Sunday, February 8, 2009

Anesthesia in the Movies

There aren't a lot of flattering, never mind realistic, portrayals of anesthetists and anesthesiologists on film. Actually, there aren't a lot of portrayals period. 

Gregory Peck once played a priest who had to give a kid some drop ether (or maybe it was chloroform?) in the 1944 film The Keys of the Kingdom (based on the novel by A.J. Cronin). That was a pretty good scene.  Actually, the whole movie was good.

Anesthesia care in another film based on an A.J. Cronin novel, The Citadel (1938), was not ideal (see time index 7:33 of this clip).  But I guess we can't really blame the anesthetist, who had to work with no monitors, no endotracheal tube, no resuscitation protocols, and seemingly no I.V. access.  I think there's a lot about medicine back in those days, culturally and scientifically, as depicted in that film, that would shock us today.

The poor little female Asian anesthesiologist in Spiderman 2 met with a bad end. Doc Ock got her.

Then there's the scandalous anesthesiologist on Grey's Anatomy, Dr. Milton, who abandoned a patient on the table during a bomb threat in an episode which aired on February 5, 2006. I can't say what I would have done in his shoes, being a parent myself, but I HOPE I would have had the courage and integrity not to desert my patient. As was pointed out in a letter from the American Society of Anesthesiologists to the show's producer, "Of all medical specialists, an anesthesiologist is probably the least likely to fall apart or 'bail out' in a crisis situation."

And of course there's the movie Awake. The ASA wasn't too happy about that one either. Movie producer Joana Vicente was quoted to have said, "Awake will do to surgery what Jaws did to swimming in the ocean." Hmm. Awake. Jaws. Awake. Jaws. I'm not seeing the comparison. Has anyone actually seen Awake? How was it?

And who remembers this quote by the ghost of Jamie in Truly, Madly, Deeply, played by Alan Rickman? "Dying's all's the general anesthetic I didn't like."  Bummer.

Last night I saw a movie in which anesthesiologists were actually a) written into the script and b) depicted fairly realistically. The film was Gifted Hands: the Ben Carson Story starring Cuba Gooding, Jr. as Dr. Carson. Although the transitions between time periods struck me as a bit choppy, the film really held my interest, especially during the most compelling moments in the O.R., which I thought were surprisingly well done.

The person playing the anesthesiologist trying to coax a young girl to open her eyes after a hemispherectomy for epilepsy had just the right manner and posture about him. Later, the depiction of the intricate separation of the German craniopagus twins that made headlines in the 1980's had us leaning forward in our seats, eyes glued to the screen. I was especially impressed that they bothered to show a moment in which Dr. Carson checked in with the anesthesia team to verify the stability of his patients and also to show those team members hastily re-hanging various bags of fluid, manually stabilizing the endotracheal tubes, and doing other important "busy work" as the separation of the twins was under way.

The 22-hour operation took not only a lot of daring but also a lot of "thinking outside the box" and preparation. And not just the preparation of a good set-up or of years of experience in medicine: the teams rehearsed, and rehearsed together. I think these were the crucial differences that allowed this operation to be a success where others had failed. I found this heart-stopping article about a more recent separation of conjoined twins that gives a detailed, vivid, blow-by-blow account of the operation. It's a worthwhile read - the story of a modern medical marvel, with all the associated highs and lows, made possible not only because of technology and talent but also because of the miracle of smooth, well-practiced teamwork.  Have a look.


Anonymous said...

Dear T!

I completely agree with you - I haven't seen any good or realistic depiction of our speciality on screen - only the opposite.

that episode of Grey's Anatomy bothered me a lot. and also another one, where the Anesthesiologist is drunk - don't you remember that one? I found that scandalous!...

but I still can't help seeing Grey's Anatomy... it must have something to do with all the Mc's that walk around that hospital ;)

I have a question for you - in my hospital, the surgeon never/very rarely interferes with our work or tells us directly what to do - in the show very frequently (every episode) a patient is about to die/cardiac arrest/arrythmia and the surgeon always says what should be done, what medication they should give - is it really like this in your country? I always wonder.

something that bothers me about Anesthesiology is that it is not very acknowledged - and luckily I work at a hospital where we have managed to conquer our space - but unfortunately it isn't like that everywhere.
what is your experience with that? I always think that maybe in the US the Anesthesiologist is more respected or appreciated than in Europe. anyway, I love being an Anesthesiologist independently of what others may think!

'rehearse everything and work toghether!' I really wish that!


Resident Anesthesiologist Guy (RAG) said...

Most of the time you see the top of the scrub hat for the anesthesiologist/ CRNA. It's not well understood, and even when there are attempts to depict it, the anesthesia provider always comes out looking badly - usually.

As far as surgeons telling the anesthesiologist what to do, that would happen (at least in my limited experience) with new residents and CRNAs. Many of the older residents and anesthesiologists understand how to manage patients medically more than surgeons do, and most surgeons understand that. At least that's what I've seen thus far.

T. said...

In most of the acute situations I've seen in the O.R. the anesthesiologist is running the show.

I have to confess I have only seen Grey's Anatomy a few times - one time being that bomb episode. I can't get past the soap-operaness of it. Residents don't have the TIME or the ENERGY to have all those liaisons! And if they did have spare time, they'd spend it SLEEPING! :)

The most unrealistic show of all in my opinion is House. There is NOTHING about that show that resembles real medicine in the least. The MOST realistic one is Scrubs. And while we're on the subject, why haven't they put Chicago Hope out on DVD,,,?! I loved that one.

