Sunday 28 January 2018

The Resident

I recently got into it with a TV writer on Twitter.  Well, that isn't exactly true.  What really happened is that she said something wholly offensive and completely bullshit, I called her out, and she responded with some almost-worse backpeddling bullshit which I couldn't see because she simultaneously blocked me like a fucking coward.  What she actually said that incensed me I'll get back to (I promise), but who she is is somewhat more important.

The writer in question is Amy Holden Jones, who happens to be the screenwriter for "Indecent Proposal" and "Beethoven".  She also is the creator of the new Fox television series "The Resident", the newest in a series of unfortunate medical dramas that have splatted on our televisions for the past several decades.  I call them unfortunate because they all invariably fall into the abyss of Bullshit-In-The-Name-Of-Drama rather than attempt even a modicum of veracity.  It is the reason I could never watch House MD for more than five minutes without turning it off - there would always be some kind of "OH COME ON!" moment that was so full of ridiculousness that I simply could not tolerate it any further.

So after my nasty little interaction with the creator of The Resident, I decided to sit down and watch the first episode, which Ms. Jones also happens to have written.  I'm not the first doctor to do this, nor (I'm sure) will I be the last, but after seeing what Ms. Jones had to say about doctors (yes, I WILL get to that, I promise), I wanted to see how she wrote about them - what they say, how they act, etc.  Keep in mind I had no idea what the show was about when I sat down, though I suspected it was about a resident (ie student doctor, junior doctor, etc).  Obviously.  I'll be writing this live as I watch, something I've never done before.

Strap yourselves in.  I don't expect this to be a smooth ride.

The show starts in the operating theatre during what appears to be an open appendectomy, soft classical music playing in the background.  At least the lights are on.  So far so good.  Someone (a student?  A resident?  THE resident?  I have no idea) mentions it's her first surgery with this surgeon (so what?), and someone else (a nurse carrying a clipboard for some reason?) says she has to get a picture of the occasion.  What?  Weird.  She summons the anaesthesiologist from around the curtain (WHAT?), which prompts the surgeon to tell them "That is totally inappropriate".  I found this line startlingly accurate, because I expected him to pose along with them and yeah, that's completely inappropriate.  "Aw, we're just having fun!" the anaesthesiologist replies, which of course is the first "OH, COME ON!" moment of the episode, and we're only 30 seconds in, people.  The bullshit gets instantly worse when the patient wakes up, opens his eyes, and starts to move while they're all busy taking selfies.


The anaesthesiologist runs back, but the surgeon, who is inexplicably still holding a scalpel in his hand (what does he expect to be doing with that at that point during the surgery?), nicks something right on the surface which starts squirting blood onto his face and gown.  OH, COME ON!  The bullshit gets EVEN DEEPER when this senior surgeon (who turns out to be the Chief of Surgery, by the way) freezes, apparently lost for ideas (like, you know, stop the fucking bleeding).  The nurse with the clipboard says "YOU HAVE TO CLAMP SOMETHING!" because no one else has thought of clamping something, and apparently she somehow knows that the patient has lost two litres of blood already (in literally 20 seconds) and the surgeon has no idea what to do.  Exactly one second later (yes, really) the anaesthesiologist announces the patient has lost his pulse and is in PEA arrest, (OH, COME ON!) and the surgeon starts CPR - on his abdomen.


"CPR isn't going to put all that blood back into his body", the clipboarded nurse says sadly as the surgeon performs his worthless abdominal compressions.  Exactly seventeen seconds later (yes, really) the anaesthesiologist says "It's no use", and the surgeon stops.


"He is so dead!" says the dramatic nurse dramatically.

HAHAHAHAHAHAHA!  No seriously, the actual line that Holden wrote for this nurse is "He is so dead."  HAHAHAHAHA!  DRAMA.

Everyone dramatically takes off their masks and gloves, and after a few glances across the room, the surgeon announces, "Well I think we can all agree it was the misdosed sevo {sevoflurane, an anaesthesia drug}".

WHAT??  Sure surgeons try to blame anaesthesia all the time (mostly joking), but not right in front of everyone!  Oh don't worry, it gets worse.

The anaesthesiologist tries to argue it wasn't his fault because the surgeon had the scalpel in the field (true), but the surgeon instantly reminds him of another patient whose oropharynx he "ripped through" on a routine intubation, and he had covered for him then.

