Polite Dissent

This transfusion comes from a Zatara story published in Action Comics #17 (October, 1939). For those unfamiliar with the character, Zatara was a magician who found himself involved in a variety of adventures. He had quite the sense of style, and was never without his top hat, even in the most extreme situations. He is the father of Zatanna, a former member of the Justice League, who shares his powers, if not his sense of style.

While on a boat to Europe for his annual vacation, Zatara encounters two old friends of his: Beth Jordan and her husband John. A short time later, strange characters try to grab Beth, but Zatara saves her. A few days after that, at dinner in a Paris café, another attempt is made — but once again Zatara saves the day (in this case by turning the assailant into a statue — which Zatara then uses to decorate his apartment. I told you Zatara had style.). The third time, the enemies have wised up and several of them jump and hogtie Zatara while other kidnap Beth and her husband.

The mysterious assailants load Beth and John on a boat for Africa. Remember the part where I said the bad guys had wised up? It seems I spoke too soon, as the villains also load Zatara on the same boat. Zatara decides not to escape, but to play along and see who is behind the kidnapping. Once the boat arrives in Africa, the trio are loaded on a plane and flown deep into the heart of the continent — to the fabled lost city of Ophir.

The Jordans are dragged before the ancient Queen Setapa, ruler of Ophir, who reveals her secret: she is an ancient sorceress originally from Atlantis who had been kept young through magic elixirs. But now her blood is so old the potions no longer work. She has decided that she needs new blood, and has kidnapped Beth Jordan because “the blood of the ancient race” runs in her veins.

John is chained in the dungeon and Zatara hoisted over a giant fire while Beth is hustled off to an operating room where her blood is transfused into the Queen. As predicted, the transfusion restores Setapa’s youth, but Beth is left a shrunken old woman.

Zatara escapes the Queen’s death trap, regains his top hat, and rescues John. Together they rescue Beth. Zatara then confronts Setapa in a magic duel. In the end, Zatara’s magic proves stronger: Beth’s youth is restored and the Queen once again becomes old and wizened. She vows revenge, but Zatara just blows it off as he and the Jordans leave Ophir.

A couple of thoughts on the transfusion seen in this story:

• Not only does the transfusion restore her youth, but it seems to change Setapa’s ethnicity as well. I think I’ll leave that for others to explain.
• Was the transfusion just of Beth’s blood into Setapa, or was Setapa’s blood also transfused into Beth? I think it must be the latter, for how else can you explain Beth’s mysterious aging? If just loss of her own blood caused Beth to age, I’d hate to be there when she accidentally cut her finger — or every 28 days for that matter.

Other Comic Book Transfusions

I may pick on modern comics for bad examples of medicine, but comics of the so-called Bronze Age were just as bad, if not worse. Just take a look at this penultimate panel from the operating room scene in Werewolf by Night #32 (August 1975)*:

What’s wrong with this scene?

(To set it up: During surgery to repair wounds inflicted by “a wild animal,” the patient’s heart has stopped and the doctor has the team wheel out the defibrillator, or as they call it: the Cardiovascular Shock Unit.)

Ignoring the “shocking-a-flatline” error, I count three fairly significant mistakes (OK, one’s more of a nitpick).

And the “not-wearing-eye-protection” was normal at this time as OSHA would not make protective eye protection mandatory for several more years.

*Fair game for my criticism because it was reprinted in a recent issue of Moon Knight.

Previous picture quizzes

Secret Invasion: X-Men #1, script by Mike Carey, pencils by Cary Nord

If Emma Frost (aka The White Queen) isn’t the most psychic nosebleed prone character, she’s definitely in the top three (I’d put Max Lord and Nate Grey — in his various incarnations — as the other top bleeders).

All previous Psychic Nosebleed Zen posts

Tags: comics medicine nosebleed x-men secret invasion emma frost white queen

Action Comics #719 “Hazard’s Choice”
David Michelinie, writer
Kieron Dwyer, penciler

This is a Superman comic from 1996 that I recently picked up in the quarter bin. It posits an interesting moral dilemma, but the more I thought about it, the more the contrived logic of the story annoyed me.

Lois is dusting her apartment and collapses after touching a Joker doll she has on her shelf. She is rushed to the hospital where the doctor tells Superman that Lois has been poisoned and only has 2 hours to live.

Superman flies off the Gotham and meets up with the Batman. The pair follows some blind leads but eventually end up confronting the Joker at Arkham Asylum. He presents Superman with a syringe full of the same poison that is killing Lois. The Joker tells the duo that if he is injected with the poison, his “chemically altered blood” will produce antibodies which can be used to save Lois. The catch is that the poison will kill him. Will Superman take a life to save Lois?

