"The Resident"

A new medical drama with the same old characters.

The show opened with the chief of surgery in the middle of a rather bloody open, not laparoscopic, appendectomy.

The circulating nurse started taking selfies with her phone; the anesthesiologist was distracted; the patient started moving; blood spurted all over the surgeon.

According to a nurse, the patient lost 2 liters of blood in 20 seconds.

What artery, other than the aorta, could he possibly have cut that would bleed so much? The chief of surgery just stood there. I yelled at the TV, “Put pressure on it for God’s sake.“

Finally, they started CPR and the surgeon seemed to be packing the wound.

"Code Black" is still on TV. Did it get any better?

Despite some recent ratings problems, the TV show "Code Black" somehow remains on the air. It has lost viewers after five of the last seven episodes including a whopping 23.8% drop in the all-important 18-49 year-old demographic after the 2/17/16 installment.

It's still viable because of fans like Sharon who said on the ratings website: "The best medical show on. I have been in the medical profession 30 years and it depicts the most true to life situations of any of the medical shows I have watched. Love the show." Sharon must work on the psych floor.

I decided to take another look at it. Having seen the 2/17/16 episode, my opinion hasn't changed. Here's why.

Telephone and television evolution through my lifetime

6-5-4. That was my home telephone number when I was growing up in the early 1950s. You may wonder how that was possible. I'll explain.

We lived in a small town. Telephones looked like this.

In order to place a call, you picked up the handset from its cradle, and an operator said "Number please."

You said the number, and she (operators were always women) made the connection for you via a switchboard.

Some folks in my town were on "party lines," which were less expensive but involved more than one household on the same line. If you picked up the phone in a home with a party line and it was being used by someone in another house, you could hear their conversation. You would have to hang up and wait until they were through before making your call. For incoming calls, the ring sequence was different for each household.

Oh, no. Not another medical TV drama

A show called "The Night Shift" has surfaced on NBC. The pilot is available for viewing on line. I'll post the link in a minute.

But first, let me warn you. Here's what happened in the first 13 minutes of the show.

The hero doctor, named TC, awakens in jail after a bad night, and while riding his motorcycle to work he comes across a roadside accident.

A man impaled by a tree branch is in shock. Paramedics are in attendance, but don't know what to do.

The doctor suggests removing the branch, which he promptly does. Blood pours out of the wound.

ED Doc clamps renal artery at accident scene

The medic says, "He's gonna bleed out."

TC says, "No, he's not. His renal artery is cut. I'm gonna clamp it." How he knows it's the renal artery I couldn't tell you. He places a clamp through the 3" long impalement wound and the bloody field.

Then he makes an incision at the umbilicus and puts in a peritoneal dialysis catheter, which fortunately the ambulance crew has handy. They also have an empty IV bag, which is used to collect the blood for auto-transfusion.

Did I tell you that this is all taking place on the ground by the highway?

On to the ED.

A two-week-old baby arrives in presumptive renal failure. Another ED doc subdues a large violent man with a "sleeper hold" reminiscent of Worldwide Wrestling. A man positioned on his hands and knees is having a scrotal laceration sutured.

Of course, there's a blossoming love affair between TC and a beautiful female colleague who both pretend they aren't hot for each other.

A new intern was juggling some things he picked out of the "lost and found" box to try to impress a woman doctor when he found out the box actually contained objects removed from people's rectums.

The hospital is having financial trouble. At a meeting, our hero insults a realistically smarmy administrator who told him a patient could have been transferred by pointing out that he wasn't a doctor.

While on break, the docs pass the time by playing basketball just outside the ED where a number of hospital personnel seem to be socializing. Perhaps this could be why the hospital is losing money.

TC puts the two-week-old baby on hemodialysis without consulting pediatrics or nephrology, mentioning how vascular access was obtained, or speaking to the parents, who apparently were not present.

That's about all I could take.

If after all that, you really must have the link, it is here.

Review: "Scrubbing In," a new medical reality TV show

I don't watch much television except for some sports. But I feel it is my duty to comment on medical TV shows, which I generally hate. A few months ago, I reviewed two shows that, as I predicted, didn't last long. Their names were "Monday Mornings" and "Do No Harm."

A third show "Married to Medicine" is rumored to be coming back for a second season despite a storm of protests over the way it depicts black physicians and their spouses. You can read all of these reviews by entering "Medical TV shows" in the search field in my blog's upper right.

