Polite Dissent

Greetings to all visitors from Comics Should Be Good (where I have a guest post today). Look around, enjoy the blog. Take a gander at the sidebar — there are great internal links (“The Best of…” and “Special Topics”) as well as a linkroll of other fine comic and medical blogs.

• If you’re interested in reading more about comic book transfusions check out the Transfusion Confusion section, which covers almost every famous (and infamous) transfusion scene in comic books, from Superman to the She-Hulk to Spider-Man.
• Comics and Medicine lists all the comic books I’ve reviewed from a medical point of view over the past two-plus years. There’s reviews of good comics and bad comics, and I do my best to point out the good as well as the bad. It’s a long list, I admit, and I’ll have to organize it better one of these days. Probably.
• Finally, check out the CBDR (the Comic Book Drug Reference), and ongoing project to catalog every imaginary drug or medication that has ever appeared in a comic book.

Tonight Fox rebroadcasts the fifteenth episode of the second season of House and it’s a good one.

This episode, Clueless, is another one that deals in great part with this season’s apparent main theme sex husbands and wives. However this time, the medical mystery is particularly clever and the solution was well done. I gave it a rare A

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Still want more top of the line medicine? Well then check out Grand Rounds, the weekly collection of the best medical blogging on the web. It always features fascinating stories, advice, and insight into the medical field. Check it out this week at Inside Surgery.

Tags: television medicine house grand rounds.

Thanks to medical science, classic literature, and comic books, we’re nearing the point where we can say we have a disease named for every color of the rainbow. Just a few more years…

• Black Flu
  Disease that killed many of the first-generation underwater Atlanteans. From Atlantis Chronicles #2
• Black Death
  The Bubonic Plague
• Green Plague
  Condition that killed many Kryptonians prior to the destruction of Krypton. From Superman: Man of Steel #1
• Red Death
  From Edgar Allan Poe’s The Masque of the Red Death
• Red Rain
  A weaponized form of Group A Streptococcus. From Avengers #65-70
• Yellow Fever
  A mosquito-borne disease of the tropics

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Speaking of diseases, here’s a couple of interesting disease-related links:

• Damn Interesting had a recent article on the Sleeping Sickness, a weird condition/disease that struck down may people from 1916 into the 1920s. Fans of Sandman will remember that this disease makes up an important part of the plot of The Dolls House (and to a lesser extent, the first story arc as well). It also plays a role in the book and movie Awakenings.
• A list of major epidemics, from Wikipedia.

Tags: comics medicine books plague epidemic

Y: The Last Man #47 “The Tin Man”
Brian K. Vaughan, writer
Goran Sudzuka, penciler

By request, a look at Y: The Last Man #47:

Dr. Allison Mann is experiencing an incredible amount of what appears to be vaginal bleeding. In fact, she’s bleeding so much that she’s going into shock from the blood loss.

What conditions could lead to this amount of bleeding?

1. Trauma
   Like anywhere else in the body, trauma (such as lacerations or abrasions) to the female genital tract can lead to bleeding. The pelvic region has a good blood supply, so heavy bleeding is possible.
2. Uterine Fibroids
   An abnormal (but non-cancerous) growth of muscle cells within the uterus.
3. Hormonal Imbalance
   Especially elevated or unopposed estrogen. A thyroid or adrenal gland problem can cause some abnormal bleeding as well, but generally not this amount.
4. Pregnancy-related bleeding
   This can include a miscarriage or threatened miscarriage. In pregnant women, placenta previa (where the placenta is lying over the cervix) or placental abruption (where the placenta is pulling away from the uterus. This can be fatal to mother and child.) are concerns. Heavy bleeding could also be from retained tissue after birth or miscarriage, such as a retained placenta. A final pregnancy-related cause would also be postpartum hemorrhage, when the uterus does not contract down after birth and continues to bleed. Postpartum hemorrhage can be fatal — but given Dr. Mann’s recnet history, that is unlikely to be the cause here.
5. Genital Tract Inflammation
   Inflammation, most commonly caused by infections, can cause bleeding, but not at the level Dr. Mann is experiencing.
6. Bleeding Disorders
   Hemophilia (though extremely unlikely in a woman), Von Willebrand’s Disease or other blood disorders can lead to heavy bleeding. Use of anticoagulant medications such as warfarin or heparin could also cause heavy bleeding.
7. Cancer
   Cancer, particularly endometrial or uterine cancer, can cause heavy bleeding.
8. Arteriovenous Malformation
   A uterus with an abnormal blood supply could result in heavy bleeding.

Note: There are certainly many other causes of abnormal vaginal bleeding, but I am focusing on the ones most likely to cause the copious bleeding.

Dr. Mann believes the cause of the bleeding is related to miscarriage she suffered earlier, before the series began. Without knowing more about the timing involved or the miscarriage itself, it’s difficult to know for sure. But if I had to speculate: Given that she was not receiving professional prenatal care, she may not have sought professional assistance at the time of her miscarriage. Thus uterine trauma or damage could have occurred during, or due to, the miscarriage. I suppose there could also be retained tissue left over from the miscarriage, but that seems unlikely given the time that seems to have passed since the miscarriage. I think we’ll just have to wait and see what Vaughan has in mind.

Other medical evaluations of Y: The Last Man:Y: The Last Man #29 (plague or botulism?) Y: The Last Man #30 (active and passive Immunity) Y: The Last Man #45 and #46 (homeopathic surgeons?)

