All of our lives, my brother and I have fought. We love each other, but we bicker. At the end of the day, we know we have each other's backs. In the days before he left for college, I noticed that my brother was wearing a Ferocious Fighters CRPS awareness band. He never said anything about it to me and honestly, I'm not even sure where he got it. However, I was so touched that he wears it and it think it makes us feel closer together. 💗
I often get asked what it's like being in and coming out of a coma. Well, sorry to disappoint you, the time I was in a coma, was a giant black hole of "nothingness". No sights, no sounds, no hallucinations, visits from dead people. Nothing. Just a giant gap in time that I wasn't aware I was missing. It was kind of like being under anesthesia for a surgery or something only for 10 days.
When I woke up, I couldn't really move my legs or my right arm. I had minimal function in my left arm. I was confused and couldn't speak. I couldn't swallow, just they had to suction me. I had horrible double vision because my right eye was crooked. I had no balance. I was in huge rage for days because of medication side effects. My fine motor and gross motor skills were shot. So much so that I was put in four point restraints for days. I had cognitive impairments that were extremely discouraging for a straight A student. After I came out of my coma, I had hallucinations that I was in this cabin at a camp in the middle of the woods and I just wanted to go home. The "Camp nurse" (the actual nurse) told me I couldn't leave and it upset me. Everything upset me for a few days following awaking up. I was a pretty hot mess to say the least. This is just a fraction of the things I experienced post-coma. It would be over 6 months before I returned to my baseline.
For people with rare and chronic illnesses, finding a physician knowledgeable about their condition can be extremely challenging. Some people are lucky enough to score one of those doctors that are perfect in every way. Not only are they knowledgeable about the condition, they have a great bedside manner, listen to you, care about your quality of life, have a variety of options available to them and are able to think outside the box when necessary.
I was lucky enough to have a doctor like that just 45 minutes from my home for four years. He was absolutely amazing and treated by Complex Regional Pain Syndrome and comorbid conditions aggressively. He also had the capability to do very important treatments called ketamine infusions to help reduce my excruciating pain. I would go from a 10+ to a 3-4 on the pain scale in a matter of days. It was amazing and because it was in-network and in-state, my insurance covered it without issues. However, when the pain management clinic was closed due to low funding, myself and other patients, many who are my friends, were forced to find a new doctor to do the therapy.
The problem has been that insurance won't cover it out of state and paying out of pocket to go to the next state over would be about $25000 a round and to travel halfway across the country, it would be $5000 minimum for the treatment, add the flights, hotel for two weeks plus, food, rental car for that time and more. Easily $10000-$12000 A ROUND completely out of pocket and 3-4 rounds would be required each year.
Only adding to this problem is the fact that I can count one hand the number of doctors that do the infusions in my home state of Pennsylvania, and the waiting list to see these doctors for the treatment is 2 to 3 years. That is a long time when you are in excruciating pain 24/7. Not only does insurance not want to cover the treatment, the ketamine infusions are not easily accessible without a bit of traveling for many people.
This situation is not unique to me or just patients with CRPS. This happens across the board all over the world with many, many rare and chronic illnesses. Unfortunately, a treatment like this is something the insurance company won't budge on. It's my last option for treatment. It's the last option for many of the friends I've met through this journey, and somewhere around the world, there is someone who is on their last hope of getting treatment, insurance is denying it, and paying out of pocket too expensive.
We shouldn't have to fight hard to find a doctor willing to take on our complex cases. We shouldn't have to fight tooth and nail for a diagnosis over a period of years. When we find that doctor and get that diagnosis, it should not have to be a fight with the insurance company to get what we need. And yet, we do. Some of it is the inherent lack of knowledge of uncommon conditions, which is understandable because no one knows everything, but the part that can more easily be controlled is insurance.
So why then, does my quality of life and survival and that of other patients depend on whether insurance approves or denies? I don't need to be "normal". Heck, what is "normal" these days other than a setting on the dryer? Myself and many other people simply want to be functional and productive members of society. Every day, we try our best to function as much as possible, but our bodies are working against us every step of the way. After five years of being a “spoonie”, I’ve realized that for the majority of my conditions, a cure is realistically a fair ways off. This means we just need to do the best with that we have, take it minute by minute, hour by hour, day by day, and do what we can in terms of treatments. It would be exceedingly helpful for insurance companies to understand what our specialists see and rather than fighting with each other, working together for the benefit of the patient.
I've had a variety of different seizures: epileptic, non-epileptic, and grand mal. Epileptic seizures are the result of electrical misfiring in the brain, Non-epileptic seizures are generally of an unknown origin.
