Surgeon Breaks Down 22 Medical Scenes From Film & TV | WIRED
Hi. I'm Annie Onishi Annie. Onishi is a surgery resident, no no I graduated. Residency, I'm a fellow in trauma surgery and critical care now you, asked for it I'm back, breaking down more clips from film and TV. Roadside. Liver surgery, the good doctor, here's, your liver I'm gonna need you to sign for it how long ago did you take it out three hours, we just lost three, hours, technically. Three hours and five minutes your, clocks on the cooler so. Once an organ has been removed from a donor that starts, the clock for what's called the cold ischemic. Time that, is the amount of time that the organ is not actively, receiving. Blood flow from, the original, patient and from the recipient, what about a police escort. My, doctor's an. MD does actually personally, deliver, that cooler you, get to write on an airplane sometimes, get to write in the back of an ambulance lights, and sirens it can be pretty exciting I don't. Know what you're looking for sure yes, I can feel it it's firmer I don't know what that means there. Must be a clot but there isn't a clot this can show no clot there's no way you would be able to detect, a clot or a thrombus inside, the liver that's just not unless. You had an ultrasound vision. Of the tips of your fingers you wouldn't be able to do that we, have to immediately remove the clot and flush the left lobe to protect it from the ice baths you don't need to protect, the liver from the ice bath I'm not sure what he's talking about okay we need to stop the car sure, yes yes we need to operate right. So. Great thank googled queen of segments, that's like, super cutting-edge super accurate so, the Queen ode segments, are how we anatomically. Divide, the liver based on its blood. Supply and its biliary, drainage, so. There are segments, one through eight this. Is correctly. Labeled it's missing segment 4a and 4b but other than that that's that's. Pretty good, this. Is also not what a liver looks like so, when a Limor is procured, from a donor it actually comes with a bunch of stuff attached, to it so it comes with the the big portal, triad attached, to it that has a basically. The business end of the liver how the liver drains it, comes a little piece of intestine attached, to it still bunch, of blood vessels in the back we, bring, more, than we're going to need basically, it does not look like that this, is better than having a baby in my car do not put that liver into me, subcutaneous. Infestation. Evolution. I.
Would. Put a tourniquet on the leg and trap it and then and go after it that's what I would do. Going. The other way how, you going in rectally. Personally. I don't think I could get to this directly. It does look pretty simcha, taneous. Agree. There is always time for lubricant. Oh. Clinch so as an expert in rectal, foreign body surgery telling. The patient not to clench is not gonna work you really have to give these people a lot of sedation and get them pretty much totally asleep if you're gonna go, up there and fish something out. He. Looks like he's in a ton of pain and obviously very, uncomfortable, there's, no chance of getting anything out. I've, never. Personally seen, a bug like that craw from the leg into the colon what do we do the only bugs, I've ever encountered. Have, been in Kenya there's an intestinal, parasite called, ascariasis, it's. A series, of tapeworms, that end up living inside, the intestinal tract and actually cause obstructions, don't. You ever do. That again. Craig Oh thyroid out of me from anaconda. That's. Not exactly, how you do that a cricothyrotomy. Is. An emergency, procedure that, is performed when. A patient, has their. Airway, that cannot, be intubated, from their mouth so looks, to me like the indication, here for Craig is that this patient has some sort of wasp in his upper airway so maybe, there's some swelling in the airway so, typically, a breathing, tube will go into the mouth into the trachea and then we can connect, that tube to a breathing machine so the patient can still breathe, in. An emergency situation like, this yeah I would probably just, use my knife get down to, the cricothyroid membrane and yes enter sharply, like he did there I'm. Not sure what kind of tube it is but it looks like a reasonably, sized tube but they would need to start ventilating right away it doesn't work if you just stick it in there you have to breathe for the person. Chaotic. Emergency, Grey's Anatomy. Can't. Frighten the, doctor here says that she can't crike and I don't know why I can almost always cry he's, got stuck you emphysema and. This, thing that she says sub-q, emphysema, what, that refers, to is that child has air, in. The skin and soft tissues, on the chest that's, usually a sign that something, really bad has happened to this kid he probably has an emergency chest tube and he certainly needs his airway controlled somehow all right. -. Orange. Drawer orange. Drawer. I knew. That no chest sounds on the right HSP. Seconds, anybody actually have chest tubes so clearly in this chaos the nurses are not here, so the doctors, are trying to do the job of both the doctors and the nurses and, this is what would happen I'm trying to set up this saline, drip and I can't get this thing to stop beeping, anyone, so that's a hundred percent accurate so when doctors. Like me try to set up IV pumps, which is normally the nurses job usually we can't figure it out usually there's, bubbles, there's beeping there's alarms nothing, works and a nurse usually has to come and rescue me IV, drip rate it's different for kids depending on the size so anybody the calculator.
