Like a lot of people in recent months, I’ve been binging on more television content than could possibly be good for me. I have a weakness for unrealistic police procedurals—you know the kind, where almost all of the cops are angelically self-sacrificing and caring, where sexual assault victims are taken seriously and treated with respect, where crimes are always solved. There is something weirdly soothing about these shows. They remind me of the Kraft Mac & Cheese of my childhood—synthetic-tasting empty calories that are oh-so comforting. 

Fake but entertaining

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I am willing to overlook almost any sort of nonsense on these television shows. Specialized computers that can access any record in any database in the world? Sure. Lab techs who participate in armed raids and do the work of detectives? Why not. Police departments where every employee is best friends with everyone else in the workplace? Love it.

As a physician, though, I am occasionally annoyed by medical details. I find it silly that any time someone is shot, another character implores the victim to keep her eyes open and remain conscious, as though somehow that makes any difference to the outcome. This trope is so ubiquitous that when I mentioned it to my daughter, she looked at me with surprise and said, “You mean it’s not important for people to try to stay awake when they’ve been injured?”

There are FBI agents and criminologists who can diagnose rare diseases from a single clue. (Just, no.) Fake cures abound. (Ugh.) These cute distortions are harmless, but some medical misrepresentations can do harm, like false depictions of mental illness. Most real people struggling with psychiatric problems don’t look crazy or act violently, nor do they appreciate their signs and symptoms being treated like adorable quirks. Spreading misinformation about mental illness can make existing prejudices worse. 

My least favorite of medical depictions on television, however, is that of cardiopulmonary resuscitation (CPR), because I have personally been party to the damage it can do. “I’ve got no pulse! Start CPR!” That sounds reasonable enough, but what comes next on television is a few seconds of butterfly-light chest caresses followed by evacuation by ambulance or, “We’ve lost her.” Cue tears. Curiously, I don’t think any of the police personnel are trained in rescue breathing; I wonder if that’s because of the ick factor for the viewers or the actors? It certainly would make the chest compressions less useful even if the chest was actually being compressed.

Now, I realize that actual chest compressions would do a great deal of harm to an actor, but that’s my point. CPR is brutal. I wish television shows could simulate what happens in real life, when enough pressure is applied to break ribs, and the compressions are so physically demanding and often go on for so long that it’s not unusual to rotate out an exhausted healthcare provider for one with fresh arms. This is not a reason to never provide CPR, which has saved many lives, but it is a reason not to provide it when resuscitation is futile, which is most of the time. 

In the setting of cardiac arrest due to a curable problem, keeping oxygenated blood flowing through the body long enough to fix the problem makes a lot of sense. When the heart stops because a patient is dying of any type of incurable disease, however, it makes no sense to try to restart it. Even when resuscitation is successful in such instances, the heart soon stops again, and nothing is achieved other than prolonging suffering. When resuscitation is unsuccessful, which is nearly every time, nurses and doctors are left feeling like they have assaulted a corpse. I will never forget the feeling of ribs cracking under my hands until the whole sternum was free-floating, and compressions suddenly became distressingly easy. 

The trouble is that patients and their families watch television, and they think of CPR as benign and curative. They will insist that they want “everything done,” and because Americans are litigious, hospital personnel follow their wishes even when they know CPR is futile. I argued with my supervisors when I was a trainee, saying that we wouldn’t follow patient preference for resuscitation if the patient arrived at the emergency department with his head detached from his neck. The answer I got is that we would do it if it made the family feel better. Later, as a supervisor myself, I tried to protect my trainees from the trauma of inflicting violence on dead people by getting patients and families to understand the harm and the futility of resuscitation in certain settings. Sometimes I succeeded in changing their minds, often I didn’t. When we were forced to perform futile CPR, I told the young doctors to view it as training. We weren’t going to save Mr. Brown, but they would get practice, and that would make it more likely that we would save Ms. Green, who really could benefit from resuscitation. 

I would like to think that the fact that doctors usually refuse CPR for themselves would convince lay people that it really can do much more harm than good. Preconceived notions are difficult to overcome, however. What I really wish is that the realities and limits of life-saving measures would be more accurately represented by the entertainment industry, which is a powerful force in shaping the views of its customers. Maybe if fans saw Lenny Briscoe, Olivia Benson or Emily Prentiss struggle with the horror of having to perform CPR on a dead character, or if they saw the brutal nature of real resuscitation, they would think harder about requesting it for themselves or their loved ones.