Why Do Men Have Nipples? Hundreds of Questions You'd Only Ask a Doctor After Your Third Martini

CHAPTER 7. MEDICINE FROM THE MOVIES AND TV

Theflurry of bathroom talk was cathartic, leaving everyone feeling purged and invigorated. Joel, with a newly found confidence, is leading a small group in a game of charades. Leyner, with the nearly empty tequila bottle in one hand and a fat Cohiba in the other, is gesturing madly and attempting to act out a scene fromGone With the Wind. I mistake Leyner’s gesticulations for a focal seizure and I run across the room to administer first aid. The group assumes that this is all part of the clue giving and continues to shout out movie titles. Leyner’s face is contorted in a bizarre grimace as I assist him to the ground and protect his airway with a head tilt and jaw thrust. Leyner is now scowling and I realize this is not a seizure as Cinderella incorrectly guessesSpartacus.

Joel shouts out,“Vision Quest!”

And Jeremy quickly replies, “Dude, they’re not wrestling, I think they are in love.”

Joel quickly responds,“The Birdcage!”

And Cinderella guesses,“Willy Wonka and the Chocolate Factory.”

Jeremy turns to me and blurts out, “Are Oompa Loompas orange from eating too many carrots or are those little bastards just using too much self-tanner?”

Before I can respond, Eloise saunters over and — astonishingly — says in a slow, wistful drawl, “It’s got to beGone With the Wind. I’d have a fit too if my ten-million-dollar Charleston bungalow burned to a crisp. Oh poor beautiful Tara.”

People often leave the movie theater filled with questions about what they’ve seen on the screen. After a thrilling episode ofER, I can always expect to get a call.

Accurate: accu•rate; adjective.

1. Correct in all details.

2. Free of mistakes or errors.

Of course it’s not completely accurate! It’s TV.

But the writing staff does capture the general controlled chaos of an ER. They deal with real medical cases but their medical depictions are always embellished to add a little extra Hollywood flair.

I did my residency in emergency medicine in Los Angeles, whenER was just starting and the writers often came by our hospital looking for new ideas. One patient I saw there was portrayed in an early episode, and highlights the writers’ taste for the dramatic. One day, a baby was playing with a coat hanger and the tip of the hanger got stuck in the back of his throat. The paramedics carefully brought the baby in to our ER with the hanger dangling from his mouth. This was, of course, very dramatic looking, and we all rushed over immediately. The child was scared but was breathing fine and my fellow doctors and I did our best to just leave him alone and keep him calm. (Rule #1 of medicine: do no harm.) An X ray showed that the tip of the hanger was superficially caught up on the back of the child’s throat. Now… for the big dramatic ending: we simply reached inside and removed it. Case over!

OnER, however, when the glamorous doctors tried to remove the hanger from the child’s throat, the baby started to bleed profusely. After an emergency tracheotomy, some miraculous bedside surgery, and a little on-screen romance, this child was just barely saved.

Amnesia seems to be one of the favored topics of screenwriters for an easy plot twist. The list of “amnesia movies” can go on and on: The Bourne Identity, 50 First Dates, Desperately Seeking Susan, Eternal Sunshine of the Spotless Mind, Overboard, Spellbound, Total Recall, to name just a few.

The amnesia that doctors see is very different than the big-screen version.

Amnesia is best defined as a failure to retrieve information or to place information in an appropriate context. Amnesia rarely erases memory of all past events. No one suffering from amnesia actually goes through the rest of his or her life without an identity or any knowledge of the past. Memory loss is usually temporary and only involves a short time span of the person’s life.

Types of Amnesia

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anterograde amnesia:

Inability to remember ongoing events after the incidence of trauma or the onset of the disease that caused the amnesia. Anterograde amnesia often occurs following an acute event such as a trauma, a heart attack, oxygen deprivation, or an epileptic attack.

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retrograde amnesia:

Inability to remember events that occurred before the incidence of trauma or the onset of the disease that caused the amnesia. Retrograde amnesia is often associated with neurodegenerative pathologies such as senile dementia and Alzheimer’s disease.

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emotional/hysterical amnesia (fugue amnesia):

Memory loss caused by psychological trauma such as a car crash or sexual abuse. Usually it’s a temporary condition.

