People often ask me what is the most realistic medical TV show. My answer comes without hesitation – Scrubs. I get confused looks right away, but somehow that quirky show with the lengthy inner monologues captures the spirit of what actually goes on inside hospitals.
The opening credits to Scrubs run to the Lazlo Bane song “Superman.” And the credits are timed to end with the lyrics “I can’t do this all by myself. No, I’m no Superman.”
This is, of course, not what a budding trauma surgeon wants to hear. My whole goal is to be a surgical superhero. Someone has a horrible thing happen to them, and I rush in and – nearly anonymously – fix the problem, only to fly away to the next patient, never to be seen again. A secret angel of the night.
Periodically this fantasy gets just enough reaffirmation to persist. Not long ago I was making early morning rounds with one of my co-residents when we went into the room of a lady who had underwent several large abdominal procedures. We were there to do an extensive dressing change and update her on the plan, just like we did every day before the sun came up. She slowly opened one eye, then the other, and then allowed herself a half grin – there are my supermen, she whispered, good morning! I allowed myself a little smile in return – it’s nice to be appreciated.
The only problem is that, in medicine, something is bound to come around that knocks you right back to earth. And, in medicine, that trip normally takes casualties.
It was Easter Sunday and I was on call in the hospital. I got a routine consult for abdominal pain, which quite honestly didn’t sound that exciting. The story was vague – intermittent colicky abdominal pain over several days, worsening this morning. Her labs were normal, an x-ray had some minimal changes in her intestines, but nothing crazy. Cardiology had some concerns, so she was put in the ICU and I put in a central line.
Within 24 hrs she was dead. She got really sick the next morning, and a CT showed pneumatosis intestinalis – air in the walls of the intestines, which we only see with necrotic bowel. It’s a surgical emergency, and one that doesn’t normally end well. In her case there was nothing to do. She was rushed to the OR, and her stomach, small bowel, gallbladder, and part of her liver were all dead. Her family withdrew care shortly thereafter.
Did I miss some obvious red flag? Everyone tells me no. Should I have been more suspicious and ordered the CT when I saw her? Everyone says there was no reason at that time. Are people just being nice to me? I’m not sure.
I know this much – that poor lady was dying when I saw her, and I didn’t realize it. I was her last chance at survival, and I failed at that task, the only task I had. Not so super at all.
There’s no good end to this story. A family lost their mother. I could go on and say that I’m more inspired to learn and work harder and all that, but that would just be rhetoric. I always try hard. That makes this even harder.
Perhaps the truths of Scrubs strikes again. I am not perfect; I’m no superman. I got that one loud and clear.
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