I should have known better, but something drove me to look at a new reality show on MTV called "Scrubbing In," which debuted last week.

A warning sign was that based upon only the show's trailer, both the American Nurses Association and the Canadian Nurses Association wrote to the network asking that the show be canceled because it depicts nurses in demeaning and unflattering ways.

I will spare you the details of the plot, such as it was. But here are a few highlights.

A group of travel nurses, mostly from Pittsburgh, to go to work at a hospital (which probably regrets its participation) in Orange County, California.

The cast features several extremely unlikable young women and a few equally unlikeable men. All are profane, unprofessional, and dishonor the nursing profession.

Most if not all of the women have had breast implant surgery and are not bashful about revealing that fact verbally and sartorially.

Two nurses, one male and one female, had to be removed from the orientation session at the hospital. Their California nursing licenses were held up because they both had prior arrests for DUI.

It's not clear what the show's title "Scrubbing In" has to do with anything, since all of the nurses who had licenses were working in the emergency department, not the operating room.

During the first 30 minutes of the show's premiere, which was all I could take, about 3 minutes took place in the hospital. The rest of the time was devoted to watching the ladies walk around in towels, swear, shower together (behind a curtain), and go on a "booze cruise" so they could all get acquainted.

There were some memorable lines however.

While taking off his shirt on the boat, one of the male nurses said, "Sun's out, guns out."

One of the nurses, discussing her prospects for the move to Orange County, said, "Nurses f--- doctors, and doctors f--- nurses."

And while in a car, one nurse says to the others, "Did you bring your vibrators?"

Not only is "Scrubbing In" the worst medical show I've ever seen, it might also be the worst television show in history.

It should be scrubbed.

"System errors" plague the NTSB and a San Francisco TV station

By now you have probably heard about the San Francisco TV station that broadcast what it thought were the names of the four pilots of Asiana Flight 214 that crashed landed last week.

The names were not those of the pilots and were typical racist stereotypes.

If you haven't seen it, here's a 30 second clip that shows all you need to know.

The station, of course, apologized and said that it had confirmed the names with the National Transportation Safety Board, which promptly blamed a "summer intern" for the debacle. This is according to an NBC News/Reuters story, one of the very few that didn't repeat the names.

That story also points out that the real names of the two pilots at the controls had been released earlier in the week.

Is another case of system errors and not human errors? Let's see.

The NTSB said, "Appropriate actions will be taken to ensure that such a serious error is not repeated." The intern was supposed to have referred such questions to official NTSB media people.

The station's vice president and general manager said, "Nothing is more important to us than having the highest level of accuracy and integrity, and we are reviewing our procedures to ensure this type of error does not happen again."

The apparently clueless anchorwoman who read the names has said, "A serious mistake was made."

Here is what spokespeople for the Asian American Journalists Association had to offer, "We are embarrassed for the anchor, who was as much a victim as KTVU's viewers and KTVU's hard-working staff."

Wait a sec. The anchor and KTVU's hard-working staff were victims?

"We never read the names out loud, phonetically sounding them out," said a different KTVU anchor.

Another AAJA member wrote, "Common sense indicates that simply sounding out the names would have raised red flags,"

Sound out the names? They were so obviously fake that a high school kid would have noticed simply by silently reading them.

How could everyone at the TV station, the producers, editors, writers and the anchor who read the story on the air with a straight face, not have noticed that the names were not only not very plausible, but also exceedingly offensive?

Also unclear is how the station acquired the supposed names in the first place.

System errors? I don't think so.

Additional source: Los Angeles Times

Search "System Errors" on my blog to see 12 other posts on this topic.

Monday Mornings: The second episode

Since my review of the first episode of the new medical drama “Monday Mornings” generated quite a few comments, some of which thought the show had promise, I thought I’d give it another chance.

Although I have started to like a couple of the characters, particularly Dr. Sung and the sassy Dr. Napur, the medical portions of the show continue to disappoint. Dr. Sung said his evolving catch-phrase “Not do—dead” at least four times and hit a milestone as he uttered a complete sentence during the show.

Dr. Villanueva, the trauma surgeon, managed to diagnose trichinosis after a brief (and I do mean brief) laying on of hands and two questions. Trichinosis is a roundworm disease caused by eating raw or undercooked pork. The CDC says there are fewer than 20 cases of trichinosis reported in the US yearly and most of those come from eating game such as wild boar. The domestic pork supply is virtually free of the problem. I am familiar with the trauma surgeon community. I doubt that many of them could have picked out that zebra.

