Surgical Resident Breaks Down 49 Medical Scenes From Film & TV | WIRED

[Music] hi my name is Annie Onishi Annie is a general surgeon at Columbia University today we're gonna be breaking down clips from movies and television about the emergency room and the operating room slapping the patient via Biss roll the clip so rule number one of CPR is never stop effective chest compressions in order to slap or yell words of encouragement at the patient's yelling at a patient or cheering them on has never brought them back to life so here we have another example we tried smelling salts caffeine injections ice baths that's not really how we do in real life we have other mean methods to wake up a patient who has some sort of neurological problem we have a proposition for you including pressing on the nail beds as hard as you possibly can or rubbing on their sternum thank you appendectomy spies like us and now the first incision first of all you need two people and two people only to remove a patient's appendix I don't know why there's 25 people in that room second of all that is the hairiest abdomen I've seen in a really long time not the succor surgeons have very severe OCD and all hair needs to be removed before we even think about operating if a patient reacts like that to an incision it means anesthesiologist isn't doing his or her job this man is dead and check out this gas now people who are about to die do display something called agonal breathing which is a very characteristic pattern of respirations but nothing like that something tells me that these guys are not real doctors [Music] coats Rookie Blue in detail that's very accurate is the first person who responded to the code did a nice job of removing all the excess furniture from the room this is gonna make a lot of extra room for personnel any equipment that may be used to help save this patient another very nice detail the nurse calls for help before she even begins chest compressions on the patient it's always important to have backup in a situation like this there a systole this scene also uses some very official sounding doctor words such as asystole and v-fib or v-tach these are also real conditions that would occur during a cardiac arrest and their responses are accurate yeah now if you check out the code scene and drop dead diva somebody in the room says prepare to intubate I need a 12 French this is basically nonsense talk it sounds medical but it's not real at all another thing I overheard someone say is given when the fluids wide open that's pretty accurate something someone may very well say in a code and the amp is sort of an unreliable way to communicate a dose of epinephrine usually we talk in milligrams run the fluids wide open refers to physically opening up the lines that the IV fluids are running in so that the patient gets as much fluid as possible as fast as possible charge in the 360 all clear so here they charge the defibrillator to 360 joules which is an accurate dose of electricity in order to get the heart kick-started into a rhythm that works we got a shockable rhythm 200 joules back in Rookie Blue they charge to 200 joules which is an outdated dose of electricity and no longer thought to be effective now in basketball they shock somebody with 15,000 volts machine only goes up to 360 so 15 thousands a little bit unreasonable you know what you're doing what's it look like an execution adrenaline to the heart okay I think it's ready an arrhythmia is when the heart is not beating in a coordinated fashion for certain arrhythmias a milligram of epinephrine or adrenaline is exactly what we would use to kickstart the heart into what we would call perfusing rhythm hurry up man hurry up here I'll tell you what thank you you can give the shot I'm what you're probably be doing chest compressions as they're trying to sort all this out thank you thank you for the shot there's a whole lot of standing around a whole lot of waiting around for you all right time is myocardium people it's got to be hard enough to get through her breastplate into her heart you also wouldn't really necessarily have to go straight through the sternum to access the heart you could very easily access the heart through one of the intercostal spaces which is the space between two ribs all right and say something something a little bit of a stretch but it is plausible that adrenaline straight to the heart would help patient privacy hangover and cough first of all if you're gonna check some old sweaty do it's prostate please put on two gloves come on what we have here on our hands is a big big HIPAA violation which is the law that protects patients privacy interesting you would never ever examine a patient in his underwear in front of a couple of other patients and you would never discuss patient care in front of someone else no big deal selfies in the or Grey's Anatomy okay what is so mesmerizing that you can't do your job those worms I can't look away [Music] if you took photos of an anesthetized patient without their explicit prior written permission you could get in a lot of trouble you could lose your medical license even almost certainly get fired no more while it may seem far-fetched there is a parasitic infection called strangle Louise this one that does cause your test ins to get completely blocked up by these worms and a lot of times you do need an operation to get them removed happy nightmares removing a bullet mr. Beach we're losing him I've gotta get in there now one of the most frequent things I hear in an operating room on TV or in the movies is losing him I have never once heard that in my real life ever once the point of trauma surgery after a gunshot wound is not necessarily to go get the bullet out what you're really there to do is fix the damage that's caused by the bullet plenty of people walking around out there with bullets that show up on x-rays all the time so the patient seems to be cured here by just the removal of the bullet which I can guarantee you is not what happens and again here we have another example of a patient being miraculously cured by just the removal of a bullet check out Harold and Kumar [Music] genius in general somebody who's shot in the chest is not cured by simply removing the bullet that bullets usually caused all kinds of damage inside that needs to be fixed you guys did it no I've never actually seen anybody cheer when a bullet gets removed