Monday, January 22, 2018

"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.

A nurse said, “CPR isn’t going to put all that blood back into his body.” It’s hard to argue with that. Another nurse said, “He’s so dead.” Also true.

The chief of surgery blamed the anesthesiologist claiming the patient woke up and allegedly bumped his arm. The anesthesiologist wasn’t having any of that until the chief reminded him that he covered for the anesthesiologist when he ‘tore through that woman’s oropharynx on a routine intubation.”

The chief also pointed out that the anesthesiologist was “at the end of a 30-hour shift”

They all decided to say the patient had a heart attack. I guess there was no autopsy or inquiry into what happened. No one was asked to explain why the anesthesiologist called for four units of blood stat as soon as he saw what had happened.

New resident Devon Pravesh was in bed with his significant other. He was pointing to and naming the parts of her shoulder. How romantic. Forgetting that he graduated from Harvard Medical School a few weeks before, she gave him a watch to commemorate his first day as a doctor.

When he arrived at the hospital, he met senior surgical resident Conrad Hawkins, an over-the-top arrogant prick, even by surgical standards.

A nurse Conrad had been dating apparently dumped him. His solution, seemingly inappropriate for 2018, was to drag her into a vacant call room and passionately kiss her. Her response was to tell him to take off his shirt and pants. He complied. Then she left and locked him in the room. Interesting that a hospital call room would have a lock on the outside that could not be opened from the inside. Seems like a significant staff and patient safety issue to me.

Conrad treated a woman with leukemia and leukopenia. Wait, I thought he was a surgeon. Oh never mind. It’s a TV show.

He found out the appendectomy patient he admitted the night before had died and asked, “what the hell happened?” His former girlfriend said “HODAD [‘Hands of Death and Destruction’ (the chief of surgery’s nickname)] happened.”

Conrad confronted the chief of surgery and told him he should quit operating and become a celebrity TV doctor because he looked the part. The chief of surgery was no slouch. He had something on Conrad too. There was a patient who died a few years ago because Conrad or someone else screwed up and gave her a fatal chemotherapy overdose. This is why surgical residents should not be administering chemotherapy.

An all too realistic scene featured an obese, non-compliant diabetic with a gangrenous foot.

Next the surgical service admitted a hysterical young woman IV drug abuser with endocarditis, another nonsurgical diagnosis. She collapsed and fell to the floor. Conrad tells Devon to run the code and he pulls a book out of his pocket which Conrad knocks out of his hand. They have a little chat while she lay dying.

He asked, “What’s the first question you ask in a code?” Devon answered, “Rhythm. What’s the rhythm?” A lesser character said, “Pulseless electrical activity.”

Here’s what the monitor showed.
 

Clearly flat line.

Devon kept on doing CPR even though Conrad told him to stop because it had been 24 minutes without a pulse. He magically restored sinus rhythm while continuing CPR, but Conrad threw a wet blanket on everything by pointing out that the woman was probably brain-dead.

At this point I was 24 minutes into the show, and I declared it brain-dead.

You should too.

28 comments:

artiger said...

Someone. Make. It. Stop. Pretty. Please.

Anonymous said...

Do you think grizzled surgeons complaining about regulations and being underpaid for their service makes for a good TV show?

lp said...

I’m surprised you made it that far. I turned it off after the appy scene.

Skeptical Scalpel said...

It would be more realistic and a refreshing change of pace.

Skeptical Scalpel said...

Ip, I stayed with it because I had a duty to my readers, but it was tough to do.

sailrx said...

Thanks for your diligence, now I won't have to waste my time 👍

Skeptical Scalpel said...

Sailrx, I am here to serve.

Jeffrey Cameron said...

I miss "Scrubs" ...

Anonymous said...

Outstanding review. Maybe the start of a second career for you?

frankbill said...

I have had many EKG's done. Never had one done without taking my shirt off. From the photo the woman looks fully dressed. So how did they place the electrodes?

Anonymous said...

Best laugh I have had in a while. You, sir, are an awesome writer with a great sense of humor.

Skeptical Scalpel said...

Thanks for the kind comments. I was unable to get every mistake into the post with making it 2000 words long. I think if you watch it again, you will see more things wrong.

Antonio said...

hell dr .... i wopuld really like to ask you some questions about surgery residency... im a third year surgery resident in venezuela, as you have heard on the news we are having bad times.. that also affects the patients, the hospital and our daily activity.. i would like to chat about it with you about some questions i have about the residency programs and troubles we are having.. can you give me some e-mail i can use?

Skeptical Scalpel said...

Yes. SkepticalScalpel at Hotmail dot com. Use the at symbol and a . for the dot.

Anonymous said...