How's. That taste Izzy's 30 kilos that broselow, tape that's, a real thing so when a child comes in it is a tape that you literally, measure their body length with and it will give you the best estimate, for how much that kid weighs, throws. Out tapes is he's 30 kilo Stanek concentration of dopamine is 1,600 mics per CC so five times 30 is 150, times 60 minutes and hours 9,000, divide that by 1,600, infusion rate is five point 65 cc's per hour so that's the kind of math that nurses, do in their heads all the time or they have memorized from giving this medication so frequently, I feel, like an idiot, brain, transplant, and get out, so in get out they perform a series of really barbaric. And racially, driven brain, transplants, luckily, in my opinion, brain transplant, is not a thing and probably won't ever be a thing. Rookie. Mistake you're all sterile, you're all scrubbed in and then you touch your mask start. Over. So. Technically those glasses don't count as eye protection. He's. A psychopath, but he should really know more about sterile technique. In. Real brain surgery, you don't actually remove, the skullcap you made sort of a curvilinear incision. Along the plane of what, part of the school you're gonna remove. So. This is clearly dr. Armitage is special, torturer. Brain surgery tre oh wait I am so. Confused. I don't, really, recognize, any, of those instruments. I think the. Instruments. Second, from the bottom, looks. A little bit like something called a Roger, which, is how you remove bone fragments, from things I see some suture. Scissors up next. Honestly, the thing on the left looks like a speculum. For lady parts but I'm not sure. I mean I've told you not to go in that house. Directing. Your own surgery, Ronin. I've. Done this many times before we. Just cut up there just. A little cut. The. Operating, surgeon here is using an 11 blade that's typically, not really used, on skin, in this manner typically. To make the first incision on the skin and use a 15 blade or a ten blade take. The clip this is a sponge stick you see a ton of sponge sticks in medical dramas it's unbelievable. Avengers. Pose. This is not how you use a sponge stick a sponge, stick is typically. Used deep in the body it's a piece of gauze wrapped around what's called a ring forceps, I'm sure it's, used to very gently retract, a very delicate structures, that are deepen in the way it's not used to the lot that's. Open it up spreads but Robert DeNiro is describing, spread spread spread which, means actually inserting, the tips of that instrument and spreading. Tissue so you can make a cavity bigger that. Is a maneuver, that we use, in surgery very commonly if we need to get access to a certain place. Dropping. Someone off at the year and then leaving Hustler's. This. Is actually a thing we, sort, of tongue-in-cheek. Refer, to this as the homey drop usually, it's because either they happen to be right by the hospital when they got hurt or somebody's, too scared to call the cops or call EMS usually. We're just grateful that they brought the patient to medical attention so we can help them heart. Surgery from Krank -. Mm-hmm. That, is not what the human heart looks like first. Of all it doesn't continue beating once it's all disconnected. Without. Sounding too creepy yes we do comment on people's insides. So. As silly as that looks, that, does actually, exist in real life it's called a total artificial, heart it's. Usually used, as a bridge to a transplant, for a patient who has something very very wrong with their with, the actual muscle of their heart yes. This, is definitely some back-alley, heart surgery I really, would not recommend going to these doctors. Jack's. Appendectomy, lost. So, you do actually flip the needle like that that's to get the little air bubbles out so you don't inject air into the patient no Jack they found some chloroform at the medical station I could not you out. Managed. With I became lidocaine, is a local. Anesthetic, that's used to numb, the area. It's, what you commonly might get in your gums at the dentist. That. Is a massive, incision. For an Appy that was huge, totally. Unnecessary. A penis short for appendectomy, which, is the surgical, operation to remove the appendix spreader. I think, that she's probably asking for what's called a self-retaining, retractor that's. A little skin retractor that would stay open by itself bring, your hands oh look, that's actually what's called a finished shuttle retractor, not, typically used on the abdomen. I'm. Sorry jack okay well, he's just being, loud and fidgety I would want him knocked out too but we actually there's a lot of reasons when you put patients under, general anesthesia for surgery obviously, one is comfort the, other is total muscle relaxation, so we actually give you a little bit of a paralytic, so your muscles completely relax and that actually makes incisions.