Before the seizure, I tend to feel a little off and maybe a little bit lethargic. I always dismissed it as me being plain tired. When you wake up, you usually have paramedics around you checking your vitals and everyone insists on crowding around asking you questions non-stop. It wouldn't be an issue if I wasn't so disoriented for one to two hours afterwards. This period of confusion is called the postictal phase. It usually subsides after a few hours. When you come to, you are usually very sore from the involuntary tensing of your muscles during the seizure, head pain if you hit the floor during the seizure, and often a sore and bloody tongue. When the body seizes it tends to clamp down on the tongue and it injures it of course. It is a very surreal experience, especially when you are lying in a puddle of your urine and stool because you lost control of your bladder and bowels. During my seizures, I am completely unresponsive. I can't hear anything, see anything, or feel anything. The seizure itself is a giant black hole for me, but the after seizure phase is one that makes me very spacey.
seizures are very scary for everyone involved or
witnessimg one. Remember to ensure the safety of the person seizing by clearing away hazards. Remove any tight fitting clothing. Don't try to hold them down. Do try to protect their head from hitting the ground by supporting it, putting a pillow underneath, or using a clothes garment like a jacket. If the person starts to vomit, turn them on their side to prevent the secretions from being aspirated into the lungs. Lastly, never put an object in a seizing person's mouth. They will not swallow their tongue.
September is U.S. Pain Awareness Month! Chronic pain is a major and quite debilitating problem in our society today. Chronic pain, in general, is defined as pain lasting longer than 3 months. While both pharmacological and non-pharmacological approaches can be taken to treat pain, there is still a huge stigma attached to it. That is what needs to change. No what's to be in nor do they want to endure the miserable treatments aimed at easing pain. More often than not, painkillers don't do anything for chronic pain or at best, merely mask the true issue. It's a big problem, but no one ever thinks about it until it happens to them. No one is safe from it. It affects all ages and all walks of life. The numbers are growing by the day, so more awareness is needed!
I deal with pain from Complex Regional Pain Syndrome, hypermobility syndromes, Stiff Person Syndrome, Dystonia, Dysautonomia, Migraines, Tension Headaches, fibromyalgia, chronic underdiagnosed GI pain, SI joint dysfunction, peripheral neuropathy, and myofascial pain syndrome every single day. I haven't been pain-free since November 2011 when I injured my knee and it never got better, before I developed all my conditions on August 24th, 2012.
Dealing with that many different conditions at once when they all cause pain every minute of everyday is exhausting.
I was to briefly mention two kind of pain that are not as well know and I'm struggling with both of them at the moment. One is called allodynia and it is a hypersensitivity to light touch. My bed sheets, clothes, the wind, water, my sweat, everything that touches me causes me pain.
The other part, hyperalgesia, is a hypersensitivity to normally painful stimuli. The other day, I accidentally pricked my fingertip with a safety pin. Not only did it hurt way more than it should have, it still hurts four days later. Honestly I barely even jabbed myself, but that would be hyperalgesia for you.
A cure for all of these conditions that cause chronic pain would be nice, but I'd be just has happy with an effective treatment! #PAM2017
That neurology appointment couldn't have gone any better! We all agreed that IVIG has been kicking my butt so hard each time I get it, that we don't want my side effects to escalate anymore to the point of danger.
So... Plan B. I am being sent back to the nephrologist (kidney doctor for the non-medical people) I saw earlier this year to go forward with plasmapheresis. This is going to involve another surgery (well, technically three) slammed into one. I'll need my existing port removed and two new Vortex (high pressure) ports placed, one on each side of my chest.
Hopefully, we can avoid the dangerous post-op crisis I experienced in April with proper post-op management (namely post-op medications and muscle relaxers). I will be requesting an appointment with the anesthesiologist to make sure that this stuff doesn't happen again. That was awful. Completely awful.
At least with the plasmapheresis, the surgery stinks, but it's a one time deal and you get it over with, unlike the IVIG, where I'm having crises every infusion.
I'm waiting for an appointment with the nephrologist, then I'll need a surgery date, then I'll need a meeting with the anesthesiologist. All of this will take some time, so more likely than not this will not all go down until the end of October-early November after I come back from Orlando.
All of the prayers definitely helped! I got lab results early this morning showing that my autoimmunity has indeed gotten worse instead of better on the IVIG, but that made my decision easier. I think we may have some other answers coming soon, but I need to talk to my doc again and do some more research. That's kind of big news for another time! 😊
Today I had a long phone conversation with the nephrologist (kidney doctor) in charge of my plasmapheresis, which means I don't have to see him before the surgery (yay for not having to go to an appointment!), because he saw me in March and my neurologist told him nothing has changed (which is true).
We are back on the pheresis route and he put the orders in for a port removal and bilateral Vortex port placement. My current port has a kink in the tubing meaning things can go in to my body, but blood doesn't come out. Additionally, it's not strong enough to handle the pressure of the pheresis machine. These Vortex ports are hardcore!
