Hi everyone! Muddles here, ready to talk about one of my favorite MCU films.
Yes, because it is about a doctor.
Yes, because that doctor is Sherlock
Yes, because that doctor who is Sherlock has a disability (and at this point, I lap up any representation of disability or chronic health problems, because frankly, there aren't enough for me to be choosy).
And most importantly because it's a great film, with real character development, some amazing action and visuals, and because it opens new doors in the MCU.
But this isn't strictly a review. Today, what I'll be doing is going through the film, and specifically focusing on medical things.
As you may know, I'm a medical student. I have some experience in hospitals, but not a lot. I will try to humour-fully point out the mistakes the film makes, but I can't promise I will be completely accurate, and there will be some things I don't know. This is just a bit of fun.
Disclaimer over, let's begin!
We begin with the famous decapitation in the library scene, which I'm going to skim over. Yes, I could argue that beheading someone from that angle in one stroke would require much bigger muscles than Caecillius has, but, you know. Magic. Sorcery. They blades were probably enchanted, or something.
So, one (really really epic) fight scene later....
We arrive in theater. Yay!
Time for me to start listing what is wrong with this scene....
So. Scrubbing. This is the way people make their hands sterile before surgery. It takes a really long time, is surprisingly hard to do correctly, and... yep, they're actually doing a pretty good job here. When rinsing the soap off, you have to keep your hand above your elbow, which Strange does really nicely. Then he dries his hands on sterile towels, another big "yep", earning a 10/10 on the actual scrubbing portion of todays exam, and...
Hmm. Surgical gown technique: poor, improvement needed. Sticking your hands all the way through the sleeves just isn't done. You're meant to put gloves on without taking your hands out from the inside the cuffs. If you think that sounds hard...it is. I could say that showing Doctor Strange flapping his arms around and contorting his wrists in every possible direction to stretch some never-quite-perfectly-fitting gloves onto his still-damp hands might break the illusion somewhat, so... Nope. I'm here to be pedantic, and pedantic I shall be. 4/10 for gloving and gowning.
And then...............
Oh dear.
In case you were wondering, scrubbing can take five or six minutes. At that point, your hands are theoretically sterile. Do you know what isn't? Your face. Or the mask you put on your face. So Doctor Strange has just repopulated his hands with bacteria. Well done. This is why you always put the mask on first. ALWAYS! 2/10 for aseptic technique.
It's kind of hard watching him put his gloves on now, especially as he pulls them on like any pair of gloves. And knowing his hands are no longer sterile. So the gloves he's about to stick inside a patient's body are covered with germs. As I said earlier, putting sterile gloves on isn't easy. Here's my brief summary:
0: Put a mask on!!!
1: Scrub the living daylights out of your hands.
2: Remember you forgot to pick you fingernails, so go back and start again
3: Dry hands, but dab, don't wipe, because all the scrubbing you've done already makes your skin liable to break. Also, you have one towel for each hand. Use them wisely.
4: Pick up gown, trying not to swing it into something non-sterile or drop it on the floor. (This is surprisingly hard, you have to pick up a folded gown, work out which end is the top, hold it up high while it unfolds, and remain aware that if it touches anything other than your hands, you have to discard it and start again).
5: Wriggle hands into gown without dropping it on the floor. If you can't picture this, imagine putting on a cardigan backwards, without bring able to touch the outside of the cardigan, or anything else for that matter, and starting by holding the cardigan by the neck. Anyway...
6: Look around hopefully for someone to do up the ties on the back of the gown. Then wish you hadn't when you find yourself suffocating for the next few hours due to some over-enthusiastic tightening. Surgical gowns are magical things, it can feel like you are in a corset while simultaneously being strangled, and still be loose and baggy enough that it will swing into every unsterile thing within arms length.
7: GLOVES!!! With your hands still inside the cuffs of the gown, you pick up the glove, position it thumb to thumb, pointing towards you, then pinch the edge and flip the rest the right way around,. Hopefully, after this, you have an empty glove hanging off your gown, which can wriggle your hand into. Hopefully. Alternatively, you watch in agony as a pretty blue glove drops to the floor, unable to do anything to stop it, and then look around for the helpful person who did you up and beg for another pack of sterile gloves to be opened. On your third attempt, you can finally succeed in getting half your fingers into the correct places, and that'll do.
