Fictional Malpractice, or How NOT to Write that Medical Scene
The camera zooms in on a man lying on a hospital stretcher in the emergency department, thin plastic tubing stretched under his nose. As the concerned family and friends gathered around the bedside sob, the perspective shifts to a close-up of an electronic monitor. A green tracing of heartbeat flattens into a solid line, as an ominous buzz fills the room.
“All clear.” A handsome male doctor wearing scrubs and a white coat bends over the bed. He presses a pair of paddles connected to plastic coils against the man’s chest, sending the patient into a convulsion that jerks his body into a sitting position. After a suitable dramatic pause, the camera pans back to the monitor, where spikes of a normal heartbeat track across the screen.
Eyes now wide open, the patient embraces the joyous people around him, including a prodigal daughter he hasn’t spoken to in years, an ex-wife he’s finally able to admit he’s still in love with, and the business partner he’s secretly embezzled from. The patient’s loved ones try to thank the doctor, but he dashes off, explaining he’s late for a scheduled surgery on a child with a brain tumor…
I know I’ve seen something like the above scene on TV more times than I can count, and variations of the same in many novels. So what’s wrong with it?
Well, pretty much everything.
A critically ill patient unable to support his own breathing wouldn’t have only a little oxygen blowing into his nostrils. Instead, a plastic tube would be inserted into his trachea (which leads into his lungs), and a machine appropriately termed a ventilator would do the breathing for him. Using an electric shock to jolt a patient’s heart into the proper rhythm so it can pump blood to critical organs does work—for specific rhythm problems. A heart that isn’t moving at all—the dramatic ‘flat-line’ on the monitor—won’t respond to electricity. Needless to say, not all doctors are male, or white, and no matter how good looking or accomplished they might be, they don’t do everything. An emergency room physician treating a patient for a heart condition wouldn’t run off to perform brain surgery. Lastly, survivors of a cardiac arrest such as the one described above would need critical interventions to recover, and would hardly be awake, alert and able to ever-so-conveniently wrap up all those critical plot points.
Dr. Stereotype, gazing off into space and not following sterile procedures.
As with any profession, the reality of a doctor’s life bears little resemblance to the fictionalized account on the page or screen. And it’s not likely most readers would want to plow through several pages of a harried physician struggling to finish up charts on a new computer system, or arguing on the phone with an insurance company to have a medication or procedure approved for a patient. Still, as with any other aspect of life, an appreciation for the reality of medicine can go a long way in making a medical drama play out in a more convincing manner.
I participate in an on-line forum with thousands of other female physicians, all struggling with work and family life. I posted a question to them: what aspects of medicine does fiction (both novels and visual media) get wrong?
Emergency physicians, internal medicine doctors and cardiologists referred to the mistakes in the scene above about cardio-pulmonary resuscitation. Surgeons complained about operating room scenes in which no one even wears a mask while doing surgery. The group’s obstetricians rolled their eyes over unrealistic depictions of labor and delivery.
Nooo! Not another clichéd birth scene!
And many different medical specialists rather wistfully remarked that the sexual shenanigans depicted in fictional hospitals don’t bear much connection to reality.
If the on-call room is rockin’, don’t come knockin’!
So, how do you write that crisis moment in the emergency department, that tense surgical drama in the operating room, or that amazing birth scene? To start off, spend some time researching the details of the medical issue you want to represent. Many specific surgical procedures are depicted in full gory detail on YouTube, including this example of a spinal surgery I often perform.
After all that wonderful research, make sure not to overwhelm your reader with unnecessary information. If your point of view character is a construction worker in an emergency room crammed with victims of a high rise apartment collapse, you can skip a lot of technical detail and focus on the emotional turmoil he’s experiencing. On the other hand, if you’re writing about a physician discovering her ex-lover among an influx of patients admitted with a fatal infectious disease, she might notice the technical issues more. Also keep in mind that many professionals involved in the delivery of health care aren’t physicians or nurses. They might be physician assistants, EMT’s, or radiology technicians, for example. Don’t hesitate to ask people in the medical field questions about their work, or grill them about interesting events or people. Everyone I know who’s worked in a hospital has some great stories!
I’ll end with some questions for my medical colleagues out there, and some for anyone who’s ever been a patient before.
For anyone working in healthcare, what are some of the biggest medicine howlers you’ve seen or read? On the flip side, what’s your favorite novel or movie that gets the medical details right?
For those of us who have experienced the medical system as a patient, what are some examples of terrible representation of a medical illness? How about books or films that did a great job?
