Medical questions related to Episode 8

All along I have been watching this show with a keen interest in both the medical and psychological conditions it addresses. I’m also learning a lot about the system of medical practice in the U.K. In this last episode I have found that our system in America has some significant differences from the one in the U.K. Let’s review what happens medically during this episode….

Louisa is leaving with her arm in a sling due to a broken collarbone. She’s on anticoagulants because she has probably had an embolism after suffering a deep vein thrombosis. She doesn’t have a cough anymore so I suppose we are expected to think her embolism is not causing any problems. (It’s somewhat unlikely that the cough would have cleared so quickly.) Martin advises her to drink a lot and try to stretch her legs during the flight, and she seems to be following his advice as we see her drinking something before getting on the plane.

The serious medical events happen once Martin opens an envelope containing Louisa’s brain scan, most likely done following her car accident. The word “scan” is used without saying whether it’s a CT or MRI. CTs are most commonly done after trauma because they are better at picking up bone fractures and bleeding, but an MRI would be more likely to indicate the existence of an AVM. (My husband thinks the scan looks like an MRI and the dye Martin mentions called gadolinium is used with MRIs.) Martin calls radiology and asks them to check the scan they have to see if they see the AVM too. Although it’s impressive that they answer quickly and do what he asks immediately, that could happen. Next he calls Louisa to try to stop her from getting on the plane, but she is in no mood to talk because she has a headache (a sign that she’s feeling symptoms from the AVM). Martin knows he has to prevent her from getting on the plane and hops in his car to race to the airport. While driving he calls the hospital to tell them he’s going to need an operating theater to be prepped for emergency surgery, and he wants it to be ready in one hour. This demand sounds pretty outlandish since he’s a GP in Portwenn and has never done any surgery at their hospital; however, when I checked, I discovered that in UK “the most important privilege conferred upon a Registered Medical Practitioner is that, unlike unregistered doctors, he or she may perform any duties as a physician, surgeon or other medical officer:

In any hospital, infirmary or dispensary not supported wholly by voluntary contributions;

In any prison;

In the navy, army or air service;

In any other public establishment, body or institution; and

To any friendly or other society for
the provision of mutual relief in sickness, infirmity or old age.”

This is very different from the US where the hospital has to have a doctor listed as on the staff and having hospital privileges before he/she can utilize the facilities of the hospital and the staff. Presumably, the hospital in Truro knows Dr. Martin Ellingham from Portwenn because he has referred patients to them and, from the way the young surgeon reacts, his reputation precedes him. (My husband has called ahead to ERs here in the US when we were in cities away from our hometown and requested they prepare for a patient, and they have never argued with him. So in emergencies, a call from a physician in the US will be taken seriously.)

Martin manages to get security at the airport to allow him to get Louisa off the plane (which is harder than working with the hospital), rushes her to emergency where they are waiting with a wheelchair, and the next scene shows him in scrubs preparing to go into surgery. He meets the very novice surgeon who he locks in a closet because he doesn’t consider him experienced enough, and once again we wonder how he could simply walk into the surgical suite and not be questioned. (The young surgeon apparently doesn’t report what Martin does to him, but he’s probably smart not to anger Martin who has the standing to make his professional life difficult.) I suppose Martin takes charge in such a way that they don’t wonder about his authority, and they may have heard his name before just as the intern had. From what we can tell, the embolization is handled pretty accurately, although it’s more common to use the femoral artery than the carotid artery as a point of entry (but this is based on US practices). In addition, in US either an invasive radiologist or a neurosurgeon would be most likely to perform this surgery, but a vascular surgeon could do it. The operation is an emergency procedure and that would mean that it would be ethically permissible for Martin to operate on his wife, unconventional but acceptable. He is clearly the best surgeon on site and should, therefore, do the surgery.

Following the operation, Louisa says her head hurts a little but she could be feeling pretty good under most circumstances. However, it would be somewhat unusual for her to go home the same day. Patients in US usually stay overnight at least so they can be observed.

The other medical situation that takes place in the show is the use of the defibrillator on Caroline. All of what happens there is also quite accurate. They do it under the supervision of a doctor, they do CPR correctly while waiting for the defibrillator, they get the pads on properly and in time, and they shock her such that her heart starts pumping again.

To sum up, most of what we’re shown appears to be accurate for the UK but different from the US in some ways.

Originally posted 2013-10-25 17:10:03.

3 thoughts on “Medical questions related to Episode 8

  1. Carol

    Thanks for all of that. You have done a terrific job in helping me to understand how they could show all of that. I have heard M Clunes saying several times that they are required to do things correctly and I have always admired that. It seemed that they threw that out in this episode, so it is very reassuring to me to know that they didn’t.

    I am really enjoying this blog because you have so much insight. Thanks again for sharing.

  2. kjacobson@mindspring.com Post author

    I am enjoying having a reader who wants to read all of my thoughts. Hang in there for several more posts coming up soon!

  3. Linda

    I was confused by the fact that he inserted the catheter on the right side of her head eventhough she was injured on the left side? is that the way it would be done? I also thought they would not have released her so soon – both the day after her DVT and after the AVM surgery. She must be one tough cookie because she was home the same day after having a baby in a pub and looked like she had just been on a stroll through a daisy field. Her dress was clean and she looked quite energetic. What a laugh says I – who was in hospital for 7 nights with my first (albeit a C section) and was still crying and wearing my flannel nightie for weeks after giving birth. I certainly never looked as good as she after any of the operations I have had!

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