LEADING A DOUBLE LIFE_002

Leading A Double Life

LEADING A DOUBLE LIFE__EPISODE 002 Code Blue Hi, everyone, and welcome to episode 2 of my podcast Leading A Double Life. I’m Kwei Quartey, a physician and author of the Inspector Darko Dawson novels. On my podcast, stories of what it’s like to be a medical doctor and a writer. This episode, Code Blue. The emergency room double doors burst open and two ambulance guys tear in with an unconscious man on their gurney. The ER trauma team usher them in as one of the EMS techs gives a brief rundown of what has happened. The man is a gunshot wound victim. As soon as he’s hooked up, the cardiac monitor shows he has flat-lined. The physician leading the team barks orders for IV infusions and different medications to inject into the victim’s veins in an attempt to resuscitate him. There’s been no response in the first ten seconds. “He’s still flat-line!” the doctor yells dramatically. “We need to shock him!” A team member removes the counter-shock paddles from the defibrillator, applies gel to their surface, rubs them together and puts them on the unconscious man’s chest. “Clear!” she shouts, and everyone steps back from the gurney. A shock is delivered, causing the man’s body to lift involuntarily a couple of inches off the bed. This could be a typical code blue scene from any number of popular television series about the drama in an urban ER. Pretty exciting, right? Maybe, but there are a couple big bloopers in the scene I’ll reveal to you a little later on in the podcast. But before I do that, here’s another scene, quite different, this time from a Netflix show called Rosewood: Preparing for a postmortem exam, Morris Chestnut as Beaumont Rosewood, a forensic pathologist, stands over a dead woman on an autopsy table. Rosewood has blue nitrile gloves on and wears a red V-neck shirt with dark blue jeans. He picks up the scalpel to begin his first incision. If you haven’t already figured out what’s wrong with that scenario, I’ll let you know in a little bit. TV programs and movies with medical or forensic content may consult physicians or other medical experts to ensure the scenes come off realistically. However, I feel American TV in particular appears preoccupied with having physicians, staff, and patients all young and beautiful. In the real world, it is often the graying, experienced physicians and nurses who are in charge of the team on duty in the ER. A dying patient really doesn’t care how beautiful his lifesavers are. My observations are that Europeans and Scandinavians are less afraid to show plain, average looking people on TV and in movies. The point is, they appear both genuine and genuinely smart. I don’t have much need for Code Blue situations in my detective novels, but forensic pathology and postmortem exams are a different matter. They are relevant and often crucial. All of my Inspector Darko Dawson books include at least one autopsy, and my novel Death By His Grace briefly describes some of the fascinating forensics of blood spatter—fascinating to me, anyway. By the way, if you use Luminol to make traces of blood fluoresce, the blood is destroyed forever and you can’t run any DNA on it. There’s something mesmerizing about the autopsy ritual—the donning of protective clothing before entry into the postmortem room, the approach to the dead person lying motionless on the autopsy table, examination of the external body before the traditional Y-incision made on the cadaver’s chest, and the anticipation of what information lies in wait to spring its surprise. It’s important to me also that the pathologist treats the dead body with respect, no matter how maimed and disfigured it may be. The murder victim is a silent self-witness to the crime. She can’t speak, but the autopsy is the way we ask her to nonverbally tell us the story of what happened. It’s certainly poignant, even maybe a little sad, that the procedure necessarily involves the infliction of more wounds than dead body already has, but obviously this time the motive is not to harm. Years ago when I had an interest in becoming a forensic pathologist, I requested permission from the LA County Medical Examiner’s Office permission to see the facilities and attend a few autopsies. A gracious and experienced pathologist there was happy to accommodate me, and she taught me a lot on my first visit. However, when the chief medical examiner at the time returned from a trip out of town and found out I was a novelist in addition to being a physician, he called me up and told me to forget about returning for another visit to the ME office. Curious, I asked him why. In reply, he said the director, cast, and crew of a certain Oscar-winning movie had once barged into the LA County Medical Examiner’s Office without full permission to film, and turned the place upside down. Whether that story was true or not, what did it have to do with me? “Just don’t come back,” the chief told me bluntly. Apparently he thought I was going to misrepresent the LA County ME in one of my novels. I have to say that a physician-author unobtrusively observing