Tags: comics medicine y: the last man brian vaughan allison mann hemorrhage vaginal bleeding

A full page advertisement from the pages of Kamandi #17 (May, 1974) filled with wonderful ad-speak:

This is Kung Fu — a force so simple yet so devastating that its techniques have stunned the world!

With so many crimes of violence about us you could be in danger — anytime — of being hurt or worse humiliated!

Because those broken bones will mend, but not your low self-esteem.

Thanks to Kung Fu you need never be afraid again. You too can learn to overcome the fear of being shamed. You too can be the one that gives the beating!

And let’s not forget the all imprtant disclaimer at the bottom of the ad:

We do not claim that physically handicapped or other disadvantaged persons can perform these feats. Nor are these techniques claimed to be effective against anyone armed with a loaded gun.

Click here or on the image for the full ad

Tags: comics ads kung-fu kamandi

There is only one medical scene in Monster, Volume 2. It occurs roughly three-quarters of the way through the book, at the beginning of Chapter 7.

In this particular scene, Dr. Tenma is surgically removing the patient’s cerebral arteriovenous malformation (AVM).

Operating Room conversation:
Cutting all arteries.
There are many vessels in this arteriovenous malformation.
Nidus extraction complete.
Now the veins.

The arteries that carry blood from the heart and the veins that return blood to the heart are connected by capillary beds. Arteries branch off into smaller and smaller arteries that eventually connect to capillaries which in turn connect to small veins which join together to make larger veins which join together to make larger veins…and so on. The capillaries are key because they are where the exchange of nutrients and chemicals between the blood and body tissue (such as muscles, lungs, intestines, etc.) takes place. They are also important because they allow a safe connection between the high-pressure arteries and the lower pressure veins.

In addition to the normally capillary beds, some people have one or more arteriovenous malformations. These can be thought of as a short circuit between the arteries and veins, bypassing the capillaries. They appear as a tangle of blood vessels, known as a nidus. Because they are bypassing the capillaries and connecting the high pressure arteries to the low pressure veins, they have a tendency to leak or bleed. If one of these AVMs is in the brain, it can lead to a stroke.

There are several treatment options for AVMs of the brain. Radiation therapy can often resolve small lesions. Larger lesions require surgical removal. A more recent technique is the embolization of the AVM — a tiny catheter is advanced through the body until it reaches the tangle, and then the AVM is clotted off using metal coils, miniature balloons or a special glue. This can be done in addition to surgery or as the primary treatment in certain cases.

In the scene from Monster, Dr. Tenma is surgically removing the AVM by clipping off the arteries, removing the tangle, and then clipping off the veins.

Previous Monster Annotions: Chapter 1 (part 1), Chapter 1 (part 2), Chapter 2, Chapter 3, Chapter 4, Chapter 5, and Chapter 6.
Coming later this week, Volume 3, so pick yours up and get ready…

Tags: comics medicine arteriovenous malformation avm stroke naoki urasawa monster

This is a comic that was produced by the United States Forest Service and the Ad Council during the 1960s and early ’70s. I remember owning it when I was a preschooler. It was always one of my favorites. It tells the true story (more or less) of Smokey Bear, who went on to become Smokey The Bear and the forest fire prevention mascot of the U.S. Forest Service.

As the comic starts, a forest fire rips through Lincoln National Forest in New Mexico. Most of the forest animals flee, but many perish in the flames. One lone animal survives the fire: a badly burned bear cub stuck in a tree. The firefighters rescued him and he was bandaged up and his burns treated. The rangers called him Smokey and he became the mascot used to remind the public that “Only You Can Prevent Forest Fires.”

Smokey lived out his days at the National Zoo in Washington D.C. I remember seeing him as a youngster in the ’70s, so I’m sure he has long since passed on. I just remember that I could care less about the pandas and the other exotic animals, it was Smokey that my sister and I desperately wanted to see on our visit to the zoo.

• Thanks to the Minnesota Department Department of National Resources, you can download your very own copy of this comic. About 3/5 of the way down the page, under the “Smokey comic book audio CD” heading is a link to a pdf file of the comic (though the last four pages seem to be the same in my copy).
• In addition to this freebie comic, Smokey had Gold Key comic book series that ran for 13 issues from 1970 to 1973. Not to be outdone, Woodsy Owl (”Give a Hoot, Don’t Pollute”) had a ten issue series, also from Gold Key, from 1973-1976.
• Wikipedia tells a slightly different origin of Smokey the Bear. I’m sure theirs is correct as it is more politically expedient, but I prefer the comic book version.
• Why should you, as a comic reader, care about forest fires? From the comic book:
  Smokey tells them how he hates forest fires!
  How they destroy his animal friends…
  How they burned up timber that could have been used to make homes — perhaps a new home for you…
  How they waste wood that could have gone into furniture…
  

Tags: comics psa smokey the bear forest fires

I absolutely loathe the use of misleading statistics or poorly-interpreted results to prove a point. I don’t care if I agree with the argument in question or not, bad statistics are bad statistics and should be addressed whenever and wherever they are found. News reports yesterday provided us a good example of this:

Fox TV: Sexual Song Lyrics Prompt Teens to Have Sex Sooner
MSNBC: Raunchy Songs Can Prompt Earlier Teen Sex
CNN: Study: Sexy Music Sexy Music Triggers Teen Sex

It was hard to miss those headlines. A recently published study, partially funded by the “think tank” Rand Corporation, addresses the subject of teens, musical choice, and sexual behavior, but the actual results are not nearly as dramatic as the media outlets — or even the study authors — would have you believe.

