A Pediatrician Reviews: Chicago Med S1E1

Some day (probably after residency and fellowship, if I’m being honest) I’ll starting blogging about writing again (have to be doing some writing first, lol). But for now I’m home sick with COVID – it finally got me after 3 years of unbelievable luck – and so I’m instead reviving this old thing to do something I’ve been saying I would do for years.

Namely, review terrible medical shows.

Let me preface this by saying I realize that some of the inaccuracies I’m going to mention are there to make for compelling television – the true day-to-day functioning of a hospital is a lot less glamorous (and a lot less sexy) than Shonda Rimes would have you believe. All of the action of Chicago Med takes place in the ED and hardly anyone gets admitted because then you’d either not see the resolution of the storyline or have to add a bunch of characters. April Kepner yanks off her mask in the OR (she would be summarily murdered by a scrub tech in real life) so that we, the audience, can see her face as she emotes. Whatever.

I’m still gonna bitch.

Now, I might eventually include some other medical shows in this series (shout out in the comments if there’s a show or episode you’d really like to see) but we’re going to start with Chicago Med because it’s one of the more palatable variations on this theme…most of the time. Reviews will be in three parts – a summary of the plot (spoilers galore, you have been warned), a non-comprehensive list of the medical inaccuracies that most annoyed me or were most amusing, and finally a “who’s getting fired this week” feature, because on Chicago Med at least one character commits an enormous ethical violation per episode (fun!). (If you want to really set me off, come to Happy Hour, wait till I’ve had a margarita, and then ask me how I think the proliferation of medical shows is eroding trust in the real medical system).

So let’s get to it!

Plot Summary

The Chicago Medical Center opens its brand new Emergency Department (I already have questions) – but the opening ceremony is interrupted by everyone’s pagers going off. An elevated train derails and one of the doctors (who was on the train) starts checking people out.

As casualties roll in to the ED, charge nurse Maggie starts sending them (and the doctors) to various rooms. Train doctor man is in the ambulance trying to intubate a patient (lol wut). He comes in riding on the gurney doing compressions and he and red-haired doctor man get to have this dramatic exchange: “I’m senior resident in this ER.” “Yeah? Well I’m your new trauma fellow.” (Where the fuck is their attending??).

A patient with CF, Jamie, is rolled into the ED. Based on Maggie and nurse April’s reactions, this isn’t his first visit. Trauma Fellow Man goes in to see him and rattles off a bunch of tests. Meanwhile Dr. Halstead (the senior resident) and an unpleasant neurosurgeon are performing a bedside burr hole on the obtunded (and as it turns out, pregnant) patient. A woman comes in who it turns out is the baby’s mother – Gina, the patient, is a surrogate. Baby is okay but Gina is unresponsive. They set up the likely main ethical question of the episode, which is whether to leave Gina on life support to be a “human incubator”. Lovely.

Trauma Fellow Man (Dr. Rhodes) is showing off what a tough and manly specimen he is by sewing up his own arm. He’s a military doc. Pretty and pregnant pediatrician Dr. Manning has a young child patient who was with her dad who was taken to a different hospital. Meanwhile, Dr. Charles (the psychiatrist) comes to see Jamie (who looks septic). Dr. Rhodes rattles off some test results and says he wants to intubate (WHAT), but Jamie says no and then they just leave him on nasal cannula like idiots. Then Rhodes argues with Dr. Charles about needing to intubate Jamie (again, there are some other things we could try!)

The original dude that Rhodes was doing CPR on has a girlfriend, and she comes in to see him. He’s being cooled for neuroprotection (real thing!). He’s for some reason still in the ER on a vent with no nurse actively monitoring him because that’s how we roll in TV ED-land. Simultaneously, Gina is getting worse – her intracranial pressure is rising and if they can’t control it she might need surgery.

Med student Sarah Reese goes in to check on the little girl with the broken leg and give her Mom and update on Dad – but while they’re talking, Rachel passes out and has no pulse. Sarah calls a code. They quickly get her back, Manning puts in the speediest IO I’ve ever seen and then…doesn’t run anything through it or flush it…and they roll for a CT. Sarah is traumatized, and Dr. Choi gives her some tough love (poor girl needs a hug and the rest of the day off, jesus).

Maggie finds a wedding ring in Jorge’s backpack and gives it to the now-fiancée. Halstead and Rhodes have a little macho standoff in the breakroom. Gina’s ICP is rising and they want to do the surgery, but the adoptive parents spring a medical POA on the team (…would have been good to mention that sooner, folks). Halstead and Goodwin (the hospital administrator) review Gina’s surrogacy contract with a hospital lawyer and Halsted acts like a tool about it.