In the end, Superman realizes that he cannot take a life — even the Joker’s — and flies off to Metropolis to be with Lois. Of course, it turns out that it’s all a moot point. Lois miraculously recovers at the 2 hour mark. It seems the Joker’s toxin was never designed to be fatal and it was all a ploy by the Joker to trick Superman into taking a life. Superman is ecstatic that Lois survived, but she doesn’t seem particularly thrilled at his choice of the Joker’s life over hers.

Detective Comics #848 “Heart of Hush”
Paul Dini, writer
Dustin Nguyen, penciller

There are lots of spoilers here, so don’t read past the warning sign unless you’ve already read Detective Comics #848, don’t plan on reading it, or promise not to whine about the plot being spoiled.

The key portion of the plot, in Haiku:

First of all, let me state what is hopefully obvious. This is no way resembles realistic medicine. It is what can be best described as “classic comic book medicine” — the same kind of medical science that attaches a man’s head to a gorilla’s body or turns someone into a man/bat hybrid. That’s not to say it’s bad, per se, just horribly inaccurate.

Without knowing where Dini is going with this, it’s hard to speculate precisely what’s happened to Catwoman (Selina Kyle), so I’ll make some educated guesses (and probably some less educated guesses as well).

There’s so much to address in this issue, I’ll just hit the highlights. If there’s anything I gloss over or miss, just mention it in the comments and I’ll address it.

Let’s start by looking at the final scene, with Selina attached to every (steampunk looking) machine in the hospital, including — presumably — the machine that goes ping, after her heart has been removed by the villain Hush.

Selina’s heart is missing, so she’s hooked up to either some sort of artificial heart or heart-lung bypass machine. Given the art, it’s hard to tell which. Selina has tubes bringing blood to and from the heart, and we can see blood in the various pumps, so that suggests a heart-lung machine. But on the other hand, why all the wires — especially that huge 220V cable — leading into the chest cavity unless there’s something in there requiring electrical power (and even so, that’s a hell of a lot of wires). I suspect the artist thinks that a heart-lung machine actually involves an artificial heart placed in the chest and doesn’t realize that all the pumping is performed externally.

How did Selina get hooked up to this monstrosity of a machine? According to Oracle, she was dropped off anonymously at Gotham General in an abandoned ambulance. Was she hooked up to any machines then, or just propped up — her heart missing? All that equipment couldn’t possibly fit in the back of an ambulance, so much — if not all of it — had to have been attached once she arrived at the hospital. Is this really the best equipment the hospital has? And why are a keg, a muffler, and R2-D2 (the same one from Werewolf by Night, apparently) as part of the machine?

Finally, a few thoughts on the de-heartification surgery scene earlier in the issue:

• Removing a heart — presuming one wants to put it, or another one, back — is an operation that takes more than one surgeon, even if they are the Best Neurosurgeon in the World* (and this is cardiothoracic surgery, not brain surgery).
• It’s nice of Hush to wear surgical gloves and a mask over his bandages (though he’s still missing eye protection and has too much exposed skin for him to be considered in surgical garb).
• Speaking of skin exposure, if Selina is “prepped and ready” for heart surgery, why is her gown still on?

*The phrase “The Best Neurosurgeon in the World” is ™ and © Polite Dissent.

House season five starts next Tuesday, so it’s time to begin this year’s House challenge.

It’s free, it’s fun, it’s easy. Here’s how to play:

Make a list of ten conditions or diseases you think will show up on House. Be as specific as possible: no categories (like “cancer” or “autoimmune disease”), and no overly broad descriptions (“liver failure” or “cardiac arrest”, for instance). The list you make will last the remainder of the season — no addition, subtractions, or swaps. Put your list in the comments section.

Each week, your list will be compared against the show. Scoring is as follows:

1 point for a brief mention or one-liner.
3 points if the team actually tests for the condition.
3 points if your diagnosis is featured in a clinic scene.
5 points if the team treats the condition (or supposed condition).
12 points if it’s actually the correct final answer (or one of the answers) of the episode.
Please note: If your diagnosis is close, but not specific enough (for example “meningitis” when the team tests for “viral meningitis”) you will earn 1/3 the points.

Scores will be collated each week and a running total will be kept. Scores will be posted late night the day of the show, or by noon the next day. After the final episode of the season, a winner will be crowned!

To play the full season, your list must be posted by 7pm (Central time) Tuesday, September 16th. Later entries are accepted, and will start accruing points the following week.