The article, “Exposure to Degrading Versus Nondegrading Music Lyrics and Sexual Behavior Among Youth“, is published in the most recent issue of Pediatrics, a well-respected medical journal – though it is toward the back of the issue.

In the study, researchers questioned teenagers by phone at three instances over a period of several years about their musical preferences and their sexual behaviors. The results suggest that there is a correlation between listening to music with degrading sexual lyrics and earlier initiation of sexual intercourse. That’s pretty much all the study shows: adolescents that listen to sexually charged music tend to experience sex earlier.

Note that the study does not demonstrate causation, it only shows correlation. It does not show that listening to sexual music causes or is responsible for this sexual behavior. The authors would like us to think that they’ve controlled for every other possible variable that could explain sexual behavior, but given that we don’t know all these variables, it’s hard to see how they could control for them. In fact, at the end of the article, the authors hedge their bets and admit this very fact.

The bottom line is that the authors and reporters are reading entirely too much into the study. It’s yet another example of the post hoc ergo proctor hoc fallacy equating correlation with causation. I’ve seen this behavior frequently from the media, but I become concerned when I see authors who should know better using the same poor logic. This is a study published to justify a point of view, not advance science.

A few final thoughts:

• Teenagers lie, particularly about sex, even to researchers on the phone. I see no mention of whether this was addressed at all.
• The study only addresses a strictly heterosexual definition of sex. Going simply by the numbers, several hundred of their respondants were likely to be homosexual.
• The musical grading of “sexual vs non-sexual” and “degrading vs non-degrading” is entirely subjective.
• The researchers only asked about an extremely limited number of performers (16).
• Many of the p values (the measure of the likelihood that the results were obtained purely by chance and not by correlation) are too high to be making such strong pronouncements. Strangley, no r values (the measure of correlation) are listed.
• Personally, I’m always suspicious of reports that come out of “think tanks” (though at least this one was published in a peer-reviewed journal).

Tonight’s repeat of House skips ahead to the 18th episode of season two, “Sleeping Dogs Lie“. It’s a good episode with the medicine earning a solid B. The best part is the sheer unethical-ness of the characters, and for once I’m not talking about House himself. This is also when the House writers really started coming into their own with the double- and triple-meanings of the titles. Off the top of my head, I can think of at least three interpretations of the title that are apropos to tonight’s episode.

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Feeling slighted because Fox is only showing one episode of House tonight? Then I suggest you check out Grand Rounds, the weekly collection of the best medical writing in the blog side of the net. Hosted this week south of the border at Mexico Medical Student.

Tags: television medicine house grand rounds.

I can’t decide if Bruce Wayne’s doctor is being very naïve…or extremely shrewd.

From Detective Comics #29 (July 1939). Script by Gardner Fox, art attributed to Bob Kane.

Tags: comics batman bruce wayne family doctor

Occasionally I will accidentally mark a post as “private” rather than public, so that it lingers in my archives but never sees the light of day. Recently while adding a new Wordpress plugin, I stumbled across three such articles mistakenly hidden away. Take a look at these posts that were supposed to have been published in August ‘05 and June ‘06:

• Outsiders #26: A Medical Review — Part of the “Human Bomb” storyline that reintroduced Katana.
• Look on My Works, Ye Mighty, And Despair — From Captain Atom #46: a literary alien
• Spider-Man and Power Pack Revisited — Always wanted to see the infamous page of Skip Wescott and Peter Parker? Now’s your chance.

The first exercise makes sense: it’s just weight lifting using furniture instead of gym weights. The second one seems a little suspicious to me. Isometrics really don’t work all that well, and that wagging the wrist is more likely to sprain a ligament rather than grant a “crushing hand-grip.” As for that last one, what exactly does “unusual vision” mean? All I can tell is the vision exercises seem to make you lose hair and go bald.

Tags: comics medicine action comics super powers

Can you match the band with the comic book it appeared in?

BANDS: 1. Ape Sex 2. The Boojums 3. Brick Springhorn and the Tenth Avenue Band 4. Dingo Baby Leclerc 5. Hypno Hustler & the Mercy Killers 6. The Maniaks 7. Mucous Membrane 8. Pale Horse 9. Sidekix 10. Ultimate Spinach Revival

COMICS: A. Anima B. Hellblazer C. Love and Rockets D. Peter Parker, the Spectacular Spider-Man E. Sonic Disruptors F. Superman’s Pal, Jimmy Olsen G. Top 10 H. The Transformers I. Transmetropolitan J. Watchmen

 

Answers: 1-C, 2-A, 3-H, 4-I, 5-D, 6-F, 7-B, 8-J, 9-G, 10-E

Tags: comics music quiz

Tags: comics robin batman

Continuing the medical annotation of Naoki Urasawa’s Monster. This time, I’ll take a look at the first half of the recently released Volume 3, chapters one through four.

Nothing medical happens in the first chapter, so the annotation begins with:

Chapter Two
Tenma is taken to treat a terrorist injured in a gunfight with the police. He realizes that the man was shot through his axillary artery and is bleeding to death.

The axillary artery is an important artery. It starts off as the subclavian artery, coming off the aorta. As it dives under the shoulder it is known as the axillary artery. It then becomes the brachial artery (the main artery of the arm) as it leaves the shoulder. It’s a large enough artery that an injury to it could lead to death from blood loss, and fairly quickly.