8: You are ready to do your procedure! Mask on, gloved up, sterile... this is normally when you trip over, sending a tray of equipment to the ground, landing on the patient, then finally roll to the floor, thus rendering the whole operating theater unsterile and the procedure impossible. (This hasn't happened to me. Yet.)
So anyway, not my scrubbing rant is over....
This is something many people may not know. A lot of surgeons prefer to operate to music. It is generally thought to reduce stress, and thus improve the quality of everyone's work, but to patient's it might seem strange. A lot of the time, media feeds us a picture of a very serious, quiet and stern operating theater where everyone is a little bit stressed. In reality... People who work together get to know each other. Before surgeries, there are often friendly conversations. During surgeries, the surgeon might be pointing out interesting features to her or his colleagues. Operating theaters are not silent, terrifying places, they're full of people who (hopefully) enjoy their work, and who want to have the best environment to do it well. And for a lot of people, that involves an "operating playlist".
That being said, music trivia is not a normal part of surgical conversation...Nor is bobbing your head to the music. Also, it's remarkable how he doesn't have to tell any of the scrub nurses or other doctors what piece of equipment he needs next. But anyway...
I suppose the next thing to discuss is Doc. Strange leaving the operating theater before the surgery is over. Basically.... yep. That happens. If a consultant surgeon is operating with someone else, once they've finished the procedure itself and all that's left is stitching up afterwards, they might very well leave, either to go and prepare for the next surgery, or write up the one they've just finished. Of course, they'll only go if there is someone who is completely able to finish the stitching able to take over. But yes, this happens.
So... now we move on to the bullet in the brain. Honestly, I'm not a neurosurgeon. I don't know how accurate his lead poisoning the brain stem theory is... what I would say is that doing brain surgery without imaging is very much not a good idea. Anyway, he's Strange, he can pull it off. And the patient is clearly the luckiest person who has ever been shot in the head.
"Doctor, cover your watch." I giggle every time. It's an iconic moment. Shame that as he's in theater, he would have to be bare below the elbow to prevent the spread of infections.... I can't imagine Strange not criticizing him for not knowing basic theater rules.
And Strange removes the bullet, all is well with the world.
Until he decides to go around, driving like a maniac until he crashes his car.
Well done.
Sometimes a genius can be incredibly, incredibly stupid.
Anyway, he's greeted by old friends in the ER. People might quibble about whether someone he dated, Dr Palmer, should be treating him, but basically she's one of the doctors on call, possibly the most senior person in the ER. In a situation like this, you don't wait for someone else to arrive because you know the patient too well.
Also, I love the exchange between Strange and Palmer when he's just woken up. I've often wondered what it must be like to be admitted to a hospital where you work, and be treated by the people you work with. When you've seen them operate, seen their technique, especially is you are like Strange and believe yourself to be better than them... how could you deal with that complex net of emotions?
It's no wonder Strange has a breakdown. He becomes desperate for any solution, ready to believe anything, ready to hope in anything. Desperate for an answer. He lashes out at everyone and anyone, becomes bitter and angry. He accuses Palmer of pitying him, of thinking that he's a charity case who needs support. Things he probably thinks about himself. Pity he feels for himself.
Tee hee. Sorry, but the next thing that happens is that Strange is given a medical file. Of a complete stranger. Together with information on how to track him down. This is a big nope. That information is very, very confidential, and sending it to Strange was enough to lose his therapist his job. But anyhoo...
Strange meets the Ancient One, and thinks she's talking about cellular biology. Actually, what she describes sounds a lot like some of the work going on with stem cells at the moment, where stem cells can be encouraged, by subtle changes in their environment, to change into different kinds of cell. So.... points to the film makers here.
Anyway, as I'm trying to focus on medical things, I'm going to have to skip ahead a bit now.
So, Stephen Strange arrives in hospital, and asks the first person he sees for Dr Palmer. Now, I know doctors spend a lot of time in hospital, but the chances of walking into ER, asking for one person and them being not only on shift, but not with another patient.... Unlikely.
Now, we can get into some medicine! "Cardiac Tamponade" says Strange. This is when fluid gets trapped between the heart, and the strong and inflexible membrane that surrounds it. Gradually the heart is compressed, and then it stops. This is a very bad thing to have. Quite how Strange kjnows that he has it, I don't know. The best way to diagnose tamponade is with an ultrasound, but maybe astral something-or-other is an alternative diagnostic test. Anyway...
