We’ve seen it so many times. A young, handsome man rushed into the emergency room with a gunshot wound. A flurry of white coats racing the clock: CPR, the heart zapper, the order for a scalpel. Stat! Then finally, the flatline.
This is Dr. Shoshana Ungerleider’s biggest pet peeve. Where are the TV scripts about the elderly grandmothers dying of heart failure at home? What about an episode on the daughter still grieving her father’s fatal lung cancer, ten years later?
“Acute, violent death is portrayed many, many, many times more than a natural death,” says Ungerleider, an internal medicine doctor and founder of End Well, a nonprofit focused on shifting the American conversation around death.
Don’t even get her started on all the miraculous CPR recoveries where people’s eyes flutter open and they pop out of the hospital the next day.
All these television tropes are causing real harm, she says, and ignore the complexity and choices people face at the end of life.
As a critical care nurse, the miraculous CPR recoveries are such a horrible disservice to our patients and their families. CPR is not two minutes of some light exercise and then the person wakes up and is ok forever.
It’s 20-30 mins of intense, brutal, scary, undignified activity followed by best case scenario, we put you in the ICU, deliberately make you hypothermic for a day or two, and hope you wake up. That increases your chances of surviving the incident to a whopping 64%.
Surviving to discharge and having a meaningful recovery is a whole other ballgame, and depends a lot on the condition you were in when you had cardiac arrest in the first place. Your elderly grandpa with cancer, sepsis, bad kidneys, etc. is probably not going to go home. Your middle-aged wife who came in because she was having a heart attack actually stands a good chance.
Movies like to show people shocking a flatlined patient who just pops up and walks away when in reality presenting fully flatlined means you’re 2-3 times less likely to be resuscitated at all.
I’m happy to leave some leeway in fictionalized depictions of medical care for the sake of story progression. But the complete ignorance currently common in fictional resuscitation scenarios feeds a really malignant sort of magical thinking that keeps us torturing elderly people. I’d really appreciate less of that in my job.
I heard that Defibrillators too don’t work on stopped hearts - only weak pulses, and if you’re hit with one you’re not standing up instantly even if you wanted to. It’s days maybe weeks of recovery
Can anyone confirm?
Yes, a stopped heart shows up as a flat line with no activity on an EKG. We don’t shock people when their hearts have completely stopped because it doesn’t do anything and can actually damage the heart. Defibrillators are named that because they’re intended to shock a heart that is in a chaotic electric rhythm called fibrillation where the heart is just kind of shivering instead of beating fully.
If a person has flatlined, you can do CPR and administer epinephrine, and if you’re extremely lucky get their heart to start fibrillating so a shock might have a chance of being effective at restoring a normal heart beat. This is why someone whose heart has stopped completely is 2-3 times less likely to survive CPR than a person experiencing fibrillation.
Thanks for the helpful info! Didn’t know about fibrillation so this was very educational. I previously assumed that defibrillators were for flatlined hearts 😳
Great reply there already, I just want to add that a timely defibrillator shock can have the patient go from unconscious without a pulse to alert and talking very quickly, provided that the time between the start of the shockable rhythm and the shock is relatively small.
Nowadays we have AED devices in many public places that any bystander could attach to a patient receiving CPR, the machine will analyse the rhythm and deliver a shock if needed.
From what I understood, defibrillators basically stop the heart, letting it restart on its own in a proper rhythm.
You are correct, and we actually also use them on people who are not actively dead, but are having a bad heart rhythm that is causing intolerable symptoms.
The shocking dead people to resuscitate them thing, the part that everyone is familiar with, is when the ventricles of someone’s heart have started quivering in a chaotic rhythm called ventricular fibrillation or vfib. If someone is experiencing vfib, they’re actually dead because vfib invariably degrades into full stop flatline very quickly. Shocking someone in vfib briefly stops their heart in hopes that it will reboot itself into a rhythm that is compatible with life.
But the right atrium can also fall into fibrillation. You’ve heard about this on TV (if you’re in the US); we call that afib. Afib is compatible with life, because the ventricles are the main part of the pump and can continue to beat even if the right atrium goes a little haywire. But often that beating isn’t very effective and people will experience low blood pressure and shortness of breath. And the right atrium isn’t clearing blood out of itself effectively in afib, which can cause the blood to clot in the heart and lead to a stroke if a piece of clot breaks off.
So, you may be thinking to yourself, wait, ventricular fibrillation we use a defibrillator, so what about atrial fibrillation, and that is correct, we can use a defibrillator to shock someone in afib, reboot their heart, and hope they go back into a normal, more effective rhythm. (We do mildly sedate people before doing that lol.) Sometimes that works, sometimes we have to just control afib with meds and we have to keep them on blood thinners to prevent a clot in the heart.
