Sir, sir, we're losing him. Clear.

(gasps)

She's crashing.

Fight!

Hi, my name is Annie Onishi.

[Narrator] 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, The Abyss.

Roll the clip.

(breathing heavily) Three, four.

Fight!

Fight!

Right now, do it!

Rule number one of CPR is never stop

effective chest compressions in order to slap

or yell words of encouragement at the patient.

Fight goddammit!

Yelling at a patient or cheering them on

has never brought them back to life.

Fight! Fight! Fight!

Here we have another example.

(mumbles)

Jesus.

Sorry, we tried smelling salts,

caffeine injections, ice baths.

That's not really how we do it in real life.

We have other mean method 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.

[Surgeon On The Left] Cut this sucker.

Surgeons have very severe OCD

and all hair needs to be removed

before we even think about operating.

(gasping)

If a patient reacts like that to an incision,

it means the anesthesiologist isn't doing his or her job.

This man is dead.

And check out this gasp.

(gasping)

Now people who are about to die

do display something called agonal breathing

which is a very characteristic pattern of respirations,

but nothing like this.

(gasping)

Something tells me that these guys are not real doctors.

(whistling)

Codes, Rookie Blue.

[Woman] She's in Vtach, I'm calling a code.

Get back please. All right.

One 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.

[Woman] She's in Vtach, I'm calling a code.

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.

Clear.

(beeping)

Asystole.

This scene also uses some very

official sounding doctor words such as

asystole. Asystole.

And VFib

or Vtach. Vtach, Vtach, Vtach.

These are also real conditions

that would occur during a cardiac arrest.

Like a heart attack.

And their responses are accurate.

Yeah. Now if you check out

the code scene in Drop Dead Diva.

(beeping) Prepare to intubate,

I need a 12 French tube.

Somebody in the room says Prepare to intubate, I need a

12 French tube. 12 French tube,

a 12 French tube, 12 French tube.

This is basically nonsense talk.

It sounds medical but it's not real at all.

Another thing I overheard someone say is

Give him an amp of epi, Give him an amp of epi

and continue fluids and run the fluids

wide open. wide open.

That's pretty accurate,

something someone may very well say in a code.

An 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.

Charging to 360, all clear.

Here they charged a 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 charged to 200 joules

which is an outdated dose of electricity

and no longer thought to be affective.

Now in BASEketball, they shock somebody with 15,000 bolts.

15,000. 15,000 bolts!

Whoa!

The machine only goes up to 360,

so 15,000's a little bit unreasonable.

Do you know what you're doing?

What's it look like?

An execution?

Adrenaline to the heart, Pulp Fiction.

Yeah it's gotta be exactly where

they're shot in the heart.

Don't know exactly where a heart is,

I mean I think it's right here.

[Man] Okay, okay, 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.

All right, hurry up man, hurry up!

Here, I'll tell you what to do.

No, no, no, no man, I ain't giving, you're gonna

give her the shot. No you're gonna

give her the shot.

Someone should probably be doing chest compressions

as they're trying to sort all of this out.

I ain't giving her the shot. I ain't giving her the shot.

There's a whole lot of standing around,

a whole lot of waiting around.

I've never done this before.

I ain't ever done it before either, all right?

Time is myocardium, people.

It's gotta 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.

(thump)

(gasp) (screaming)

If you're all right, then say something

Something.

Little bit of a stretch, but it is plausible that

adrenaline straight to the heart would help.

(chuckles)

Patient privacy, Hangover.

Turn.

All right.

(groaning)

And cough.

(coughs)

First of all, if you're gonna check

some old sweaty dude's prostate,

please put on two gloves, come on.

(laughter)

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?

Are those worms?

I can't look away.

[Man] Oh.

(upbeat pop music)

♪ I won't apologize, you better recognize ♪

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,

and you would almost certainly get fired.

No more photos.

While it may seem far-fetched,

there is a parasitic infection called strongyloides.

This one.

