Hospitals are Not Entertainment

February 11, 2013 at 3:17 pm | Posted in Death, Emergency Unit, Ethics | Leave a comment

For my first proper post, I thought I’d talk about a placement I had as a student, at a large Emergency Department (ED) and some of the experiences I had there. Then I thought about it some more and realised that the vast majority of them were probably not fit for public consumption (for example, the man with a broken-off neon light-bulb tube in his rectum, always a good one for Foreign Object Top-Trumps) and that I should be a little bit careful about what I talked about. So I decided I’d talk about TV crews.

TV crews are maladjusted.

I’ll let that sink in.

Sunk in?

Good. Now I’m going to justify it.

I had the terrible misfortune to spend a couple of months working in an ED at the same time that a well-known TV company were there filming for a fly-on-the-wall documentary program about amusingly lodged foreign objects the sterling work of the heroic medical professionals who staff these bastions of all that is good about humanity.

Some of what the TV crews did caused me to have… Let’s call them “ethical doubts” about their presence.

Case 1: Morbidly Obese Man in Cardiac Arrest.

Most EDs have a Resuscitation Room (“Resus” for short) right next to the ambulance entrance. It’s where you’re taken if you’re:

a) Already dead and we want to try to bring you back, or;
b) Looking like you’re about to die and we want to try to stop you.

Think of a big, brightly lit room full of excitingly medical looking kit (a surprising amount of which is used for putting various tubes in various orifices) and wired-looking people in scrubs. Now add a slightly nervous looking yet ruggedly handsome student nurse to the picture and you’ll have it about right.

On the day in question, an ambulance came in under blues and twos (blue flashing lights and two-tone siren) with a very obese man on board in cardiac arrest (his heart had stopped). The paramedic was pumping on his chest as the doors opened, and we got him out and on the table in double-quick time. Pretty quickly he had various tubes inserted in various orifices, various needles inserted in various vessels, various sticky things stuck on various exposed flesh, and the tightly controlled chaos of a crash unfolded.

Folks, this bit is going to shock you: “ER” is full of crap. Most crash calls are not successful. Even the few that are successful are very rarely followed by successful rehabilitation and discharge of the patient. If you have a cardiac arrest, it is extremely likely that you will die.

So our very obese man passed away in a frenzy of activity.

Do you remember the picture you formed earlier of Resus? Kit, tubes, caffeine-addicts, student nurse? Add three more people to the scene.

A camera man.
A sound man.
A producer.

Now imagine the events of the day again, but this time imagine the TV crew filming the whole thing, from the back of the ambulance and through Resus.

Imagine, if you will, your ruggedly handsome student nurse threatening to turn the boom mic into just another Amusing Foreign Object, sans lubrication, if the sound man doesn’t get it out of the damned way of the damned lights. Imagine the crash team, already under immense pressure to get every single decision right because every single one of them might dictate whether their patient lives or dies, and now imagine how much more pressure is on them because it’s being filmed for national TV. Imagine how the patient would have felt – stripped to his underwear, bowels and bladder voided on the table, wobbly bits wobbling. Imagine a nurse doing chest compressions and having to pump hard enough to break the patient’s sternum just to get his chest moving – Crack! “That’s great TV!”, says the producer.

Afterwards, I asked the producer to explain the ethics of their presence to me.

“Well,” he said “If the patient lives, we ask permission to film afterwards. You know, retrospectively. If they die, we ask their family.”

I think I must have looked puzzled at this point, because he went on to say a lot more, using much longer words like “demographics” and “public right to know”. It didn’t really add content to the opening reply, though.

Case 2: Dying Lady who Didn’t Know She Was Dying

Later the same day, we had a patient brought in by her family following a collapse and loss of consciousness at home. Much testing and scanning revealed that she was in the extremely advanced stages of cancer and had collapsed due to metastases in her spine and brain. Oncology gave her a few days to live, and were frankly baffled that she’d still been upright and able to mask the symptoms from her family for so long. The job of breaking the news to the family fell to a young, newly qualified doctor, who was accompanied by a nurse (nurses are generally better communicators than doctors) and a student nurse (who needed to learn how these things are done).

Unknown to us at the time, there was also a TV camera poking through a gap in the curtain, filming the exchange.

News was broken. Weeping ensued from family, comfort was given as far as possible by medical persons present, grief counsellor was recommended via information leaflet.

And then: Curtain is drawn back, smiling TV producer with clip-board in hand turns to family and says:

“I wonder if I might talk to you about consenting for us to show that discussion you just had on TV. You want to be on TV, right?”

The TV crew were forcibly ejected by nursing staff at that point.

I’ll end this post, which is already longer than I planned, by telling you that I refused to sign a consent for the TV company to show any footage of me – so they couldn’t use any of the film they shot that day, because I was in almost all of it.

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