And lastly, there’s a more complicated heart rhythm called Supraventricular Tachycardia or SVT that sometimes also responds to being shocked. We try a couple of other treatments first for SVT, but shocking can work. And again, people are mildly sedated for that.
As a CPR/first aid instructor I’d be happy if we could just get a few good CPR depictions. Hard surface, proper compressions WITH counting out loud, maybe do an ABC assessment to begin with… And if we for once could get compressions on a bare chest, that’d be great.
Not looking for an instructional video when watching Reacher. Realism is OK, and people not knowing CPR is unfortunately real, but maybe medical dramas could get it right.
Learned a lot there. Thanks!
Fuckin a that’s a great idea. But also, violent death should be portrayed more accurately. Less John Wick, more Saving Private Ryan. Less cool, more horror. Lot more horror.
Our wish to protect our youth from depictions of horror is very heavily contributing to our worlds problems, in a very large number of ways. They’re frankly just deciding they’re perfectly okay with actually just doing it irl, far too commonly. Not knowing how it’d actually look and feel is a major component of this imo.
There’s plenty of horror that really needs to be shown with “natural” deaths as well. All of the shaking and pained gasping that typically happens leading up to the final moments should scare the absolute shit out of everyone.
It’s just one of those things society tries to hide and pretend went peacefully like childbirth. The only actually peaceful death I’ve ever witnessed was my dogs being put down by a very nice vet.
I work in hospice, so comfort and a peaceful passing is always our goal. There are some deaths that are more unfortunate than others, but with support the majority of deaths under care thankfully aren’t “shaking and pained gasping.” Still far from the Hollywood version of being coherent enough to pass along one final message before heading into a bright light. When these types of media are the most common source of information regarding death, it can definitely be more challenging to prepare a family or patient for what’s to come.
That “final moments” thing is hard.
The last time my mother was remotely coherent was about a week and a half before she died (cancer, hospice, at home, 2010 when I was 23), and she said some really awful stuff to me and about me that still sticks with me today…
I know her brain was heavily misfiring at that point, because she also called me mommy and curled up in my lap, but it still never really leaves. It’s an incredibly painful memory I have of her last moments of being able to communicate… and I had/have no idea how to handle it.
Also that whole closing the eyes thing? Yeah, I was incredibly disturbed that that doesn’t work at all. There’s a reason they cover the face with a sheet.
Upvote and thanks for doing the meaningful, difficult work that you do.
Peacefully like childbirth
My mom would like to have a word with you
Morphine
Listen my porn needs less pizza boxes with holes in it too!
Yes, and then somewhere a war or a catastrophe happens and you have to somehow merge your casual picture of the world with what’s coming from there.
I’d also like people treat crime this way, with all seriousness. Trafficking, abductions after which you may be found in pieces somewhere really far, and what happens before that.
That’s all around us.
Using a single punch as a quick way to knock someone out and they’re just fine when they wake up is my pet peave. Any hit hard enough to cause a blackout is likely to bring long term damage.
I used to fight professionally in my youth (muay Thai). I’ve seen people out cold a good few times and every time they were up and walking minutes later. Concussed for sure but otherwise fine.
The worst I had was an 8 count from a head kick where I couldn’t remember after the fight if I’d won. Kept asking my wife. I felt mentally foggy for a while but was fine within about two weeks.
My sister has a few years she can’t really remember resulting from a series of concussions. Head injuries shouldn’t be treated casually.
Apologies, that wasn’t my intent. I was just trying to get across that people do get moving quickly after being knocked out. It’s usually caused by a sharp drop in blood pressure (that’s why chin shots are so effective, it momentarily cuts off blood supply) so folks do get up quickly after it.
Concussions are serious. I had a rule that I would stop fighting after my third because your chances of suffering depression later in life or lasting damage after 3 increases quite dramatically after that. Luckily for me I got too old first. :)
Well… Did you win?? Don’t leave us hanging!
Oh haha, sorry. I actually managed to scrape a draw!
Yep, hockey here. Head met ice and I saw birds at one time. Only out for a few seconds, definite concussion, but I’m alright. For the most part.
“Acute, violent death is portrayed many, many, many times more than a natural death,”
Is a gunshot wound not considered a natural death in America?
Only in K12
Do you mean K-12 education? Chapeau! So what is it after that, death from “Freedoom” ™?
What about an episode on the daughter still grieving her father’s fatal lung cancer, ten years later?
This would be very affirming to see represented honestly.
I just had my second Christmas without my dad because of cancer, and there are moments when I still feel like I am in the hospital room watching him die. It’s hard to even talk about because it seems like two years later it shouldn’t hurt so bad and I don’t think people really understand how grief works.
Sorry for your loss.
Obligatory: fuck cancer!