On The abdominal wall much easier would, you rather be dreaming about something nice back home eating. Human, brain from, Hannibal see the brain, itself. Feels no pain carries, that that concerns you so, it is actually true the brain itself, has no pain fibers so, once the patient has been sedated, and, the craniectomy part, has been performed, they don't actually did numb the brain in any way here's, the. SAC. That contains, the brain. So. Here this little membrane dr., Lecter's removing is something called the dura it's not really that stretchy, or. Kind, of shiny like that or rippable like that but that is an actual layer that protects the brain between the brain tissue itself and the skull and, if you look at this diagram here you can see all the different layers in the head so you have the scalp the, skull then, there's a potential. Space with, the different layers of dura followed, finally by the brain tissue actually below all of that. That's. Smells great I. Personally. Prefer mine with a little more garlic than that but I'm sure this is fine so I'm not a brain surgeon I do know that in some neurosurgical, procedures. The patient is actually wide awake so, that fine, elegant, tasks. Such as speech or fine, motor movement, can continue, to be tested while the surgeon is operating, on that particular, area of the brain so. That way the surgeon knows this is the area that's controlling this for this patient we shouldn't cut that we shouldn't touch that self. Surgery in Wolverine. I. Gotta. Get that thing. First. Of all I wish my scalp was attached to my hand like that that would be pretty cool. That. Looks like pretty pure CGI to me doesn't look like real x-ray. There. Are some, operations, that we do use active, x-ray, so we can monitor. Certain parts of the body while we operate on them keep going, so our, orthopedic, colleagues always use something, called the CRM which is a dynamic, movable x-ray, to take pictures of the bones as they're getting fixed, same, thing with vascular surgeons they very commonly use x-ray to take pictures of the blood vessels that they're operating on and to fix those blood vessels so the use of x-ray in and of itself during surgery is very common the. Surgical checklist er. Remember. Being asked if dr. Benton could scrub in for this this is an example of how a surgeon, comes in with his hands sterile and somebody else helps him get dressed put him under let's do this what, about the checklist excuse. Me, safe. Surgery checklist this safe surgery checklist is, a real thing that's practiced, every day in every operating room in this country I've, had 10 cases a day doctor it only took a minute 1 minute John Carter here for a right cadaveric renal, allograft does. The patient have a known allergy, no. Does. Anesthesia, anticipate. A difficulty, or no is the risk of bleeding greater than 500 CCS, so that's a great representation of a surgical time out that's really thorough it goes, through all the major important, things any nursing, concerns you don't have any reperfusion solution we, won't be meeting it. They. Said they didn't have enough perfusing, the solution in the room so the nurse went to go get it and that's gonna save them some trouble later on in the operations, that people aren't rushing around trying to get what's needed I think that this is an excellent teaching opportunity, we take, this practice, from airline, safety so before an airplane takes off the, pilot.
