5 Movie and Television Medical Myths

Over the holidays I saw an action picture by a major director. I am always struck by the lack of medical science in television and movies. As a medical professional most of my friends are in the same field. When we see movies together we always have a good laugh about how medicallyridiculoussome things are. This is a personal top 5 list of the ones that bother me frequently . Taking these in reverse order I will get my pedantic "geek" on.

5. Dead People and Blood:I do not mean zombies. I am not trying to kill (Pun Intended) someone's need to be campy or takeartisticlicense. Still many serious dramas choose to put the camera on the dead character and it just fails to look real in any way. In real life when people die theircirculatorysystem stops and they take on a waxy yellow appearance. TV and movies try to make people look dead but it is never correct. To me characters who die often appear like actors pretending to sleep. I am not asking for directors to really kill people. Just try a little make-up. The worst offenders don't even edit out the actor breathing. Theatrical blood fails to look real as well. The blood looks like what a special effects guy thinks blood looks like, not the actual fluid. It ruins my suspension of disbelief when I see the vampire with strawberry syrup around the mouth. There is a widevariationin theatrical blood and yet it always seems a little off. Everybody cuts themselves. you would think special effects guys could look attheirownpapercuts.

4. Sci-Fifuturisticmedicine"He's Dead Jim.":I am a big Sci-Fi fan and I am alwayscompletelydisappointed by the fictional future's medical treatment. I admire Gates McFadden's(Dr. Beverly Crusher on Star Trek TNG) for requiring medicalcontinuityin the program. Continuity is sorely lacking in future medicine.Star Trek TOS Dr. Leonard (Bones) McCoy I think his job was pronouncing people dead. If he likes you you're OK, if not " He's Dead Jim.". In one episode he re-attaches Spock's brain utilizing ancient knowledge. The knowledge runs out before he finishes, yet he completes the surgery with his own medical knowledge. The next week Kirk's Native american wife gets stoned(I mean in the biblical sense) and he says "sorry there nothing I can do.". Take out your brain in 23rd century no problem. Hit with rocks, sorrynothing we can do about that. Apparently the Federation eliminated the AHA CPR classes. Spock, Kirk, nobody says "So were not even going to beam her up and try to save her?" It's not just Star Trek at fault. In Star Wars Darth Vader needs to be ventilated constantly yet he can pick people up with one hand and throw them. If they can stick Luke into the "Bacta Tank" and fix him up how comeVader is still a big mess. There is no limit to the Nit's I could pick in this category. For 2012 the bad medical science winner was Prometheus the aliens prequel. The surgery machine in the movie what a great idea. Having the female protagonist getting up and running after having abdominal surgery impossible. I don't care how many staples you shoot in her belly she is not getting up.

3. Bullet and Arrow Wounds:I will tell you that being able to walk around with an arrow sticking out of your chest is very very unlikely to happen. The hero with the arrow sticking out of the left chest wall holding his arm isextremelyimplausible. Anything penetrating your chest below the collarbone will put you out ofcommission99% of the time. There is no safe spot to get hit in the upper chest. At best it will collapse your lung with a pnuemothorax and you will have respiratory failure. You will not ride away on your horse to pull the arrow out later. In Braveheart, one of the characters has an arrow pulled out and they cauterizes the wound. He is up and going again after a shot of liquor. Great scene but not going to happen. Air will be sucked into the wound collapsing your lung leading to respiratory distress and death. FYI if you are not in the old west or ancient times pulling out any penetrating trauma is the wrong thing to do. You will cause more damage and likely reduce your ability to survive. It needs to be removed surgically. Bottom line, ifpenetratinginjuries don't kill you, you are better off leaving it in. While on the subject of pulling things out. Bullets left behind are not always fatal. Movies often lead you to believe that you have to cut the bullet out of the victim or the character will die. A common scene is the movie doctor giving up" the bullet is too deep", a movie death sentence. In real life digging in the wound with a knife is probably more fatal. The movie Tombstone with Kurt Russell is an example of this medical mistake. I see radiographsregularlywhere the bullet fragments have been in place for decades. It keeps you from getting an MRI but not much else in life. In their defense, it is a period film. Doctoring was primarily opiates and amputations in post civil war era. Sorry Iron Man you don't have that excuse, shrapnel will not slowly migrate into your heart. Putting in a car battery powered magnet will not save you. The invasive wires would result in a infection and that would be lethal. Movies do get some medical trauma right. Gunshot wounds to the belly to "Make him suffer". Abdominal GSW is a slow death if you miss the liver, kidneys, spleen or messenteric artery. The intestinal injury results in a slow painful infection and death.

2. Knocked Out and He's OK folks:Being knocked unconscious is by definition a brain injury. It does not matter the mechanism. If you areunconscious from a blow to the headit is huge amount of force. Our head has evolved to take a pretty good shot. A mechanical analogy for the head is a water filled helmet wrapped with leather. Anything that sufficientlytraumatizesthe brain despite that will cause damage. That damage would last months at least and may be permanent. In the ER the only time we are concerned with head injuries is when you were knocked out. Concussed patients don't just wake up in 20 minutes and go back to life as usual with a mild headache. If you crack someone across the Occiput with a Glock hard enough to knock them out, they may never wake up. Countless movies use this useless plot mechanism. Maybe Mr. Spock can nerve pinch someone and have them wake up in 20 minutes. Do it any other way and they may never wake up.

1.And the #1 dumbest thing I see in TV and Movies, Defibrillation:I do not know where the idea that shocking flatline patients came from but it needs to stop. Human beings are not Chevy's. You cannot restart someone's heart with adefibrillatorshock. There are many offending movies but my favorite was the 90's movie the Abyss. In the movie a female lead becomes hypothermic and anoxic to get her through water to safety. In the movie the "Cold" will slow down her metabolism and she will survive. That is minimally plausible. Then they shock her to try to restart her heart. It doesn't work. Then the movie gets it right. The male lead refuses to give up and begins CPR. Sometimes when movies get it wrong they get it right. Medically Asystole or Flatline is a condition treated by CPR and medication. Defibrillation will do nothing. Defibrillation is for patients in Ventricular Fibrillation. In simple terms the electrical activity in the heart is irregular, shocking can reset the natural pacemaker. Shocking asystole does not kick start the heart, a laFrankenstein. Shocking dead patients as a plot tool isubiquitous. A whole movie from the 80's Flatliners was based on this medically wrong premise. Even when movies and TV use a defibrillator right they still get it wrong. There is a classic X-Files episode where "Dr. Scully" runs into a room with an elderly man that appears to be having seizure and pronounces "he is in ventricular fibrillation get the crash cart". Apparently she can see electrical impulses by looking at a patient without a monitor. She could qualify as a JREF paranormal prize challenger. Maybe Mulder was looking an X-file in the face for 8 years. More likely it was bad writing and medical fact checking.

So when you see me sitting in a movie laughing at a scene that is not funny, give me the benefit of the doubt that something is medicallyridiculous.

I tried to limit this to my biggest pet peeves. I did leave out honorable mention transthorasic intra-cardiac injection. These were made famous in the IconicPulp Fiction and The Rock scenes. More crap. If you see someonesuffering from a drug related issue and another person is going to jam a EPI shot intotheirchest, stop them. You may save a life.

If anyone else has any medical pet peeves with TV and Movies feel free to share.

Happy New Year!

References:

http://www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Defibrillation_UCM_305002_Article.jsp

http://www.netplaces.com/first-aid/serious-incidents/penetrating-trauma.htm

http://www.netplaces.com/first-aid/first-aid-basics/first-aid-myths.htm