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lacunar amnesia:

Inability to remember a specific event.

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Korsakoff syndrome:

Memory loss caused by chronic alcoholism.

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posthypnotic amnesia:

Memory loss sustained from hypnosis. Can include inability to recall events that occurred during hypnosis or information stored in long-term memory.

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transient global amnesia:

Spontaneous memory loss that can last from minutes to several hours and is usually seen in middle-aged to elderly people.

Here are some movies that Hollywood executives would like to forget: Gigli, Ishtar, Howard the Duck, The Postman, andThe Adventures of Pluto Nash.

“No, you don’t gotta fucking stab her three times! You gotta stab her once, but it’s gotta be hard enough to break through her breastbone into her heart, and then once you do that, you press down on the plunger.”

— Lance (Eric Stoltz),Pulp Fiction

No, intracardiac injection is not recommended for routine use during CPR. Translation: ER docs don’t ever inject anything directly into people’s hearts. There is an uncommon procedure called a pericardiocentesis when a needle is inserted under the breastbone and into the sac around the heart to remove excess fluid. This is done when fluid or blood surrounding the heart is restricting its function. This is only done in serious emergencies.

InPulp Fiction, John Travolta and Samuel L. Jackson are trying to save Uma Thurman from a drug overdose by injecting her with adrenaline. Instead, they should have given her an injection of a medication called Narcan to reverse the effect of the heroin. Adrenaline (epinephrine) is often given during cardiac arrest but only through a vein. Sorry, not as dramatic but definitely less painful.

In the movies and in the dictionary, “shock” can mean to strike with great surprise and emotional disturbance. In medicine, “shock” is a major medical emergency. When doctors talk about shock we are referring to the failure of the circulatory system to maintain adequate blood flow. This requires rapid treatment, otherwise it can lead to death.

There are a number of different causes of medical shock, including bleeding (hypovolemic shock), inability of the heart to pump enough blood (cardiogenic shock), severe infection (septic shock), and life-threatening allergic reactions (anaphylactic shock). People suffering from shock have low blood pressure, difficulty breathing, a weak rapid pulse, cold and clammy skin, decreased urination, and confusion.

So, the shock that we so often see on-screen should be more appropriately called freaked out.

If real life were a soap opera, then the answer to this question would always be yes. Unfortunately, coma is a very serious problem and although people do wake up, the longer they remain in this state, the less likely they are to return to consciousness. This is a very delicate question because doctors can’t really predict which patients will wake up and which will not.

If you look carefully in the original movieComa, you will see Tom Selleck, that’s right, Magnum, P.I., in a state of suspended animation. Recent movies likeWhile You Were Sleeping, Kill Bill, andTalk to Her also used coma in their stories. The medical story of coma isn’t as glamorous as Hollywood portrays.

To begin, there are several different categories of coma, or disorder of consciousness. Consciousness can generally be divided into two main components, arousal and awareness. Coma is defined as a state of unresponsiveness from which an individual has not yet been aroused. Patients in a coma are neither awake nor aware of their surroundings. On average, coma doesn’t usually last very long. After several weeks, most patients either regain some level of consciousness and if not are classified as being in a persistent vegetative state. Persistent vegetative state is characterized by complete lack of awareness of self or one’s environment. These patients can appear awake and even have their eyes open but are totally unaware of their surroundings.

Another category of consciousness is the minimally conscious state, an intermediate stage of consciousness, which indicates that a patient is somewhere in between a persistent vegetative state and normal consciousness. These patients can show intermittent signs of awareness.

The “locked-in” syndrome is a rare condition that must be distinguished from disorders of consciousness. It is characterized by complete paralysis of the voluntary muscles in all parts of the body except for those that control eye movement. These patients can think and reason but are unable to speak or move.

It certainly would be dramatic if we had our gunshot trauma patients take a swig of whiskey and bite on their belt as we removed the bullet with a knife that had been sterilized by heating over a fire. I also would love to ride a white horse to work every day but that doesn’t happen either.

In old Westerns, there is an urgency involved with removing a bullet, as if this is the life-saving maneuver. In reality, doctors are not concerned with the presence of the bullet but rather the damage that it does on its way in or out. We often see patients who get an X ray for another reason only to find a bullet from a previous injury.