Here are last year’s final scores.

I’ve had several people ask me what I thought of FOX’s new show Fringe.
I liked it. It was an enjoyable action procedure with some potentially interesting characters. The science was questionable — fringe at best, pseudoscience at worst — but that’s pretty much as advertised.
I’ll certainly keep watching for few more weeks, at least long enough to see if they give Pacey Peter Bishop any actual personality.

The Plot:FBI Agent Olivia Dunham is part of a team evaluating a fatal outbreak of an unknown disease aboard a plane bound for Logan International Airport. While following up a seemingly minor lead, Dunham and her partner/lover Agent Scott manage to stumble upon the prime suspect and his secret lab. They give chase, but the suspect triggers an explosion that knocks Dunham unconscious and exposes her partner to mysterious chemicals which affect him in a similar way to the mysterious plane contagion. Doctors are at a loss and Agent Scott is placed in a medically induced coma.

Searching the internet for answers, Dunham discovers the work of a Dr. Walter Bishop, a schizotypal genius scientist who has been confined to an insane asylum for the past 17 years. She tricks his equally genius (but much more sociable) son Peter into helping her get Dr Bishop released from the asylum and working to find a cure for Agent Scott. Through a combination of legwork, questionable science, and chutzpah the team succeeds and is able to cure Agent Scott — but even more questions are uncovered.

Thoughts, good and bad, about the science/medicine:

1. The Contagion
The writers are quite vague — intentionally, I’m sure — about the nature of the “contagion” aboard the plane. It is strongly suggested that it is an infectious agent. If so, that was an incredibly fast spread of the disease. From one person infected to an entire planeload in just a handful of minutes. So the agent not only has to infect and affect a person in mere minutes, but is able to get far enough along in it’s life cycle to allow that person to become virulently contagious in the same period of time. That’s unnaturally — and I’d wager impossibly — fast.
Later, it’s suggested by Dr Bishop that it may be a “leprotic contagion.” (i.e. leprosy based). I guess (shrug). Leprosy really looks nothing like that, is a very slow infection, and is not particularly contagious.

2. The Cow
Why use a cow as a test subject? Peter Bishop says, “genetically, humans and cows are only separated by a couple lines of DNA.” That’s certainly true, but following that logic, why not choose something with even an closer DNA match to humans, like primates (monkeys and apes)? In fact, cows are rarely used for medical testing. Monkeys are used frequently, but so are mice and rats, which have an immune system and pharmacokinetics surprisingly similar to humans.
Not to mention you’ll need more than one test subject.

3. Synaptic Transfer
The whole concept of Synaptic Transfer is just plain silly. Brains do have an electrical field, but different parts of the brain have different electrical patterns – that’s why an EEG has more than one lead. Synchronizing the overall electrical pattern of two brains will not allow them to communicate or share thoughts. Medically, I’d be worried that the person who was having their brain waves “adjusted” to match the other person’s would suffer as seizure, as that’s what unwanted electrical activity in the brain tends to cause.

4. Drugs
Doctor Bishop wants to give Ketamine, Neurontin, and LSD to Dunham before placing her in the sensory deprivation tank. His choice of drugs makes a fair amount of sense.
Ketamine is a dissociative anesthetic — it makes a user feel as if they are outside their own body. It is used primarily as a veterinary anesthetic, but is also infamous as a date rape drug.
Neurontin (gabapentin) is a drug that was originally developed as a medication to prevent seizures in epileptics. It has also proven to be useful for treating neuropathic (nerve) pain and chronic pain. Of note, it is a relatively recent drug and had not yet received FDA approval when Dr Bishop last conducted his experiments — though it had been known for some years before that.
LSD (Lysergic acid diethylamide) is a fairly well-known and infamous psychedelic hallucinogen.

5. Stored Blood
Color me skeptical that FBI agents keep blood stored in case they are wounded in the line of duty. Stored blood has a limited shelf life, so they’d have to keep donating more every few months. They would also need to donate multiple units of blood because serious injuries take more than just a single unit.

6. Technobabble
“The active toxin was a magnesium based ethylene glycol…with an organophosphate trig-”
“Calcium gluconate in a thiamine base”

Kids dropping out of high school must have been a big problem in the 1950s and 60s (or at least DC Comics editorial thought it was a big problem — at least among their readers) because there were multiple public service ads on the topic. Today, we add one more to the list with this PSA from November 1960: Keep Learning — the Key to Success.