Much appreciated.
Fuck cancer indeed.
My dad died 10 years ago and I still grieve for him. Not all the time, obviously, but I’ll watch a movie that I think he would like or I’ll read an article that I wish I could talk to him about and I grieve. He died when my daughter was four. She was asking about him the other day and I grieved again talking about him. I had to hold back tears. A couple of years ago, I watched a TV adaptation of an off-Broadway musical he loved and I was crying almost the entire time despite it being (mostly) a comedy. I’m fighting back tears right now.
For that matter, I still grieve my first dog who died 15 years ago.
I don’t know that grief ever entirely goes away.
I’m sorry about your father.
It’s hard for sure. I shared a lot of common interests with my dad, so there are many things I do that I associate with him and it always hurts to do alone.
Silly things, too. I nearly broke into tears on Christmas because my wife gifted me a box of candy that my dad loved and I wasn’t able to find anywhere.
Yeah, I totally understand. Like the musical. It’s about a gay man dealing with his former wife and child and also his first new boyfriend after coming out. And it’s really funny. My dad (not because he could relate, he was CisHet) absolutely loved the music and listened to the cast album all the time.
And I just watched the entire time with tears streaming down my face.
Wow. I can relate to you and Nate’s conversation so closely. I lost my dad to brain cancer 2 years ago. We both enjoyed discussing the latest discoveries in astronomy. Now, I don’t follow anything about it. But every time I come across new jwst image on here, my eyes start leaking.
I’m told that it is healthy to continue doing the things you associate with the person you lost, but I can’t seem to muster up any desire to do so.
My dad got me into Star Trek when I was a kid; he loved it and I idolized him, all I wanted to do was watch it with him but it came on after my bedtime and it was like a forbidden fruit. As an adult I watch The Next Generation start to finish every couple of years and I have for a long time.
Since he died I haven’t watched a single episode. The thought of it makes my stomach ache. I just can’t do it. I’m overdue for a watch and I just can’t make it happen.
Yeah, that’s sounds right. I think I could force myself through it if it helps. But at the same time, I only ever followed the latest findings in order to have that conversation, so… I don’t know. I guess I don’t see the point (for me).
Right after he died, I got an achievement on GitHub because I contributed 2 lines of code to opencv and NASA used opencv on the Mars helicopter. I totally lost my shit. My dad would have thought that was the coolest thing even if my contribution was negligible. I guess I’m trying to say that whole part of me just feels completely meaningless now.
Lol. I don’t where I’m going with all this. Stay strong dude.
Sometimes it’s cool to just write out the shit you’re trying to figure out, glad I could be a sounding board.
Somebody gets knocked out, wakes up THE NEXT FUCKING DAY as if they had a good night’s sleep, get up and walk away.
If you get a blow to the head and you’re out for more than 10 seconds, you’ll likely have damage. If you’re out for minutes, you’re likely having lasting issues and a long recovery period.
Similarly : people being sedated with a towel with chloroform, or a dart in the neck and they wake up the next day. I’m far from being an expert but I do know it’s VERY hard to keep him and unconscious safely, it’s why anesthesiologists make so much money. If you take someone out the other way there is a good chance they simply won’t wake up.
Yes. But also no.
Anesthesiology has a lot of parts. Antigrade amnesiacs, painkillers, muscle paralyzer, and the drugs to actually knock you out. They have to monitor vital signs to see how the drugs are behaving and keep you under for extended periods. They make sure you don’t go into respiratory arrest or vomit and asphyxiate on it.
If you are only knocking someone out with drugs, it’s not as precise and just removing the drugs is usually enough to cause them to wake up. Keeping them under for any length of time readminstering drugs will take some skill. But not to the level of an anesthesiologist, especially since they can wait and see the person wake up a little to knock them out again vs an anesthesiologist that needs them not to even wake up a little.
Lol last night we were watching Reacher, the dude received head trauma from multiple sources including a baseball swung crowbar to the side of the head, THEN he drowned a little bit. He finished killing all the bad guys and goes home for a nice hot recovery shower. Dude definitely suffered some brain trauma but a hot rinse and he’s all good.
Thad is immune to concussions now.
Or just look at Home Alone reviewed by trauma surgeons
Home Alone gets a pass because it exists further into the animated cartoon laws of physics side of fiction.
That’s a whole different thing, because Home Alone is a live-action cartoon. The bandits play the same role as Tom chasing Jerry.
I feel strongly about this. People are clueless thanks to these depictions.
CPR works outside the hospital 5% of the time and inside the hospital 20% of the time. If you need CPR, you’re very, very likely going to die. Those that do recover are often permanently disabled.
The article mentions the depictions of recoveries several times. Getting CPR and then getting up off the ground, or walking out of the hospital the next day. Nah. Usually there’s days or weeks in the hospital and months of rehab.