Dr. Tina Ridgeway, the female neurosurgeon who is destined to hook up with the hunky neurosurgeon with nightmares (another Dr. Jekyll? See “Do No Harm”), presented a case at M&M conference. The patient, a chef, suffered olfactory nerve damage during a craniotomy for a meningioma. She acknowledged that she relied on the resident to obtain informed consent. This is not permitted in most hospitals. The chief of surgery then castigates her for allowing the resident to do the case. When I was a chief of surgery, I usually was faced with the opposite problem. Some of the attending staff were not letting the residents do enough.

By the way, Dr. Hooten calls himself “Chief of Staff” and he never takes care of any patients. While it is true to life that many administrators don’t actually treat patients, I know of no surgery department in which the chief does not operate. It is very easy to criticize others if you don’t ever have to get in the line of fire yourself.

The transplant scenes lacked realism. The doctor who wants the organs cannot go around and ask for them. Ethically, he must refrain from any hint of solicitation. When organs are donated, they are distributed by a network of organ banks. They rarely would stay at the procuring hospital. There are waiting lists and priorities. Donor families and recipient families would never be in the close proximity that was depicted in the show.

I liked it at M&M when the chief said to the evil transplant surgeon, “Tell us how you’ve been bad.” I wish I had thought of that one when I was running those conferences.

The story line about the girl with the brain tumor was good except for the part where the trauma surgeon helps talk her into agreeing to the operation. He’s a versatile guy. But really, a grand piano in the lounge?

Why is everything so dark at the hospital? Is there a problem with the power grid? I’m waiting for someone to ask for a flashlight.

The show is better at character development than medicine. Maybe they should stick to the former.

“Do No Harm” is “Down the Drain.”

Late yesterday, NBC canceled the series “Do No Harm” after just two episodes.

You may recall that I blogged on January 31^st about the comically inept medicine portrayed in the first three minutes of the show’s pilot. The show’s premise that a modern day Dr. Jekyll and Mr. Hyde who had nightly 12-hour blackouts could be a practicing neurosurgeon with what appeared to be the open knowledge and support of his colleagues and the hospital administration was far-fetched, to say the least.

The viewers voted with their feet—making “Do No Harm” the lowest rated debuting series in the history of the big four (NBC, CBS, ABC, Fox) networks.

The second episode, which I’m told featured the neurosurgeon drilling a burr hole (to alleviate pressure in the skull) on a man pinned in a car at the scene of an accident, drew even lower ratings than the first.

Perhaps having an inkling of what was to come, Steve Pasquale, the show’s leading man, told the Huffington Post before the premier “Ultimately in this scenario, I'm just the actor who's saying the words."

My question is who thought this was a good idea? I can try to imagine the meetings where the idea of a modern day Dr. Jekyll who had to be home by 8:25 every night and did medically impossible things during the day was pitched. People with money and experience in television apparently sat there and said “What a great premise.”

Are those who make TV shows and movies so far out of touch with reality?

H. L. Mencken said, “Nobody ever went broke underestimating the taste of the American public.” In this case, he may have been wrong. The American public apparently has its limits.

“Monday Mornings” Review Part 2

Yesterday I posted a review of the new medical drama Monday Mornings. I based it on a 5-minute preview that was available on line.

I was very critical of the way surgical M&M conference was portrayed. Then I thought maybe 5 minutes wasn’t enough. Against my better judgment (again), I watched the whole show.

I stand by my first impression. The show is a typical medical soap opera filled with the usual array of doctors—the arrogant one, the beautiful one, the arrogant and beautiful one, the black guy, the Asian guy, the devious one, the vulnerable one, etc.

Forgetting about the acting and the heavy handed directing (extreme close-ups, focusing back and forth, quick cuts) and the funereal music, I will just point out a few errors and implausible medical situations.

