The much-derided run of Fox’s drama The Resident has sent a firestorm through medical Twitter, with real working doctors tearing the show various new ones that should all probably be treated at a hospital better than the one in The Resident.
Dr. Esther Choo calls the show “1970s medicine,” which she credits to the claim that a writer’s “father was her best source for this.” Surgeon Mark Hoofnagle documents flat-out crimes that happen in the course of the show and compared one episode’s realism to that of Pulp Fiction.
So we went to a source. Dehra McGuire is a fourth-year medical student at the University of Oklahoma and founder of non-profit Girl Med Media. She also loves TV and, like most people who’ve spent large portions of their lives immersed in an industry, knows when it’s hocking BS. So of course we sat down to watch the pilot of The Resident.
Paste: If you’re not a resident, how do you know what being a resident is like?
Dehra McGuire: Residents are largely in charge of medical students, so when I’m rotating through different specialties, I basically spend the whole day with the resident. I get there when they get there, I go through handoff with them, I’m assigned my patients, and then I go see the patients and present to the resident before the attending doctor. I go to OR, get consents, do bedside procedures, and sometimes I even go see consults before the residents.
The pilot’s opening shot is an operating room in the middle of surgery.
McGuire: That’s not how we do appendectomies. They’re almost all laparoscopic.
Paste: So the chair of surgery doesn’t just slice dudes all the way open like that?
McGuire: Chairs have a lot of administrative duty, so in my experience they don’t operate a lot, or they only operate on pretty complex cases. Not appendectomies. Medical students are at the bottom of the totem pole, followed by interns, junior residents, senior residents, chiefs, fellows (if any), and attendings. Within departments you have a program director in charge of the residency program and a chair in charge of the whole department. He’s the big boss.
Second, that’s a GIANT incision for an appendectomy, which are almost all done these days by making really small incisions and using long tools and a camera in the abdomen to take out the appendix.
Paste: This is medieval just for the sake of gruesomeness? And wait, there’s an extra blood-spurty slice from that trembling surgeon chair.
McGuire: No one is going to leave a scalpel on a patient like that and there is NOTHING near the appendix that bleeds like that.
A doctor appears to perform CPR on the patient’s belly button.
Dehra McGuire: IS HE DOING CPR ON THE ABDOMEN??
The surgeons conspire to cover the death up under claims of a heart condition, as one of the other surgeons has also apparently killed a patient through negligence.
Paste: How much blackmail have you encountered in your medical experience? Are hospitals like The Wire? Is there a White Wall of Silence?
McGuire: When we have adverse outcomes in surgery, we present them to others at conferences to determine what happened and how to keep it from happening again… We don’t cover it up!
The protagonist of the show, Devon Pravesh (Manish Dayal) is in bed with his girlfriend, doing some medical dirty talk before his first day of work at the hospital.
McGuire: Woof, that guy just pointed to her manubrium and said “sternum.”
Paste: Did you see his diploma? It said Bachelor’s Degree of Medicine from Harvard.
McGuire: We’re doctors. We get doctorate degrees.
Paste: Good thing she gave him a nice big watch as a first day present after he messed up his anatomy facts.
McGuire: That’s such a bad gift. Do you have any idea how much we wash our hands?
Paresh gets to work, meeting the chair of surgery and bad boy doctor Conrad Hawkins (Matt Czuchry). Hawkins has a tattoo on his forearm.
McGuire: Oh my God. That tattoo is the wrong symbol.
Paste: It’s really tacky, right? Like the medical version of a tribal tattoo.
McGuire: No, well, I mean yes, but it’s a Caduceus, which really has no medical meaning. The Rod of Asclepius is the one that’s actually medical. The Caduceus was used by mistake in the mid 1900s and people keep using it.
Paste: Can residents fire other residents? Or is this guy just a dick?
McGuire: No, and this cliché hookup scene make no sense. Hospitals are disgusting. Literally the least sexy place in the world.
