As he has mentioned in a previous post, Dr. Cranky has a deep aversion to medical TV shows. There was a time in his life when he tried to watch such drivel but would inevitably end up laughing uncontrollably, shaking his head in disgust, or would start arguing with the television set (which Mrs. Cranky, who is not at all cranky herself, would find most disconcerting). After discharging far too many neurons thinking about it, Dr. Cranky has decided to try and exorcise these personal demons by detailing his aversion for your personal edification. Buckle your seatbelt, dear reader, for you are about to find out in no uncertain terms why your faithful correspondent is known as Dr. Cranky.
First of all, medical dramas pollute the culture by providing the public with a completely laughable picture of who doctors and nurses really are. Second, such shows promote an unrealistic idea of the care medical professionals can honestly provide. And finally, such twaddle inevitably results in more work for the good men and women who staff America’s emergency departments as they try to sort the wheat from the chaff.
Fictional Medical Drama vs. Doctors & Nurses: Who We Really Are
Like Lake Wobegon the televised medical drama takes place in a land where, to paraphrase Garrison Keillor, “the men are good-looking, the women are gorgeous and the patients are all in desperate need.” Take a look at the publicity photo from ER above. Look carefully at it. Do you notice anything unusual? No? OK then, how about this one?
Still don’t see it? Dr. Cranky does. They all look fabulous! And sexy, too! To begin with, the men are all young hunks. Even the nerdy one doesn’t look all that bad (and there’s always at least one nerdy guy in the bunch). They’re all in great shape, too! Dr. Cranky has been in the medical profession for over 20 years and believes he can make the following observations without fear of contradiction:
- It takes emergency department doctors who go straight through the training process about 12 years to complete their education following high school (four years of college, four years of medical school, and anywhere from three to four years to finish that period of involuntary servitude known as an emergency medicine residency). The majority of the last eight years are spent in the classroom, laboratory or hospital; chronically sleep-deprived and with little opportunity for proper diet or exercise. The medical training process ages those who partake of its pleasures and we all tend to end up looking a bit older than our birth certificates would suggest. Dr. Cranky can assure you that we are not the young stud muffins depicted above. As one trip to any OR changing room will attest, we tend to be an older, fatter, balder group of guys with lots of back hair and sundry skin blemishes containing various colors of the rainbow. One of his partners, a middle-aged gentleman about 45 years old, once showed a family vacation picture of himself wearing a Speedo to Dr. Cranky and the result was years of intense psychotherapy. Dr. Cranky has no illusions and realizes that he, himself looks more like Berkeley Breathed’s Bill the Cat than he does George Clooney. These observations apply, of course, to the men. Please be aware that Dr. Cranky has never been in the women doctors OR changing room and can only speculate as to whether they have the same problems with errant hair, excess body fat or dermatologic pathology. He suspects they do but would never have the temerity to admit it to their faces.
- Take a look at women in the photograph above. They look HOT don’t they; absolutely SMOKING HOT, you might say. Except for the well-groomed but slightly dumpy-looking gal (and there’s always a well-groomed but slightly dumpy-looking gal to be found). Well, Dr. Cranky regrets to inform you that the reality just isn’t so. You see, medicine in general (and emergency medicine in particular) is a stressful business and all that stimulation of the autonomic nervous system needs an outlet of some kind. And that outlet, dear reader, is . . . food! That’s right, not sex but food. Dr. Cranky is willing to bet his last kopek that right now, in almost every emergency department across this great land of ours, be it large or small, there can be found a various assortment of empty or half-empty pizza boxes, stale birthday cake, homemade/store-bought cookies, chips, candy, half-empty bottles of soft drinks and maybe even a covered dish or two. It’s kept in the back, of course, but trust Dr. Cranky when he says that it’s there. And all that food has to end up somewhere, now doesn’t it. To be bunt, emergency medicine is a fat cell’s best friend. Your faithful author loves the people he works with. He is convinced that he could not find a more compassionate, caring, hard-working and courageous group of people anywhere else on the face of this Earth. That being said, the unfortunate truth is that many of us in this business tend to find ourselves a little, shall we say, calorically challenged.