WHAT???!?  What the ever living fuck is this supposed to be?  Doctors don't cover up other doctors mistakes, especially in front of the entire operating team.  We have morbidity and mortality conferences where we actively discuss mistakes, both serious and common, and everyone learns from them so that mistake doesn't get made again.  We don't do quid pro quo where if I fuck up you cover for me, so that gives you a Get Out Of Fuckup Free card the next time you make a fatal error.  This is such egregious bullshit I am absolutely livid and frankly shocked that this made it onto television.


As the members of the surgery team all discuss the situation, the nurse says "We're all on the same team here . . . right?", with the clear implication that they all need to cover for each other.  Someone else says, "Maybe he had a heart attack?"  WHAT???  The surgeon shuffles away as the anaesthesiologist looks at the chart and tremulously says "Yes, there's . . . some family history of heart disease."  "Yes," the nurse says definitively, "his left main {coronary artery} clogged.  Sudden cardiac event."


"That's right, that's exactly right.  There's no way to prevent this," says the surgeon.



That's right, we are that chock full of some of the most putrid, absurd, repugnant blather I've ever witnessed on television, and we're only 4-and-a-half minutes into this travesty.

And we STILL haven't even met The Resident yet.

If you're worried the bullshit starts to lessen as the episode progresses, you're in for a huge disappointment.  In the next scene Devon (The Resident) meets Conrad, his senior resident, who quite authoritatively tells Devon The Resident that he has to do everything he says or he can remove him from the program (uh, no you can't - you're both residents).  If that weren't bad enough, Conrad gives Devon The Resident a code blue on his very first day as a doctor.  Uh, no.  And then Connor slaps Devon's cheat sheet away when Devon tries to reference it.  You know, so he doesn't kill the patient.


The one bit of truth in this episode comes in the next scene when Conrad chastises The Resident on continuing that code for too long, which ends up regaining the patient's heartbeat but leaves her brain dead (Jahi McMath, anyone?).  "All we want to do is help our patients, but what they don't teach us in medical school is there are so many ways to do harm", Conrad philosophises.

Ouch.  Very true, but very ouch.

But just when I thought the bullshit was over, it jumps right back into it with a wealthy philanthropist awaiting robotic prostate surgery which is to be done by a visiting second year resident (WHAT??), though the philanthropist wants The Surgeon to do it even though he's never even touched the robot before, not to mention the fact that prostatectomies are actually be done by urologists, not general surgeons.  This is a most basic fact-checking failure that anyone in the medical field, even the radiation oncologist who created the show with Holden Jones, should have picked up.

But then Holden Jones finally shows her true colours, her agenda behind this absurdity.  As The Resident worries over his brain dead patient's future and if there will be an investigation, a nurse (who happens to be Conrad's ex-girlfriend - DRAMA) tells him the hospital will probably give him a medal because they will bill thousands of dollars every day she's in the ICU.  Because, she explains, "It's a huge payday for them.  Medicine isn't practiced by saints . . . it's a business."


If that weren't bad enough, the nurse goes on to tell The Resident of a surgical error that killed her mother after a routine test gone awry.  "This happens all the time, Devon.  Medical error is the third leading cause of death in the United States after cancer and heart disease."

Ok, fuck you Amy Holden Jones.  FUCK YOU.

I'd like to address this "third-leading cause of death" myth before I go further.  I see anti-medicine people use this "statistic" all the time, always in an attempt to make doctors in general look bad, and it drives me fucking bonkers.  Fortunately I don't really have to address it fully, because Dr. David Gorski, a surgical oncologist and prolific medical blogger, has done so already.  Long story short: no, medical error is NOT the third-leading cause of death, not by a long shot.  The only reason Holden Jones could have possibly included this line in the show is to make doctors look bad.  That is the only reason.

I had a very strong feeling that Holden Jones had an anti-doctor agenda when I started watching, but I never in a million years thought she would just put it right out there on a silver fucking platter.  The reason I had that feeling was the tweet I alluded to previously.  This one:
It's all there in black and white, a very real and very libelous declaration that cancer doctors are nothing but money-hungry ghouls who are paid kickbacks (which are illegal) to prescribe toxic chemotherapy to patients, even when it is no longer indicated.


Holden Jones tried to defend this indefensible statement by giving an example of one unscrupulous cancer doctor who made money by giving chemo to patients who did not need it.  Yeah, that guy was an immoral asshole who abused patients and deserves every minute in prison that he got.  But one example does not describe all the other oncologists around the world who chose that specialty knowing they would be dealing with some of the sickest patients, who have dedicated their lives to a specialty that can help many but save few.