Tenma apparently* stops the arterial bleeding with direct pressure, a valid approach, but he succeeds conveniently quickly. Next he announces that he needs to close the injury to the skin which he proceeds to due with a handy stapler. This makes little sense. I have no problem with the use of the stapler — it’s nearby and it works — I’m just not clear on why he closed the wound in the first place. Tenma knows the patient will require a surgical repair of the artery, so the doctors will just have to open the wound up again. The closed skin may provide a little pressure which will help keep the artery from bleeding, but a simple pressure dressing would do the job much better.

After closing the wound, Tenma places the injured arm in a sling, picks the man up fairly roughly (especially considering he is nearly dead already) and moves him outside for the police to find.

Read more…

It’s time once more to take a look back at some of the classic medical comic books of the 1950s and ’60s. For the third year going, it’s time for Flashback Week!

After the infamy of the 1950s Senate hearings on the comic book industry, EC abdandoned their traditional horror and true crime stories for a new public-friendly approach. One of EC’s new comics was M.D., a comic about doctors, told in the delicate art and typographic fonts common to classic EC comics.

M.D. #4 was published in October/November 1955 and contains four short comic stories, a one page text piece, and a letters page. The cover by Johnny Craig shows physicians resuscitating a drowning victim. Note the old-style approach to artificial respiration, with the patient laying face down and the doctor’s weight on the back of the patient’s chest and abdomen. This was the standard approach until mouth-to-mouth respiration was developed.

The first story, “So That Others May Walk”, concerns polio. Thanks to immunizations, polio is thing of the past in the developed parts of the world and we’ve forgotten how devastating this disease truly is. I think a copy of this story should be provided to everyone who questions the need for vaccinations.

Danny Hoyt has contracted polio and has been placed in an iron lung. His mother Francis is concerned that the doctor is treating her son as a number, and not a real person. Dr. Wolack tells her the story of Jimmy, a young boy who contracted polio just like Danny. Jimmy had to learn to breathe on his own again and then had to learn to walk. It was slow going, but Jimmy persevered. Even though he walks with a limp, he still made it a point to play sports. He studied hard and made it through high school as the valedictorian. He went on the college and then medical school. That’s right: in that hopeful twist that occurs in many medical stories, the boy Jimmy grew up to become Dr. Wolack, the physician treating Danny. Reassured, Danny’s mother thanks him and goes to spend time with her son.

Next is a one page text piece about Dr. William Harvey, the doctor who discovered the circulation of the blood. He was ostracized and considered a heretic for his views. He was even placed on trial. Charles the First remembered Dr. Harvey though, and when a French countess was bitten by a poisonous snake, he sent for him to treat her. Click here for the full fascinating tale.

The second story, “New Outlook”, tells the story of Marian, a college student who suffers extensive facial injuries in a car accident. She is horrified by her appearance, and locks herself away from her family and boyfriend. The plastic surgeons calmly work with her, and after more than a year and multiple surgeries, she regains her beautiful countenance and says yes when her boyfriend offers her his fraternity pin.

The third story, “Point of View”, is fairly disturbing. Donald Archer wakens in the hospital after a terrible car accident (yes, another one). He demands to know what happened to his daughter and wife. The doctor tells him that his daughter is fine, but that his wife has died from her injuries. The doctor then asks for permission to transplant his wife’s corneas into a blind patient. Donald refuses and orders the doctor out of his room for even suggesting such a thing. The doctor doesn’t give up and keeps talking to Donald about the need for the corneas but Donald remains adamant and refuses to give his permission. Finally, the doctor brings in an ophthalmologist who manages to talk Donald into donating his wife’s corneas. At the end of the story, when Donald finally gets the chance to visit his daughter, he discovers that she was the blind patient. The doctors needed his wife’s corneas to repair the eye damage his daughter suffered in the accident — though you think it would have gone smoother if they told him who the blind patient was from the beginning.

“Worried Sick”, the final story, is an unusually downbeat story — in an O. Henry kind of way — for this comic. The story concerns a man with a stress induced ulcer. He is an up and coming grocer, but that’s not enough for his wife. She keeps pushing him to expand his business, and he does — time and time again — until he is the top grocer in the city. He doesn’t see any money though, because his wife keeps spending it. He sees the doctor about some stomach pain he’s been having, and the doctor informs him that his has an ulcer and puts him on a special diet. The grocer explains things to his wife, and she promises to cut her spending, but she keeps throwing expensive parties and he ends up requiring surgery for a perforated ulcer. This time, the doctor speaks to the wife himself and explains how the stress from her spending is causing her husband’s ulcer. She promises to restrain her spending. All seems well until her husband returns home from the hospital and finds his wife and thrown him a get well party – and told the caterer to bring the best food money can buy. The look on her poor husband’s face is priceless.

Like previous issues, M.D. #4 contains interesting glimpses of state of the art medicine from a half-century ago. It also contains some not-so-subtle sexism, but I’m afraid that’s standard issue for most of these classic medical comics.

Tags: comics medicine m.d. polio iron lung ulcer william harvey

Keeping with the theme of Flashback Week, here is a PSA from the inside back cover of Dr. Kildare #5 (March - May 1963) encouraging eveyone to get regular physical check-ups. (Click on the image for the full PSA.)

It’s an interesting PSA for a number of reasons. First, the technology. Apparently in-office fluoroscopy (x-ray) was recommended for a regular physical, exposing the patient (and the doctor, if you look at the picture) to unnecessary radiation. While there isn’t that much radiation in an x-ray, the amount does add up and you try to avoid them except when absolutely necessary. Also the odds of finding anything abnormal in a random x-ray of a healthy patient is quite low, and anything you find is likely to be a false positive (requiring more tests and x-rays).