There are some special situations when we worry about leaving a bullet in a person’s body. When bullets or fragments are near large blood vessels, nerves (especially the spinal cord), or in a joint, then they can migrate and cause damage. In these cases, bullets are usually removed.

People have also asked whether or not you can get lead poisoning from bullets that are left in the body. In general, lead fragments in soft tissue become surrounded by fibrous tissue and are therefore essentially inert. If a bullet is in a joint, there can be a problem with lead poisoning. A study in Los Angeles in 2002 looked at more than four hundred patients who had bullets retained in their bodies. They found increased levels of lead in a small percentage of patients. Bullets or shotgun pellets are 50 to 100 percent lead and people are more likely to have problems with lead poisoning if there are multiple bullets or multiple fragments in the body. Sorry to disappoint you spaghetti Western aficionados, but the old whiskey-and-leather routine is just for show.

Action heroes like Arnold Schwarzenegger often find themselves faced with an interrogator who uses a truth serum to get the hero to reveal his secrets. In the movies, our heroes are able to resist these potions and hide the truth. Hiding the truth seems to also prepare action heroes for a successful career in politics.

They seem pure fiction, but truth serums do exist. Barbiturates such as sodium amytal and sodium pentothal were first used as truth serums in the early twentieth century. These drugs inhibit control of the central nervous system and were used by physicians to help patients recover forgotten memories or repressed feelings. They are also used for patients with suspected conversion disorder, a condition in which psychological problems produce physical symptoms.

An “amytal interview” is performed by administering a small amount of this drug intravenously. The drug produces a state of drowsiness, slurred speech, and relaxation. This condition makes patients more susceptible to suggestion, allowing the potential to uncover repressed feelings or memories.

Today these interviews are seldom performed. The “truth serum” will not necessarily make you tell the truth. Patients may lose inhibition but will not lose all self-control. Therefore, they are still able to control their behavior and lie. Studies have shown that during these “amytal interviews,” patients often demonstrate a distorted sense of time, show memory disturbances, and have difficulty distinguishing between reality and fantasy, so the line between fact and fiction becomes even more blurred.

We’ve all seen it in the movies. The bad guy grabs someone from behind, places a rag over the victim’s nose and mouth, and instantly the person slumps to the floor.

This isn’t exactly how anesthesia is administered in a hospital, but many people wonder if this rag trick is possible, and if so, what is the chemical on the rag?

Chloroform and ether are the two possibilities. In the mid-1800s, both of these chemicals were being used as anesthetics. Chloroform is the more common substance discussed in these cinematic knockouts but actually doesn’t work as swiftly as portrayed. It usually takes several minutes to induce a state of unconsciousness with chloroform. Chloroform also causes a lot of side effects including nausea, vomiting, and skin irritation.

Ether was discovered in the 1500s and later used as an anesthetic. It was also used to treat respiratory ailments such as asthma. Ether became popular and turned into an early party drug that people used to get high. Unfortunately, ether can’t deliver that dramatic takedown either.

Another option for the quick movie knockout involves secretly dissolving a pill in a drink. This is often referred to as “slipping a mickey” or a Mickey Finn. Spiked drinks in this sense contain Chloral hydrate dissolved in alcohol. Chloral hydrate is a sedative that is used in hospitals today, often to sedate children prior to procedures. Other modern movie knockout options are the so-called date rape drugs: GHB, Rohypnol, and ketamine.

In the movieSpinal Tap, Eric “Stumpy Joe” Childs, the second drummer in the eponymous band, died in 1974 from choking on vomit. As the movie reveals, “The official cause of death is he died of choking on vomit. It wasn’t his own vomit. He choked on somebody else’s vomit.”

This event is said to have been inspired by the death of John Bonham, the drummer of Led Zeppelin. In 1980, Bonham was found dead after a drinking binge. He apparently had passed out and choked on his own vomit.

This is a true and potentially dangerous possibility with excessive alcohol intake. Death from alcohol abuse most often occurs from aspiration. Aspiration is defined as breathing the vomit into the lungs, which causes the victim to essentially drown.