This PSA was written by Jack Schiff with art by Bernard Baily. It could be found in such titles as Adventure Comics #278, House of Mystery #104, Superman’s Girl Friend Lois Lane #21, Wonder Woman #118, World’s Finest #113, and Action Comics #270 (where I found this particular example).

This week, Ash, Gerrit and DrBoy all lead the pack with a score of 10. In fourth is Hugo with 8 points, and Sable Hope is in fifth with 7 points.

UPDATE:
Oops. Two problems with this week’s scoring.
1) Some entries got caught in the Akismet spam filter.
2) I overlooked some entries that had “leprosy” listed.

Problem #2 was my fault. That’s what I get for trying to add up scores too late at night. Scores have been fixed, but this problem might always happen again, so if you think I miss something you had right, let me know.

The corrected winner of this week was Ash, with 22 points. In second was Estella with 17 points, and third was George with 12. DrBoy and Gerrit are now in fourth with 10 points. (Sorry to break up the winning class, guys.)

Full corrected scores are available here.

The fifth season starts with an enjoyable episode with a mostly-satisfying conclusion, though the writers played a little fast with the clues tonight.

Lou, a thirty seven year old female, is admitted to House’s service for what at first appear to be psychiatric symptoms. She works as the assistant to a high profile feminist activist and travels around the world at her boss’s side. In the middle of a meeting, Lou suddenly began to hallucinate ants crawling all over her body. Other admitting symptoms convinced the team that her problem was not psychiatric; she was also found to have abdominal pain, anemia, bradycardia (an abnormally slow heart rate), and some memory loss. Various diagnoses were suggested: an infection she obtained while traveling (but she didn’t have a fever), amphetamine abuse (drug screen was negative), vitamin B12 deficiency, and an insulinoma (an insulin secreting tumor). House felt that the labs were most consistent with B12 deficiency and ordered a B12 injection for Lou.

While Thirteen was administering the shot, Lou complained of fecal incontinence, but Thirteen discovered that she had instead passed a large amount of blood. Upper and lower endoscopies were normal and no source of bleeding could be found. Her pregnancy test came back positive, but when Kuttner performed a uterine ultrasound, he was unable to find a fetus. The team now considered the diagnoses of choriocarcinoma (a tumor that secretes βHCG, the “pregnancy hormone”), immunoglobulin A deficiency, and βHCG injections (injections of the “pregnancy hormone” would give a false positive pregnancy test). House disagrees with all three possibilities and reveals that the patient has an ectopic pregnancy (a pregnancy outside of the uterus). It has implanted in the intestine, and this is causing her bleeding and other symptoms. The fetus cannot survive where it is, and is a threat to Lou’s life, so Chase has to surgically terminate the pregnancy.

Lou continues to have a slow heart rate after the surgery and also develops new neurological signs, such as constant blinking. Her heart rate continues to drop, and in fact drops so low that she slips into cardiac arrest, but the team is able to implant pacer wires and revive her. Anxiety, stroke, and Tourette’s Syndrome are suggested for her neurological symptoms, but Taub points out that they wouldn’t explain her low heart rate. Thirteen suspects multiple sclerosis, and the patient is started on interferon. There is no improvement on the treatment — in fact, she develops a fever. Thirteen now suspects Lou somehow became infected during the surgery. On reviewing the surgical tapes, the team notices a small nodule in the intestine that they think might possibly be a ganglioma (a tumor composed of ganglion cells) which might possibly have caused her symptoms. They want Chase to perform another surgery to biopsy it, but he refuses, pointing out that the patient barely survived the first surgery. Instead, they decide on a do it yourself biopsy procedure involving an endoscope, a light, and a scalpel — and no anesthesia. Ultimately, and painfully, the biopsy is obtained. Under the microscope, it shows no ganglioma, and is suggestive of amyloidosis. To treat the amyloidosis, Taub states that they need to discover what caused it, and the team considers rheumatoid arthritis, familial Mediterranean fever, and lymphoma as possible causes of the disorder. Wilson looks at the biopsy and decides that while it doesn’t necessarily look like lymphoma, it doesn’t not look like it either, and that’s good enough for Foreman to start Lou on chemotherapy. She does show improvement on the chemo, so lymphoma seems to have been the cause of her problems. But then House appears — and pointing to the previously unmentioned bruises on her legs — points out that she has diffuse lepromatous leprosy and this is what has been the cause of all her problems. Some antibiotics and Predisone, and she’ll be cured.

