Polite Dissent

X-Treme X-Men #18 Day of the Dead
Chris Claremont, writer
Salvador Larocca, penciler

This is the book that made me realize what a horrible job comics do of portraying medical care. I threw it across the room several times in disgust before finishing it. It is especially sad because Claremont thanks an actual nurse for helping him with the medical part. I hope he didn’t pay her too much.

Play by play is in black, my comments are in red. This is a long one, so buckle your seatbelts and let’s get started.

The issue begins in an Army MASH unit (Claremont calls it a M*A*S*H. Hollywood added the asterixes; the real Army just calls it a MASH — and does the Army even use that term anymore? I was an Air Force doc, not an Army one). In typical Claremontian fashion, the doctor then proceeds to explain to his experienced triage team exactly what triage is. There are a lot of bearded doctors in this Army hospital, which makes no sense. Military men do not wear beards and civilians would not be in a battlefield MASH (see endnote).

As the Avengers bring the wounded X-Men in, medical babble is going on in the background:
A “type and cross match” is called for. Type and cross is too slow for trauma work; if blood is needed Type O is given.
Plasma is called for. Plasma is not used for trauma, just for clotting disorders.
Ringers and Normal Saline IVs are started. Good.

Everything goes to hell when Storm is brought inside in cardiac arrest. Her vitals are crashing, so they start CPR (though Claremont, in his usual wordy fashion, calls it “CPR – chest compressions”). First, they need to remember the ABCs – Airway, Breathing, and then Circulation. Second, CPR is reserved for patients without a pulse, and Storm has one, albeit a weak one.

A medic starts artificial respirations with an Ambu-bag. The count is wrong: 2 person CPR is 5 chest compressions to 1 breath, not 5 to 2.
Chest leads are called for, as are blood gases. The leads are a good idea, but they need to expose her chest to place leads. Blood gases may or may not be a help. I’m not a big fan of them in trauma situations, but other docs swear by them.
The leads show V-Tach (ventricular tachycardia), and they finally cut the clothes off her. y put the leads on in the first place without removing the clothes?
Now they‘re placing the leads on the exposed chest. Again, how did they get a rhythm if they are just placing the leads now?

Two IV lines are started: a lidocaine drip and normal saline, and both are “pushed hard.” Normal saline is appropriate for fluid resuscitation, but you don’t “push it” (pushing is for small volumes, not large volumes like a bag of IV fluid); the correct terminology is to “run it wide open.” Lidocaine is the wrong drug. While lidocaine can be used for V-Tach, it is a second line drug behind epinephrine. Defibrillation should be attempted before any medication is administered. Plus, a “drip” is only started when the patient is stable and a slow infusion (a “drip”) of the medicine that returned the patient to a normal rhythm is used. Finally, you can’t “push” a “drip”, it’s contradictory.

Now Storm degenerates into V-Fib (ventricular fibrillation). Paddles are called for and she is shocked at 200 Joules. This is correct. Shocking is appropriate (she should have been shocked for her V-Tach/V-Fib before any medicine was given), and 200 J is the correct starting voltage. The doc calls “clear” too, good.

Flatline. A second shock at 300 Joules. Fine.

She’s still flatline with crashing vitals. Epinephrine is injected (though again Claremont is too wordy here. “Epi 1 mg now” would be more appropriate than “Pump Epinephrine 1mg in Saline”). Epinephrine is the right drug; it should have been used instead of lidocaine.

She’s shocked again at 300 joules. Wrong. 360 is the correct voltage for the 3rd shock.

“Atropine 1 mg – Direct injection into the heart!” Aaghhh! Wrong, wrong, wrong. What is it with Claremont and injecting atropine into the heart? It isn’t done. See the explanation here (he used the same trick in X-Treme X-Men #24).

The doctor is prompted to call the code, but he chooses to keep going. With a young, otherwise healthy patient, this is the right choice, though ultimately it’s the lead doc’s call. He keeps defibrillating her, and then injects calcium chloride. Continued defibrillation is fine, but the calcium chloride is a strange choice. It’s not a usual cardiac medicine.
The issue now breaks down into spiritual psychobabble, and the medical part is over.

Thank God that’s over. I hope it was readable, and not as painful for you as it was for me. Generally, I enjoy Claremont’s writing (even if he is wordy), I just hope he avoids scripting any medical situations in his X-Men and Excalibur runs.

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NOTE:Sgt. Mom provides a good rundown on the Military for Hollywood. This list applies to comic books just as much.