Anonymous said...

Is there any profession that gets represented in the least bit realistically on TV?

Anonymous said...

I have read some of Dr Carson's books. He is amazing. In the books he talks a bit about how very important the anesthesiologist is to his success and how he picks them to work on his team.

Map said...

Thanks for the review, T. Can't wait to watch Gifted Hands: the Ben Carson Story.

BTW, I have been scheduled to take my oral boards in April. Any suggestions on how to spend the day before my exam? Thanks.

T. said...

Map - I encourage you to do what I did the day before my orals: take your review books, flash cards, practice exams, notes, etc. to the post office, pack them into a box, and mail them home; then go to a spa and have a massage or a favorite luxurious treatment of choice; then have dinner with some friends whose company you enjoy!

Map said...

Thanks, T! Love the advice.

Anonymous said...

I took care of a teenage girl whose boyfriend convinced her to watch Awake the night before surgery. Brilliant.

Alice H. Cash said...

Hi Dr. T, I love your blog and have commented in the past. I'm wondering what you think about the patient listening to slow, steady instrumental music through headphones during surgery as a way to entrain the heartbeat and breathing with the music and keep the body relaxed so that (hopefully) less anesthesia will be needed? Thanks!

Alice Cash

T. said...

Hi, Alice - I've allowed patients to bring in iPods with headphones if they want to have them as the anesthesia is being administered. So far I have not observed that music can diminish the anesthetic requirement; that usually depends heavily on the surgical stimulus as well as the person's native chemical receptors / tolerance to narcotics and sedatives.

Alice H. Cash said...

Thanks Dr. T! Would you be willing to take a look at this: I'm actually looking for an anesthesiologist to collaborate with on this project. Would you be interested? A hospital in the NYC area is going to test my music and headphones with colonoscopy patients. We beleve that even if they have the perception of a better experience, it would be worth it.

Alice H. Cash said...

Oops! I'm sorry. Here's the correct link


Anonymous said...

Regarding Resident Anesthesiologist Guy's comments; I find your remarks bordering on offensive...
I am a CRNA and I practice anesthesia independently. I can assure you that the average CRNA has thorough understanding of the medical management necessary to care for a patient. Your comments suggest that CRNAs rely on the surgeon to make medical management decisions for the patient. That is absolutely untrue. CRNAs will obviously collaborate with the surgical team when it is necessary, but be certain that CRNAs are competent and prepared to function independently.
Your comments imply that we are the equivalent of a "new resident", which is again, blatantly wrong. The average CRNA has completed about 3 years of graduate education focused on anesthesia and has performed approximately 700 cases before they graduate.
If you would like to complain about being misrepresented or portrayed in an unfavorable light, step into the shoes of a CRNA.

T. said...

Anonymous CRNA - thanks for coming by. First let me state that I totally agree CRNAs are much misunderstood and unfairly underestimated. I don't believe RAG intended any disrespect, however, but rather was reporting what he has SEEN at the institutions he's been in. Perhaps in his hospital, that's the way surgeons treat and regard CRNAs. If so then its those surgeons that misrepresent the value of CRNAs and fail to acknowledge their expertise.

Anonymous said...

Dr. T,
Your point is well taken.
In my opinion, the comments posted by RAG represent a common trend. I have noticed that in departments where MD anesthesiologists and residents work along side CRNAs, the type of relationship that develops between the two providers is contagious. For example, if the MD anesthesiologists interact with the CRNAs in a manner that is perceived as condescending to the CRNA, then that model of interaction seems to spread on to residents and surgeons.

RAG's comments, although subtle, represent a trend that I hate to see perpetuated.

j88r said...

One BIG PROBLEM with anesthesiologists is the new guy - the one who's already written 15 papers, who doesnt address the patients when coming into the room - just shows up and starts to unwrap the needle pack! Unfortunately for us, patients are now going to risk management and voicing loudly criticisms - and they should! If you dont want to communicate with the human race, I guess ours in the specialty to choose. Sad

T. said...

Anyone who chooses anesthesiology to avoid having to "communicate with the human race" is not only in for a bitter shock but also setting up future patients for poor care.

Anesthesiologists have to be effective communicators, and in a variety of ways. Ideally they should be able to transmit comfort and compassion to patients as well as competence and clarity of thinking when advocating for those patients. They need to be able to be persuasive but also respectful of all members of the team.

We're with patients at their most vulnerable moments. If we don't feel like talking to them, or don't care enough to do so, ours is NOT the specialty to choose. We have to be able to express concern and show leadership in situations where there are other lead doctors also in the room - i.e. surgeons. If we can't speak up for our patients, ours is NOT the specialty to choose either. People who don't want to hold their patients' hands shouldn't go into medicine.

Øystein said...

Nice overview. I'm gonna check out "Gifted Hands" for sure.

And thanks for the link to the conjoined twins article. Brilliant!

g said...

Check out "the PARALYZING AGENT."




Anonymous said...

I know this is a couple years o;d but I was looking for the topic and I saw your blog. Interesting. Have you seen the movie "Malice" . There is a couple of OR scenes in there. The anesthesiologist acting in there is a real anesthesiologist. He was in my residency class. He helped to adjust the dialogue and make the plot more realistic. I dont know if he has had more acting jobs. I know he still works in LA as an anesthesiologist.

T. said...

Oh! I saw Malice a long time ago but don't remember those scenes. I'll have to check it out. Thanks for the tip!