The “cardiogram” seems to only have a single lead. This would be fine for looking at the heart rhythm, and it may detect heart damage if it’s in the right place, but it won’t tell you much more. Today’s 12-lead EKGs give a vastly superior idea of what’s going on in the heart and allows us to better localize damage or injury to the heart.

Second, despite this PSA’s insistence that everyone needs regular physicals, there’s heated debate today about how necessary routine physicals actually are. There’s conflicting views: on one hand, physicals aren’t very cost effective. On the other hand, preventative medicine is being stressed more, and it’s hard to perform good preventative medicine without a periodic medical examination. My opinion falls somewhere in the middle of the two camps.

Finally, I can’t help but notice the second to last line: “Everyone, husband, wife or child, has a moral obligation to stay in good physical condition.” Sure, it would make my job so much easier (and the nation’s health care expenditures so much lower) if everyone did feel an obligation to stay in good condition, but the statement strikes me as a little fascist. Plus it smacks of Mary Baker Eddy — are those who get sick somehow less moral?

Click on the image for the full PSA

Tags: comics medicine psa flashback week dr. kildare

Tonight Fox repeats both parts of the two-part episode of House where Foreman comes down with a strange disease and ends up locked and dying in an isolation ward. It’s a good episode with some strong character moments for Foreman and some great House/Cuddy interaction. I gave the episodes a strong B the first time around.
Review of Euphoria, part 1
Review of Euphoria, part 2

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Need even more good medicne after that double serving of House? Then I suggest you check out Grand Rounds, the weekly collection of the best medical writing in the blog side of the net. Hosted this week over at Hospital Impact.

Tags: television medicine house grand rounds.

For those of you too young to remember (including me), Ben Casey was television show that ran on ABC from 1961 to 1966. It starred Vince Edwards as Dr. Ben Casey, a neurosergery resident at the hospital 59 West. Dell published ten issues of a Ben Casey comic book from 1962 through 1965. Today’s topic is Ben Casey #3 from December, 1962.

Dr. Ben Casey and his co-worker Dr. Maggie Graham take their boss Dr. Zorba out to dinner for his birthday to the Periscope, an expensive seafood restaurant. Also dining at the Periscope that night is the famous actor Brent Calhoon. An obnoxious drunk spills some food on Calhoon’s wife and then picks a fight with Calhoon. It’s a vicious fight and both combatants end up down for the count. The drunk has been knocked unconscious and Calhoon has multiple facial lacerations and fractures.

Ben Casey examines the drunk and realizes that he’s in bad shape with a probable subdural hematoma. The ambulance arrives and both patients are rushed to the hospital. Casey operates on the drunk, drilling several burr holes to drain the hematomas. It’s a tough operation and the patient survives — at first, but dies from his injuries about an hour later.

Dr. Casey then goes to evaluate Calhoon. As he surmised at the restaurant, Calhoon has suffered a couple of jaw fractures, something easy for good oral surgeon to fix. When Casey informs him that the other patient died, Calhoon becomes hysterical. It takes an injection of a sedative before he finally calms down.

Outside Calhoon’s room, Casey encounters the press corps who want to know about Calhoon and the other patient. Casey starts to explain the situation, but a reporter accuses him of covering up the fact that Calhoon is guilty of murdering the other fighter. That doesn’t sit well with Casey who is ready to start a fight of his own, but luckily at just that moment he is called to Dr. Zorba’s office.

Inside the office, Dr. Casey finds the District Attorney waiting for him. The DA is ready to charge Calhoon with murder, but wants Dr. Casey’s opinion on the case as he operated on the dead man. Casey informs the DA that the operation revealed that the patient had suffered multiple head traumas over the years that had weakened his blood vessels. Thus while Calhoon may have struck the fatal blow, the previous injuries had contributed to the death as well. Furthermore, Casey points out that he recognized the patient as a local professional boxer. That means that his fists are considered lethal weapons and according to the law, Calhoon was merely acting in self defense. After his talk with Dr. Casey, the DA drops all charges against Calhoon.

Meanwhile, Calhoon has become paralyzed and is unable to walk. He is convinced that he has suffered some brain damage in the fight and he needs immediate brain surgery. He knows this because he once played a doctor on TV. Casey has a different opinion. He recognizes that Calhoon is suffering from hysterical paralysis from guilt over the death of the drunk. Casey recommends a psychiatrist, but Calhoon refuses, demanding surgery.

Eventually Dr. Casey relents and Calhoon is wheeled off to surgery. Once the patient is anesthetized and the surgery started, Casey hands the scalpel off to another doctor. A few hours later, Calhoon is wheeled back to his room for recovery. The next day, miraculously, Calhoon is no longer paralyzed and can walk again. Talking privately to Calhoon’s wife, Casey tells her that they never performed any brain surgery on her husband, they just repaired his jaw fractures. They lied to him about the brain surgery so he would think he could walk again. Casey tells Calhoon’s wife to keep this a secret, and then he, Maggie, and Dr. Zorba head off to the hospital cafeteria to finish Dr. Zorba’s birthday dinner.