On behalf of oncologists everywhere, I called her out on her bullshit:
Unsurprisingly she did not seem to take this well, as she immediately blocked me.  She did, however, respond to me before doing so (not that I could actually see it):
Unclear?  No, Ms. Holden Jones, it was not unclear in the slightest.  What you said is a vile lie and it exposed your true motive behind your writing.  You made your anti-doctor sentiment more than clear through your tweets, but you managed to crystalise them very nicely with your bullshit script on your bullshit show.

If you're looking for some risible anti-doctor soap opera twaddle on which to waste an hour a week, look no further than The Resident (apparently there are more episodes to come).  But if you'd like an interesting new television series that won't make you want to punch your television, set it on fire, bash it with a sledgehammer, throw it in a wood chipper, and never watch it again, try Black Mirror, Stranger Things, or Star Trek: Discovery.  Or get into Game of Thrones.  You still have at least a year before the final season starts.

And if you're wondering, no I will not be watching episode two.

EDIT: Let me make one thing abundantly clear here.  I am not upset that the show features typical television-medical-drama-bullshit.  I was not looking for a scientifically accurate program, and I certainly did not find one.  What pissed me off is the anti-doctor rhetoric that was rampant throughout this episode (and that apparently features prominently in another episode, as was told to me by a reader).  



    ZDoggMD's review of the same episode. A few less F Bombs and doesn't get into it about the writer...who likely watched the interview with the voodoopath that was claiming that oncology docs were money grubbing ghouls (see this ZDoggMD podcast

    Glad I didn't watch it. For the record, I liked the first couple seasons of House...after that, not so much. Incidentally, one of my supervising docs was a consultant for one of the episodes in the first or second season - a weird thing he came across working in Australia of medications being bottled incorrectly.

  2. The closest to "medical shows" ive watched actively is izombie (stop laughing im serious). Which only includes the work in a morgue. And isnt about medicine. Its a semi police procedural (semi as what your really there to watch is the overarching storylines which take up over half of each episode). Its a show about a former surgeon who got scratched by a zombie and now works in a morgue where she eats brains to stay normal and gets the memories of the person whose brain she ate and uses them to help solve murders (stop laughing im serious) it sojnds stupid but its legitimately great.
    The one time they were trying to save someone actively dying from bullet wounds they didnt even mention taking out the bullet. (They save his life by turning him into a zombie. Much more realistic)
    Its a great show with the dumbest sounding name and dumbest sounding premise but it is one of the best shows you will Ever watch,and i recommend it to everyone. Everyone Ive convinced to watch it has fallen in love by episode 3, and ive convinced a wide range of different people to watch it all of them with different tastes and interests.

    1. it sounds absurdly entertaining.

    2. When watching the show its really not so absurd as it sounds...kind of. Its all on netflix still (thecw show. Who knew they could actually make something good?) 4th season starts next month actually

    3. I'll try to remember to give it a look if the next shift goes well.

  3. for the record, I feel the same way about the new show, "911"

    and similarly about Chicago Fire.

    (and I believe I may have mentioned we show Backdraft as a training video. as in "if we catch you doing anything you see in this movie, you're out of the program.")

    1. I tried watchkng 911. My sister and her boyfriend like it a lot for me doesnt cut it. Ive moved onto higher quality shows like game of thrones or izombie (stop laughing im serious)

    2. 911 is just a soap opera set in the world's least professional emergency services organization, ever.

  4. DB, I can certainly understand your outrage. I think this show speaks to a really sad aspect of our health care system, which is a general erosion of trust in it. It's mostly due to the constraints insurance companies have put on doctors - and everyone else - and Big Pharma. Also, doctors have enormous and unreasonable expectations put on them by patients and everyone else. In such a set up, they are doomed to fail now and then.

    Probably the only other human relationship that has such unrealistic expectations - and projections - on it, is marriage. And we know how successful that is. Expectations are tricky because while we all have them about other people, no one else is obliged to meet them. It's our problem, not theirs. We try to get over this by formalizing them in the form of contracts and professional standards, etc., but clearly that doesn't always work either.

