“LIGHTS, CAMERA…NAH!”

By Dr. Geeta Sundar

I love my profession, especially neurosurgery. I really do. More so, I love melodrama, trauma, and karma, and if you pack them all into a television show or movie, trust me, I’ll sit in on that one and munch popcorn. Having said that, I have been around enough and watched enough shows and documentaries to tell you what the shows get wrong. (Quite, literally).

I may with the magnality of my heart, overlook the surgical skills and the surgical techniques they get wrong, but I can’t keep silent of the blunders they get wrong. They tell the world imprecise information which the mass, the media, the AI too, people believe. People sprout the bull in the silver screen and make assumptions on those parameters. Which leads me to write this, because let’s face it, its “Bah, humbug!” The details need to be right – “Everything is important – that success is in the details – Steve Jobs”. It is one thing to fantasize about vampires, witches, and the whole shebang, but fantasizing about medicine can be savage.

It was a rather chill day in the ICU. Boss was on rounds, and he was calmer than most of his usual fired up days. We were changing footwear to leave the ICU, discussing about an ICD for a patient who developed pneumothorax after a central line insertion and he turned towards me. “What IC space do we place the ICD usually for pneumothorax?” I replied the answer I have known all my life since I read Bailey. He smiled. “Did you notice…” he trailed, unsure how to ask me about what was on his mind. “Yes, of course sir, Benji’s scene in Mission Impossible 8 was wrong.”  His eyebrows shot up. “You watched it?” I nodded. Lest boss figure out how much I adore action movies and I am a sucker for them. Details like this, can be life and death – who knows if the AI bot gets fed this information from the movie and feeds it to another lay person who thinks he knows how to diagnose pneumothorax and treat it? Dangerous.

…The lady doc packs a punch to the mafia crowd. She weighs 40 kgs. The thugs are at least 20 pounds higher. After thrashing them senses away, she attends to the mafia ring leader whose EDH has suddenly caused anisocoria and drop in GCS….

I feel my blood rising to the fight, but it does little to calm my crazy intuitive mind.

No! Nobody can pack a punch like that, lol. The patient gets priority. Her fight is not humanly possible (unless she is Ronda), one, and two, the security personnel will disrupt it, and three – mafia or no mafia, people don’t walk around announcing they are thugs! Simple. Even if I am super-duper pissed at some patient or his family, I am civil enough to pay attention to the patient and handle the family like a reasonable human. No doctor wilfully targets anyone to strike up a fight. And if I am the victim receiving an onslaught of abuse – mental or physical, I am smart enough to call for help and try to handle the violence calmly.

…The father has no money to pay for his son’s treatment and he is in such a desperate situation that he decides to end his life. He finds the roof and stands on the edge, ready to give it all up. He awaits some godly intervention, and the lady doc comes running, shouting, agitated, worried and stops him from that act by sharing her own sob story…

P-l-e-a-s-e. Please, stop at these! Everyone is desperate sometimes; we are all human and humane. We see desperation right up close every day. The family can’t afford treatment, but care doesn’t stop and we try in all our efforts to pitch in and get some pro-bono and funds for them. But nobody, I mean nobody has access to the roof and nobody commits such an act. There are cries and drops to the knees, hand-clutching, teary moments, but we try our best to handle them like professionals. Empathy, compassion and firm sympathy. The kind of wrong information this gives out to the youth is alarming – anyone can come and stage a desperate act (true/otherwise) and appeal on humanitarian grounds for a subsidence in the bill. If things go south, they can easily drop the onus of the complications on the hospital. So facile, so scary.

…The night is dark. A shadow skirts around the entrance of the hospital. He makes his way inside. The door to the room housing the patient is open. No one seems to be around. The clear, crisp night portends an eerie siren and he walks into the room with a knife clutched. His intentions are open. He wants to do harm to the patient. But the lady doc is there, keen and observant, she thwarts his plan and saves the day…

OMG. But these are too similar, too forward, garbage and completely non-plausible in a real case scenario. Firstly, no one has access to the patient’s room unless you have some ID proof and a card that can give you access. High intensity, ICU, and important wards are usually held together at the entrance with security personnel and the family may only visit at visiting times. And even so, the visit is always manned by nursing staff or doctors and under watchful eyes. Trust me, if you give something/do something to my patient, I will know, the nurse will know. Nothing usually escapes our acute perception. And we can smell malingering from a damn mile away! And we are really good with detecting ‘intent-to-harm’; we can protect our patients like ‘mama bears’.