Jorge codes (much better compressions this time) and he ends up brain dead. Rhodes immediately sends in the hospital admin and a woman from an organ procurement agency in to talk to her (…see below). Manning brings an iPad in so Rachel’s dad can video chat with mom and see Rachel, and she watches them with puppy dog eyes (presumably because she’s doing the “single mom thing” as Maggie had put it earlier).

The intended parents allow Gina to go in to surgery. Fetal heartrate drops and they prep for crash section – but they don’t end up having to do it. Gina and the baby both make it through surgery.

Turns out that dead Jorge is a match for Jamie, but his fiancée won’t consent to organ donation. So Rhodes and Charles bring Marianna in to look at him and guilt trip her into donating her dead fiancé’s lungs what the actual fuck and she says yes because she’s not a monster but wow. So bad.

Rhodes walks in on Sarah practicing the central line she missed earlier on a dummy. According to him “every med student, once they start working with patients, thinks they’d do better in pathology” (I can attest this is false).

April walks in on Manning crying in the locker room over a pic of her dead baby daddy, who was in the army. Rhodes encounters Charles drunk at the bar while Jamie’s surgery is going on. Charles shows him a disgustingly adorable card Jamie made for him when he was eight. then he walks out without paying for his drink because we don’t do that on TV shows apparently.

Montage: Rachel is wheeled out of the hospital as she waves to Sarah. Gina opens her eyes and the intended parents smile at her. A patient is wheeled into the ER and Choi holds his hand. Manning, Maggie and April build a baby crib together. Dr. Charles watches a movie as Jamie lies in a bed. Fade to black.

Medical Inaccuracies

• Okay so first off, that CPR. What’s with the single hand? Why are they doing continuous compressions without an advanced airway? Terrible. Not going to work.
• A surprise point of medical accuracy! Obtunded patient comes in with a King airway
• Why is a 4th year med student placing a femoral line in a trauma? Why are they all standing around WITHOUT COMPRESSIONS while he flatlines? Also – you DON’T SHOCK A FLATLINE. All these people need to do their ACLS recertification
• This is not so much a medical inaccuracy so much as a potential legal one – or at least a real squicky situation. The surrogate has been living with the intended parents since before she got implanted?? I don’t like that power imbalance at all
• This is more of a gray zone, but…Halstead says the 24 week baby is not yet viable. This episode aired in 2015, which is before I started med school, but I’m pretty sure only a couple of years later I was seeing 24- and even 23-weekers resuscitated. Now it’s a difficult decision, and there are a lot of risks, but it’s definitely done at centers with high-level NICUs.
• A pH of 7.14, the kid is on nasal cannula, and he wants to INTUBATE HIM?? Can we try some BiPAP first maybe? Jesus Christ on a cracker. Oh…oh we’re just going to leave him on NC? Sure that’s fine.
• All the things they try to do for Gina’s increase in ICP are real things you would do – hyperventilate, mannitol, etc. They don’t need to take her off he vent to do it though – they can just increase the vent rate. Also why is this girl not already in the ICU.
• When Jorge codes, Rhodes says he is in “sinus tach”. If he lacks a pulse, he is by definition in PEA (pulseless electrical activity) and they should be giving epi and NOT SHOCKING THAT IS NOT A SHOCKABLE RHYTHM WTF
• Why don’t they have an interpreter for this poor woman
• He JUST TOLD HER HER FIANCE WAS DEAD literally seconds ago and they sent in organ procurement?? What the fuck
• Also it is SUCH a conflict for the doctor involved in a patient’s care to be the one introducing organ donation, that should never happen
• Speaking of conflicts, I cannot believe it would be allowed for intended parents to be the medical POAs for a surrogate. Maybe it is, I just…really hope it’s not.
• However I can state with absolute confidence that this is NOT, at ALL, how organ donation works. In order to avoid situations exactly like this. I cannot even explain in one bullet point how fundamentally wrong this process is depicted at every level, and all for the sake of drama. Clearly everyone in the writer’s room just decided to pretend that UNOS doesn’t exist.

Who’s Getting Fired Today?

Rhodes and Charles. Hands down. They violated so many ethical and legal boundaries in their interactions with Marianna and I’m truly flabbergasted and disgusted.

Okay that’s it! Stay tuned for more reviews as I convalesce.