My name is Katrin Hollister and welcome to my second WATTPAD BLOCK PARTY post! I mainly write fantasy with copious amounts of backstabbing, political conflict, manipulation, and death, and with little or no romance. By day, I am also a paediatrics doctor. I graduated with an MBChB degree from the UK in 2015 and have been working in a variety of specialties, including general surgery, gastroenterology, palliative care, orthopaedics, respiratory medicine, and acute medicine since.

You know what really gets a medical professional (e.g. paramedics, nurses, doctors etc.) riled up when watching TV drama? Medical bullsh*t. There's nothing wrong with dramatising or adding a dash of fiction to your medical setting. Heck, nobody watches medical drama to learn about medicine and if you're a writer worth your salt, you wouldn't do research on writing hospital scenes from watching Grey's Anatomy either. But the issue is when TV gets things so wrong, so often that it gets ingrained into the regular Joe's mind that it's actually how medicine works. And that's when things get dangerous -- because they think they can implement it in real life or have unrealistic expectations of medicine because "that's not what it's like on TV".

So, today, join me for my Top 5 things fiction often gets wrong in medicine. It'll be a useful read if you want to include hospital or medical scenes in your writing. Please note there may be regional variances in terms of hospital policies, legalities, and protocols.

1) "OMG HE'S FLATLINING!!"

The most common occurrence in fiction and literally the thing that grinds a medical professional's gears. Because you wanna know why?

You don't shock asystole.

See the second one up from the bottom? That is asystole, AKA 'flatline'. It means there is no electrical activity in the heart. Shocking it will not work. Compare it with attempting to restart a computer when the socket isn't plugged in. It won't work. You do CPR. You give IV adrenaline. You do more CPR until the rhythm changes or you announce time of death. Same for PEA (bottom pattern). For further details on how cardiac arrests are managed, see the ACLS algorithm.

(Yeah, 'Flatliners' the film, you can shut up.)

There are only two shockable patterns: ventricular fibrillation (VF; the diagram above splits it into 'fine' and 'coarse' but it's the same management. This is when the heart is beating but it's super uncoordinated and quivering like mad, i.e. 'fibrillating', and not pumping out any blood effectively as a result) and ventricular tachycardia (VT. This is where the main pumps, the ventricles, of the heart is pumping rapidly, regularly, but disregarding whether it's actually filling with blood or not, so you still don't have any effective blood pumped out).

Every single medical scenario ever that delivers a shock (defibrillation) to asystole is wrong, wrong, wrong.

Side point: when someone yells 'Clear!' prior to delivering a shock, please have your character actually looking and checking the area is clear, i.e. nobody is in physical contact with the patient, otherwise, you will actually electrocute them.

2) When CPR is a miracle cure (WTF)

CPR is brutal. CPR is delivered as compressions to the chest at 100-120 pumps per minute with the deliverer's arms straight, crushing the patient's ribs. CPR involves a team, with some managing the airway via intubation (sticking a tube down the patient's throat to keep their airway open -- as it collapses when a person is unconscious), someone ventilating (pushing air in and out of the tube with a bag), cannulating, drawing blood from both veins and arteries, delivering fluids, delivering shocks (if applicable) between compressions.

CPR is not a bent-elbow chest massage lasting five seconds, snogging the patient a few times, and then the patient opening their eyes, leaping up, and thanking everyone. There is no way anyone who survived CPR immediately can get up and do anything. The odds are pretty bad as it is at 25% chance of the heart restarting if the person arrests in a hospital (worse if they have pre-existing illnesses) and 12% if they arrest out of hospital. [Source: AHA Cardiac Arrest Statistics.]

Their ribs have been broken, they've had tubes shoved down their throat, their brain and all the organs have been going with insufficient amounts of oxygen and their heart has stopped for however long their downtime was. Their brains might have been damaged. Their other organs might have been damaged. The above percentage talks only about how many people's hearts start pumping again thanks to CPR, regardless of the damage already done. Even if they remain a vegetable forever, they are a success statistic.

The risk of repeat arrest is high because CPR treats the cardiac arrest, not the precipitant of the arrest (see 4Ts and 4Hs). If it's because you've got a giant clot stuck in your heart's artery causing your heart to stop beating, restarting your heart will not dislodge that clot. You need PCI/thrombectomy or thrombolysis, i.e. either bust that clot to pieces or whip it out. The patient needs to be in ICU for monitoring and further treatment. And they stand a good chance of re-arresting again and again and then dying.

To put things into perspective, if a person has a cardiac arrest outside of the hospital and survives the journey to hospital, they have a 2.2 to 12% chance (regional variations) of actually living to be discharged from hospital, whatever their neurological status (ranging from same as prior to their arrest to losing all independence and being discharged to a nursing home). At 30 days after the event, only 9.3% of those who arrested are alive -- again, whatever their neurological status. [Source: "Data quality and 30-day survival for out-of-hospital cardiac arrest in the UK out-of-hospital cardiac arrest registry: a data linkage study" Rajagopal et al. BMJ 2017].

And they would definitely be dead without hospital intervention. So, yeah, Peeta Mellark would be dead, dead, dead if Suzanne Collins actually researched how cardiac arrests worked when writing The Hunger Games.