The Copilot and, the, air traffic controller, go through a checklist where they check every single system on the airplane and make sure everything's in working, order before the plane takes off a surgical. Checklist is the same thing we make sure that we have identified, the proper patient, that we're doing the correct, operation, that we have all the equipment week we need and it, really is meant to reduce medical, errors and surgical errors now, let's just take. That time and introduce the room she'll Elaine scrub, nurse paula cheney circulating. Nurse k Schumacher, anesthesiologist. Randall Aukerman chief surgical resident, Ethan, Dean Surgical. Intern that's, actually a great representation of who all is in an operating room he had the attending, he had two assistants, that resin in the intern, those. Two nurses they're the circulator, and the scrub tech as, well as the anesthesiologist, this is actually very accurate warning. Antibiotics, given in the last sixty minutes just starting them now. If. You running any marks prior to incision you've got the risk of infection by half dr.. Benton, you're. A guest here and I, don't like guests. As, a friend of the patient you're, welcome to sit observe. And shut, up. In. Real life surgeons are definitely, not that impatient, they will absolutely wait for the antibiotic to go in because they don't want the patient to get an infection any concerns from the surgical team only that you're wasting my time so it seems like this surgeon, who's about to do this operation is sort of anti checklist, that's, really a no-go these days so we always do a time out in a matter way that has a lawsuit waiting to happen, impersonating. A nurse the, dark night. So. Nurses do where Nursing Uniforms that's a little outdated old school most of them are just regular scrub, tops and a uniform top that just says RN in the name of the hospital. So. If Harvey Dent really had a burn like that in real life he, would be intubated, he don't be on a bunch of medications, receiving, a ton of IV, fluids, he would be really really sick and really not able to fight back when the Joker comes. And. Here. In the background you see some coronal. Images, which is a means. A picture taken in this dimension, of the body that, looks like an MRI slice of a brain it looks pretty normal I'm not sure why Harvey Dent would have needed to have had an MRI I, don't. Want there to be any hard feelings between us Harvey a patient. Intake survey Parks and Rec everything, you write down is confidential. We need you to give real answers fine. So, there are definitely some patients, I meet that are not super, trusting. Of doctors, it's, okay you know it usually comes from probably. A bad experience, but, there are better ways than what she's doing to sort of work around that and get the patient to warm up to you a little bit Ronde you. Redacted, all the information, answered some of them for date of birth you wrote springtime. You should be a little more friendly her, tone is little terse she looks a little impatient, her, facial, features are not super, friendly warm welcoming, or patient so she could probably take. A chill pill and try again organ. Procurement Robocop. To make it fast because six minutes before the. I'm. Not sure what she's talking about the. Brain is always, gonna be this list there's no such thing as a brain transplant. So. This is the way how they would brain, surgeons, like to do crazy activies, which is like a full top. Skullcap, craniectomy. But. That's not really how it's done in real life as. Far as I know there's no suction. Cup effect but correct. Me if I'm wrong. So, this makes no sense at all, so this guy supposed to be dead this is a bypass machine so the bypass machine is pumping. Blood for him in a supposedly, dead body so. Not. Terribly consistent. I've. Never seen a dissection like that I don't think you can get all those parts out together unblocked. Like that I mean to transplant, organs you just put them in a little bag with ice in a plastic bucket you don't use, this bubbling. The fishtank sort of set up I've never seen that before poor old literally a, gunshot. Wound from Seraphim Falls. You.
Don't Necessarily need. To remove a bullet just because you have a bullet inside but, if you want to have Pierce browse and take his shirt off and flex this is a good excuse to do it. So. You could definitely use a red-hot. Metal blade to cauterize a wound but that thing was not actively, bleeding so I really I would just have left that alone another. Shirtless, guy using fire to cauterize his wound Rambo 3. Here's. Another guy with limited medical resources. And what appears to be a soft, tissue injury in, the absence, of you. Know hemorrhage, or something that really needs to be controlled I would just I would just leave these wounds alone but I think this is pretty reasonable technique, to cauterize but again completely. Unnecessary. Serious. I'm. Serious the. Janitor makes the diagnosis, the fugitive. Can. You give us a hand here you bring this kid down to observation, room - it. Would not be typical for someone. From the housekeeping, staff to transport, a patient. This. Doctor. / janitor, is looking, at the x-ray of what looks like a baby you can tell sort of from the dimensions, of the chest and the way the bones look he's also looking at that x-ray backwards, you can tell because the, heart, is not where it's supposed to be. Your. Brother, they downstairs, I. Can't. Exactly tell he's crossing out and what he's about to write but on any medical record it would be really suspicious to cross something out you'd have to get new for him. Investors. So. Patient, handoff doesn't really work like that these days. Usually. It's, a, series, of phone calls from the nurse in the ER to, the accepting. Nurse and the o.r on the floor same, thing with the doctors there's a series of what, we call handoffs. About the patient what their diagnosis, is what workup has been done what other tests, don't need to get done it's usually not like this where it's kind of a word-of-mouth and a trust this guy in the janitorial uniform, to give me this Candice diagnosis, that's a little suspect. I, don't, typically. Affectionately. Rub the faces of my patients before they get wheeled off the surgery no that's not really my style.
