Hospitals: TV vs. Reality

I have decided today to write a bit about hospitals in TV vs. Reality.  I will share the TV scenario and then how it would actually go down in a hospital.  Remember, I am a lab scientist, so you'll be able to tell that.  Did you know that healthcare workers voted and named the most realistic medical drama as "Scrubs?"  Second place was "St. Elsewhere."  Last place? "Grey's Anatomy."

1. Start of Shift
   
   TV:  "Okay, listen up people. [everyone gathers round] There have been nine disasters, but we're going to be okay.You are all trained, and people are counting on us.  [Proceed with ridiculous pep talk]."
   Reality:  "Okay, let's have shift huddle. Any safety concerns? [waits for responses] Okay, so [patient] has a cold aggluttinin.  The floor knows, and they're supposed to be sending CBCs on hot-packs, but look out.  We're out of methanol, but we called LDS to borrow some and there's some coming with the next courier. VA called and they need beta-hydroxybutyrate strips, but they're going to check with University of Utah, because we only have one box, but if University doesn't have the same method, they'll call us back.  They're testing the generators at 4 am, so have fun! [proceed to joke about ridiculous things and bond as a shift until we get samples pulling us away]."
   
2. Doctors do everything
   TV:  Doctor: "I'm going to draw some blood now, and then I will go to a dark room and I'll flip on the light, then put a drop of blood from a red-top on slide and turn on the microscope and make my viral diagnosis."  (just a note, you can't do that with blood from red tops, because they have no anti-coagulant, you have to smear blood on a slide unless you're looking for weird stuff like malaria or leishmaniasis, you can't put a slide of blood under the microscope without staining it, and you can't diagnosis a virus from a microscope).
   Reality:  Doctor says, "I want to order x testing."  Doctor then needs to write an order in the chart.  The nurse takes that chart to a HUC who enters the order into the lab information system.  The nurse either draws blood or calls a phlebotomist to draw the blood.  The blood is properly labeled, packaged in biohazard transport bags and sent in a pneumatic tube to the lab.  A lab assistant takes the blood out of the biohazard packages, receives the samples into the lab information system (documenting that they got to the lab and when), and then prints out the labels.  The lab assistant gives them to a lab scientist, who runs the testing and does all that stuff.  Alternatively, the lab assistant will package it to go to another lab if it is rarer testing. The lab scientist enters the results into the computer, making sure that they are not immediately life-threatening. If they are immediately life-threatening, the lab scientist calls the nurse and says so.  If they are not, the nurse will see the results when he or she thinks to look at the computer, and then if they're concerning, they call the doctor.  If they're not concerning, the doctor won't even see them until probably the next day during morning rounds.
   
   
3. Hospitals don’t lose power
   TV: The power goes out and then they have resuscitate by hand, get everyone on life support to the generators, and then diagnosis with flashlights.
   Reality:  The power flickers for less than one second before a generator takes over.  Every life support machine or essential functioning equipment is on "gray power" (the color of the outlet) which has a maximum of one second delay before there is generator power on it.  Some overhead lights and non-essential machinery is down, and we have headlamps if we need a bit more light, but it is not by any means flashlights only.  You don't even notice the power was out except for the alarms of things that are mad that they aren't on anymore.
   
4. Different support jobs
   TV:  There are only doctors.  They know how to do lab testing, and run CT machines, and can do physical therapy, etc.
   Reality: Doctors rely on a wide-range of support personnel.  Doctors have no clue how most lab testing works, and sometimes they don't even know what it means.  They have no clue what any of the buttons on a CT machine does, and doing physical therapy would be irresponsible, because they'll probably get someone hurt.
   
5. Doctors only run in one situation
   TV:  Anything goes wrong, and doctors run everywhere. They're track stars.
   Reality:  If you hear an alarm and the words "Code Blue," get out of the way.  Trust me, if you're not on the code team, you get to the side of the hallway.  If you are on the code team, you run.  Also, not every available doctor runs to the location of a Code Blue.  Only specific doctors each day respond to Code Blues. You don't run other than that.
   