3) When doctors also simultaneously become porters, nurses, techs, social workers, etc.

Who the hell could do everything? Heck, it's not even a single doctor deciding everything. It's a whole team of doctors: the junior doctor/intern/house officer(s), the specialty trainee/resident/medical officer(s), and the consultant/specialist, and any other specialist consults required.

Doctors on TV, apparently, defy that normality. They make all medical decisions no matter their specialty, give all the drugs, move patients (portering), all the procedures like catheterising (which in reality we don't do unless nurses fail -- in which case, I'm screwed!), sit down as a group with a patient to break bad news, know every single patient like they're my BFFs. And we sort out family drama! No. Even moving a patient from sitting to standing to the toilet safely is a skill called manual handling and the nurses know it like the back of their hands. Me? Not so much. It's not easy moving even a 50kg frail little old lady who hasn't been out of bed independently in weeks in time to the toilet so she could pee -- without breaking her.

Breaking bad news is usually one to two doctors and the nurse looking after the patient. Ideally always at least two healthcare professionals, but not too many to crowd the room, and the relevant people at the receiving end. We don't have time to spend hours at a bedside holding a patient's hand. Our pagers are constantly going off. Nurses are telling us their patient looks unwell or needs an update or they have concerns we need to address. There's a wandering patient with dementia or delirium. We have ten other phone calls to make so that a patient can get their timely transfer to another hospital for further scans. Five others are going home that day. Two patients' families want 'a quick update', which inevitably drags on to 30 minutes. There's still a whole other ward of patients you haven't rounded on yet.

Most of what I describe TV doctors doing is actually what nurses do (bar the portering). They're the ones who deliver the correct meds at the correct time, run the IVs, help the patients wash and dress and move to the bathroom, spend time with the patient and know them well (and thus nurses are the ones who know when the patients are non-specifically unwell and need a medical review), who discuss a lot of the jargon doctors use and any information the patient wanted clarifying, who advocate for the patient and raise their concerns to the rest of the team, who update the family when they come for a visit. Nurses are the backbone of the hospital. They run the wards. Yet in medical fiction, often nurses are either invisible, meek subordinates who get bossed around by the doctors, or just there for the doctors to bang because ~drama~

We need our nurses, auxiliaries, porters, technicians, phlebotomists, ward clerks etc. Hospitals function as teams. Without a porter, that patient isn't getting down to the X-ray department for their scan. Without a technician, that patient isn't getting the scan. Without a ward clerk, we can't gain access to the patient's files. Without phlebotomists, we spend two hours a day every day taking blood. Without auxiliaries and nurses, we have nobody catching our mistakes, ensuring our patients are safe and well, and the healthcare system falls apart.

4) When doctors seem to do nothing but bang... or save the ALL the patients.

Contrary to the drama and colourful social lives of doctors on TV... typically, doctors' lives aren't that dramatic. If anything, because we're always at work or home exhausted from work, there's very little drama. Because we don't see our spouse. If we even have one. Bonus points if they're also medics so they're always on shift when we're not and vice versa.

Doctors deal with a lot of paperwork. Referrals. Discharge letters. Investigation and procedure requests. We sprint after consultants/specialists on ward rounds and try to write down everything legibly (hahahaha) and correctly before they've already dashed to the next patient, and the next -- all the while trying to keep a list of jobs to do after the ward round and racking our brains for any need for clarification from the big bosses (exactly what to put on the radiology request details so it doesn't get bounced back, pertinent details when discussing antibiotic regime with the microbiologist) before they disappear to the operating theatre/clinic for the rest of the day.

That's not interesting. I know. Paperwork never is -- that's probably why TV dramas don't have 70% of the script with the doctors slaving over the computer with three cups of coffees beside them.

Oh, and hanky-panky between healthcare professionals in a hospital almost never happens. Think of the germs! Ew.

5) Doctor-Patient Romances

*twitch* Ew.

Just, no. Personal-professional obligations aside, this is a serious power imbalance between the professional and the patient, like that between the teacher and the student, the guardian and the guarded, the boss and the employee. It's an abuse of power. Plus with the issue of professionalism, so much as adding a patient on Facebook or saving their phone number on a personal mobile can get a doctor disciplined, never mind actually seeing them socially. There are very strict rules between what kind of relationship or interaction is acceptable and unacceptable.

Ain't nobody gonna give up their entire career for a flirt. Please.

So...

What do you think? Have you got questions about how medicine is portrayed on TV? Other things on fiction TV that grind your gears (Cue "That's not how hacking works!!!" from computer-savvy folks)? Would you like to suggest medical things for me to explain in a blog post? If you want more REAL MEDICINE meets CINEMA SINS, check out THE FROG BLOG by yours truly at https://katrinhollister.wordpress.com/ , where I've most recently ripped apart "Doctor Strange" for shocking asystole amongst a host of other sins. Other shows also receiving the same treatment are The Vampire Diaries and Orange is the New Black.

To celebrate the #WATTPADBLOCKPARTY, I'm giving away a 2018 YA Fantasy release to ONE lucky winner. This giveaway is open internationally as long as The Book Depository ships to you. The giveaway link will be posted at the bottom of this post!

Much love,

Katrin Hollister

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