Horse. Tranquilizers, are straight to the neck old-school. What. Kind of good is this, that's. A tranquilizer, gun. Not. Exactly, sure what tranquilizer. Was in that tranquilizer. Dart but one common, tranquilizer, that we might use in the emergency, setting is something called ketamine. Yes. Is. A drug. That works very quickly it, doesn't cause any major, hemodynamic. Shifts, meaning it will alter your blood pressure too much and. It's a quick on quick off kind of drug so it's pretty it's a pretty good medication, to sedate a person in the emergency room if you have to do some some quick procedures, we. So. Definitely as the medication, is setting in patients, will start to feel foggy start to feel groggy and may yeah I have some mental slowing. Whoa. Impersonating. A doctor catch me if you can gentlemen. What. Uh what. Seems to be the problem. Bicycle. Accident, spongy. Check strikes again actual. Tibia about five inches, patella. Dr.. Harris yes. Do you concur I mean, he sort of looks like a doctor, he talks like a doctor, I think he could probably trick a couple people but, I think that this is a little bit of a stretch I think. We should take an x-ray then stick him out you put him in a walking cast, so. I completely, disagree with his suggestion, I get this kid in a walking cast what that looks like is called what we call an open fracture, meaning, you can see the bone through the injury, so, that actually is, pretty involved it's usually more of a severe injury that patient you should probably, go, up to the operating room get a really good washout for concern, for infection. And probably get some surgery to fix that bone a. Dead. Giveaway here is the nahji most, doctors aren't too squeamish. Here's. An example of a patient arrival, in code black, 16. Year old boy fell down stairs minor. Okay hey. How you doing buddy fine I fell this is all probably overkill did, you see Vincent sir, no I did anything, else you can tell us nothing, so this is a pretty good example of, the first responders, doing what's called giving, report, they are bringing, the patient in they're telling, the doctors. And nurses in the hospital what happened, to the patient it sounds like this patient fell down a set of stairs minor burns no ko when they say no ko means, no loss of consciousness or, no knockout anything. Else you can tell us so, here we have two nurses sort, of dividing and conquering one, nurse is getting what's called collateral, history from the person who came into the hospital with the kid and the other nurse is attending, to the, child's medical needs right now that's a really. Dumb actually, I fell down some stairs this, seems like a pretty stable patient, with a relatively, minor, mechanism. Of injury so for that reason there's, no trauma. Team or a bunch of surgeons running around trying to figure out what happened to the kid it's pretty much just nurses at this point. Tick-borne. Illness, house. Tick. Paralysis. Damn, tracked a tick onto his jeans all rights don't ordinarily cause I feel like shocked this girl's allergies, are not ordinary. It's, just gonna get worse so that bag-valve-mask that's, like atrocious, right there bag, valve mask ventilation, is, seen here with this purple that's called an Ambu, bag as well, as that mask that's on the patient's face that, Ambu bag should be squeezed in a very particular way to observe, the Chester eyes and a certain rate so, the rate at which she is squeezing which is really, fast that's gonna cause. A couple things number one is hyperventilation, number. Two she's just gonna fill that patient's stomach with air which can cause. A lot of other problems down the road as. Long as we're stuck here it's not even time to look for that tick. That. She was wearing off so he says here the atropine, is wearing off atropine. Is a medication, that we would use for bradycardia. Which is when the heart rate is really slow so, it sounds like she got really bradycardic. They gave her atropine, it's wearing, off meaning, her heart is slowing down again, and on the monitor you see that her heart rate is 45, so it's pretty slow we. Treat her symptoms she dies we find the cause she lives that, tick is an IV drip of poison we ever get to be fine oh my god. See.
Usually. With tick borne illness you get like a what's called a dilated cardiomyopathy but. That takes like weeks, to months develop, this is that's just this is not real I don't know how to tell you conclusion. I realize that a lot of what Hollywood does in, the or in the ER is for dramatic effect but it's pretty fun to check out what they do right and what they do wrong and don't forget if you're enjoying technique, critique subscribe, to Wired.