This was an entertaining story with a couple of clever plot twists. The “hands are lethal weapons” was a nice way out for Calhoon, though I wonder if that’s true legally or just an urban legend. Calhoon’s hysterical paralysis added another dimension to the story though the sham operation was more than a little unethical and is likely to backfire when (and if) Calhoon realizes the truth. While not quite unethical (at least according to the 1960s), you’ll notice Dr. Casey was freely sharing a great deal more of his patients’ medical information than he should have been

In addition to the Ben Casey main story, the comic contains a four page Dr. Dan Dazzler backup story as well as a one page text story about Dr. Lester Dingwall and a pet monkey. The inside covers concern the history of medical inventions and the founding of the county’s first tissue bank. The back cover piece is about Florence Nightingale.

Tags: comics medicine ben casey flashback week

It still amazes me that EC could publish a comic book series on psychoanalysis; it just doesn’t seem like a topic that would lend itself well to the comic format. Part of EC’s “new direction” following the Senate hearing, Psychoanalysis lasted for four issues. The first issue was surprisingly good, if a little unrealistic in the way everyone had their problem solved so neatly in a single session. This second issue is not nearly as good, mainly because the writer did such a good job tying up the plot threads with the first issue, there’s not as much to go on in this issue. The plot revelations seem random and unfocused.

Freddy Carter was seeing the psychiatrist because he had been caught stealing his friend’s watch. In the first issue, we learned that he stole from his friend because he envied his friend’s loving family life and wanted some part of it for himself.

In this issue, psychoanalysis reveals that Freddy wanted to be caught. He knew that the only attention his parents ever paid to him was when he did something bad. His father would yell at him and hit him which led to his mother pampering and coddling him. We also learn that Freddy gets asthma attacks during times of stress. The doctor informs him that this is not real asthma, but instead a psychosomatic affliction to gain him sympathy from his parents. The psychiatrist tells Freddy that he needs to grow up and start acting like a fifteen year old and not a young child.

Ellen Lyman was an anxious young woman who had a recurring dream of a empty garden. The psychiatrist explained that the dream meant that she was jealous of her older sister and wished her harm. In this issue, Ellen comes to the office complaining that her life is hopeless. She knocked over the water cooler at work and her boss yelled at her. This reminded her of her father. Digging deeper, the psychiatrist discovers that her father often yelled at Ellen, and her mother routinely ignored her in favor of her older sister. During childhood, Ellen had a couple of accidents that landed her in the hospital. Much like Freddy’s psychosomatic asthma, the doctor informs Ellen that she caused these accidents herself trying to gain the attention of her parents. Furthermore, her other symptoms are due to the fact that she feels guilty because she blames herself for the fact that her parents always fought. The psychiatrist informs her that this is all nonsense, her parents simply did not love each other and it was never her fault. “Oh doctor!” says Ellen. “I feel as if a great weight has suddenly been lifted from my shoulders!”

The third patient is Mark Stone, a television writer who is having conflicts between writing for money and writing as an art. Last issue, the psychiatrist also realized that Mark’s late father’s frugal ways were also responsible for Mark’s anxiety. This issue, the psychiatrist addresses Mark’s weight”

“Ten pounds overweight is carelessness. Sixty pounds? That’s deliberate self-punishment! Why are you trying to hurt yourself?”

Next come a confusing series of revelations. Mark overeats because he loved his mother. No, he overeats because he was ashamed of her immigrant manners and ate to punish himself. Then Mark suddenly confesses that he thinks he shot a man during hunting season a few years back. The psychiatrist calmly informs him that the “man” he shot was just his memory of his dead father and he too needs to grow up and stop competing with a dead man.

Again, three more conveniently neat endings with all the (new) plot threads tied up. We’ll have to see if the third and fourth issues can refocus the meandering plots or if they scatter them even farther.

Tags: comics medicine psychoanalysis flashback week

Dr. James Kildare is one of the best known fictional physicians. He has appeared in movies, on the radio, and even in a daily comic strip. Dr. Kildare is probably best remembered as a TV show starring a young Richard Chamberlain that ran on NBC from 1961 to 1965. Much like their Ben Casey comic book, Dell also produced a Dr. Kildare comic book that ran nine issues from 1962-1965.

The Dr. Kildare comics were not quite as dark as the Ben Casey comics. There was always an easily identifiable right and wrong, and there was almost always a karmic twist in the story. Dr. Kildare #5, from March-May 1963, is an almost perfect example of this kind of story.

Dr. James Kildare has been assigned to work with the top surgeon in Blair Hospital, Dr. Leon Gillespie, for the next several weeks. In addition to working as a surgeon, Dr. Gillespie is also the hospital chief of staff. Gillespie is concerned because he has to give his annual speech to the hospital trustees later in the week. It is an especially important speech because he feels that the trustees were especially tight-fisted on the budget for the coming year and he wants some new equipment for the hospital. One of the trustees in particular, Mr. Jenkins, is very unhappy with the way Blair General Hospital is run. He feels that the hospital should be run more like a business. Drs. Kildare and Gillespie try to convince Mr. Jenkins that hospitals have different needs and serve different functions than a factory like the one he runs. They argue in vain and Mr. Jenkins cannot be convinced. He is particularly incensed that the hospital wants to buy duplicate equipment for back-up, just in case something goes wrong with what they already have. Regular maintenance should be enough, he tells them.

Across town, a young girl named Cathy is playing in her yard when she complains of chest pain and suddenly collapses. She is rushed to the hospital where Dr. Kildare examines her. By looking at the x-ray¹, he diagnoses her with a ventricular septal defect – a hole in the heart between the left and right ventricles. Her condition is severe and she will need immediate surgery². The local heart doctor is on vacation, but Dr. Gillespie has experience in these situations so he agrees to perform the surgery. There’s just one catch: the hospital’s only artificial heart lung machine is broken.