So I'll have the 3 in 1 surgery, probably in early November. The reason for the delay is primarily academic (I can't just drop everything in the middle of the semester and have surgery!), but I have a few athletic endeavors coming up that I have been training so hard for and I am not giving that up! There's no major rush either, as long as it's done soon.
But... That means I have to do one more booster of IVIG. For those of you following the saga, you know how I feel about it (or the side effects rather), but something has to bridge the 2.5 month gap between my last infusion 8/30 and the surgery plus two week waiting period that the ports "can't" be used. I guess that's what I'll have to do, but only one more! 🎉
(For those wondering, we are not going the tunneled catheter route first, it is because of my lifestyle, infection risk, and the duration of expected treatment. One, my active lifestyle with taekwondo and going to the gym would likely dislodge a Hickman line in a day. I could do that so easily. Two, infection risk on my ports vs. the Hickman line. I am extremely strict with the people that access my port. You violate sterile protocol, you start over. There are some nurses that hate me for that, but oh well. As long as I'm not getting an infection. With the Hickman you can do everything right and you're still more likely to get an infection with it than the ports. Oh yeah, and every time I sweat, I would have to change the dressing. Anyone who really knows me knows that just that is a giant problem. Three, some people experience almost immediate relief (2-3 days), but in my case, we are trying to reverse a year of contractures in my lower leg. Naturally, it's more likely to take longer, hence the ports.)
Hopefully, this is will all do the trick and get rid of Otto!
Recent blood work has shown that I am positive for 18 different infections (none of which are contagious) and about 6 more different antibodies in high levels. A very extensive Lyme disease panel was run and that all came back negative, as I fully expected it to. While I would rather not have to deal with any of this, it's good that the test results explain what I've been dealing with for years.
Some can be corrected with aggressive immunotherapy (IVIG, which clearly hasn't worked in this case. Plasmapheresis, and other oral and IV immunosuppressants), which should dramatically reduce certain symptoms. Also, some can be corrected by taking supplements. Hopefully between the supplements and the plasmapheresis, my body can start to try and heal itself.
I'm eager to see what my doctor will say about the results as a whole, but I do know that a lot of these results can clearly explain several symptoms. That's the latest from the medical front.
***Originally from an email***
Please allow me to introduce myself. My name is Meghan Bayer and I am a junior Emergency Medicine and Communication double major at the University of Pittsburgh. I am in the planning stages of my senior thesis in which I am planning to do research on rare diseases, specifically SPS, and the diagnostic process that patients go through. I am planning to use public support groups, online forums, personal testimonies, existing studies, and interviews to extract my research.
Now you may be wondering of all the diseases defined as “rare” by the National Organization for Rare Disorders, why SPS? My logic is two-fold. One, even if the number affected by SPS is higher than the 7000 people estimated to have SPS worldwide (which I believe it is much higher with many people being misdiagnosed and/or going undiagnosed), I still believe that the number of Americans affected would still fall under the “less than 200,000 Americans affected” definition that NORD utilizes. For purposes of this research, a “rare disease” will be a disorder affecting less than 200,000 individuals, in large part because it is the most commonly used definition that I have seen across different specialties. Public resources and support groups are readily available sources of information, straight from the patient, which I believe is important.
Second, for the last five years, I have dealt with several chronic illnesses and autoimmune diseases. For years, it was “focal dystonia secondary to Complex Regional Pain Syndrome”, which quickly became “generalized”. While I don’t doubt that I have some dystonia secondary to CRPS and neither do my doctors, we know it is not the whole story. I know the difference because the spasm patterns are different if that makes any sense. When the GAD65 came back high in serum and CSF, along with elevated levels of several other antibodies, like islet cell, amphiphysin, and thyroid antibodies (with normal TSH) to name a few, we investigated further. On 44mg clonazepam, 160mg of baclofen, and 400mg of dantrolene a day, all my EMGs have come back inconclusive, but showing signs of agonist-antagonist co-contraction and continuous motor unit firing. All 3 QSARTs have come back very abnormal, as did my tilt table test (further evidence of dysautonomia). CT scans and x-rays have been negative for malignancies or any other cancerous process.
We know three things; this is neurological and autoimmune in nature and is more likely than not on that “GAD65 spectrum”. I have almost lost my life several times because of refractory status seizures, profound bradycardia/hypotension from dysautonomia, respiratory arrest, and unexplainable encephalopathy (not consistent with AI encephalitis) to name a few. This fiasco started two weeks after my 16th birthday and the amount of information available on pediatric onset SPS/GAD65 mediated disorders is almost non-existent. My point is that even with all these tests coming back positive or highly suggestive of SPS, it still took over 5 years after they got all those test results back to get an official diagnosis and in turn, a treatment plan. This journey has been long and precarious, but I would like something good to come out of it and I believe that this research will do that. I can see myself continuing with more advanced research after medical school. I figure if this research helps make the diagnostic journey shorter for someone else then it is worth it.
