the delivery room.

And the dialogue--"Sometimes you just...gotta be a cowboy," said Dr. Rorish

Anonymous said...

Thank you for reminding me why I do not watch TV and haven't in years. I'd rather fill my mind with useful, thinking information ... which is why I follow this blog. If a few of the regular posters had a blog, I'd follow them. I work for the government, I do not need more stupidity.

Les said...

Ah, they went for the emergency C-section over cricothyrotomy.

Libby said...

I was going to PVR it because just the trailers sounded stupid. I wanted to see just how stupid it was. There have been some really silly ones in the past few years & as Steve said, "the dialogue is just so over the top and overly dramatic that it's laughable even to someone not in medicine." So true & very disappointing for a fan of medical shows.
Thanks for the review, though if I'm bored & too lazy to initiate something better (like sorting dirty laundry) with the stars aligned just right, I just may turn on the idiot box and watch it. At least I may get some exercise shaking my head.

Thirsty Scholar said...

I agree with the above characterizations, but have a single point to clarify.

Code Black is based upon a documentary of the same name, filmed by one of the LAC/USC EM residents. The documentary is actually reasonably good (http://www.imdb.com/title/tt2759372/).

The phrase "Code Black" is in common usage at LAC/USC and denotes high emergency department acuity/overcrowding and the facility's inability to accept most interfacility transfers. Seems to be quite overdramatized (the status of the EM can be found on the hospital intranet not on a large stylized lightboard), but it is based upon a kernel of truth.

artiger said...

I wish we could make this show DNR. And all the rest of the medical shows while we're at it.

Skeptical Scalpel said...

Les, I would have preferred the cricothyrotomy. At least it is plausible in an ambulance. There's a video of a medic successfully doing one in a helicopter in Afghanistan. (https://www.youtube.com/watch?v=SBuoULSKMgQ)

Thirsty, I was aware of the documentary. I haven't seen it. The NY Times review said it was good. Other than the title, the show doesn't seem to bear any resemblance to the film--or reality.

Anonymous said...

Was going to watch it this week but sad to hear it has so many flaws...

I thought it would be more accurate since the creator is a EM physician who did a documentary called Code Black about LA County

Ronald Hirsch, MD said...

There is protocol when writing reviews to start with notice of a spoiler alert if you are going to discuss important plot points. I guess I'll have to watch a rerun of ER instead.

Skeptical Scalpel said...

My bad. I think you're better off watching ER or better still C-Span.

artiger said...

Dr. Hirsch, if a show is already rotten, we can't spoil it any more. So, no need for an alert.

Skeptical Scalpel said...

There's no way to describe how preposterous the Show is without revealing the plot.

Anonymous said...

How about the central lines they were putting in this week after touching tons of other stuff beforehand? They might as well have stuck their finger up their nose first. It was a CLABSI waiting to happen. No Chlorhexidine in sight. It would be GREAT if they could show some evidence based patient safety protocols being used as a public service to those in the biz watching and shaking their heads at the plot line. Personally, I find the show an entertaining diversion. There is just something fun about yelling "Yea RIGHTTTTTT" at the TV, and informing my daughter why this or that never happens in real life... but then I'm a bit twisty ;) LOL

Can't wait to see what they continue to dig up and portray as common place! Marcia is a terrific actress. That is why I tuned in to begin with. I hope it stays on the air.

Skeptical Scalpel said...

I agree that like Rocky Horror Picture Show, Code Black is so bad that it can be entertaining. Marcia may be a great actress, but she hams it up in this show. Granted, she doesn't have much to work with.

Despite this, I don't think I can take another episode.

Karani said...

I love the show. The medical situations are very plausible and the acting is top notch. But most importantly the show is not just about medical situations but the struggles we all have to be human and the writers nail it. I am a writer and I know how hard it is to do what they do.They are geniuses. I cry every episode, happily because I am touched deeply, and that's a nice change from all the apocalyptic, superhuman or anxiety ridden characters through out media...some of which I love too...but again these writers hit it perfectly.

Skeptical Scalpel said...

You are entitled to your opinion. However, if you read my two posts about this show (heres the other one http://skepticalscalpel.blogspot.com/2015/10/code-black-part-ii-it-gets-worse.html?showComment=1445453018446#c534408143533586075, you will find that the medical situations are not plausible.

Residents do not perform cesarean section in ambulances, ED docs do not take patients to the OR for ovarian torsion etc. It is nonsense.

Diamond Dave said...

Something I have noticed as a Respiratory Therapist is that anyone hauled in there on a non-rebreather mask is that the bag is never inflated. And I personally have never been in a code where an ambu bag was not in use.

Skeptical Scalpel said...

Dave, the problem with an ambu bag is that you can't see the actor's face. It's the same problem with surgeons in the OR. Their damn masks cover their faces. Here's how Code Black dealt with that in the second episode. http://skepticalscalpel.blogspot.com/2015/10/code-black-part-ii-it-gets-worse.html

patricia hitt said...

