“Code Black” should be pronounced dead

A new television series called “Code Black” debuted last night on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a "Code Black."

There is the usual array of standard medical characters—the inexperienced new residents on their first day at work, the savvy nurses, and the cocky, overconfident attendings. This one has a few twists. The world-weary head nurse is a Hispanic man, and the headstrong know-it-all attending is a woman, Dr. Leanne Rorish. She has early conflict with the handsome, more cautious Dr. Neal Hudson, but I see romance in the future should this show manage to stay on the air.

It takes 5 people to push an empty gurney at Angels Memorial

The show started off with a gunshot wound to the neck that the docs had to retrieve from a car which had been abandoned in the hospital parking lot. Although no one had been putting pressure on the damaged carotid artery for an undetermined period of time and blood was visibly spurting out of the wound, the patient pulled through the resuscitation thanks to Dr. Rorish who replaced all his blood with cold IV fluid. She spiced up the resuscitation by asking the new residents questions about what she was doing.

A man with head trauma and a Glascow Coma Score of 3 was brought in and declared brain-dead on the spot. The transplant team was on its way in. Apparently Angels Memorial Hospital has no brain death protocol.

Another man came in with expressive aphasia due to a stroke, received tPA, and promptly woke up and told his wife he loved her. That’s not the way it works.

My favorite vignette was the arrival of a young boy who was short of breath. Learning that he was Norwegian, Dr. Rorish immediately diagnosed a pneumothorax and assigned an unsupervised new resident to insert a chest tube. He of course was a bit nervous. It was touch and go for a while, but he eventually got the job done. The patient was remarkably calm despite not receiving any local anesthesia which, by the way doesn’t work too well for chest tube insertions anyway.

In the midst of all the chaos, Dr. Rorish fired one of the new residents, a woman who disobeyed her by ordering a urine toxicology screen on a patient who was discharged and later determined to be suffering from carbon monoxide poisoning.

I won’t bore you with the details but the fired resident somehow ended up going in an ambulance to get the patient at her home. On the way back to the hospital, they got stuck in traffic. Drs. Rorish and Hudson talked the resident through a cesarean section which she performed in the ambulance without any assistance.

Did I mention that Dr. Rorish was doing a burr hole on a patient with an epidural hematoma while all this was going on? This scenario was plausible since it can often be difficult to get a neurosurgeon to come to the hospital.

At this point, Id had enough.

Here’s an idea that I’d like to pitch to the networks. It’s a show about the fast-paced world of nursing homes, and it’s called “Code Brown.” For those of you who don’t know, a Code Brown is called whenever a patient poops so much that it takes four people to clean up.

ADDENDUM: I had heard about more crazy stuff in the second episode of Code Black. Against my better judgment, I watched it. To read my review of that one, click here.

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