10 May 2014

Nerd Rage: Captain America's little flaw

Got a childfree night tonight so we went to see Captain America: The Winter Soldier. This is not a movie review, nor will it contain spoilers, I think. If you are extremely sensitive to this sort of thing, please stop reading now, go see the movie (because it is amazing and awesome and I freaking love what Marvel is doing with their properties) and then come back so I can complain in peace.


As noted above, I really enjoyed the movie. I enjoyed the lack of gratuitous T&A, the large quantities of gratuitous stunts, and the infinite supply of explosions. I also enjoyed the plot. I say this as someone who does not read a lot of comic books and comes into the Captain America franchise completely blind to prior history, so bear with me if you don't like something they changed from the long history of comics. I don't know what you're talking about. All I know is that Steve Rogers and his red-white-and-blue suit represent the ongoing struggle between truth, justice, the American way, and the moral high ground, and I like it. I also really like Scarlet Johannson kicking people in the face, which is another bonus for Marvel. There are some things Marvel is still working on in terms of translation from print to screen, but this is a story worth telling.


I just have one serious quibble with the movie, but it's kind of a big one. And in this case I'm going to spread the love around, because I have the same quibble with DC in Superman Returns. It involves hospitals and operating rooms and more specifically code scenes. (No spoilers!) And both movies have the same flaw. It's game-breaking for me and it disrupts my suspension of disbelief, and I said that while talking about a 95 year old genetically reengineered man with a flying shield made of vibranium while using my serious face.


It is this: CPR.


In Captain America somebody dies (hint: It's not Dumbledore). In Superman Returns, the Man of Steel sort of semi dies (if I just spoiled that movie for you I am sorry but the statute of limitations is one franchise reboot). Both of them wind up in a hospital being attended to by a team of Serious People in Scrubs, which is what we all look like when bad things happen in the hospital and is so far believable. Both of them are hooked up to cardiorespiratory monitoring, which is also part of the Bad Things Happening algorithm. I will even give Superman a pass on the whole "they showed a flatline before putting EKG leads on him" thing because Dramatic Timing (also, what are they starting an IV with in that scene? A spinal needle?). But here's the part that is driving me berserk:


Two movies. Like ten minutes of scenes with People Trying To Die and telemetry showing Bad Heart Things. Not one single chest compression. Superman is being wheeled in, bag-valve-mask ventilated, and nobody is on the cart doing compressions. It's the number one rule of resuscitation, people: it is so important that we don't even tell lay people to do rescue breaths any more. If you have an unresponsive victim who is not breathing or only agonally breathing, you do chest compressions. Over the sternum. Two inch compression depth, one hundred times a minute. Count out "Staying Alive" in your head to keep the beat.


Chest compressions, people.


When Unnamed Dying Character is lying on a surgical table after taking multiple gunshot wounds to the center mass, intubated and ventilated, and they are far enough along in the surgery to be getting out the suture, I expect to see blood everywhere. Buckets of it. I saw a chest wound. I expect that if they're sewing this character up there has been a thoracotomy or at the very least a chest tube. Someone has opened this person's chest. And abdomen. And there should be blood flowing. Trust me on this one, trauma surgery is messy and involves emergency release blood units.

When you have a patient on the operating room table and they attempt to die on you, you don't stand around. Someone does chest compressions. A lot of them. A hundred times a minute. Someone else gets the defibrillator and someone else (probably anesthesia) pulls drugs. You don't stand around, comment "we've got V fib" (I checked, it looked accurate on the telemetry strip) and then wait for the paddles to show up. You do chest compressions. You shock the patient. You do chest compressions. You re-analyze AFTER you do chest compressions. You check for a pulse AFTER you do chest compressions. All the time you are pushing on the chest, hard and fast.


And most importantly, when the line goes flat on the monitor, you push epinephrine and then you do chest compressions (am I repeating myself? Good). You don't stand around hoping that the drugs make it magically from the vein in the arm all the way to the heart. If the heart is not beating -- if you do not feel a pulse -- then sheer external effort is the only thing that is going to get blood to circulate through the body. It's the only thing that's going to move medications. It's the only thing that is going to give any resuscitative effort a fleeting chance of success.


Unnamed Character lays on the table in the operating room -- in a trauma OR, I can only assume, because where else are you going to take someone with multiple gunshot wounds, and this is SHIELD, people are getting shot all the time as far as I can tell, they have to be prepared for this kind of thing -- and gets a couple of desultory shocks (good job turning up the joules to 200, that was appropriate) and a push of epinephrine (also good job, right drug) and then they just stand around for about a minute and wait to see whether magical epinephrine fairies are going to transport the drugs to the heart.


Surprise: no compressions, nothing happens. So after a minute or so they give up, call Unnamed Character dead, and get on with the business of things. Never mind that no medical professional worth the surgical facemask is going to spend less than two minutes pretending to run a code. Never mind that if Unnamed Character has been so lucky as to have undergone a thoracotomy the surgeon in charge is going to rip open the wires and attempt manual heart massage (don't look shocked: I've seen it done on the cardiac recovery floor -- with temporary success, to boot). Never mind all that. The magical epinephrine fairies failed to perform, show's over, so sorry folks.


If you're going to fake a hospital scene, at least put a little effort into it. Next time call me. I'll be happy to screen your movie so people can die convincingly. I've been there. We don't give up that easily. Not on Unnamed Character, not on anybody.


Okay, nerdrage over. Go see The Winter Soldier. The bad part's only a few minutes long, and the rest is seriously awesome. But don't forget to do your chest compressions.