…He has bipolar disorder, admitted to the psychiatric hospital due to his manic episodes. But he is so handsome, like some Greek adonis. The nursing caretaker is a woman of pure intentions. In her help towards the patient, she falls in love and enters an abusive toxic relationship because it is what she thinks she needs to do. Guilt-tripping. Stockholm syndrome. All hail!

People need to stop romanticizing psychiatric disorders and patients. They are as much as patients as any other. And whilst I can tirade about love and its impossible neurochemical transmission, and I understand love is not explainable, actively seeking out abusive relationship is moronic. Young teenage girls who watch this, accept that is a norm and look for such a feeling of love. Only to fall prey all their life and be sucked into a vortex of desperation with difficult exits. We as medical professionals already have enough stress counterbalancing our lives, and to add toxic relations to that would be very unwise. It is called ‘toxic’ for a reason, eh?

In extension, so many times TV shows get the symptoms and behaviours of the psychiatric patients wrong. Not everyone hospitalised is catatonic. Or harming one self, shouting, screaming, yelling, or ‘mad’! Patients can be as normal as a patient next door with bowel symptoms. Its high time we start understanding the spectrum of such cases generously.

…” Search his dustbin.” Dr. House gets off the table, limps on his leg with the cane.

Th number of times I have seen this and laughed out loud; I’d be richer than Bezos. Nobody searches dustbins or even remotely goes to the house of the patient because “everybody lies”.  This is in very poor light of the untruth the family confides and also disrespectful of the patient. I have seen fear of the unknown can create enough tension and stress in the family and the patient to reveal the truth. Especially in neurosurgery, there is nothing like a shock of one’s paralysis that gets the beans spilling. So, yeah, a little dance around the truth and I have the honesty.

…” Book the OR. I have told you. I am in charge.” Lady doc commands the resident. She is the fellow on call and thinks the patient needs surgery. But in her ability to make decisions, she refuses to streamline to the protocol of informing the senior staff. The patient is a borderline case for surgery.

Whatever be the situation, the decision comes from the higher ups. It’s like a stabilized system of hierarchy that is ingrain into our teachings. Decisions like surgery are life-altering. We make the decision and stand by it with the head consultant and whole team. We don’t amok, or throw out personal gains and surgical chances, just because we can or want to prove a point. So many shows get this wrong – a new procedure, a new test, some procedure someone saw online is tested on the patient, because its ‘dire’ emergency! No, we never make our patient guinea pigs unless evidence backs it, or we are officially running a trial.

…Coma for 2 years. The camera zooms on a patient lying in the hospital bed, no tubes on his body, just lifeless, pale (surely the cosmetics can add the color), and not on ventilation. The woman at his bedside runs a wet cloth over his hands, crying, asking, “When will you wake up? When will you see our baby?” Two years and nothing, but suddenly hearing her words, the patient has a little movement in his fingers and then lo! He is awake! It’s a miracle! God is great!

C’mon, surely this is as ridiculous to me as it is to anyone with a prefrontal cortex? How can a person in ‘coma’ for 2 years not have a tracheostomy or an ET tube? Coma means your reticular formation is damaged, implies your sensorium is so poor you can’t even respond or breathe for yourself. How on earth can they keep you alive for 2 years without a tube? Leaving that aside, the longer you get away from activity, the harder the recovery. For a poor GCS patient like that to open his spontaneously, the trauma must be reversible! No other way! Coma is coma, lets just give coma the status it deserves. People assume coma can be reversible and makes it so much harder to counsel family and explain about the prognosis.

I mean I could go on – how the shows depict the doctors putting their masks on after entering the OR once they have scrubbed, or sharing data against the confidentiality, of emergency surgeries performed in the elevator or the portico because an OR was not available and time was so crucial; of crazy shenanigans in the duty room (this is extremely illogical and insane and we don’t really have the time to spare; we’d rather sleep or eat, tbh), of people being admitted for every ‘gastroenteritis’ with ‘IV drips’; of smoking or drinking on hospital premises, of people diagnosing themselves based on TV serials, of people believing that acupuncture can cure cancer…and on forth.

Not everything you see on the entertainment panel is truthful. More so than not, its gibberish with baseless foundations. Your doctor and her/his team are professionals who study and train hard to reach their level of competence to serve the society. It is not warranted to question their intentions based on some script writer who knows nothing sensible in the world of medicine.

Images – Google©