My faculty supervisor and I are currently applying for IRB exemption status, but I was hoping to collect some good resources that are already out there prior to starting. If you could recommend some reputable articles or even share some information yourself, I would greatly appreciate it.
Meghan L. Bayer
I met with my Office of Vocational Rehabilitation (OVR) counselor a few weeks ago. I learned some valuable information that I want to share here:
I could get Schedule A Letter later. This is a letter that would be sent with my application and it would get prospective employers more incentive to hire me by receiving extra grant money.
Grocery shopping in a chair is hard. Pushing a cart is harder. Using a reusable cloth bag to hold groceries in your lap or having a net under the chair can help a lot.
Battery-powered air compressors are helpful for easily keeping wheels pumped up.
Casters are hair magnets. Clean them regularly.
My chair is titanium, so even if the paint gets chipped off, the chair should not rust or have any structural integrity problems.
If insurance won't cover the Smart Drive (power assist) for my wheelchair, OVR can potential cover it.
August 24, 2012... It ranks up there as the third-single most life-changing day of my life, behind the day I was born (obviously!) and the day my hearing loss was diagnosed. At the time, I had no clue I would remember this day for the rest of my life. I mean, why would I remember a random day in August in the summer of 2012?
Today, five years ago, I went to my primary care doctor for my WPIAL sports physical as I did every year and at the end of the appointment I was told I should receive the Gardasil HPV Vaccine. My parents had me vaccinated with everything suggested up to that point, so my mom agreed. I received the first of three injections and I felt sick that night. And the next week. And the next week. I told myself I was just overdoing it playing basketball for hours everyday and that the stress of the hardest year of high school, junior year, was just tiring me out. I wish I was right. I wish it was just "stress" or "exhaustion".
I got sick that night and five years later, I've never felt the same. When my immune system was "modified" by the vaccine (part of the purpose of vaccines in general) to confer immunity from HPV, something happened in the process to turn my body on itself and I can link every single symptom and condition I've been diagnosed with straight back to the now revised Gardasil package insert. There are antibodies in my system now in dangerous levels that I previously tested negative for the year prior. Antibodies that shouldn't be in the body, and if they are, should only be in the blood, that are in my spinal fluid. Of course that spinal fluid covers the entire central nervous system, which has been under siege since and immunologically, we have never gotten it under control.
We've been doing damage-control the whole time. We know that my thyroid and pancreas both are under attack with extremely elevated antibody levels. We have to wait for them to fail, before we can treat it. No one has ever considered what we could do to prevent further thyroid or pancreas damage, which irks me because we know what those antibodies are doing.
My central nervous system is what most providers would consider irreversibly "re-wired" and damaged at this point with the technology and medicine we have now. My autonomic nervous system (controls all the body's involuntary functions) is always in a state of dysfunction. The ANS innervates just about every organ in the body. And the list goes on... All 17 conditions last I counted.
I never did get the last two injections in the series and honestly, I don't think I'd be here today if I did. I'm not going to start rambling with statistics, but they are absolutely horrifying. I wish we could prevent the stuff we can expect will come from the antibodies (that we know about), but medicine today is reactive and not proactive. Just when I think one thing is under control, another 3 go out of control, so I'm always struggling to catch up.
I've learned a lot from the last 5 years that I wouldn't have learned otherwise and that are motivating my research for my senior thesis in communication this year, but it angers me that a vaccine that was supposed to prevent cervical cancer as a result of (four of the 200+strains of) HPV works for a maximum of 5 years, and long term studies that I've seen are inconclusive as to whether or not it actually works. All of that will remain to be seen when long term study results become available, as it has only been on the market since 2006. Had I known what I do now, I never ever would have gotten it and I know my parents wouldn't have either. Unfortunately, in 2012, the accounts of others like me were not available or seen as quackery for the most part.
For a maximum of 5 years protection, I get to spend the rest of my life like this. This is the real Gardasil.
The Evolution of America’s TV and Film Doctors from 1960-2017
University of Pittsburgh
22 June 2017
In the mid-1950’s, television viewers were introduced to a new genre of television. The new shows were primarily set in the hospital when doctors and nurses frantically scramble around to save their patients. Sometimes they would be successful in protecting their patients, and sometimes, despite their best efforts and technology, the patient would end up dying. As with most things, medical dramas have evolved since the first one aired in the 1950’s. Starting in 1961 with Dr. Kildare and Marcus Welby, M.D., continuing with Emergency! from the 1970’s, and moving into Awakenings and Patch Adams from the 1990’s, before finishing up with the modern shows like Grey’s Anatomy, House M.D., Private Practice, and The Doctors.