The 1976 TV movieSybil was based on a book of the same name written by Flora Rheta Schreiber. Both of these accounts were based on a real-life patient and psychiatrist but recently there has been controversy over whether the real Sybil actually had multiple personalities at all. Other movies likeThe Three Faces of Eve, Psycho, andMe, Myself Irene have also dealt with multiple personality. Once this disorder was popularized in the movies, the number of diagnosed cases increased dramatically.

Multiple personality disorder is no longer the term used to refer to this disease. It is now referred to as Dissociative Identity Disorder (DID). DID is defined as a disorder where two or more distinct personality states or identities alternately control or take over a person’s mind. This disorder is a result of many factors, most commonly severe emotional stress.

You can scare the pants off someone or be scared shitless, scared stiff, or scared out of your wits. But is it really possible to be scared to death?

There is significant evidence that psychological and emotional stress can increase the likelihood of a heart attack. So it makes perfect sense that the stress of fear could lead to sudden death.

InThe Hound of the Baskervilles, a famous Sherlock Holmes story that has been adapted into film several times, Sir Charles Baskerville dies of a heart attack after being frightened by a ferocious dog. An article from theBritish Medical Journal in 2001 entitled “The Hound of the BaskervillesEffect: A Natural Experiment on the Influence of Psychological Stress on the Timing of Death” examines whether this phenomenon is actually true. These researchers wanted to show that people are more likely to die of a heart attack when they suffer extreme emotional stress, so they focused on the death rate on the fourth day of the month. In Japanese and Chinese cultures, the number four is associated with death and is feared and avoided. This is not true in other cultures.

When the death rates between Japanese and Chinese Americans and white Americans were compared on the fourth of the month, the researchers found that death rates on this day peaked in the Japanese and Chinese but not in other groups. So it seems as though you can be scared to death — by the number four at least.

Even if you don’t end up choking on your own vomit, alcohol is still pretty dangerous. The consumption of even small quantities of some types of alcohol, such as methanol or rubbing alcohol, can be fatal.

With ethanol, the alcohol that is found in vodka and wine, for example, too much can certainly lead you to the pearly gates. People often wonder how much alcohol can be life threatening. In medicine, we use the term LD⁵⁰to describe the dosage or amount of alcohol that causes death in half of the population. The LD⁵⁰for alcohol is equal to a blood-alcohol concentration of 0.4 to 0.5 percent. That would be about four to five times the amount required to make you legally drunk.

To give an example of how much drinking this means, a hundred-pound person would need to drink about ten drinks in an hour to threaten his or her life. Our bodies tend to protect us from alcohol-related death by vomiting or passing out. The danger occurs when you puke and faint at the same time. If you are brought to the hospital, we will protect your breathing and wait for the alcohol to move out of your system. Stomach pumping for alcohol abuse is a myth since you do that yourself when you puke. Oh, and occasionally when it is a slow night in the ER, the staff will bet on who can guess your blood-alcohol level, just to pass the time….

On an episode ofKing of the Hill, Hank accidentally sees his mother in bed with her new boyfriend and suddenly loses his vision. In the movieHollywood Ending, Woody Allen’s character has the same problem because he is so nervous about the film he has to direct. So, does this sudden blindness really happen outside of the movies and TV?

The answer is definitely yes. And it is not unusual to see these patients in the ER. Hysterical blindness can occur as a result of a psychological stress (a conversion disorder) or someone can intentionally fake blindness for some secondary gain (malingering) — a prisoner who says he can’t see in order to try to avoid going directly to jail. It is not difficult to figure out when patients say they are blind but can actually see. We have a simple test that lets us determine whether the eyes are functioning. Using a rotating striped drum, we test for something called optokinetic nystagmus. As the drum spins, normal eyes will be seen moving back and forth.

If a striped rotating drum is not available, you can always use a picture of J. Lo’s rear. Move it back and forth, and any normal eyes will follow.

Leyner: So…

Gberg: Just sent you the blindness question.

Leyner: Okay… just got the e-mail… I’m reading it now… hold on (to something of your own choosing).

Gberg: Just hold on to what you’ve got. You’ve got a lot girl, you’ve got a lot. Got a lo-ovely feelin’. Hang on, hang on to what you’ve got. I may have left out a “hang on” in that musical interlude. Singing doesn’t really work on IM.