As fate would have it, Cathy is the granddaughter of the stingy hospital trustee Mr. Jenkins. With the realization that his grandchild’s life is at stake, Jenkins suddenly experiences a change of heart and realizes that Dr. Gillespie’s plan for having back-up equipment was really not a bad idea after all. Dr. Kildare is able to find a hospital with a spare heart lung machine, but it is too far away. Jenkins volunteers his corporate helicopter to retrieve the machine and the operation is back on schedule.

Dr. Gillespie pulls Dr. Kildare aside and tells him that because he will be operating on Cathy, it is up to Dr. Kildare to give his talk to the trustees and convince them that the hospital needs more money. Dr. Kildare shows up at the trustee dinner but they are insulted that they are to be lectured by such a young doctor. He sternly takes them to task for showing disrespect to Dr. Gillespie, who personally sent him to talk to them. He gives an impassioned speech and receives a standing ovation. Mr. Jenkins arrives just in time to tell all the other trustees that he agrees with all that Kildare has said. The hospital budget is increased and new equipment is ordered. Drs. Kildare and Gillespie return to Blair General Hospital to finish their rounds.

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Notes:
¹That’s a pretty impressive x-ray to show a ventricular septal defect.
²Modern VSD sugery is usually much less invasive.

Tags: comics medicine dr kildare dell flashback week

For the last subject of Flashback Week 2006, I thought I’d take a look at Ben Casey #4. It features another strongly moralistic story of the Ben Casey standard: A street thug moves into a new neighborhood and begins terrorizing the resident. He sends one young boy to the hospital with a crushed skull. The boy’s brother goes looking for revenge and ends up getting shot by the thug. In a scene almost identical to the much maligned one from Detective Comics #814, the police use the wounded patient as bait to lure the thug to the hospital. In the end it is Dr. Casey who sudues and captures the criminal in an operating room.

The reason I’m mentioning this book is the art. For starters, take a look at the thug. Look familiar? Tell me that’s not Sean Connery (with a few extra warts). And that one fight scene sure looks like Sean is taking on Elvis.

The art is clearly just phoned in on this comic. The few times the artist has to show a face that is not obviously light-boxed or cut-and-pasted (literally, this was 1963), it is horribly drawn and carries no resemblance to the appearance of the same character just the panel before.

Tags: comics medicine ben casey sean connery elvis flashback week

I mentioned last post how poor the art was on Ben Casey #4. On first reading the comic, I noticed how much the one character looked like Sean Connery. Then I noticed how I kept seeing the same heads over and over again. Take a look a Ben Casey, particularly his head in the next few panels — it’s the identical head, just tilted slightly from panel to panel…

Here’s Ben looking pensive.	Here’s Ben flirting.
Here’s Ben taking charge.	Here’s Ben whining.

What’s that you say? You want to see some action shots? Sure thing!

Ben in a knife fight.

And Ben dancing.

Tags: comics medicine ben casey flashback week

Yet another example from the mid-’90s of DC’s full page AIDS PSA starring various characters of the DC Universe. I certainly give DC credit for trying to make a difference and the information they highlight in the ads is always important, stressing knowledge and tolerance.

However, there are a several things that bother me about this ad.

For starters, like many other PSAs, we have heroes acting out of character. In this ad, it’s Gar’s turn to have an ONISGS (Oh No, I Suddenly Got Stupid) moment.

Next, what’s with the orange curtains? Who thought that was a good idea? And against purple walls no less. (Of course, the decor’s not the only thing that looks horrible here. Calling Blockade Boy: Donna desperately needs your help here. Or is that Mirage? It’s hard to tell.)

Finally, notice the mixed message of this PSA. On one hand, we are told (correctly) not to fear or shun people with AIDS, and reminded that HIV cannot be spread through casual contact. Yet where are all the patients? Sequestered in an “AIDS Ward” — kept away from other people and publicly labeled as suffering from an incurable disease that even now carries a definite public stigma.

Tags: comics medicine psa hiv aids titans nightwing donna troy changeling

Tonight Fox repeats “No Reason,” the season finale of House. It’s a strong episode with some memorable graphic scenes, even if I did feel a little cheated by the end of it the first time I saw it.

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This week marks the 100th edition of Grand Rounds, the weekly collection of the best medical blogging on the ‘net. This week it is being held over at The Examining Room of Dr. Charles. Go check it out!

Tags: television medicine house grand rounds.

Civil War: Frontline #1 “The Accused”
Paul Jenkins, writer
Steve Lieber, artist

I want to take a brief look at Civil War: Front Line #1. Not the boring main story, but the first of the backup stories — the one that deals with Robbie Baldwin, a.k.a. Speedball.

Speedball was caught in the explosion that kicked off the “Civil War” and was blown 500 miles away. He was found unconscious in a field and is now being cared for in some sort of highly secure government facility. It is unclear how much time has passed since the explosion and what precise injuries he suffered.

When we see Speedball, he is lying unconscious in a hospital bed and bruises can be seen on his chest, mouth, and eyes. His head has been shaved. There are electrodes attached to the left and right sides of his chest and abdomen. There is an IV running into the back of his left hand (most of the time) and there is a pulse oximetry monitor on his left index finger (which reads the amount of oxygen in his blood). He has a nasogastric tube in his right nostril, and there is tape over the bridge his nose.