Conrad takes off his shirt, revealing a “Death Before Dishonor” tattoo in Hot Topic font.
Paste: The Caduceus tattoo wasn’t the only one!
McGuire: That back tattoo is so bad they broke the fire code to lock that call room from the outside.
Paste: But now he’s free and off to yell at… his boss’s boss’s boss?
Shortly after, a sick girl comes to the hospital and collapses. Pravesh is put in charge.
McGuire: Under no circumstances is a first-day intern given charge over a code—and they’re reading it wrong.
Paste: Wait, how?
McGuire: She’s coding, meaning her heart isn’t working correctly. There’s an entire team in the hospital for these scenarios and typically the most senior doctor present usually takes charge, because it’s important. You don’t give it to a terrified first-day intern. Based on whether you feel a pulse and the rhythm you get on that monitor next to her, there’s an algorithm to follow. There was a flat line on that screen—which is asystole, meaning the heart isn’t pumping. Pulseless electrical activity (or PEA, which is what they said in the show) is when you see a rhythm on the monitor but don’t feel a pulse. That sends you down a different part of the algorithm entirely.
Paste: So that guy just looked at the monitor and said entirely the wrong thing?
McGuire: Before I started my third year of medical school I was required to pass a course on this, and I have to take a refresher course before I start residency. This show was totally going for House of God vibes and honestly it just feels like House of the Damned.
Paste: Throwing water all over that lady… that’s not real, right?
McGuire: Cardiac massage comes WAY before a glorified ice bucket challenge. Besides, if she’s getting chemo, where are the oncologists? Where are the internal medicine attendings? Where are ANY attendings?
Paste: The show only has like four doctors who, I guess, do everything. But now the rookie has got to perform another procedure.
McGuire: He asked for a scalpel to do a central line. You start with a syringe,
this is wrong.
Paste: Tell me why this is silly.
McGuire: Central line is an access point to draw blood or give medications. Basically it’s a tube that goes almost directly to the right atrium of the heart. Most cancer patients undergoing chemo, like the patient in question, would probably already have one, or have a port. The right way to do it isn’t to slice a patient’s neck with a scalpel right off the bat. You insert a syringe slowly to find the internal jugular vein, and then you insert a bigger needle that you put a guide wire through. About halfway through the procedure you use a scalpel to make the hole in the neck big enough for a dilator so that you can thread the tube through. Honestly, if the writers had Googled “how to do a central line” they could have gotten this right.
Paste: That sounds so much more dramatic than just slicing one thing.
McGuire: I just found a video explaining how to do it. It’s a four-minute video.
Paste: At least we’ve moved on to this old man faking a surgery.
McGuire: Why is he doing a prostatectomy? Did he magically become a urologist? This is a completely different field of surgery.
Paste: Ta-da, it wasn’t him. The most telegraphed twist of all time. But now we get more Dr. McTattoo talking about all the patients he’s killed.
McGuire: How do you give someone too much potassium? Do you know how many red flags that would trigger for pharmacy?
Paste: No, not at all.
McGuire: We don’t just go around injecting people with potassium. We replete it slowly and if someone starts to have potassium that’s too high, someone will definitely notice because there are signs. Unless you just walked in with a syringe of potassium, we’re gonna know.
Paste: Are you saying this show might be unrealistic?
McGuire: I think in the next episode they give a patient’s infected heart to someone else in a transplant. That’s the reason she was in the hospital in the first place. Heart infection. It’s generally bad practice to replace a heart with a sick heart.
The Resident airs Mondays at 9 p.m. on FOX.
Jacob Oller is a writer and film critic whose writing has appeared in The Guardian, Playboy, Roger Ebert, Film School Rejects, Chicagoist, Vague Visages, and other publications. He lives in Chicago, plays Dungeons and Dragons, and struggles not to kill his two cats daily. You can follow him on Twitter here: @jacoboller.