That does cause your intestines to get

completely blocked up by these worms and a lot of times

you do need an operation to get them removed.

Worms are a deal breaker.

Happy nightmares.

Okay, nope, nope, nope.

Removing a bullet, Mr. Bean.

Sir, sir, 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

We're losing him! We're losing him!

I have never once heard that in my real life ever once.

We're losing him. Ever.

The point of trauma surgery after a gunshot wound

is not necessarily to go get the bullet out.

You can't just, it's too dangerous.

What you're really there to do is fix the damage

that's caused by the bullet.

Whoa, this guy's gonna die!

Plenty of people walking out there

with bullets that show up on X-rays, all the time.

(clattering)

[Woman] Her beat is stabilizing,

blood pressure's climbing back.

(triumphant music)

The patient seems to be cured here

by just the removal of the bullet

which I can guarantee you is not what happens.

Again, here we have another example

of a patient being miraculously cured

by just the removal of a bullet.

Check out Harold and Kumar.

(intense music)

That was genius. (applause)

In general, somebody who was shot in the chest

is not cured by simply removing the bullet.

That bullets usually cause all kinds of damage inside

that needs to be fixed.

Great job. (applause)

You guys did it, no, it's you.

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

dink, dink, dink, dink, dink. (dinking)

Doesn't happen in real life.

Those buckets are actually plastic, so, less impressive.

Operating room galleries, Seinfeld.

Kramer, stop it.

(thumping)

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.

Get.

Don't they have work to do?

No.

Back in the day before we had the internet or text books,

operating galleries did definitely exist,

they were depicted in a number of famous paintings

from the 20th century, but these days it's just not a thing.

I can't see.

Sorry.

Operating room fashion, Dead Ringers.

(dramatic 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 Awake.

[Surgeon] Okay, open him up nice and wide.

[Surgeon] Okay it's happening again.

Okay, it's fine, just control it like before,

you can do this.

Here we go, here we go, come on man just swallow it.

Wake up.

This is a young man undergoing what looks to be

an open heart operation who is fully conscious

of the proceedings around him.

[Patient Voiceover] Am I supposed to be asleep right now?

[Surgeon] So you live in the city, Larry?

[Patient Voiceover] Guys, I can still hear you.

[Surgeon] Huh?

In general, patients don't really dream

while they're under anesthesia.

This phenomenon is called intraoperative awareness

and luckily, it is exceedingly rare.

[Patient Voiceover] Yeah, right.

And this detail right here.

[Surgeon] You ready?

[Surgeon] As ready as I'll ever be.

Where the patient's eyelids are taped closed

while they're asleep, very real.

It's to prevent corneal abrasions.

[Surgeon] Sleeping like a baby.

For me, the most cringe worthy aspect of this clip

is the hair removal from the patient's chest.

Razors actually case very tiny abrasions in the skin.

All right, okay.

Which lead to a higher risk of surgical site infection.

[Patient Voiceover] Don't you guys use shaving cream?

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.

The players may have a changed,

but the game is still the same.

Things getting stuck in patients' butts

from a whole lot of TV shows.

Oh my god!

How does that stuff even get up there?

(screams)

(grunting)

(screams)

You know, in real life this is very, very common.

Whatever floats your boat, man.

I got musical farts.

(harmonica music)

I've seen a carrot, an eggplant, all kinds of dildos

of different shapes, sizes, and electronic capabilities,

a wine glass, an Axe can of body spray, shaving cream,

that's about it.

I was bored.

Emergency airway control, The Heat.

I need a knife and a straw please!

I need a knife and straw please,

the lady needs a knife

and a straw? I need them because

I need to perform an emergency tracheotomy.

I'm gonna need a glass of vodka.

I really admire Sandra Bullock's chutzpah here.

I do think that she's really trying to take this situation

into her own hands, so good for her.

I don't know what I'm doing! Stop crying, you did this!

However, in a choking patient,

emergency tracheotomy may not necessarily help.

(gagging) Okay that goes in

deeper than I thought.