a few autopsies would have constituted the least of the LA County Medical Examiner’s problems. Not only back then, but to this day, the office has had tremendous challenges with a surfeit of cadavers, pending autopsies and lab reports. To their credit, just last week the ME’s office announced that they had cut the backlog by better than half. On TV shows, the detectives get an autopsy this afternoon and the DNA results tomorrow morning. The reality is not quite that sanguine. Around the world, many medical examiner offices are burdened with stacks of dead bodies waiting for autopsies, and I’m not using the word “stacks” metaphorically. In my novel Gold Of Our Fathers, Darko found the morgue in one hospital was so full of corpses that some were being stored in plain view on the floor, a very disturbing sight. Neither does Darko often have the benefit of DNA analysis, because in Ghana, blood and other fluid samples have to be outsourced to a lab in South Africa or the US, and the results take ages to come back. In the time it would take, the case would go cold. I’ve seen quite a few postmortem exams in my years of medicine, and in writing crime fiction I have a unique opportunity to impart to the reader what an autopsy is really like. I want to put the reader right there, so I describe the smells, sights, sounds and the tactile experience. Now back to the two scenes I described at the outset. First, let’s look at the one from Rosewood on Netflix: I wonder, did they even bother to consult a physician or other medical expert? It’s simply unheard of to perform an autopsy in street clothes. You can’t even enter the postmortem room dressed like that. One must wear Personal Protective Equipment: at the minimum, surgical scrubs, surgical cap, eye shield, mask, gloves, shoe covers and a protective apron. Some places also require fluid-resistant surgical jumpsuits with long sleeves and latex boots. You have no idea what you could get splashed with during an autopsy. Now the ER code blue scene. What are its issues? First, we don’t apply gel to the defibrillation paddles and then rub them together. That takes too long, it’s awkward, and could be dangerous. Instead, we put gel pads on the patient’s chest and press the paddles against them. It saves precious seconds. Thankfully, cumbersome defibrillation paddles are slowly becoming obsolete, now being replaced with adhesive pads that detect the cardiac rhythm as well as conduct the shock to the person’s chest as soon as the defibrillator is fully charged. These are the same kind of pads found included with the Automatic External Defibrillator machines you sometimes see in public places and on airplanes. Second, when someone has flat-lined on the monitor, we don’t ever, ever deliver a shock. Let me say that another way. No matter what you see on TV, you simply cannot, must not, shock a flat line. At best it will do nothing, at worst you might be nailing the poor fellow’s coffin shut. Assuming all the leads are connected the way they should be and the patient has really flat-lined, we proceed to shoot adrenaline straight into a vein. But no shocks. That’s like flogging a dead horse. The heart irregularities for which we give shocks are called ventricular tachycardia and ventricular fibrillation. That’s why delivering the shock is called defibrillation. There’s an impression that we give a person in cardiac arrest an electric shock, we are trying to “jump-start” the heart—you know, like a dead battery. That’s not correct. The purpose of defibrillation is to alter the electric charge in the heart’s cells all at once so that they become synchronized and hopefully resume normal cardiac electrical impulses. When defibrillation works, it’s a magical and gratifying moment. Sometimes the patient, who has been unconscious, will suddenly open her eyes, look around and mutter, “What happened?” On such occasions I’ve been tempted to say, “You just died, but we resurrected you.” A variation on defibrillation is called cardioversion, where we want to convert a non-life-threatening heart irregularity to a regular rhythm. In this procedure, we sedate the patient and deliver a synchronized shock. Although it gives him quite a jolt, he won’t remember it if he’s been adequately sedated. At least he’s not supposed to. I once had a patient—let’s call him Jasper—who bizarrely seemed to have enjoyed his cardioversion. Every time he came into see me he asked, “How ‘bout giving my heart another jumpstart, Doc? I feel like it needs it.” “Uh, no, Jasper. That’s gonna kill you.” “Sure, Doc,” Jasper said brightly, “but then you could just resurrect me again.” That’s all for this episode. Again, thank you for listening. If you’re not already acquainted with my website, kweiquartey.com, k-w-e-i-q-u-a-r-t-e-y dot com. please check it out and subscribe to my email list for alerts on my blogs, book giveaways, and contests with great prizes. The podcast is available on iTunes and my website, which is getting a makeover and will soon have a great new look. I’m on Twitter as @doublekwei. Until next time, be happy and healthy.