There have been many changes over the past nearly 60 years, but for the purposes of this paper, the following will be addressed: the gender differences of the TV physicians of 1960’s to the TV physicians of 2000’s, the differences in the portrayals of doctors in movies vs. televisions shows, the differences in the behavior of physicians on talk shows vs. those on medical dramas, the transition from a focus on the patient to a focus on the private lives of doctors, the changes made to TV medical dramas in hopes of making them realistic without allowing the show to be boring and modifications to the places in which doctors practice medicine. Doctors are often made out to be savior figures with a God complex because they are in fact handling lives and making decisions that determine who lives and who dies. Also, doctors have evolved, and the setting in which they practice has changed as well. Doctors can practice in hospitals, clinics, and a variety of other unconventional places. With a broad range of media texts covering different types of medical shows, many trends and changes to the role of the doctor on television or the big screen.
The first significant trend I want to explore is the gender differences of TV physicians of the 1960s to the TV physicians of the 2000s. Three of the most popular TV shows of the 1960’s and 1970’s are Dr. Kildare, Marcus Welby M.D., and Emergency!. In all these television shows, the doctors are all males and nurses are all female. The two leading doctors in Dr. Kildare are Dr. Gillespie and Dr. Kildare, who are both males. All of the nurses on the show are women, and the attendants (patient care technicians) are male as well. (Comack, 1971) In Marcus Welby, M.D., the two principal physicians are Dr. Welby and his assistant, Dr. Kiley. Their secretary-nurse Consuelo Lopez assists them. Again, we see that the males play the role of doctor and the females play the role of the nurse. (Victor, 1969) Similarly, in the 1970’s television series Emergency!, the two most prominent physicians Dr. Brackett and Dr. Early are both males, and Nurse Dixie McCall is a female. Even though they aren’t doctors, it is worth mentioning that paramedics John Gage and Randolph Mantooth are both males. In the 1970’s, women were not allowed to serve in emergency medical services (EMS). It wasn’t until the 1980’s that they started to fill that role by proving they could be “one of the guys and lift like the guys.” It is important to note this because this is one of the smaller details that changes across the decades. Women become more involved in a variety of different medical capacities. (Webb, 1972)
In the early 1990’s, we start to see a transition to some female physicians with the release of the movie Awakenings. While the main character, Dr. Oliver Sacks is a male, there are minor supporting roles in which we start to see a few female doctors every once in a while. (Marshall, 1990) Patch Adams, released in 1998 continued the integration of women as doctors with the addition of many female medical students in Adams’ medical school class. While they weren’t technically doctors yet, they were taking serious steps to achieve that goal, something we have not seen much of in the previous 25-30 years. (Shadyac, 1998)
Today, House M.D., Grey’s Anatomy, Private Practice, and The Doctors, like most modern medical dramas, have a mix of male and female doctors, as well as male and female nurses. House’s team consists of himself, Dr. Foreman, Dr. Chase, Dr. Cameron, Dr. Kutner, Dr. Taub, Dr. Hadley, Dr. Masters, Dr. Adams, and Dr. Park over the course of the show. That’s a total of six males and four female doctors in a primary role. Additionally, the head of the hospital, Dr. Lisa Cuddy, is also a woman in a position of power. On the show, there is a mix of male and female nurses primarily in the roles as extras. (Shore, 2004)
On Grey’s Anatomy, the gender of the doctors, residents, and interns is almost a 50/50 split with some individuals from both sexes serving in positions of power. Dr. Miranda Bailey serves as the Chief of Surgery, Dr. Richard Webber serves as the Chief of Residency, Dr. Meredith Grey is the Chief of General Surgery, and Dr. Alex Karev is the Chief of Pediatric Surgery to name a few people in leadership roles. As demonstrated, the split is roughly 50/50 on Grey’s Anatomy for doctors, and while there are several male nurses on the show, it seems that there are more females overall. However, that was difficult to quantify because all the nurses are supporting roles and primarily extras that frequently change. The main character for which the show is named is, in fact, a female as well. Regarding equality on the show, Grey’s Anatomy is one of the most balanced shows currently. (Rimes, 2005)
Private Practice, a television series directed by Shonda Rimes, the same director that brought us Grey’s Anatomy, developed this series as a spin-off of the successful Grey’s series. However, the show was disappointing to many of the people that had fallen in love with the original series. Again, the main character, Dr. Addison Montgomery is the head of the practice and happens to be female as well. The female doctors (Dr. Naomi Bennett, Dr. Charlotte King, and Dr. Amelia Shepherd) outnumber the male doctors (Dr. Samuel Bennett, Dr. Cooper Freedman, and Dr. Pete Wilder) four to three. Also, the practice has a female psychologist, Violet Turner. In this series, Shonda Rimes brings some serious girl power to the entertainment industry. (Rimes, 2007)
The cast of The Doctors is constantly changing, but there is usually at least two females in the group of five to six doctors depending on the episode. The males have always outnumbered the women on the show. (Hermstad, 2008)