because that's usually the least exciting part of that operation and of course with every bullet removal there's the quintessential thank you doesn't happen in real life those buckets are actually plastic so less impressive operating room galleries Seinfeld so just like in Grey's Anatomy this fictional hospital also seems to have a viewing gallery for people to just sit around and watch operations don't they have work to do Oh back in the day before we had the internet or textbooks operating galleries did definitely exist they're depicted in a number of famous paintings from the 20th century but these days is just not a thing talking she's sorry operating room fashioned dead rares [Music] you'd think red scrubs were not very realistic but it turns out they are surgeons and people who work in the operating room have to wear a specific color of scrubs and at my hospital it's red once you've scrubbed in and your hands are considered sterile you do need other people's help to get you dressed patient awareness during an operation from the film so this is a young man undergoing what looks to be an open heart operation who is fully conscious of the proceedings around him I'm supposed to be asleep in general patients don't really dream while they're under anesthesia this phenomenon is called intra operative awareness and luckily it is exceedingly rare yeah in this detail right here the patient's eyelids are taped closed while they're asleep very real it's to prevent corneal abrasions sleeping like a baby for me the most cringe-worthy aspect of this clip is the hair removal from the patients chest razors actually cause very tiny abrasions in the skin which lead to a higher risk of surgical site infections we would never ever ever ever ever use a razor we use electric Clippers this is something I've never actually seen film or TV get right players may have changed but the game is still the same things getting stuck in patients butts from a whole lot of TV shows no in real life this is very very common whatever floats your boat man I got musical farts I've seen a carrot and eggplant all kinds of dildos of different shapes sizes and electronic capabilities a wineglass an axe can of body spray shaving cream that's about it emergency airway control the heat [Music] perform an emergency tracheotomy I'm gonna need a glass of vodka so I really admire Sandra Bullock's hutzpah here I do think that she's really trying to take this situation into her own hands so good for her however in a choking patient emergency tracheotomy may not necessarily help okay if the food particle is stuck further down than where you would put the hole in the neck however she did do her research cricothyroid membrane is exactly where you want to go you probably could have just pulled the piece of pancake out of his throat now if you want to see it done right check out this clip from house here we have a nice long midline incision so you don't ding either the carotid or the jugulars you have a quick dissection right down to the trachea and an insertion of the tracheotomy to perfect very well done good cool self-rescue Casino Royale I'm going to pass out in a few seconds and you need to keep your heart going push the red button now bond this scene has a lot of problems you're welcome for a heart rhythm tune require different relation it needs to be what's called a non perfusing rhythm meaning patient would therefore most likely be unconscious there's really never a situation where a patient would be awake and able to do complex tasks like this but also required to fibrillation don't interrupt if double-oh-seven is conscious and able to have enough dexterity and mental acuity to perform this complex task he almost certainly is not in photography phase and it's not like you can only be partially in v-tach it's like being a little bit pregnant you're either in v-tach or you're not thank you cliche medical terminology 10 cc's of it 500 CC's 5 cc's of that 500 CC's CC actually stands for cubic centimeter which is the same as a milliliter boils are dropping I tell my medical students vitals are vital we always talk about them we always want to know what they are and yes we ask what they are on the regular sinus you know one vital that they never report on in the movies or on TV is urine output okay for surgeons urine output is probably the most vital vital sign this is actually from the Latin stem which means immediately very commonly is would be a great spokesperson for things music in the operating room scrubs we need to make this decision now Marlon it's on you nurse eraser Yes Doctor this is a very accurate depiction of how the music gets chosen for the o.r yes it is in general the attending surgeon is the boss and the attendant gets to pick the music I think you saw we usually wait until the patients asleep until we put the music on two men but the discussion before the operation of what we should be listening to is a tale as old as time in the o.r it makes you think you know better now if you check out nip/tuck eyes without a face by Billy Idol facial plastic surgery do something wrong pretty good alternatives to anesthesia Harold & Kumar Go to White Castle we should probably use marijuana that'll sufficiently sedate the patient for surgery marijuana would be a very bad drug to anesthetize a patient with ripping I found it really does nothing to desensitize your awareness or your sensation of pain another example of where they got it wrong is in faceless what are you doing you're crazy patience completely wide awake for a face transplant totally unrealistic small bowel resection the neck we must operate but we cannot do it to a man who can feel pain so I think this clip is really well done in terms of an accuracy standpoint the description of the operation is really well done on the nerves in the spine between the thoracic vertebrae 6 and 7 so as to stop the brain from learning of the pain their attention to historical detail is also pretty good too in terms of having an open our gallery people without gloves on people without gowns and masks that's just about accurate for the 19th century so I know we've already discussed that oh art galleries aren't really a thing anymore but back in the 19th century they totally were and you can see that here I know it looks scary but this is an early prototype for a stapler that is used to connect to portions of small bowel still