Leyner: I think we need to explain just what that test is, then maybe make some joke about something visual that would be almost impossible not to react to, like some starlet’s muff for instance, then… maybe a joke about what might cause hysterical deafness.

Gberg: Very good. Will do. Let’s focus on the intros.

Leyner: Okay… let me read through the intro again….

We’re not sure that we can answer this one with any scientific references, and there probably isn’t a hospital that would allow you to study the consequences of leaving movie candy inside a patient during surgery. This is not to say that surgeons don’t occasionally leave things behind. Surgical sponges and instruments are the most common items left behind, and believe us, it has happened.

In theSeinfeld episode, the patient makes a miraculous recovery and it is implied that the mint may have prevented infection. Although there are some reports about using granulated sugar and honey on wounds, having a Junior Mint inside your body is more likely to cause an infection. So, remember to always ask your surgeon to step out of the operating room if he or she needs a snack.

One of Mark Leyner’s favorite recent news stories is that of Armin Meiwes, a German computer technician who was convicted of murdering someone for sexual pleasure and then eating him over the next several months. Mr. Meiwes had advertised on the Internet for “well-built young men aged eighteen to thirty to slaughter.”

Mr. Meiwes in interviews with court psychiatrists said that his fantasies of cannabilism began as a child from watching horror films. For those film buffs who are looking for a viewing list, these movies all involve cannibalism: Alive; Eating Raoul; The Silence of the Lambs; Hannibal; The Cook, the Thief, His Wife, and Her Lover; andNight of the Living Dead.

So, is it dangerous to eat another human being? I am sad to report that it really isn’t that dangerous. Human flesh holds much nutritional value and will keep you alive if your plane goes down and all you have are your fellow, more unfortunate, passengers. Unless you are eating the brain.

A rare disease called Kuru can occur from eating human brains, which killed about 10 percent of the Fore, a New Guinea tribe of cannibals. The Fore would honor their dead by eating them. The brain was reserved for the female relatives and children. Whole villages were wiped out by this rare neurodegenerative disease.

Kuru manifests with muscle weakness and trouble walking. The Fore would then have trouble talking and could no longer stand, sit, or even hold their heads up. Death ultimately resulted from starvation or an infection that developed when they became so sick. Researchers were very interested in this disease because it is very similar to mad cow disease.

12:40P.M.

Gberg: Time really flies when you are typing away at this IM thing.

Leyner: Are you being sarcastic?

Gberg: No.

Gberg: How was the lamb your mother-in-law made last night?

Leyner: The goat you mean.

Leyner: It was great.

Leyner: I love goat and all things goat.

Gberg: I made a mean beef tenderloin last night.

Leyner: Meat, cheese, milk, etc.

Leyner: How’d you make it?

Gberg: In a red wine sauce, tender and delicious.

Gberg: Did I tell you that I added in your favorite story of that German cannibal?

Leyner: That sounds great.

12:45P.M.

Leyner: I saw that… that’s essential and indispensable for this book.

Gberg: What an insane story.

Leyner: It’s a lot more common than you think. Families tend to keep cannibalism hushed up… I had an uncle…

Gberg: I will never come to your family’s for Thanksgiving.

Leyner: Never mind.

Leyner: I was looking up satyriasis.

Leyner: Speaking of goats.

Gberg: What is satyriasis?

Leyner: It comes from the word “satyr,” meaning part man, part goat (fond of Dionysian revelry).

Leyner: Satyriasis: abnormal sexual craving in the male.

12:50P.M.

Gberg: Says on the Internet that it is caused by extreme narcissism.

Leyner: Really… I’m in the high-risk category then.

Leyner: I can spend all day just staring at a single vein on my left bicep.

Gberg: There are treatment options available, medication or… I assume that castration is not an option.

Leyner: I’m not taking some horse suppository, son.

Gberg: Maybe some very tight underwear?

At the end ofScarface, Tony Montana gets shot many times but doesn’t lose his ability to spew obscenities. In the hospital we believe that an innocent person will get killed by a single gunshot but the meanest, guiltiest thug can survive multiple gunshots and simply get up, curse at the doctors, and walk out.

