Doctors are pushing Hollywood for more realistic depictions of death and dying on TV

www.npr.org /sections/health-shots/2023/12/28/1221645389/doctors-are-pushing-hollywood-for-more-realistic-depictions-of-death-and-dying-o

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.

45 comments

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.
  
  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.
- 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.
- Morphine
- Listen my porn needs less pizza boxes with holes in it too!
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.
  
  Well.... Did you win?? Don't leave us hanging!
  
  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" (TM)?
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.
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.
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?
This would make for the worst action movies.

45 comments