Anonymous Europe: In the German speaking area of the world we have our own super doctor series. It is called Der Bergdoktor (The Mountain Doctor). The guy is supposed to be a GP, but worked in New York at an ER unit and moved back to his hometown in Ellmau (that is in Austria, Europe, no kangoroos..:D) and took over the local GP's office. He does EVERYTHING from virology to pediatric traumatology to epidemiology to subarachnoidal aneurism surgery..:D A real polihistor.:D:D::D BTW, guys after work I just have pretty much enough of the monster that is called health care. I would never ever watch a doctor series.Period. Everyone should seriously get a hobby, which is other than surgery/medicine....:) It helps with decreasing blood pressure, stress levels and prevents burnout.:)

artiger said...

Anonymous Europe, the problem isn't with those of us in health care watching this crap, it's with the patients and general public watching it. They believe it's reality.

Lady Anne said...

This sort of crap - utter disregard for the facts of any given profession is everywhere. Some of the scenes in CSI are just as bad. I don't watch TV, other than the Big Bang, but he was alternately shouting and moaning about a scene where a woman was trying to track something on her computer, and a colleague came up to help her. They were typing on opposite ends of the same keyboard! I'm sure any police officer could give you a run-down on the cop shows. Same thing.
Yeesh. Don't these producers ever call in a technical advisor?

William Reichert said...

Recently I read a piece in the NYT that said that trust in physicians is at an all time low.. I honestly believe the media has a lot to do with this. Shows like The Resident clearly contribute.
Morons like Dr.OZ play a role. Stories about curing strokes by retrieving the clot with a catheter ( in carefully selected cases) exist but are rarely helpful so it leaves patients wondering . Social media allows any and all views to compete with science. But hey! money is being made with all this display of medical incompetence. Any way I was LMAO reading your review. Thanks.

Skeptical Scalpel said...

I agree that the public believes that this stuff actually happens regularly since nearly all medical shows are overly dramatic and oversexed.

Lady Anne, the shows all have tech advisors who I'm sure take the job saying to themselves "I'm going to make sure everything is realistic." But then the people in charge say, "Spice it up a little."

William, I agree with everything you said. I'm glad you enjoyed the post.

Anonymous said...

Anonyomous Europe: Artiger, point totally taken! I spend unfortunately a lot of time in the outpatient unit and people behave there as if they learned their manners from these shows. A morning there makes a raging bull even from the calmest doctor...

William Reichert said...

When will this episode appear on The Resident?

https://www.kevinmd.com/blog/2018/02/dont-know-test-will-save-life.html

Skeptical Scalpel said...

William, probably not.

Dr prabal roy said...

Thanks for your diligence

Unknown said...

Interesting thing is, I read two other reviews of the show, from two internal medicine physicians who also have a strong social media presence. Neither of them picked up as strongly on the RIDICULOUS surgery scenes in the show. Beyond the opening, later on a second year resident is shown to be the hospital's expert on performing "robotic" prostatectomies. Beyond a general surgeon doing a urologist's job, show me a second year that can complete that operation by themselves...

Skeptical Scalpel said...

Unknown, I wouldn’t expect an internist to know what surgical scenarios are bogus just like I wouldn’t know whether the doses of some drugs were wrong.

I agree that a second year resident would not be an expert in robotic surgery.

Let’s face it. As far as the medicine and surgery go, the show is hopeless. Watching it will only give you agita.

frankbill said...

This is in reply to William Reichert
I can only speak for myself but if others have the same experiences with care providers as I have. It is no wonder that trust in physicians is at an all time low. After 10+ years without a real diagnoses you lose faith in physicians.
Maybe part of the my problem is I am in the VA health care system But The VA I go to is affiliated with both Dartmouth medical school now know as the Geisel School of Medicine and the University of Vermont (UVM) College of Medicine. Some of the providers that I see work both for the VA and Dartmouth Medical Center as well. I have also been to Dartmouth Medical Center as well and get the same results.
From my research as well as some results if CT scans that show a tumor on my adrenal gland and having high blood pressure and potassium that tends to run a bit low. The most likely cause of many of my symtoms is hyperaldosteronism
How ever most providers believe this is so rare they will never see any one that has it. Even though current research says between 5 and 13% of us that have blood pressure is caused by primary aldosteronism This information can be found in uptodate https://www.uptodate.com/contents/pathophysiology-and-clinical-features-of-primary-aldosteronism?source=outline_link&view=text&anchor=H1#H1
I have askes many providers about hyperaldosteronism and get the same answer that it is very rare. In my case I had the screening test but was on meds that interfere with test results.

Gary Koch said...

I’m surprised you were able to write this post. Twenty four minutes into that rubbish would make me brain-dead! Thanks for taking one for the team, glad I didn’t waste my time.

frankbill said...

In todays world the real life surgeons are seeing to many war like wounds.

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