The truth is that it really depends on where the bullet hits you.

It happened inAn American Werewolf in London, and who can forget Michael J. Fox asTeen Wolf? Lyncanthropy refers to the delusion that one is a wolf. This can definitely be seen in psychiatric illness, but it may be that in some cases this is not a delusion at all. The werewolf legend may have originated out of two medical conditions.

Porphyria is a rare hereditary blood disease. There are two types of porphyria. In one type, cutaneous porphyria, the symptoms can resemble the characteristics of a werewolf. These patients become extremely sensitive to sunlight, grow excessive amounts of hair, and develop sores, scars, and discolored skin. Porphyria also leads to tightening of the skin around the lips and gums, and can make the incisors stand out (think fangs).

Another disease that may have contributed to the werewolf myth is congenital hypertrichosis universalis, sometimes known as human werewolf syndrome. This is another rare genetic disorder that is characterized by excessive hair growth over the whole body, including the face. If you travel to Austria, you can see portraits of the first family discovered with this condition in Ambras Castle near Innsbruck.

So, there isn’t really such a thing as a werewolf, but there is a possible medical explanation of how the stories began. Sorry, we don’t have a medical explanation for Dracula, Frankenstein, or the Abominable Snowman, but we’ll do some research and include it in our next book,Why Are Women Smarter?

InMonty Python’s The Meaning of Life, a man eats a massive feast, but one wafer-thin dinner mint puts him over the edge. He explodes all over the restaurant. With the obesity epidemic in our country, we have a great deal to worry about, but don’t expect to see people exploding at McDonald’s. People won’t explode from overeating, but if you eat too many Big Macs, you can rupture your stomach.

Stomach rupture, or gastrorrhexis, is a rare condition, although it has been reported to occur from eating too much. In a 2003 issue ofLegal Medicine, Japanese scientists Ishikawa et alia, reported the case of a forty-nine-year-old man who was found dead in a public restroom after his stomach exploded from eating too much. There is no mention of what his last supper was, and therefore no reason to suspect Pop Rocks and Coke (see chapter 8, page 192).

Does anyone else remember the Man from Atlantis? Patrick Duffy (Bobby Ewing fromDallas) played the last man from the legendary underwater city of Atlantis. He had webbed feet and hands and gills instead of lungs. This fantastic show only lasted for one season, but it inspired a TV junkie to ask if people could really have webbed hands and feet.

The answer is yes! People can have webbed hands and feet. Actually, it is more common than you may think, occurring anywhere from one in one thousand to one in two thousand births. There are two types of webbing: syndactyly is when two fingers or toes are fused or webbed; polydactyly involves the webbing of more than two fingers or toes. We all start life with hands and feet that resemble a duck, and between the sixth and eighth week of development, our fingers and toes separate. The failure of this separation is what leaves you looking like the Man from Atlantis.

It always happened to Wile E. Coyote. The Road Runner drops an anvil on his head and then the poor coyote sees stars circling his head. Not only does this happen in cartoons but it is actually a sign of a concussion. A concussion is simply when an injury to the head causes your brain to move around inside your skull.

As for the stars, what probably happens is that the portion of your brain that is responsible for visual information, the occipital lobe, bangs up against the side of the skull.

WHAT WAS WRONG WITH THE BOY IN THE BOY IN THE PLASTIC BUBBLE?

In 1976, one year before John Travolta was dancing his way throughSaturday Night Fever, he was inThe Boy in the Plastic Bubble. The film was based on a true story of a boy suffering from a rare inherited disease called Severe Combined Immunodeficiency Disease (SCID). SCID is now often referred to as “bubble boy” disease, thanks to this cinematic tour de force.

Severe Combined Immunodeficiency is a life-threatening syndrome in which there is a defect in the white blood cells that protect us from infection. This lack of a functioning immune system leads to frequent severe infections. Patients are usually diagnosed before they are three months old and if untreated the syndrome can be fatal. New treatments such as stem cell or bone marrow transplantation can save many patients. Gene therapy now also shows promise as a treatment for one type of this syndrome.

After some of his more recent movies, John Travolta has been rumored to be photographed by paparazzi attempting to re-enter the bubble. Good idea.