If the food particle is stuck further down

than where you would put the hole in the neck.

I gotta go! I'm so sorry!

What are you doing?

(coughing)

(screams) Someone do

something! Asshole!

However, she did do her research.

Cricothyroid membrane Cricothyroid membrane

is exactly where you wanna go.

You probably could've just pulled the piece of pancake

out of his throat. He's alive isn't he?

Now if you wanna see it done right,

check out this clip from House.

(intense music)

(snapping)

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, too.

Perfect, very well done.

Good call.

Self rescue, Casino Royale.

You're 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 to require defibrillation,

it needs to be what's called a non-perfusing rhythm meaning

I'm a whiz.

A 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 require defibrillation.

Don't interrupt.

If 007 is conscious and able to have

enough dexterity and mental acuity

to perform this complex task,

he almost certainly is not in Vtach or VFib.

(grunting)

And it's not like he could only be partially in Vtach.

It's like being a little bit pregnant,

you're either in Vtach or you're not.

Thank you.

Cliche medical terminology, 10 CCs of this.

500 CCs. Five CCs of that.

500 CCs. CC actually stands for

cubic centimeter which is the same as a milliliter.

Vitals are dropping. Vitals are dropping!

As I tell my medical students, vitals are vital.

We always talk about them,

we always wanna know what they are,

and yes, we ask what they are on the regular.

How are the vitals?

You know one vital that they never report on

in the movies or on TV is urine output.

Okay I'm Googling purple pee.

For surgeons, urine output is probably

the most vital vital sign.

We need to do round of sequence intubation, stat.

Stat. Get me a box of kittens,

stat. Stat.

Stat! This is actually from

the Latin, statim, which means immediately.

Very commonly used.

Wouldn't I be a great spokesperson for things?

Music in the operating room, Scrubs.

We need to make this decision now.

Fine, then it's on you.

Nurse, Erasure.

Yes, Doctor.

(whirring)

(upbeat music)

This is a very accurate depiction

of how the music gets chosen for the OR.

Yes it is!

In general, the attending surgeon's the boss,

and the attending gets to pick the music.

I hate this song.

We usually wait until the patient's asleep

until we put the music on.

Me too man, me too.

But the discussion before the operation

of what we should be listening to

is a tale as old as time in the OR.

What makes you think you know better?

Now if you check out Nip/Tuck.

(upbeat music)

♪ Eyes without a face ♪

Eyes Without a Face by Billy Idol,

facial plastic surgery.

Is there something wrong?

Pretty good.

Alternatives to anesthesia,

Harold and Kumar Go to White Castle.

We should probably use just marijuana.

That'll sufficiently sedate the patient for surgery.

Marijuana would be a very bad drug

to anesthetize a patient with.

It's a good thing I found you two.

It really does nothing to desensitize your awareness

or your sensation of pain.

Another example of where they got it wrong is in Faceless.

(gasping)

What are you doing?

You're crazy!

(whimpering)

(mumbles)

Patient's completely wide awake for a face transplant,

totally unrealistic.

Small bowel resection, The Knick.

We must operate, but we cannot do it

to a man who can feel pain.

I think this clip is really well done

in terms of an accuracy standpoint.

The description of the operation is really well done.

Numb the nerves in the spine

between the thoracic vertebrae six and seven

so as to stop the brain from learning of the pain.

Their attention to historical details also pretty good too

in terms of having an open OR gallery,

people without gloves on, people without gowns and masks,

that's just about accurate for the 19th century.

I know we've already discussed that OR 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

two portions of small bowel.

Still used today.

All right, check this part out, I love this part.

There were sutures found in two spots

where the obstruction backed up with pressure on them

you should've re-snagged it.

The Knick 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 Knick 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.

(yelling)

(intense music) (splashing)

Mesentery never gets any love.

You're gonna wanna tell your father all about this.

Timing the surgery, Grey's Anatomy.

You need some help?

Why? Cristina.

I'm on a clock and you're wasting my time,

what is your problem?