    TV is a great desert. Entertainment for the masses. The masses are stupid. Object to what you see, but don't take it too seriously. I always try to take it as a peek at the preoccupations of the unconscious of mah fellow Amurcans. That's why I haven't watched it for 4 or 5 years now. Yuck. But that's show business!

    1. I used to avidly watch tv until the dark days of the kardashians and honey boo boo. Then i dicovered a few shows worth watching like game of thrones

    2. Martin has the dubious distinction of being the author of a fantasy book I have put down. only a few writers have accomplished that.
      I won't watch reality TV, either, but I see no reason to watch gratuitous brutality.

    3. Ken, good to see I'm not alone in my dislike of George R.R. Martin. Read a short story of his years ago before he was quite so popular and hated it.

      Controversial opinion to have these days!

  5. I got as far as the camera coming out and had to turn off the TV to go retrieve my eyeballs from where they had rolled. It never ceases to amaze me how ignorance is lauded as authority and the uninitiated are so easily duped.

  6. love the show but glad to hear it is fantasy!!

  7. That show sounds absolutely ridiculous. It sucks when a writer goes in with such a clear and distinct bias and manages to influence a lot of casual TV watchers unwittingly.

    Have you heard anything about The Good Doctor?

    1. I would be interested in Doc's opinion of it. I have seen a couple episodes, and found it mostly inoffensive, but a bit farfetched in scope.

  8. Appreciate the warning. Unbelievable that writers cannot craft a realistic script without being absurd. Medicine is interesting (as evidenced by your own adventures!) and the fake "taking photos in the OR, CPR on the abdomen, blaming/cover-up" bullshit does a disservice to those of us who actually do the work.

    1. people who have seen real CPR find movie and TV CPR to be incredibly fake.
      of course, they are usually using a real actor, and doing real CPR on a real actor is kind of rough on the actor.

  9. Wow! Jones sounds like an idiot. The last medical-related show I watched was Saving Hope, a Canadian production. The medical aspect was very preposterous, but I had a crush on one of the leading actors and that's why I watched. Silly, I know. Speaking of the patient waking during surgery, that's happened to me during every surgery I've had - tonsillectomy, two carpal tunnel releases, two knee replacements, spinal fusion/laminectomy. The anesthesiologists were always surprised. I've never received an explanation why this happened.

  10. Since you mentioned Jahi McMath, Doc, you might be interested in the latest ploy by the plaintiff attorney and Dr. Shewmon -

    1. The whole case proves that yes you can survive without yourbrain just fine her "supporters" have been doing it for years now!

  11. ** read Doc Bastard's list of alt-med memes as found in the "Resident" show **

    Well, that went quickly overboard.
    I wonder what they will do for season two. The Resident discovers in the finale of season one The True Cure They Don't Want You to Know About (tm), becomes a follower of the Church of Mineral Wonder Solution, and start dosing everybody with bleaching agents?
    (the last part? No, not making that thing up. Some snake oil peddlers do sell people bleaching agents as therapeutic agents)

    Re: cancer treatment, for anyone interested, here is a blog by someone currently undergoing treatment for colon cancer. Radiation, surgery, chemo, the whole shebang.

    A bit graphic sometimes. Worth a read if you are looking for a real patient point-of-view.

  12. If you liked that, you'd love

    One of the overarching ideas of that show was that the FDA spent all it's time getting in the way of new miracle treatments, and with just a bit of silicon-valley can-do, all medical problems could be fixed. Amazing what a bit of code can do.

  13. I feel the same way about Prison shows and what bullshit os spewed in the, they make the guards look stupid and the inmates smart. It's a totally ridiculous lie. All of the prison movies or shows I've seen were a complete joke and not how prisons are run. The guards know what they are doing and the inmates do not sit around speaking like intellectuals. It's such an insult how HollyWeird portrays any occupation, because it's all faulty. In the UK, anything medical done in a show must be deadly accurate or they get in big trouble. I believe it's against the law to put a procedure on TV that isn't accurate if it is produced in the UK. In the USA, they make shit up for dramatic effect which is irresponsible.

    1. That's a wildly inaccurate analogy, in my experience. Most prison shows take the stance that all prisoners are, by default, terrible, terrible, people and the guards are almost all great, heroic guys.