Medically, the main concern for Speedball would be the damage he sustained from the explosion as well as from the force of his landing. His powers seemed to have protected him from most of the damage, but seem to have been burnt out in the process. If I were his physician, my main concern would be why he is unconscious and not whether or not he has lost his powers. I think it’s safe to assume that they’ve taken the necessary precautions and ruled out any spinal trauma or cerebral hemorrhages.

Speedball is in an intensive care setting, so the heart monitor and pulse oximetry make sense (though I’d recommend placing the electrodes where the heart actually is, on the left side of the chest, not evenly spaced over the entire torso). It’s always a good idea in critical care situations to have intravenous access, though Speedball seems to have a magic IV — sometimes it’s on the back of his hand, sometimes it’s in the crook of his elbow. Nasogastric tubes are generally used either to deliver food, fluids, or medicine to the stomach — or to suck out gastric contents. In this case, I suspect they’ve been feeding him through the NG tube, but it doesn’t seem to be hooked up to anything. It’s not clear why his head has been shaved — maybe surgery — or why he has tape on his nose — maybe it’s broken?

There are all sorts of other equipment around the room including surgical lights, monitors, and what appears to be an unused dialysis machine. They may have used these when he first arrived, or may have them around just in case they need them later. I have no problem with this. The middle of an emergency is the wrong time to go scrounging for the piece of equipment you need. Still, I bet if we look hard enough, I’m sure we can find the machine that goes “ping.”

Doctor #1: John! We’ve got a spike!
Doctor #2 (presumably John): What? What kind?
Doctor #1: EEG!* He’s coming to!**

I have a couple of problems with this. First, this is not how EEGs work. They can’t magically and instantaneously tell the difference between unconsciousness and alertness. They show differences in voltages across the brains as a series of waveforms, and many of these waveforms can be the same for alert, asleep, and unconscious patients depending on the circumstances. Anyway, “spikes” on EEGs do not represent waking up, but instead signify epileptiform behaviour — in other words, seizures.

Finally, I’d have a lot more faith in this doctor’s interpretation of EEG reading if Speedball actually had any EEG electrodes on…

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*I could be reading this wrong. The doctor in question might not be saying “E.E.G.,” but may instead have made the exclamation “Eeg!” – just as others might say “Arrgh!” “Jeepers!” or “Hoboken!” The lettering is not clear.

**Boy, that’s some of the most awkward dialogue I’ve seen in a while. Try reading it out loud, emphasizing the words the way the author did.

Tags: comics medicine civil war front line speedball eeg paul jenkins steve leiber

Like many pieces of legislation that were rushed through Congress, the recent Superhero Registration Act is vague in certain areas and unexpected questions have cropped up. Luckily the government was able to provide this handy guide to common Registration Act questions:

Q: I used to be a mutant but I recently lost my powers. Do I still have to register?
A: No, you do not need to register, but you do need to fill out form 341-T “Declaration of Cessation of Urban Vigilante Activity”. Fill out the personal information, mark the appropriate box for the reason behind your loss of powers, and drop it off at the nearest FBI or SHIELD office. Farm-based hereos will need to fill out form 341-W, which applies to rural activities.

Q: I have to wear a respirator at work and it covers up most of my face — does this mean I have to register as a masked hero?
A: If your gear obscures your identity, then that qualifies as a mask and you are required to register for the Act. As a rule of thumb, if you have to wear a name tag or have your name stenciled anywhere on you clothes, then you need to register. This means that the following professions are required to register by the Act:
• Firemen
• Scuba divers
• Surgeons
• Dentists and Dental Hygienists
• Painters
• Clowns
• Emo kids with hair over their eyes (The United States v. Death Cab for Cutie)
• Rock singers wearing makeup (The United States v. Simmons, Stanley, Criss, Frehley, et.al)

Q: I work as a professional wrestler and wear a mask, do I need to register?
A: If your role is as a heroic or good-aligned wrestler, then yes, you are expected to register. If you play an evil or villanous wrestler, then you are exempt from registration because due to an inadvertant oversight, the Act as written only applies to heroes. If you foresee your role changing, it would be best to go ahead and register now.

Q: Since I’ve registered, can I now declare my costume and other super hero expenditures as work-related expenses on my tax forms?
A: Yes. You can also declare super-hero based medical care as well, and don’t neglect to deduct for mileage and depreciation on vehicles.

Q: I’ve heard that the divorce rate is higher for super-heroes who register.
A: Nothing could be farther from the truth! In actuality, our very scientific studies have shown that a full 78% of indivduals report improved satisfaction with their marriage after registering*.

Q: What about Halloween? Will the Registration Act affect the wearing of costumes and trick-or-treating?
A: Halloween and all pumpkin-related festivities are now illegal under Section II of the Superhero Registration Act. For reasons not entirely clear, Arbor Day has also been outlawed.

Q: My super powers are granted directly by my deity. Isn’t registering as a superhero with the Federal Government overnment a violation of the Establishement Clause?
Q: I’m the Norse God of Thunder. I thinketh that registering with the government dost be a violation of my First Amendment rights to Freedom of Religion.
A: Under the direction of the President, the Department of Justice has determined that the rights “guaranteed” by the Constitution and subsequent amendments do not necessarily apply to super-powered individuals. The only people who would disagree this decision are clearly communists and/or terrorist sympathizers. You’re not a terrorist sympathizer, are you?

Q: As a foreign operative and/or alien and/or time-displaced individual and/or artifical lifeform**, am I still required to register for the Act?
A: Yes you are. Any super-powered or masked individual who operates on American Soil — including outlying territories, helicarriers, and assorted secret moon bases — are required to register with the Federal Government.
In addition to the standard registration