One of the most noticeable differences is the portrayals of doctors in movies vs. televisions shows. In both, they are often seen as savior figures because they are supposed to save lives. Doctors seem more human when they get scared or cry, but in the public’s eye, they are not expected to be allowed to cry. They get scared too and research backs this up. Did you notice that most of the conditions that House and his team diagnose are either neurological or infectious in nature? The neurological diagnosis is the diagnosis that they try to stay away from the longest. This is a phenomenon that medical students and young doctors are afraid of diagnosing neurological disorders known as neurophobia. So they will pursue any diagnosis other than the neurological diagnosis. This neurophobia is believed to affect some of the logical processes of doctors. The presence of this phenomenon portrays doctors as being scared individuals. Being scared or having emotions is not always a bad thing either. Emotions are useful for doctors to allow them to connect to their patients. Although these moments are often rare and fleeting, they can be comforting to the patient. Neurophobia is demonstrated in many episodes when the doctors always include lupus in the differential diagnosis. Generally, lupus is not a neurological disorder, which might explain why the doctors are always hoping that it is lupus. It is less scary to them. (Thomas et, al., 2009)
Many of the TV doctors have a God complex or a sense of superiority. Over the last 60 years, differences in the ways doctors treat their patients and their colleagues have developed. For instance, Dr. Kildare starts out as a bumbling resident and eventually becomes an excellent, cool doctor by his third year (season 3) of practicing. On the other hand, Dr. Meredith Grey was smooth, even as a resident, but has more of a God complex. Kildare and his assistant Dr. Kiley seemed more human than many of the modern TV doctors. The same can be said for Dr. Brackett from Emergency!, who is an incredibly kind, humble, and personable doctor. (Webb, 1972) Patch Adams is one of the last movies with a doctor who is not extremely full of himself. He cares for the kids and not only does he want to heal them physically, but he also wants to heal them emotionally too. (Shadyac, 1998)
While Lawrence and Jewett’s have a definition for the classical monomyth and the American monomyth, it leaves the potential for a third category to arise. This third monomyth could be an average person in an average world filled with problems that responds in an incredible (seemingly supernatural or superhuman) way. Some doctors on TV fit this description, in that they are average people in an average world, but they have a capacity to save lives in their line of work. Now saving lives and improving the individual's quality of life is their job. However, it is not something that everyone gets the opportunity to do. Therefore, it could be perceived as “superhuman,” especially when the odds are stacked against the patient and the doctor does something radical to save their life. Some modern examples of this type of monomyth would be Meredith Grey, Dr. House, Dr. Brackett from Emergency!, and Dr. Montgomery. Lawrence and Jewett’s definitions of the classical monomyth and the American monomyth don’t work particularly well to describe doctors. (Jewett et, al., n.d.)
In the last two decades or so, a new type of medical show has become popular daytime television. On these shows, real life doctors treat real life patients on the air. This has led to some differences in the behavior of doctors in medical talk shows and those on medical dramas. On medical talk shows, they refer out to other doctors for treatments, like on The Doctors and the Dr. Oz Show. (Oz, 2009) On medical dramas, it’s a story, and within that storyline, patients are treated, but treating the patient is not usually the priority. However, on talk shows, they are dealing with real people that are being affected by real life medical problems. For example, on one episode of The Doctors, a patient with complex regional pain syndrome, a neurological pain syndrome, is featured. On the show, they briefly discuss her history with the syndrome, before offering her several therapies at no expense to her to try and treat her condition. In this case, there’s no do-over if they mess up a treatment or an intubation versus doctors on medical dramas. It can be difficult to compare the two because you are comparing real life doctors with real patients to doctors played by actors to patients played by actors, but there are still some fundamental differences between the two. (Hermstad, 2008)
Another notable transition has been a shift from a strictly professional portrayal of a doctor to a focus on the private lives of doctors. Obviously, doctors are human, so like us, they are going to have personal problems. The shift has been from not divulging any details about the doctor’s own life to telling viewers everything about their personal lives and relationships. Grey’s Anatomy is full of failed relationships and divorces (Callie and Arizona, April and Jackson), marriages between two staff members (Meredith and Derek, April and Jackson), sibling rivalry (Derek and Amelia), death of friends and staff members, traumatic tragedies (plane crash that killed Izzy, injured everyone onboard, and caused Arizona to lose her leg, Derek’s death by car accident), and being sent to jail (Karev). These are some of the major personal aspects explored by the shows, but there are a variety of smaller everyday things the doctors deal with as well. (Rimes, 2005) In House M.D., Wilson deals with a cancer diagnosis, Cuddy deals with adopting and raising a kid, while trying to run a hospital and keep House from getting arrested, House deals with chronic pain, a Vicodin addiction and being arrested, Thirteen is diagnosed with Huntington’s Chorea, the genetic disease that took her mother as a child, Chase deals with family problems, and Foreman deals with racial discrimination as a result of being African-American. (Shore, 2004) They all have issues. In Dr. Kildare, Marcus Welby, M.D., Emergency!, and Awakenings, the doctors were portrayed in a strictly professional manner. The focus was always on the patients, and while the doctor may have personal issues going on, they were never revealed to the patient or the audience. From 1960 to 2017, we have a seen a shift from a purely professional portrayal to the revelation of more details about physician’s personal lives.