  14. Doc B and fellow readers:
    Normally I only weigh in on Jahi McMath (nice discussion in The New Yorker today) but I have some standing in this issue.
    I worked with Harrison Ford in his portrayal of Dr. Richard Kimble in The Fugitive (I was his role model for some the scenes - not in the OR - and responsible for much of the medical detail). That's me taking the kid with the tension pneumo up to surgery - if you look quickly you'll see that Harrison is holding the X-ray backward - they didn't want to reshoot because the scene came off well and would cost more money.
    My job was to make it as realistic as possible, which I tried to do. The medical sets and stuff like that.
    But like the backward X-ray, sometimes as technical advisor, you are overruled by the powers that be. When I noted something like the orderly roller blading down the hall and I said that's little overboard, I got "When we want your opinion we'll ask for it" Pleasant but firm.
    Basically they want reality- but not too much reality.
    They are advancing their narrative. There isn't really much point in getting upset about it - I learned that thru experience.
    A little bit of fudging is acceptable. A lot of meddling with the truth is not - see "I Tonya", "JFK" or even "The Post".
    When they have an agenda they are going to push it.
    Not much you can do but occasionally call them out (fortunately on The Fugitive for the most part they were accurate and didn't mess with my advising) .
    I used to teach critical care to ER residents and had to go to the ER all the time. When ER came out my kids watched but I didn't' (advice to Dr. B -don't watch if it upsets you). I came in the room one time and saw some nonsense and said to my kids, "You know, it's not really like that" . They rolled their eyes and said "What do you know dad, you're not an ER doc"
    No point arguing.
    It's a lesson about medicine and show business.
    Dr. Franklin

    1. Just out of curiosity but what was harrison ford like to you? Howd he treat you etc? Just curious

    2. Very nice. Good sense of humor.
      Very observant. Watching you and asking questions. I think that is necessary to be a good actor.
      But he was always a bit on guard- everyone bends from the ankles to him and so its hard to know how to act around him.
      You try and be yourself but trust me, it's harder than it sounds.
      Dr. F.

    3. Dr. Franklin, thanks for pointing out that article in the New Yorker. I have a lot more sympathy for the family and their choices after reading it. I revisited it today to find the author had corrected an earlier version which stated that Jahi's mom had requested a DNR order on her daughter's behalf. I guess her mother would want a full code performed should Jahi's heart stop again.

      It also explained that Jahi's bloated appearance in recent pictures is due to the steroids she is on to keep her blood pressure up.

      DocBastard mentioned awhile back that he might have another post to write about Jahi in the near future. I wonder what his thoughts are on the New Yorker article. The author actually visited the family recently and seemed more informed about the history of the case.

  15. I wonder what would happen should she become seriously ill say with cancer, who will she go running to first?

  16. ROFL! I tuned into that show during the very scene where The Resident was doing CPR, got the heart restarted & was told the pt was brain dead after 12 min. with no oxygen. I just laughed & kept channel surfing.

    I have it on good authority that the medical consultants for tv shows make a 6-figure salary for what is basically a part-time gig, since they don't film all year long. So can any of our illustrious doctors here explain how doctors who are paid to check the writing for medical accuracy let shit like that slide? Or do they just submit their notes every week, cash their paychecks & forget about it?

    IF your name is associated with a show as the Medical Consultant, won't it hurt your professional reputation if the medical scenes are bullshit when the show airs? IJS...

  17. Good news: didn't hurt my reputation (at least not that I can tell)
    Bad news: i made $1100 for a movie that grossed over $400 million worldwide.
    Next time I get a better agent.
    Dr. F.

  18. it occurs to me that the correct response would be to make a TV drama about TV show writers...

    1. Bones did that once. Just one episode out of many, but it explained how there can be bullshit in a show made after a book an actual forensic anthropologist wrote, despite the fact that she co-writes the show herself.

      Of course, the movie they made in the show was even worse and completely over the top, but the message was clear: sometimes, drama is more important than accuracy.


  19. Please try The Good Doctor, I’d love to hear your opinion about it.

  20. After Black Mirror, watch Philip K. Dick's Electric Dreams. It will give back to you what Black Mirror took away.

  21. I'm always amazed when, in medical TV shows, the surgeon comes to talk to the family, and he's wearing bloodied scrubs. REALLY???

  22. This is why I can’t watch law shows. Being an actual lawyer, they hurt my brain.

  23. Awesome. What a great retelling. I've discovered that I watch these shows to get a laugh. I've also discovered that a lot of people think this is how it really is. . .so disturbing. I'm a clinical ethicist by the way. I was yelling at the screen during the opening scene. Absolutely absurd.


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