6. Do not EVER have contact with patients
   TV: Doctors take a personal liking to a specific patient who they identify with.  They give them their cell phone number and tell them to call them if they need anything.
   Reality:  Doctors are concerned, so they call a social worker who will find the help the patient needs.  You never make promises you can't keep, and you never say that you will always be there fore them.  It's like when I worked on the crisis line.  We always trained our staff to say, "The Crisis Line will always be here for you," and never to say, "I will always be here for you."  Don't make promises you can't keep. 
   
   
7. Do not EVER restrain someone in a seizure
   TV:  "He's seizing!" (grabs the person by the shoulders and holds them down, and starts messing with the person)
   Reality: Put them on their side, get objects out of their way, deliver anti-epileptic drugs if you're trained, and then stand back until it stops.
   
8. Hospital Resuscitation
   Only about 5-10% of hospital resuscitations are successful.
   TV:  "Clear!" (shocks them and they're back)
   Reality:  "Call a Code!"  The person hits a button on the wall that triggers the code blue alarm and the response team.  They do chest compressions until the code team gets there.  The code team attempts resuscitation until they clearly cannot resuscitate, and then they're done.
   
9. Asystole is a non-shockable rhythm
   TV: "They're flat-lining!"  (shock them and it works)
   Reality: "They're in V-fib!" (shock them) "They're flat-lining!" (do chest compressions, use drugs, or call time of death (depending))
   
10. People walking into the ER and collapsing
    TV: Person walks into ER and says "Hello," promptly collapses and then the entire ER staff runs to help them
    Reality: Person walks into the ER, checks in with the triage people, they are triaged, and then probably they get to wait.
    
11. People walking into the main area of the ER
    TV: Person walks into the ER and walks up to the nurse's station.
    Reality: You have to go through about three doors to get to a nurse's station.
    
12. You don’t rub paddles together
    TV: "Charge the paddles!" (Rubs them together)
    Reality: "Charging." (Person rubs them together...other person asks, "What the crap are you doing, and why?")
    
13. People have sex all over the hospital
    TV: Hot, smokin' sex in all on-call rooms and supply closets
    Reality:  Do you have sex in your break room?  Your supply closets?  What would happen if you did? Does that answer your question?
    
14. Doctors have specialties
    TV: I'm a doctor.  That means that I work in ER, do brain surgery, interpret x-rays, see patients in the inpatient areas and do autopsies.
    Reality:  ER doctors work in the ER.  Neurosurgeons do brain surgery.  Radiologists interpret x-rays.  Hospitalists see patients in inpatient areas.  Pathologists do autopsies.
    
15. Shifts Ending
    TV:  Our shift is ending, we all walk out arm-in-arm.
    Reality:  I get off at 6:30a. I have coworkers that get off at 7:30a, 8:30a...etc.  So, end of the day, "Okay, I'm going home." I do my paperwork, pass off projects that are still running to coworkers, wish everyone a good day and walk out.  My coworkers say, "See you tonight, Hannah." 
    
16. I don’t really see my coworkers not at work
    TV: All the staff of the hospital hook-up, form relationships, drink with one another and never actually have relationships with other people.
    Reality: My coworkers are great.  I consider them my friends, and I know about their lives and we get along awesome.  But I don't go out to drink with them (I also don't drink...).  I have many other friends, and I have never dated any of them.
    
17. You break laws or break ethics and you’re not coming back from thatTV: Doctor breaks a law or acts unethically.  Ends justify means, and no one does anything.  Or they get a slap on the wrist.
    Reality:  Doctor goes to jail. Or at the very least loses their license.  You can screw up and get reprimanded and come back. But you break a law or ethical codes and you're done in healthcare.  No ifs, ands or buts.