Palmer percusses on the chest to see if the "chest is clear"... maybe she should start trusting the wizard. If he says there's blood in his pericardium, there is quite likely to be. But anyway.. the weird thing is, the normal thing to do is an A-E assesment, where you go through the airway, breathing, circulation etc. to work out what is wrong. She doesn't do that, and she also doesn't call for help, which is... strange. She clearly trusts Strange's self-diagnosis to an extent, but... let's call it shock and move on, shall we?
And then Strange passes out. And an epic battle begins. I can't hide the fact that I love this scene.There's fighting and things shaking and then Strange flatlines...
sigh.
OK, flatlining does happen. But people don't normally go from normal heart rythmns straight into no heart rhythm at all, they drop down through various stages where the heart tries to correct the damage and keep going. And, importantly, once someone is flatlined, their heart cannot bs started by shocking. Defibrillation corrects abnormal, potentially life threatening rhythms, but it does this by interfering with the heart's electrical activity and forcing it to essentially reset itself. If there is no electrical activity in the heart to start with, shocking it can't fix the problem.
But... here it does. Magic. Sorcery. Or just bad science, I don't know.
Well, next thing we see is Strange being stitched up. This is.... worrying. Tamponade, in his case, is most likely caused by damage to the heart, and the only way to stop it from coming back is to treat the original cause. Which I don't really think Christine can do on her own, without being sterile... Maybe Strange is subconsciously correcting it with magic for the rest of the film. I don't know. But if a normal human did that, they would be, well... unwell.
Now, I should skip to the next hospital scene, but I love the conversation between the Ancient one and Strange so very much. Doctors swear to do no harm, and Strange says that killing someone breaks this and upsets him. The Ancient one points out that Strange became a doctor to keep himself interested, not to heal people.
Anyway, the Ancient one is defeated in battle and comes to hospital. Strange... I'm not really sure about this one, but it seems like Strange traveled in the ambulance. I'd love to heart the conversation the paramedics had on the way to the next job.
He arrives in ER, calls for Christine, and the Ancient One is rushed into surgery. And he follows. That's just not very OK. Firstly, he isn't in proper theater attire, so by being there in his robe he's contaminating all over the place, secondly, last time Christine saw him, probably only a matter of a couple of hours before, he was dying. You think she'd want to stop and check up on him, to insist that he goes and rests.
Yes, because it is about a doctor.
Yes, because that doctor is Sherlock
Yes, because that doctor who is Sherlock has a disability (and at this point, I lap up any representation of disability or chronic health problems, because frankly, there aren't enough for me to be choosy).
And most importantly because it's a great film, with real character development, some amazing action and visuals, and because it opens new doors in the MCU.
But this isn't strictly a review. Today, what I'll be doing is going through the film, and specifically focusing on medical things.
As you may know, I'm a medical student. I have some experience in hospitals, but not a lot. I will try to humour-fully point out the mistakes the film makes, but I can't promise I will be completely accurate, and there will be some things I don't know. This is just a bit of fun.
Disclaimer over, let's begin!
We begin with the famous decapitation in the library scene, which I'm going to skim over. Yes, I could argue that beheading someone from that angle in one stroke would require much bigger muscles than Caecillius has, but, you know. Magic. Sorcery. They blades were probably enchanted, or something.
So, one (really really epic) fight scene later....
We arrive in theater. Yay!
Time for me to start listing what is wrong with this scene....
So. Scrubbing. This is the way people make their hands sterile before surgery. It takes a really long time, is surprisingly hard to do correctly, and... yep, they're actually doing a pretty good job here. When rinsing the soap off, you have to keep your hand above your elbow, which Strange does really nicely. Then he dries his hands on sterile towels, another big "yep", earning a 10/10 on the actual scrubbing portion of todays exam, and...
Hmm. Surgical gown technique: poor, improvement needed. Sticking your hands all the way through the sleeves just isn't done. You're meant to put gloves on without taking your hands out from the inside the cuffs. If you think that sounds hard...it is. I could say that showing Doctor Strange flapping his arms around and contorting his wrists in every possible direction to stretch some never-quite-perfectly-fitting gloves onto his still-damp hands might break the illusion somewhat, so... Nope. I'm here to be pedantic, and pedantic I shall be. 4/10 for gloving and gowning.
And then...............
Oh dear.
In case you were wondering, scrubbing can take five or six minutes. At that point, your hands are theoretically sterile. Do you know what isn't? Your face. Or the mask you put on your face. So Doctor Strange has just repopulated his hands with bacteria. Well done. This is why you always put the mask on first. ALWAYS! 2/10 for aseptic technique.
