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The Scary Truth
Infusing medical authenticity starts with finding real cases. Stories come from everywhere. Magazines, newspapers, medical journals -- including JAMA and Annals of Emergency Medicine -- and nurses and residents around the country. "I'm always asking people I meet at parties if they know of interesting cases, and they usually do," says Tony Phelan, an executive producer on Grey's Anatomy.ER's medical advisor Einesman has seen several of his real-life cases end up as episodes, and he recalls one that still haunts him to this day.
In the mid-1980s, a 45-year-old man was rushed to the hospital after having a massive heart attack. "When we did CPR, he would open his eyes," Einesman recalls, "but every time we stopped, his eyes would close and he'd fade away. This went on for 40 minutes, until finally we had to let him go. When I saw it on ER, I became emotional for the first time; in the hospital I had to remain objective and didn't have the luxury of reacting emotionally."
Einesman has shared that lesson in reality when advising actors about how to make their interactions with patients look real. "I tell them, 'You don't have time to emote here; you have to get the job done. There are 35 people in the waiting room, and you have to see one patient every 15 minutes.' "
On House, consultant David Foster, formerly an instructor at Harvard Medical School, makes sure the title character sounds authentic while talking about medical jargon. "When House and his team argue about a particular diagnosis," says Foster, "it has to be a condition that is actually debatable." Character is one thing, but the props and special effects are equally important. Chest cavities, ribs, layers of intestines, hearts and brains -- usually prosthetics made of latex and rubber -- have to be anatomically correct. Medical consultant Linda Klein sometimes relies on her local butcher shop to supply cows' brains and intestines.
Scrupulous attention is also paid to getting the various consistencies of blood right. According to ER's Einesman, there are 17 different types, including circulating, congealed and mouth blood -- appropriate for specific procedures or injuries. Karo syrup mixed with blue and red dye, for example, gives the thick, drying blood you'd see congealed on an old knife wound or a battered corpse.
Actual cervical-spine x-rays and MRIs from anonymous patients' files are used on ER, and the medical equipment on these shows -- heart monitors, respirators, EKGs -- is also authentic, as are the machines' numerical readings to reflect the cases being portrayed.
Still, for all their realism, these dramas remain, at heart, fiction. "They set up unrealistic expectations about doctors and hospitals," points out Professor Turow. "Who wouldn't want a Dr. McDreamy listening intently to their problems? But when you go to a hospital, it can be a scary place. Doctors and nurses are overloaded, and in these days of managed care, you're lucky if you see the same doctor twice."
"The idea that there's one brilliant doctor, like Gregory House, who would become that invested in a real-life patient's case is very appealing," says David Foster. "Anyone who's gone to an HMO knows differently."
A persistent criticism of these series from the medical community is the survival rate of both CPR and coma patients, which medical research says is much less successful in real life. Another criticism: Nobody ever talks about money or insurance.
"Now and then on ER, you'll get the sense of a beleaguered hospital with people waiting for care," Turow says. "But you don't see anyone at the reception booth being asked for their insurance card. And there's no real social context -- American society owning up to what it means to have the baby-boom generation marching toward its final years."
Still, there's no arguing with one aspect of medical dramas. The successful formula of presenting doctors who care but have flaws and make mistakes leads to a scary truth. Says Turow, "It's a crapshoot on these shows as to whether a patient will come out okay -- which is just like in the real world."
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