used today all right check this part out I love this partner searchers failed in two spots for the obstruction backed up with pressure on them you should rethink the neck is very accurate in terms of representing a body part called the mesentery which is almost never depicted in Hollywood it's the actual connective tissue that brings the blood supply to and from the small bowel the Nick does it right but so many examples where Hollywood gets it wrong here's an example from Hannibal where the mesentery is just completely absent shot mesentery never gets any love yeah I want to tell your father all about this timing the surgery Grey's Anatomy you know why Cristina I'm on a clock and you're wasting my time what's your problem surgeons are some of the most competitive people on planet earth so it really does not surprised myself that dr. yang is timing herself doing this procedure my personal record for cholecystectomy is 22 minutes very nice homemade surgical instruments dead ringers surgeons instruments are really extensions of their hands and certain surgeons have very specific preferences for the instruments that they use I've just made brand new a lot of our instruments are actually named after the people who did at one point invent them at home and bring them in to try them out all right so these instruments are kind of interesting they look both futuristic and medieval at the same time I'm afraid I'm not familiar with these instruments doc and I can only guess that they're used in gynecology it's a this reaction to bleeding is a little bit dramatic yes patients bleed in the operating room no people don't sort of run around and scream the patient's bleeding stopping a surgery at the last second house I can't feel my lights I can't feel my legs so I've seen a couple of patients have panic attacks before operations before we do any operation we go through a very extensive checklist with the nursing staff with the anesthesiologists it helps us review why we're there in the operating room what the possible risks of the operation are and just make sure everybody's Ducks are in a row John we're gonna figure out what's wrong with you first we need to know one thing it's pretty unlikely that we would get to the point of doing this checklist and not really realize some kind of massive major problem with the patient would be having right before they get induced under anesthesia dr. Wilson we have a problem and check out dr. House's clothes first of all he doesn't have a hat on second of all he's in his street clothes in real life that guy would have been tackled by about six tiny perioperative nurses far before he got to the operating room what did you do stealing a dead body from the hospital from Little Miss Sunshine I have never worked in a hospital that has patient care rooms on the first floor hospital windows don't even open patient is super sick is gonna have all kinds of tubes attached to them lines some hospitals even have patient tracker bands that the patient wears so you can know when the patient for example is at the cat scanner in the operating room you can't just abandon the body that would set off some alarm somewhere in the hospital the only one is has somebody died here today okay emergency arm amputation requiem for a dream [Applause] Savva they're using is more commonly used in autopsies to get the chest open but not something that we would use on a living patient no autopsies you guessed it from Grey's Anatomy don't even tell me you're doing what I think you don't in real life pathologists do autopsies these are medical doctors who are specifically trained in this type of procedure at this point what could it hurt surgeons don't do them internal medicine doctors don't do them not only did you disregard the family's wishes you broke the law and doing an autopsy on a patient without that family's informed written consent is a big big illegal no-no huge trauma arrival Westwick visible so even though this patient is the president it is very standard to have a lot of people involved in any trauma resuscitation you know they're gonna bill me for that sometimes there's as many as 10 maybe 12 or 15 people in the room all there to take care of the patient you need medical conditions well I'm in shock everybody has one specific job and one specific job only you do that job and you get out at this point most family members are in a waiting room somewhere we do need to all do our jobs and take care of the patient in that moment and it can be very distracting with a hysterical family member in the room mom's gonna be pretty pissed a resident struggles in the operating room Grey's Anatomy it's secured directly or clinched I don't know what to do I don't know she's crashing in this scene we have dr. Cristina Yang who is a resident doing a open heart operation with her attending in the background reading The Atlantic Monthly why isn't she helping so this would never happen in real life surgeons and residents learn to operate in a step-by-step process that we refer to as graded autonomy we learn the steps of an operation and very slowly gained her independence teaching she's learning if a patient was ever in trouble if the resident couldn't get themselves out of danger in an operating room an attending would always step in and help yeah he's killing her patient Altman's reading The Atlantic Monthly totally unrealistic surgeons don't read it like monthly waste of time right they read the New Yorker a surgeon removes a live bomb Grey's Anatomy no longer inside of me threatening the life it belongs to surgery to remove unexploded ordnance is a real thing the Army has published guidelines on how to do it safely [Music] arterial spray Blackhawk down that's quite dramatic blood can spray from an artery if it's severed in an open wound but that specific example personal on the loop is under quite a bit of pressure and the human body does not generate that amount of blood pressure it's not possible like a surgeon by Weird Al Yankovic [Music] everything depicted here in this music video is according to my experience 100% accurate and true just kidding it's completely ridiculous but it's still very funny and I love it conclusion at the end of the day I don't expect the directors and the actors to get every little detail right but it's still pretty fun to watch and by the way if you are enjoying technique critique subscribe to Wired step