It's kind of hard watching him put his gloves on now, especially as he pulls them on like any pair of gloves. And knowing his hands are no longer sterile. So the gloves he's about to stick inside a patient's body are covered with germs. As I said earlier, putting sterile gloves on isn't easy. Here's my brief summary:
0: Put a mask on!!!
1: Scrub the living daylights out of your hands.
2: Remember you forgot to pick you fingernails, so go back and start again
3: Dry hands, but dab, don't wipe, because all the scrubbing you've done already makes your skin liable to break. Also, you have one towel for each hand. Use them wisely.
4: Pick up gown, trying not to swing it into something non-sterile or drop it on the floor. (This is surprisingly hard, you have to pick up a folded gown, work out which end is the top, hold it up high while it unfolds, and remain aware that if it touches anything other than your hands, you have to discard it and start again).
5: Wriggle hands into gown without dropping it on the floor. If you can't picture this, imagine putting on a cardigan backwards, without bring able to touch the outside of the cardigan, or anything else for that matter, and starting by holding the cardigan by the neck. Anyway...
6: Look around hopefully for someone to do up the ties on the back of the gown. Then wish you hadn't when you find yourself suffocating for the next few hours due to some over-enthusiastic tightening. Surgical gowns are magical things, it can feel like you are in a corset while simultaneously being strangled, and still be loose and baggy enough that it will swing into every unsterile thing within arms length.
7: GLOVES!!! With your hands still inside the cuffs of the gown, you pick up the glove, position it thumb to thumb, pointing towards you, then pinch the edge and flip the rest the right way around,. Hopefully, after this, you have an empty glove hanging off your gown, which can wriggle your hand into. Hopefully. Alternatively, you watch in agony as a pretty blue glove drops to the floor, unable to do anything to stop it, and then look around for the helpful person who did you up and beg for another pack of sterile gloves to be opened. On your third attempt, you can finally succeed in getting half your fingers into the correct places, and that'll do.
8: You are ready to do your procedure! Mask on, gloved up, sterile... this is normally when you trip over, sending a tray of equipment to the ground, landing on the patient, then finally roll to the floor, thus rendering the whole operating theater unsterile and the procedure impossible. (This hasn't happened to me. Yet.)
So anyway, not my scrubbing rant is over....
This is something many people may not know. A lot of surgeons prefer to operate to music. It is generally thought to reduce stress, and thus improve the quality of everyone's work, but to patient's it might seem strange. A lot of the time, media feeds us a picture of a very serious, quiet and stern operating theater where everyone is a little bit stressed. In reality... People who work together get to know each other. Before surgeries, there are often friendly conversations. During surgeries, the surgeon might be pointing out interesting features to her or his colleagues. Operating theaters are not silent, terrifying places, they're full of people who (hopefully) enjoy their work, and who want to have the best environment to do it well. And for a lot of people, that involves an "operating playlist".
That being said, music trivia is not a normal part of surgical conversation...Nor is bobbing your head to the music. Also, it's remarkable how he doesn't have to tell any of the scrub nurses or other doctors what piece of equipment he needs next. But anyway...
I suppose the next thing to discuss is Doc. Strange leaving the operating theater before the surgery is over. Basically.... yep. That happens. If a consultant surgeon is operating with someone else, once they've finished the procedure itself and all that's left is stitching up afterwards, they might very well leave, either to go and prepare for the next surgery, or write up the one they've just finished. Of course, they'll only go if there is someone who is completely able to finish the stitching able to take over. But yes, this happens.
So... now we move on to the bullet in the brain. Honestly, I'm not a neurosurgeon. I don't know how accurate his lead poisoning the brain stem theory is... what I would say is that doing brain surgery without imaging is very much not a good idea. Anyway, he's Strange, he can pull it off. And the patient is clearly the luckiest person who has ever been shot in the head.
"Doctor, cover your watch." I giggle every time. It's an iconic moment. Shame that as he's in theater, he would have to be bare below the elbow to prevent the spread of infections.... I can't imagine Strange not criticizing him for not knowing basic theater rules.
And Strange removes the bullet, all is well with the world.
Until he decides to go around, driving like a maniac until he crashes his car.
Well done.
Sometimes a genius can be incredibly, incredibly stupid.
