This article is part of the Science in Sci-fi, Fact in Fantasy blog series. Each week, we tackle one of the scientific or technological concepts pervasive in sci-fi (space travel, genetic engineering, artificial intelligence, etc.) with input from an expert.
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About the Expert
Stephanie Sauvinet has worked as an oncology and stem cell transplant nurse for over seven years. She is a science-fiction writer and reader who doesn’t get tangled in the “Are you a Star Wars fan or a Trekkie?” debacle because she loves both and doesn’t see why she would have to choose between Luke and Picard (Pike or Kirk if you’re going old school.) She wanted to be an archeologist for a long time just so she could find the Stargate but settled for the endless possibilities of the SF/F genres. You should find her on Twitter.
Medical Misconceptions in Fiction
Part of me could almost forgive medical misconceptions in general, maybe if we were a hundred years back when social media and our dear Google didn’t exist. But really, in this day and age, there are so many venues through which to do research, it is hard to believe some of the following misconceptions are still perpetuated.
Misconception #1: The defibrillator myths
Shocking a flat line
The doors to the Emergency Room fling open, a patient is lying on a gurney, obviously unconscious and maimed. The EMS paramedics scream that the blood pressure is dropping and they’ve stopped breathing. The monitor next to the patient shows a ‘flat line’ and someone dramatically grabs a defibrillator, shouts “Clear!” and shocks the patient back to life.
Everyone’s heart has an electrical current running through it, that is how the heart is able to beat. Just like a car engine, the heart needs to beat in a specific rhythm so as to pump blood adequately through one’s body. A heart monitor depicts that rhythm. The purpose of a defibrillator is to “reset” the irregular rhythm of the heart by shocking it (think CTRL+ALT+DELETE). So if the rhythm isn’t appropriate to circulate the blood to the rest of your body, shocking it will hopefully reboot the rhythm to its intrinsic and effective rhythm.
When a flat line occurs (also called ‘asystole’), that means NO electrical current is running through the heart. If PEA occurs (pulselessness electrical activity), there may be a tiny bit of quivering going on but the heart isn’t beating nevertheless (hence why there is no pulse). Shocking it won’t help because remember, shocking it means resetting the current’s rhythm, not adding current. That is why medications like epinephrine are administered, because we need to chemically add some current so the heart can start again. Once the flat line/PEA changes to show some adequate current, then we can worry about whether it’s appropriate to shock it (all based on the rhythm shown on the cardiac monitor.)
Rubbing the defibrillator paddles
A defibrillator has hand-held paddles the physician must rub together while the defibrillator charges up.
Rubbing the paddles together may look dramatic but it does absolutely nothing. If nothing else, it may damage the paddles. If gel is applied to the paddles, it is possible to rub them together to spread the gel, but really the gel will usually spread once the paddles are placed on a patient’s chest.
To be honest, the most up to date CPR guidelines prefer self-adhesive pads over paddles. They are placed on the patient’s chest and stay there for the entire duration of a code. They prevent the delay between stopping chest compression, clearing and applying the paddles to the chest. Moreso, pads allow for heart pacing. It means that if a patient’s heart rhythm comes back as being too slow for example, the defibrillator can be used as a pacer to pace the heart rate to a safe range.
When a patient gets shocked, their entire body lifts off the table
Surely, defibrillators are so powerful that when they are used on someone, their entire body jerks, contracts and convulses off the gurney.
One pad/paddle is placed on top of your right chest and the other under your left breast, laterally. The point of this placement is for the shock to go from right to left and from up to down, which is roughly the way the current goes through your heart. Once it reaches the left pad/paddle it dies off. There is no way the patient’s entire body muscles will contract and only really rarely (I have personally never seen it) when chest muscles will contract enough for it to actually make the patient move significantly.
Misconception #2: Injecting medicine straight into the heart
In a desperate last attempt to save someone, a doctor stabs a three inch long needle straight into the person’s heart, delivering life-saving medication. Seconds later the person wakes up and miraculously survives. All is well in the world.
The truth is if you ever do that to someone, you might as well sign their death certificate. The vascular system is a closed system for a reason and you definitely don’t want to be poking a hole in the main pumping station, unless you want the person to bleed to death or die from cardiac tamponade (when the sac surrounding the heart fills up with blood and squishes down on the heart to the point where it can’t beat efficiently.) The best way to administer life-saving medication is through an IV. But you may think that outside of a hospital, you may not have an IV, then it’s simple: use the needle to inject the medication into a peripheral vein and if the person’s heart has stopped, give some cardiac compressions to circulate it throughout the body. Isn’t that what CPR is really about? Well, yes.
Misconception #3: Pulling out foreign objects
Our hard-working heroes make a habit of getting themselves into trouble and it sometimes include getting stabbed or impaled by various foreign objects. But “pain is the mind killer” and our heroes are so mighty they muscle through and yank that bugger out, carrying on with their world-saving venture.
Our heroes won’t do anymore world-saving when they bleed to death after removing the one thing that kept their innards together. That arrow/pole/knife may be plugging up a whole in an artery or vein. As soon as you remove it, you may bleed to death. The best thing to do is cut the parts that are sticking out (so our hero doesn’t get caught on stuff) and seek professional help to remove it.
How to get medical facts right
Social media is your friend. There are so many venues to start a conversation with someone. Most people in the medical field (I know I do) love to talk about what they do. Trust me, we’d rather stab ourselves in the eye rather than read a novel/watch a movie where those facts are totally wrong. Strike up a convo, ask around.
Use real science as a base, every time. Not everyone writes hard science-fiction where all the facts need to be accurate and tediously studied. Unless you happen to write a novel that is largely relating to your own field chances are you’re bound to stretch things a little, or even a lot (depending on the type of novel you’re writing.) Regardless, your concepts need to be anchored into some real life facts. We aren’t meant to master all sciences but sprinkling some basic science-based concepts will make your invented concepts sound more realistic.
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