I also think realistic depictions of shootings and shooting deaths would significantly reduce gun violence. Even the movies that show over-the-top blood splatter and stuff fail to capture the actual gore and misery of someone dying from gunshots, bleeding out alone.
Don’t even get her started on all the miraculous CPR recoveries where people’s eyes flutter open and they pop out of the hospital the next day.
The next day? In the first Jurassic Park movie, the kid gets CPR and is running away from dinosaurs minutes later!
There’s at least the (very weak) justification that the fibrillation is externally caused. Once the current is removed, the heart can sort itself out and start beating spontaneously. In that case, the CPR actually did nothing useful. If done right, however, it would be running with broken or dislocated ribs.
What do you mean I can’t just “walk it off” if I get shot right next to my heart?
What, your pericardium isn’t made of Kevlar?
I’d recommend Andor to this doctor, and also anyone
This would make for the worst action movies.
Lord of the rings… What’s his fave fights “unbeatable orc’s”, kills a dozen or so, gets shot with an 1/2" thick arrow in the chest, kills another 3 or so, takes another arrow in the chest, kills some more orc’s, takes another few unbeatable orc’s, takes another arrow and finally starts slowing down.
I know, I know, I know, it’s a movie but seriously? Is it that hard to have a tiny about of realism?
It’s called fantasy, don’t ask for realism when there are hobbits and orcs and magic lol
Hmm, I never had the impression that the orcs or urukai as unbeatable. They can be beat easily as you mentioned in your example.
The character’s name is Boromir.
What do you think would be the mechanism of death when he gets hit by an arrow? Even bullets rarely kill instantly. Bullets stop people because they hurt and people go into shock. A properly trained soldier absolutely is capable of continuing to fight through this. Short of a head shot, the most likely mechanism of death is blood loss, which takes a little time. When. Boromir dies, he is ashen pale the way a person with catastrophic blood loss would be. I think that death scene is more realistic than you realize.
LOTR in general was written by a person who had spent some time in WWI trenches.
It may not be very specific on the issue of Aragorn’s pants’ existence, but touches a few times on how death smells and on wounds and how easy it is to die.
IIRC not a lot of time has gone since the party discovered Frodo’s disappearance, went searching for them, then the younger hobbits and Boromir encountered Orcs, and then Aragorn heard Boromir’s horn and ran down to find Boromir dying and have a short conversation.
I suspect the original comment’s author just isn’t familiar with that book, having seen only that movie with plenty of CGI.
I like that wounds are a big deal in LOTR. Frodo is stabbed in the chest and it’s a life threatening crisis. Granted, it’s with a dark blade, or whatever. But just like in real life, surviving that wound is several weeks of care, it never really fully heals and still bothers him decades later. They are very clear that 100% of surviving a battlefield is doing your best to not get wounded in the first place. Even exposure to elements threatens the lives of Frodo and Sam near the end in ways that are almost never portrayed in fantasy works.
It also shows early that traveling on foot is hard, that you need food to survive, that cold weather can be murderous, that drinking bad water can be dangerous, and that trying to be smarter than the road you’ll get lost.
Also shows effects of old age and PTSD well.
And it shows age as something very different from mainstream popular culture, where the best part of life happens somewhere in 18-23.
This doctor needs to find a hobby. They’re MOVIES. It’s expected to suspend a bit of disbelief when watching them. If every profession pursued a realistic representation of their career in movies, we’d have nothing but boring movies.
People watch movies to EACSPE reality. Not become engrossed it it. If someone wants to see how REAL medical procedures work. They can google it or watch a documentary.
People watch movies to EACSPE reality
This argument never really makes sense to me. Obviously some people just want escapism, but this line is brought out to justify any sort of discrepancy even when the more realistic option would be less jarring and therefore make better escapism by not reminding the viewer that they are watching a movie.
the desire to make movies more palatable for wider audiences comes only from either the production houses trying to make more money, or the Mary Whitehouse style Republicans who believe it makes Jesus cry when we say poopoopeepee on TV.
The concept is called attraction to mediocrity - in which with so many competing detractors, art by committee ends up being bland, fake, dry, mass produced and mass consumed.
Also, plenty of people are interviewed for interest segments in media and still have hobbies? It’s not like this doctor dedicated years of her life to these comments.
Hey I got hit in the head and fell unconscious for a few minutes but the guy in the movie I saw just walked it off. I’ll be fine.
Yeah. That’s how movies are. Want tutorials? Go to YouTube.
Lol, I want him to go to the hospital instead of walking it off.
Naaah. If they’re so dead-set on following the “reality” of how things are in movies…. The world might be better off if they take their chances and just walk it off.
This 1000% is the answer.