Channel: WIRED

Views: 6,878,202

Rating: 4.943346 out of 5

Keywords: doctor, dr, emergency room, er, grey's anatomy, jargon, medical, or, surgeon, operating room, arts & entertainment, technique critique, medical breakdown, or/er, annie onishi, general surgery, medical expert, expert break down, movie scene break down, medical scene, medical terms, medical jargon, stat, hipaa, operation, movie scene, operation room scene, er scene, surgery, movie breakdown, movie facts, doctor movies, breaks down, hollywood, movies, wired

Id: vGOL7ZvuGMc

Length: 20min 56sec (1256 seconds)

Published: Wed Mar 14 2018

Reddit Comments

[u/cupidd55]

Always liked the language and accent technique critiques. Hope they expand this series.

[u/TV_is_my_parent]

Cool, informative. Loved the surgeon's demeanor.

[u/BraveStrategy]

Very interesting. I always thought it was weird that they act like just pulling out the bullet was priority after a gsw. She does a great job. She could definitely be on camera more.

[u/Fizrock]

Very doctorly. Breaks things down and explains them well. Nice.

[u/roseserpentmoon]

I knew Weird Al’s ‘Like a Surgeon’ was totally correct presentation of surgical procedure!

[u/Neeeechy]

As someone in medicine, I second her support of "Scrubs" and "The Knick" being the most accurate medical shows.

[u/CopyX]

This is awesome. I'm glad Wired expanded their series to include this.

One thing they didn't include in there that is my cardinal pet peeve is people yell "flatline" and then shock the patient. She made a good point that the only shockable rhythms are VTach and VFib. Asystole is not shockable.

[u/dembro]

I actually filmed a brain surgery for work a year or so back. Room had a gallery that we could watch from, a rotation of Neuro ICU nurses were watching so they could learn what their patients go through. So that’s actually still a thing.

[u/WonaBee]

Awesome video, loved her full-body shiver when the worms were shown.