Leyner: You think THAT’s sophomoric?
Leyner: That’s the whole comic tragedy of life!
Leyner: And the central thesis of our book, yo.
Gberg: What is the thesis of our book?
Leyner: The intertwining cosmic threads of poop and porn.
Leyner: That’s string theory, ever hear of it?
Gberg: I am very slow on the keyboard this a.m.
Gberg: I think my head is going to explode.
Leyner: That we valiantly attempt to create poetry and architecture and pass along culture and bequeath our genetic heritage, ALL in the face of certain decrepitude and the abject indignities of old age and DEATH.
Leyner: It’s a grim struggle each and every day to maintain my dinginity in the face of “reading glasses.”
Leyner: Dignity.
Leyner: I misspelled in my passion.
Gberg: Hold on 1 sec.
9:55A.M.
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CHAPTER 7. MEDICINE FROM THE MOVIES AND TV
Theflurry of bathroom talk was cathartic, leaving everyone feeling purged and invigorated. Joel, with a newly found confidence, is leading a small group in a game of charades. Leyner, with the nearly empty tequila bottle in one hand and a fat Cohiba in the other, is gesturing madly and attempting to act out a scene fromGone With the Wind. I mistake Leyner’s gesticulations for a focal seizure and I run across the room to administer first aid. The group assumes that this is all part of the clue giving and continues to shout out movie titles. Leyner’s face is contorted in a bizarre grimace as I assist him to the ground and protect his airway with a head tilt and jaw thrust. Leyner is now scowling and I realize this is not a seizure as Cinderella incorrectly guessesSpartacus.
Joel shouts out,“Vision Quest!”
And Jeremy quickly replies, “Dude, they’re not wrestling, I think they are in love.”
Joel quickly responds,“The Birdcage!”
And Cinderella guesses,“Willy Wonka and the Chocolate Factory.”
Jeremy turns to me and blurts out, “Are Oompa Loompas orange from eating too many carrots or are those little bastards just using too much self-tanner?”
Before I can respond, Eloise saunters over and — astonishingly — says in a slow, wistful drawl, “It’s got to beGone With the Wind. I’d have a fit too if my ten-million-dollar Charleston bungalow burned to a crisp. Oh poor beautiful Tara.”
People often leave the movie theater filled with questions about what they’ve seen on the screen. After a thrilling episode ofER, I can always expect to get a call.
Accurate: accu•rate; adjective.
1. Correct in all details.
2. Free of mistakes or errors.
Of course it’s not completely accurate! It’s TV.
But the writing staff does capture the general controlled chaos of an ER. They deal with real medical cases but their medical depictions are always embellished to add a little extra Hollywood flair.
I did my residency in emergency medicine in Los Angeles, whenER was just starting and the writers often came by our hospital looking for new ideas. One patient I saw there was portrayed in an early episode, and highlights the writers’ taste for the dramatic. One day, a baby was playing with a coat hanger and the tip of the hanger got stuck in the back of his throat. The paramedics carefully brought the baby in to our ER with the hanger dangling from his mouth. This was, of course, very dramatic looking, and we all rushed over immediately. The child was scared but was breathing fine and my fellow doctors and I did our best to just leave him alone and keep him calm. (Rule #1 of medicine: do no harm.) An X ray showed that the tip of the hanger was superficially caught up on the back of the child’s throat. Now… for the big dramatic ending: we simply reached inside and removed it. Case over!
OnER, however, when the glamorous doctors tried to remove the hanger from the child’s throat, the baby started to bleed profusely. After an emergency tracheotomy, some miraculous bedside surgery, and a little on-screen romance, this child was just barely saved.
Amnesia seems to be one of the favored topics of screenwriters for an easy plot twist. The list of “amnesia movies” can go on and on: The Bourne Identity, 50 First Dates, Desperately Seeking Susan, Eternal Sunshine of the Spotless Mind, Overboard, Spellbound, Total Recall, to name just a few.
The amnesia that doctors see is very different than the big-screen version.
Amnesia is best defined as a failure to retrieve information or to place information in an appropriate context. Amnesia rarely erases memory of all past events. No one suffering from amnesia actually goes through the rest of his or her life without an identity or any knowledge of the past. Memory loss is usually temporary and only involves a short time span of the person’s life.
Types of Amnesia
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anterograde amnesia:
Inability to remember ongoing events after the incidence of trauma or the onset of the disease that caused the amnesia. Anterograde amnesia often occurs following an acute event such as a trauma, a heart attack, oxygen deprivation, or an epileptic attack.
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retrograde amnesia:
Inability to remember events that occurred before the incidence of trauma or the onset of the disease that caused the amnesia. Retrograde amnesia is often associated with neurodegenerative pathologies such as senile dementia and Alzheimer’s disease.
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emotional/hysterical amnesia (fugue amnesia):
Memory loss caused by psychological trauma such as a car crash or sexual abuse. Usually it’s a temporary condition.
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lacunar amnesia:
Inability to remember a specific event.
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Korsakoff syndrome:
Memory loss caused by chronic alcoholism.
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posthypnotic amnesia:
Memory loss sustained from hypnosis. Can include inability to recall events that occurred during hypnosis or information stored in long-term memory.
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transient global amnesia:
Spontaneous memory loss that can last from minutes to several hours and is usually seen in middle-aged to elderly people.
Here are some movies that Hollywood executives would like to forget: Gigli, Ishtar, Howard the Duck, The Postman, andThe Adventures of Pluto Nash.
“No, you don’t gotta fucking stab her three times! You gotta stab her once, but it’s gotta be hard enough to break through her breastbone into her heart, and then once you do that, you press down on the plunger.”
— Lance (Eric Stoltz),Pulp Fiction
No, intracardiac injection is not recommended for routine use during CPR. Translation: ER docs don’t ever inject anything directly into people’s hearts. There is an uncommon procedure called a pericardiocentesis when a needle is inserted under the breastbone and into the sac around the heart to remove excess fluid. This is done when fluid or blood surrounding the heart is restricting its function. This is only done in serious emergencies.