In early times, when medical technology wasn’t as sophisticated, the number of errors made on television was substantially less. As a result, we have seen significant changes in the type and amount of medical inaccuracy of TV medical dramas. Today, we see CT scans upside down, nasal cannulas, and stethoscopes on backward, medical procedures being done out of order, and doctors calling out the wrong dosages of medications. The average layperson would not know that a lot of this stuff is happening, so the entertainment industry can get away with these inaccuracies, but for those of us with medical training, it frequently makes us scratch our heads. Many directors hire real-life doctors to provide medical advice for the show to make the show as accurate as possible. The majority of these errors were not issues for Dr. Kildare and Marcus Welby, M.D. because the technology was not yet used and the shows were much simpler regarding illnesses and treatments.
Some shows are very realistic, but the majority are overly dramatized. Now, dramatization is critical to the success of most medical dramas, but Scrubs is proof that it does not have to be the whole series. Statistically speaking, Scrubs is the most realistic modern medical show, from the way the doctors act toward their patients, the way they act towards each other, the medical procedures, and the general running of the hospital. (Lawrence, 2001) It is not as dramatized as some of the other modern shows, like Private Practice or Grey’s Anatomy and it has the lowest average of medical inaccuracies. (Tapper, 2010)
One fundamental difference that we have seen in medical dramas from 1960 to the present is the setting in which the medical care takes place. For most of their history, medical dramas have been traditionally set in a hospital. Then, in 1972, the world was introduced to the very successful military medical drama, M.A.S.H. One of the main reasons why M.A.S.H was so successful is because not only did it focus on the military, but it also came during the period where the United States was involved with the highly controversial war in Korea. However, the launch of M.A.S.H marks one of the first times that medical care is taking place outside of a hospital in a large tents or field hospitals. Many of the patients on the show are younger men who have been injured in the line of duty. Almost all of them require surgery. The majority of the show is spent addressing the war and the number one injury on the show, gunshot wounds. There is minimal variability in the conditions that these medics are treating, which is believed to be a part of the reason the show lost some steam with the American public after running for 11 seasons. With the change in the medical setting, we see a shift in the credentials of the people treating patients. In the Army, the majority of medical personnel are medics, meaning they've received extensive medical training, but most have not gone to medical school to become a doctor. There are a few doctors on the show, but the majority are medics, and this was a new concept for TV viewers. While M.A.S.H was very successful, the repetition of the same injuries each episode combined with the lower level medical skills of the characters led to the show's end in 1983. (Gelbart, 1972)
One of the lesser known, but still successful medical shows is a British television series called Doc Martin. The pilot episode premiered in 2004, and it ran for seven seasons. The main character, Dr. Martin Ellingham is a surgeon in a London hospital when he suddenly becomes afraid of blood. This causes him to move to the small fishing village of Portwenn and open up a clinic. His social awkwardness and bluntness frequently get him in trouble. He pushes everyone that cares about him away until he finds the love of his life and they have a child that he comes to adore. During this main storyline, he is taking care of patients in his surgery. As long as there's no blood, he is fine. The sight of blood causes him to gag and sometimes vomit, an irony that makes the show so amusing. While he is working in his small freestanding clinic the majority of the time, occasionally he will head out into the community to care for people in their homes. This clinic is several hours from a hospital, so Dr. Ellingham is forced to deal with the majority of medical cases, no matter how big they are. The series ends with the family of three living happily ever after. The majority of Doc Martin after the pilot episode is set hours from a hospital and that makes for an environment challenging to even the most skilled of physicians. This is the single most impressive aspect of the series. There is speculation that the series will be revived within the next year or two and it remains to see what is up with Doc Martin, his family, and the people of Portwenn. (Minghella, 2004)
2009 brought Royal Pains, the popular medical drama featuring brothers Hank and Evan Lawson. Dr. Hank starts out at a hospital in New York, and when he decides to save a kid over the hospital benefactor, his superiors are angered, and he is fired. After a year of pouting, he is convinced to come to The Hamptons and open up a concierge medical practice. This means that while Hank is occasionally at the hospital and can send patients to the hospital for additional testing, he primarily sees them in their home or wherever they are when illness or injury strikes. While Hank always has at least one patient with a dramatic past, he is always on standby for an older man with a fatal genetic disease. Because of this gentleman, Boris, is so rich and people want him dead, there is always drama in Hank Lawson's life. The show is about 50/50 medical and personal life. In his own life, Hank is dealing with girlfriends, Boris, his brother's awful financial advice, and the repeated imprisonment of his father. Just when he thinks he has life figured out, something else happens to rock the world again. This split between a medical drama and a comedy made the show successful, as it ran for eight seasons before concluding its run. (Rauch, 2009)