- As a side note relating to the superficialities of physical appearance discussed above, Dr. Cranky would also like to take this opportunity to clear up another great misconception promulgated by those wonderful folks out there in TV land. We are not all lusting after and having affairs with each other. Lets us assume, for the moment, that we were able to get past the premature aging, bulging midriffs, back hair and skin blemishes. Set aside the peculiar body odor we all possess as a result of the excess cortisol secretion from our overly-stressed adrenal glands. Forget the gag-a-maggot odor of feces, urine, vomit, body odor and toxic sock syndrome wafting throughout the department from the street-person three beds down the hall. The simple fact of the matter is that we’re just too busy to be skulking around, screwing each other like crazed rabbits. And even if we had the time and opportunity to do so we’re all just too damned tired. As the Big C used to say, “Emergency Medicine is a contact sport and exhaustion quickly becomes a way of life.” Dr. Cranky raises a glass to the Big C’s wisdom and lets slip a hearty “hear, hear.” He could not have said it better.
So much for appearances, what about the things we think about on a daily basis? Do these Vogue and GQ wannabe’s think the same things as the rest of us? In TV Land, the doctors and nurses are always engaging in earnest conversations during which they reveal deep thoughts and, with apologies to Doug Adams, ponder profound questions about the nature of life, the universe and everything. They analyze each others motivations, hopes, fears, tragedies and triumphs in exquisite detail. They not only do this with each other, they also do this with their patients!
Let’s do a little math. Dr. Cranky sees, on average, about 4.2 patients per hour. That works out to approximately 34 patients during a typical 8 hour shift. That means Dr. Cranky has only about about 14 minutes he can devote to each patient. Gosh, you might say, 14 minutes is a lot of time. Surely Dr. Cranky has the opportunity to discuss the principles of Cartesian Dualism with the mechanic in Room 12 who just smashed his thumb with a hammer! Sorry, but it’s not that simple. You see, during that 14 minutes Dr. Cranky has other things he has to do. For example, he must order any lab studies or X-rays which might be needed, check to see if the lab studies and X-rays from other patients are back yet, interpret said lab studies or X-rays, review any old charts of other patients which finally arrived from medical records, perform any sacred rituals which might be required, speak with consultants and/or admitting doctors about other patients in the department and document his various patient’s histories, physical exams, lab studies, X-rays, conversations, re-evaluations and dispositions for posterity. He’s sorry, but Rene Descartes will just have to wait.
So what does Dr. Cranky (and by extension, his partners and coworkers) think about when he is at work and actually has some spare time on his hands? Is he concerned about Patient X’s mental anguish over her pending divorce or whether Dr. Y has a “God Complex” (or some other such rubbish)? No, Dr. Crankys thoughts tend to drift back and forth between one of three basic themes:
- Arcane points of medical practice – Such as whether or not the ASSENT-4 Trial, as reported in The Lancet, truly demonstrated that patients who received tenecteplase-facilitated PCI really had a statistically higher incidence of stroke during their hospital course as well as more frequent ischemic complications (such as repeat target vessel reinfarction and revascularization). Also, was there really no diference between the groups in regards to major non-cerebral bleeding complications? Does this mean Dr. Cranky should not give tenecteplase to his patients who are having an ST-elevation MI?
- Problems at home – Such as when is he going to find the time to fix that damn garage door.
- More immediate concerns within the department – Such as whether or not he should have another piece of that stale birthday cake which is calling to him from the nurses lounge!!!
So, dear reader, there you have it. We doctors and nurses of America’s emergency departments aren’t hip or exciting or the glamorous stud-muffins/hot babes our television counterparts would have you believe we are. We don’t lust after each other, nor do we exchange smoldering glances whilst saving lives. When you look closely at us, you’ll discover that we’re just like you but with one small difference. We’re men and women who, for a variety of reasons, have decided to dedicate our lives to a wonderful profession which allows us to care for and comfort the sick and injured among us. The Big C summed it up best when he said, “Ours is the only specialty which will see anyone, for any problem at any time; regardless of their ability to pay. No other specialty in the great House of Medicine can make that claim. Truly, we are the guys and gals who still wear the white hats.”