Anyway, he's greeted by old friends in the ER. People might quibble about whether someone he dated, Dr Palmer, should be treating him, but basically she's one of the doctors on call, possibly the most senior person in the ER. In a situation like this, you don't wait for someone else to arrive because you know the patient too well.
Also, I love the exchange between Strange and Palmer when he's just woken up. I've often wondered what it must be like to be admitted to a hospital where you work, and be treated by the people you work with. When you've seen them operate, seen their technique, especially is you are like Strange and believe yourself to be better than them... how could you deal with that complex net of emotions?
It's no wonder Strange has a breakdown. He becomes desperate for any solution, ready to believe anything, ready to hope in anything. Desperate for an answer. He lashes out at everyone and anyone, becomes bitter and angry. He accuses Palmer of pitying him, of thinking that he's a charity case who needs support. Things he probably thinks about himself. Pity he feels for himself.
Tee hee. Sorry, but the next thing that happens is that Strange is given a medical file. Of a complete stranger. Together with information on how to track him down. This is a big nope. That information is very, very confidential, and sending it to Strange was enough to lose his therapist his job. But anyhoo...
Strange meets the Ancient One, and thinks she's talking about cellular biology. Actually, what she describes sounds a lot like some of the work going on with stem cells at the moment, where stem cells can be encouraged, by subtle changes in their environment, to change into different kinds of cell. So.... points to the film makers here.
Anyway, as I'm trying to focus on medical things, I'm going to have to skip ahead a bit now.
So, Stephen Strange arrives in hospital, and asks the first person he sees for Dr Palmer. Now, I know doctors spend a lot of time in hospital, but the chances of walking into ER, asking for one person and them being not only on shift, but not with another patient.... Unlikely.
Now, we can get into some medicine! "Cardiac Tamponade" says Strange. This is when fluid gets trapped between the heart, and the strong and inflexible membrane that surrounds it. Gradually the heart is compressed, and then it stops. This is a very bad thing to have. Quite how Strange kjnows that he has it, I don't know. The best way to diagnose tamponade is with an ultrasound, but maybe astral something-or-other is an alternative diagnostic test. Anyway...
Palmer percusses on the chest to see if the "chest is clear"... maybe she should start trusting the wizard. If he says there's blood in his pericardium, there is quite likely to be. But anyway.. the weird thing is, the normal thing to do is an A-E assesment, where you go through the airway, breathing, circulation etc. to work out what is wrong. She doesn't do that, and she also doesn't call for help, which is... strange. She clearly trusts Strange's self-diagnosis to an extent, but... let's call it shock and move on, shall we?
And then Strange passes out. And an epic battle begins. I can't hide the fact that I love this scene.There's fighting and things shaking and then Strange flatlines...
sigh.
OK, flatlining does happen. But people don't normally go from normal heart rythmns straight into no heart rhythm at all, they drop down through various stages where the heart tries to correct the damage and keep going. And, importantly, once someone is flatlined, their heart cannot bs started by shocking. Defibrillation corrects abnormal, potentially life threatening rhythms, but it does this by interfering with the heart's electrical activity and forcing it to essentially reset itself. If there is no electrical activity in the heart to start with, shocking it can't fix the problem.
But... here it does. Magic. Sorcery. Or just bad science, I don't know.
Well, next thing we see is Strange being stitched up. This is.... worrying. Tamponade, in his case, is most likely caused by damage to the heart, and the only way to stop it from coming back is to treat the original cause. Which I don't really think Christine can do on her own, without being sterile... Maybe Strange is subconsciously correcting it with magic for the rest of the film. I don't know. But if a normal human did that, they would be, well... unwell.
Now, I should skip to the next hospital scene, but I love the conversation between the Ancient one and Strange so very much. Doctors swear to do no harm, and Strange says that killing someone breaks this and upsets him. The Ancient one points out that Strange became a doctor to keep himself interested, not to heal people.
Anyway, the Ancient one is defeated in battle and comes to hospital. Strange... I'm not really sure about this one, but it seems like Strange traveled in the ambulance. I'd love to heart the conversation the paramedics had on the way to the next job.
He arrives in ER, calls for Christine, and the Ancient One is rushed into surgery. And he follows. That's just not very OK. Firstly, he isn't in proper theater attire, so by being there in his robe he's contaminating all over the place, secondly, last time Christine saw him, probably only a matter of a couple of hours before, he was dying. You think she'd want to stop and check up on him, to insist that he goes and rests.
Comments
Post a Comment