As a real nurse on the set of Code Black, they didn't even try to make sense. In Center Stage where all the major trauma is filmed real medical are mingled with non real medical and it still doesn't matter as we were prohibited from answering anyone's questions and and to defer to the tech adviser. The problem with this is that she would tell us to talk to her second in command. The problem: her second in command is a veterinarian tech. When I found this out I started asking questions. Even though the producer of the show claimed to have hired REAL trauma nurses that couldn't be further from the truth. Not his fault, he delegated to the tech adviser and she in turn hired friends and family with or without a medical background.
As for Dr McGarry, he was on set a few times but it appears he has succumbed to the Hollywood bug. And the guys I was told were real doctors, haven't even entered med school. Which accounts for the look I got when I asked a question about his background.
When they set a scene in Center Stage they seemed to acquiesce to the written page even though it makes not sense.
In one scene, during rehearsal, the main actor playing the doctor looks at time and says 'prep for an airway'. The condition of the patient meant he needed intubation when I told the actor that he was at the wrong place to perform intubation he said that is all that is written.
We were there to make it look real but they tied our hands.
In another scene I was preparing to rush the crash cart
into the lobby when the very nice prop woman came up and stated absently playing with the buttons on the defibrillator as we talked. It went live and she taken aback that it was real. Worse part was that she didn't know how to turn it off. I let this play out a few seconds then turned it off.
A live defibrillator on a set with untrained people and the one person responsible for it doesn't know how to turn it off.
I was there the day Dr Roarish packed the kids nose using coffee for liquid and had to bite my thumb to keep from commenting.
As for the term Code Black? Never in my 30 years has that meant anything other than Bomb Threat.
I did rotations at Big County and it is busy. But they are making it look silly busy. The system in L.A. is plagued by over-saturation and the law is that no county hospital is permitted to close. So when the private hospital close to saturation all road eventually lead to Big County which is why they are always busy and saturated. I think this is what they were going for but did not explain it. Code Black in Los Angeles never meant over saturation.
Again, there were quite a few REAL medical people on-set but were not allowed to interject at all.

Skeptical Scalpel said...

Patricia, thanks for the interesting insights into what goes on behind the scenes. I am not surprised. Clearly, no one with medical training is supervising the action on this show.

Last I heard, it has not been canceled yet. http://tvseriesfinale.com/tv-show/code-black-season-one-ratings-38252/

patricia hitt said...

Sorry for the typos. Little sleep when typing.

The sad part is, it didn't have to be that way. There is a core of real medical people that shows can draw from. But because these tech advisers want to look good to friends and family the medical core is left by the side of the road.

Cop shows are plagued with nepotism. I'm sure we have all seen technical errors. Believe it or not, in the beginning CSI was the worst offender.

Even before I got on set I new they would have a tough time. Viewers are technically savvy now.

The documentary is actually quite good although Dr. McGarry was not the first to do that.

In the 80's and 90's it as called the Knife and Gun Club documentary.

Skeptical Scalpel said...

I understand the need to be dramatic but at least a passing acknowledgement of the medical facts would be nice. I guess it happens in every occupation. A couple of weeks ago, the Wall Street Journal ran an opinion piece saying the the movie "The Big Short" had a lot of mistakes and omissions in it.

patricia hitt said...

Before the show started we were invited to a medical boot-camp. This was supposed to determine what our level of skill was. The few real nurses and medics that were there quickly realized that their skills would be underutilized. Normally on a medical show a nurse is the tech advisor. ER was the only show I can remember that actually had real doc's on set all the time. The tech on Code Black was out of her depth from the get go. This is her first job running solo. Instead of using us to help her, she took everything on herself. The show had the potential to be great and they are throwing enough money at it that this shouldn't fail so miserably. As a member of S.A.G., and a nurse, I was more than a little bit ticked that the tech advisor was given such latitude and the unskilled 'friends and family' she brought in were not vetted. If the powers that be on the show paid more attention, they might have had a better outcome. Don't get me started on the writing.

Skeptical Scalpel said...

Ah, the writing. So much sexual tension. The drama.

patricia hitt said...

Poor Marcia Gay Harden.

Unknown said...

Patricia Hitt- I agree with you. I am a medic and experienced ER RN and I happen to also work as a set medic and, occasionally, a tech advisor. I go out of my way, even when I'm not on set as the tech advisor, to suggest more realistic ways to get the shot the DP and Director want and have it as close to reality as possible.

Skeptical Scalpel said...

Unknown, you need to work on more medical shows.

Anonymous said...

i just started watching and man! at least put the stethoscope in your ears the right way!

Skeptical Scalpel said...

I have an idea for a drinking game. Watch the show with friends, and every time someone spots a howler like that or worse, everyone else must take a drink.

Anonymous said...

Hey Skep,

That much drinking at one time can kill you.

Skeptical Scalpel said...

Yes, one would have to be careful.

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