Surgeons are some of the most competitive people

on planet Earth so it really does not surprise myself

that Dr. Yang is timing herself doing this procedure.

My personal record for cole-is discectomy is 22 minutes.

[Man] Very nice.

Home made surgical instruments, Dead Ringers.

[Surgeon] We'll use these.

A surgeon's instruments are really

extensions of their hands

and certain surgeons have very specific preferences

for the instruments that they use.

I've just had them made.

They're brand new.

Keeping on the five.

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.

(grunts)

These instruments are kind of interesting.

They look both futuristic and medievals at the same time.

I'm afraid I'm not familiar

with these instruments, Doctor.

And I can only guess that they're used in gynecology.

Oh my god, she's bleeding!

I know, get a crate for god's sake.

I would say this reaction to bleeding

is a little bit dramatic.

Get them the hell out of here!

Yes, patients bleed in the operating room.

No, people don't sort of run around and scream

The patient's bleeding! She's bleeding!

Stopping a surgery at the last second, House.

I can't feel my legs, I can't feel my legs!

What'd you guys do? Stop, John,

calm down, we didn't even operate.

I've seen a couple of patients

have panic attacks before operations.

I can't move my leg!

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

that 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've 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.

Just carry it, but be gentle.

(upbeat music)

Wait, wait, wait.

I have never worked in a hospital

that has patient care rooms on the first floor.

No! I got him, I got him.

Hospital windows don't even open.

A patient who's super sick is gonna have

all kinds of tubes attached to them,

lines. Dammit.

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 or in the operating room.

You can't just abandon the body.

That would set off some alarm somewhere in the hospital.

I don't think you're

listening-- Sir, sir, you are not

the only one that's had somebody die here today, okay?

Emergency arm amputation, Requiem for a Dream.

(cheering) (whirring)

The saw that 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?

No.

Autopsies, you guessed it, from Grey's Anatomy.

Don't even tell me you're doing what I think you're doing!

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.

It's huge.

Trauma arrival, West Wing.

[Woman] He's been shot in the abdomen,

there's an entry and exit wound.

BP 134 over 78.

Even though this patient is the President,

it is very standard to have a lot of people involved

at 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.

Do you have any medical conditions?

Well I've been shot.

Everybody has one specific job, and one specific job only.

You do that job, and you get out.

Daddy?

It didn't hit anything,

they're just gonna look around and make sure.

I'm so happy to see you.

Mom's on her way.

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.

I could suture directly or clamp,

I don't know which one to do.

I don't know either.

I'm not the one operating.

[Man] That's a lot of blood.

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.

[Attending Surgeon] Look at the aorta,

what does it tell you?

That I have two options and I don't know which one to do.

Why isn't she helping her?

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 gain our independence.

What the hell are you doing?

I'm teaching, she's learning.

She needs help, she may be too proud to say it,

but how about we don't let this patient die?

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 an help.

How's it going?

Yang's killing her patient

and Hoffman's reading the Atlantic Monthly.

Totally unrealistic, surgeons don't read Atlantic Monthly.

Waste of time, right?

They read the New Yorker.

A surgeon removes a live bomb, Grey's Anatomy.

♪ All down on paper, it's no longer inside of me ♪

♪ Threatening the life it belongs to ♪

Surgery to remove unexploded ordinance is a real thing.

The Army has published guidelines on how to do it safely.

♪ An hourglass glued to the table ♪

You did good.

Arterial spray, Black Hawk Down.

Let me get a look of that.

That's quite dramatic.

(yelling)

Blood can spray from an artery if it's severed

and an open wound, but that specific example.

[Man] Direct pressure on the wound.

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.

♪ Hey like a surgeon ♪

(whirring)

♪ Cutting for the very first time ♪

♪ Organ transplants ♪

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.

♪ It's a fact ♪

[Narrator] 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.

By the way if you are enjoying Technique Critique,

subscribe to Wire.

Stat.

[Man] All right, great, it's a wrap.

Awesome. Good job!

(applause) Woo!