In 2011, the TV show Hart of Dixie premiered, and it featured a young, ambitious surgeon named Dr. Zoey Hart who is brought to Alabama against her will to run her father's medical practice with his unpleasant longtime partner. In the heart of the south, the medical clinic is small, freestanding facility in a town called Blue Bell. There's no hospital affiliated with it and the capacity to perform procedures and tests more than something simple is severely limited. In fact, other than a few small exam rooms, a waiting room, and a reception desk, the clinic is not all that big. In fact, it serves as a primary care place for routine checkups more so than for acute care. While Dr. Hart and her partner are capable of caring for many ailments and injuries, the facility is not very sophisticated, thus limited their scope of practice. This differs drastically from other modern shows like Scrubs and Grey's Anatomy where they are always near the next level of care, machines required for testing, specialists, and nearby operating rooms that are available should they become necessary. (Paymer, 2012)
Additionally, it is not infrequent that someone in town is seriously injured, for instance, in a farming accident, and they get trapped. Whenever there is a substantial injury, Dr. Hart is usually called to the scene to help out. The medical care is coming to them, which is not an unusual thought as we have EMTs and paramedics in most areas. However, the average doctor does not make house calls. All of this leads to exciting drama, and as I mentioned earlier, there is a heavy focus on the personal lives and interactions of the doctors versus the actual medical aspects. Hart of Dixie is so different from other medical dramas, and it has such a heavy focus on the personal issues instead of the medicine that I am reluctant to call it a medical drama, but there is certainly a strong medical component. (Paymer, 2012)
Call the Midwife premiered in 2012 and it is currently in its seventh season. This show is unique in that while it is filmed in the 21st Century, it is set in the early to mid-1950s. Set in one of the most impoverished areas of London, Call the Midwife follows the journey of a young nun living in a convent that specializes in providing midwifery to lower income women. The focus of the show is primarily about the struggles of the sisters to keep their facility running more than personal turmoil. However, every once in a while, an episode will focus on the private lives of the midwives. The medical care provided is always exclusively midwifery, and the nuns make house calls. Very rarely does someone come to their facility to give birth. The idea is that they got to where they are needed the most in the community. (Lowthorpe, 2012)
The medical sophistication is non-existent. There are a few simple tools they keep in their bags, but they rarely use them. Most of the time they can get by with ordinary household items like towels, blankets, hair clips, and scissors. Unlike the other two TV shows I mentioned, all of the medical care in Call the Midwife takes place in the patient's own home, which in the mid-1950’s is not as radical of a thought as it is now. This series has found ongoing success because the ideas behind it are so novel to us today. If someone were to watch this period drama in the 1950’s, they probably would not find it as appealing. (Lowthorpe, 2012)
Many complex changes and trends have taken place over the past 60 years, but some of the most notable ones are: the gender differences of the TV physicians of 1960’s to the TV physicians of 2000’s, the differences in the portrayals of doctors in movies vs. televisions shows, the differences in the behavior of doctors on talk shows vs. those on medical dramas, the transition from a focus on the patient to a focus on the private lives of doctors, the changes made to TV medical dramas in hopes of making them realistic without allowing the show to be boring, and changes to the setting in which doctors practice. There is no shortage of media texts consisting of various types of medical shows which allow us to track and study the many trends and changes to the role of the doctor on television and the big screen.
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I am a 20 year old junior at the college of my dreams. I am studying Emergency Medicine and Communication Rhetoric and minoring in the Administration of Justice and National Preparedness and Emergency Management certificate. At some point, I want to go and get my paramedic certification when my health allows. I have several chronic illnesses and this blog and website serves as a place for me to share my journey fighting CRPS and my other conditions. I hope that this blog can also serve as an outlet for raising awareness for rare diseases. Thanks for reading and I hope you enjoy! Feel free to comment; I'd love to know what you think!