Today, my registrar said, “Dr Zimble, I’ve got a fascinating case to show you.”
Well, have you ever seen an irate zimble? The hair stands on end, the face turns fire engine red and the arms fly back and forth.
“Warning! Warning Will Robinson!”
Only the indiscriminate use of hydroponic Roma tomatoes on an otherwise edible salad sandwich makes for an angrier Zimble.
There are no “fascinating cases”. People come to hospital because they are very, very unfortunate or a bit stupid or occasionally both (Mavis, that’s you). One finds every groove of human existence in the medical ward and enough pathology to make ones head spin but no one person is a “fascinating case”.
My registrar got the message when I asked him to grab an auroscope and check, yet again, for the elusive moth that Mrs Hemplestead is certain resides in her left ear while I joined the telephonic queue at Pay Office.
What is fascinating is why medicine is so often turned into television drama and nowadays, reality TV. Tonight there are no less than four medical shows listed in the program. Why medicine?
I want to know the trials and tribulations of the guy who controls the water temperature of the Beijing Olympic pool. I want “House of the Dead” brought to life. I want a vegetarian cooking show, like Two Fat Ladies with tofu. What I want is the hero’s journey: the triumph of the brave, the selfless, the bubble permed. [Mavis, take that last bit out right now...no, it's not funny]. Heck, give me unconditional love in the digestive tract of a deep space monster and I’ll be happy. Am I asking too much?
Television medicos go back a long way. By way of childhood deviancy and later, study and occupation, the zimble has been an interested observer. Take, for example, the publicity photo (above) of Jack Klugman in "Quincy M.E." It’s beautiful in its irony because he doesn’t know that forensic pathologists look at microscope slides and not photographic slides.
ER stands as an institution of season cliff hangers, Emmy award nominations (104) and strangely, hordes of moribund medicos. A helicopter whose tail rotor takes a surgeon’s arm returns a few episodes later to kill the surgeon by falling on him in the ER parking lot. This is the typical ER demise. These doctors are some of the unluckiest people you are ever likely to meet.
Unfortunately, they’re also some of the most incompetent. They’re sloppy and slow. They never keep contemporaneous records. They bring their myriad social and emotional problems to work. They are rude to their patients, the nurses, the relatives and each other. They don’t listen to their seniors, they don’t acknowledge best practice and they are not infrequently unethical. Then, they are ever so surprised when they are fired from their jobs or are hauled in front of disciplinary panels or are dead!
While I’m at it, why are they so loud?
“F.B.C. …CHEM SEVEN…CROSS TABLE C SPINE… STAT!”
I understand what they want but why are they shouting?
While I’m still at it, what about the direction? In the multi-trauma scenes the doctors and nurses attend the patient en masse, crowding around him, with we, the viewers, looking up from the patient’s feet.
“Oh, for heaven’s sake, let me put in that chest tube for you, you bubble headed boo-boo!”
In reality there is you and there is a nurse (and a medical student who is collapsed, fainted, in a corner of the room).
“No! Stay where you are! Don’t try to get up!”
One morning, a long time ago, my world and that of the medi-drama collided. I was finishing my night shift, collecting my purse and keys. Leaning back on the handrail in the lift, I swung my stethoscope across the tops of my shoes, watching it as it went back and forth, as you do. The lift stopped on the second floor and the doors opened.
I looked up and acknowledged, with a small nod, one of the hospital administrators and a young woman with a head of wondrously long red curly hair. We smiled and she and the administrator got off at the next floor. I thought nothing more of it other than that she looked too well to be a member of staff.
A few weeks later, I sat down to watch the much hyped new television series, “Emergency Action” (or something). We knew it had been filmed locally, as there had been a blurb in the paper and the ED docs said their stuff was being borrowed.
The series was dire in so many ways and mercifully, lasted perhaps, three episodes. The best and funniest thing was spotting the locations for the ambulance shots. The vans would zoom up one Brisbane freeway ramp and barely seconds later, zoom down another some twenty minutes across town on a different freeway. Why not simply turn the ambulance around and zoom back down the ramp you’ve just zoomed up? We don’t mind.
Meanwhile, back at the hospital, about half way through the first episode, there is a scene involving an intern who has an argument with someone outside a lift. The intern then gets in the lift and leans back against the handrail and swings a stethoscope back and forth across the tops of her shoes.
“Holy mouldy macaroni Batman! It’s the redhead!”
There are only two medi-dramas I cannot watch. One is another dire Oz drama called “All Saints”. The writing is so bad it should be called “All Saints turn in their graves”.
The other is “House”. My problem with House is that it is based on the premise that good diagnosticians use algorithmic thinking and when that doesn’t work, there is some random element of God given genius that provides the answer. Perhaps this is the way it is in the blessed nation but in the rest of the world it doesn’t work like that. Most of us don’t have the time or inclination to use a white board and genius is rare.
Another misrepresentation of some medi-dramas is their prognostic licence. One mob of researchers reported they had watched all the episodes of ER and Chicago Hope during the 1994-1995 viewing season and 50 consecutive episodes of Rescue 911 broadcast over a three-month period in 1995.
“There were 60 occurrences of CPR [cardiopulmonary resuscitation] in the 97 television episodes. In the majority of cases, cardiac arrest was caused by trauma; only 28 percent were due to primary cardiac causes. Sixty-five percent of the cardiac arrests occurred in children, teenagers, or young adults. Seventy-five percent of the patients survived the immediate arrest, and 67 percent appeared to have survived to hospital discharge.”
In reality, cardiac arrest is most often caused by coronary artery disease, mostly occurs in the middle aged and elderly and is survived to discharge about 5% of the time. I don’t necessarily agree but was once told the only reason to resuscitate is so that when there is the rare occurrence of an arrest of a young person, you are practised in the skills that will give them a chance. I guess futility doesn’t make for interesting television.
Back to the matter at hand: it's the hands that matter. When I watch a tele-medico at work, I immediately know whether they ‘get it’ by observing their hands. Most will prod and poke as though they’re testing the reliability of a li-lo.
Rarely, I see a quality to the touch and a confidence in the movement of the hands that usually only comes with experience. When it is there, it’s lovely to watch and I appreciate it.
Well, that’s enough of my babbling and by the way, M.A.S.H. is on - it's the one when the unexploded bomb lands in the centre of the compound. Hawkeye! [Swoon].