A child bumps his head playing soccer and appears fine. The ED docs order an MRI “as a precaution.” (And you wonder why the cost of medical care is so high?) It shows a large brain tumor which the arrogant neurosurgeon declares is an emergency that requires surgery that same morning. The patient has uncontrollable bleeding and his blood pressure drops accompanied by blood squirting out of his head, which I have never seen happen especially since the kid was hypotensive. No code is called, but the neurosurgeon without even applying pressure or packing the bleeding area, opens the chest and does internal cardiac massage. Since there was no chance that would work, it didn’t. He is understandably upset. (More about this later)

A woman is brought in as a possible “suicide by car” because there were no skid marks. She is intubated but moving. The chief of trauma walks by, shines a flashlight in her eyes and declares that it was not a suicide, but rather a bomb went off in her head. He means she had a hemorrhage. She then undergoes surgery for a brain aneurysm. There is no way that he could have made that diagnosis with a flashlight. The patient would have had a CT scan anyway since even kids who have no signs or symptoms of brain injury get MRIs in that hospital.

There is a Korean doctor who is one of the worst stereotypes I have seen in recent memory. His command of the English language is limited to 3-word sentences and his bedside manner calls to mind Donald Trump. When asked whether a procedure he recommended was really necessary, he replied, “Not do—dead.” He was told to improve his English by the chief of surgery in a hallway conversation. He also grilled the med students without mercy. However, he is a genius at deep brain stimulation.

At the end, the neurosurgeon who lost the child on the table (I will omit the part where he has a flashback to his own childhood) has to face the music at (da-da-da-dum) M&M conference. It comes to light that the tumor was much worse than anticipated and the kid would have died anyway, but the crafty chief of surgery was holding back a card. He somehow found out that the child’s estranged father had Von Willebrand’s disease, which the neurosurgeon was unaware of. It usually is a very mild bleeding disorder and would not cause fatal hemorrhaging. The type that does cause hemorrhaging would surely have come to light with easy bruising or other issues in at 10-year-old boy. And wouldn’t the mother have known about this and told the surgeon? After all, the chief of surgery knew. The neurosurgeon was appropriately beside himself about this and refused to be consoled by the pretty one who no doubt he will hook up with in a future episode despite the fact that she is married.

In the final scene, which is one of the few believable parts of the show, the chief of trauma tells the neurosurgeon that a trauma case is on the way in and he needs to pull himself together.

As we have all been in the position of feeling terrible about a complication or death but had to go back to work the next day, that scene at least rang quite true.

I categorically refuse to watch medical shows on television. Here's why.

Thanks to Karyn Traphagen who posted a link to the Grey’s Anatomy episode in which a surgeon tweeted while operating. Having just watched the 8 minute clip, my reservations about medical television shows are reinforced.[Updated on 1/31/13: I'm sorry to say the video has been taken down. Maybe it's available on Hulu.]

A surgeon is doing a Toupe procedure, an operation to prevent esophageal reflux, and [I guess] damages the colon and pancreas. A medical student is tweeting the progress of the surgery and taking questions from surgeons all over the country. The chief of surgery finds out about this because students who are ostensibly watching a case he is doing are following the tweeting case on their phones. During the surgery, the Twitter surgeon takes a break to have a milkshake and runs into the chief of surgery in the cafeteria. He tells her to stop tweeting during the procedure because he is worried about the medicolegal ramifications. She goes back to the OR and finds a leaking pseudoaneurysm of the splenic artery which necessitates a total pancreatectomy. She disobeys the order not to tweet and gets a number of helpful suggestions and insightful questions from the Twitterverse of surgeons. She realizes that removal of the entire pancreas will create a diabetes problem. To address that, she helicopters over to Tacoma Methodist to pick up the equipment to extract islet cells from the removed pancreas for injection into the portal vein. The chief of surgery receives a shout-out from a former resident via Twitter and is now converted to an avid Twitter supporter.

How the audience of Twitter surgeons found out that this case was ongoing was not stated.
I have never in my 40 years of surgery seen a surgeon take a milkshake break during a case.
Disobeying the chief of surgery’s orders is a good way to see what the job market is like.
In the world of fantasy which is television, there are surgeons at Mayo Clinic, Johns Hopkins and Emory who apparently have nothing else to do that day and are glued to their computers/smartphones breathlessly anticipating every twist and turn of the procedure.
Total pancreatectomy is rarely indicated even for gunshot wounds. She must have really screwed up the surgery to end up needing to do that.
It is not clear how the staff at Seattle Grace [the hospital of Grey’s Anatomy] is to be inserviced on islet cell extraction and transplantation.
Oh by the way, is there going to be a morbidity and mortality conference to discuss the colon and pancreas injuries during a simple procedure for esophageal reflux?

Other than those few issues, the episode was pretty realistic.