Major complaints are in red, minor in blue, nit-picking in green:

The team should not have missed an ectopic pregnancy, that’s a first-year medical student mistake. A positive pregnancy test, abdominal pain, and abnormal bleeding — that’s an ectopic pregnancy until proven otherwise.
You don’t start chemotherapy for lymphoma by thinking it kind of looks like it. For one thing, it helps to know what kind of lymphoma you’re going to be treating.
Not mentioning the bruises until the very end was kind of cheating, don’t you think?

Apparently the team immediately knew that Lou had secondary amyloidosis (amyloidosis caused by another condition or infection) as opposed to primary amyloidosis — which is what it’s been every other time amyloidosis been mentioned on the show.
It takes more than a single injection of B12 to correct a deficiency.
Lou may have been too unstable for general anesthesia, but there’s no reason they couldn’t have used IV sedation, local anesthesia, or at least painkillers.
Maybe when Lou spiked a fever, they should have remembered that they only ruled out travel related infection initially because she didn’t have a fever.

There’s a bit of a paradox in today’s final answer. The (ectopic) pregnancy caused her symptoms which then caused her ectopic pregnancy. According to Thirteen, the pregnancy caused Lou to develop nodular leprosy, which caused her symptoms — including the scarring of the fallopian tubes. But it was these scarred fallopian tubes which led her pregnancy to become ectopic. The tubes didn’t suddenly become scarred the instant she conceived, they must have been scarred for some time before that. But according to Thirteen, they didn’t become scarred until she became pregnant…
Kudos: the surgical team all wore eye protection this time, a definite improvement over previous episodes. Now if only they’d carry that over into the other procedures as well.

So how did I grade episode one? The medical mystery was interesting, though the writers were too stingy with the clues, so it scores a solid B. The final solution was a stretch, but clever, and also earns a B. The medicine was pretty weak, and the team overlooking the ectopic pregnancy was a big miss, so only deserves a C-. The soap opera was very good, if more melancholy than usual, and earns a B+.

A list of all prior House reviews

What will probably become my standard Fringe disclaimer: I am perfectly willing to accept “fiction” as part of my science fiction, but I do have a problem when the science [sic] violates many of the basic tenets of biology, chemistry, and physics without any explanation — not even any good technobabble. And Spoiler Warning.

I found the first episode more enjoyable — this one struck me as overly clichéd with the cold case serial killer and the all too common science fiction plots (the rapid aging, the quick pregnancy, the victim’s last vision).

The Plot: A woman is dropped off at a hospital, clearly in an advanced state of pregnancy, yet she claims she’s not pregnant. From what the viewer has seen, she apparently proceeded through nine months of pregnancy is a matter of minutes. She dies during labor and an emergency c-section is performed to save the child. The child lives for only a matter of hours, rapidly aging, and dies a withered old man.

Agent Dunham is able to tie this case into one of her older cold cases, a serial killer who removed the pituitary glands of his female victims. It also seems to tie into some of Dr. Bishop previous research, where he was trying to develop a perfect soldier — someone who aged from birth to 21 years in just three actual years. He casually mentions that stopping the accelerated aging was the problem. Bishop hypothesizes that the killer is one of these experiments, and uses the pituitary glands of his victims to stave off his rapid aging. Another victim is found, and Dr Bishop is able to use a fancy machine from Massive Dynamics to recreate some of the last visions she saw. Using these clues, Dunham and Peter Bishop are able to stop the serial killer — who dies of old age before Dunham’s eyes — and rescue his final victim

Given that Fringe is science fiction, (and thus far, not particularly original science fiction) I am willing to accept that — due to genetic manipulation — the killer rapidly ages. For the sake of argument, I will also accept that quaffing a handful of pituitary glands (of comely young women of questionable morals) every couple of years will stop this rapid aging.

But even accepting those, several items caught my eye:

1. The Pregnancy, Birth, and Child
Pregnancy is a joint relationship between mother and fetus — just because the fetal aspect has accelerated growth doesn’t mean the maternal aspect will be able to keep up. A miscarriage would seem to be the most likely outcome.
What type of c-section was that? Emergency c-sections are performed vertically along the abdomen as it’s the fastest way and scarring (and uterine rupture in subsequent pregnancies) is not an issue.
There has to be some conservation of mass. Where did the child get all the protein and other building blocks necessary to grow that fast? He would have to have been eating a tremendous amount from the minute he was born.
Funny how his entire body seemed to age — except the umbilical cord.

2. Neuromuscular blockade
Neuromuscular blocking agents paralyze skeletal muscles. Higher doses may paralyze the diaphragm and lead to respiratory paralysis and side effects are known to occur. These drugs have no effect on cranial nerves and would not in any way “freeze” the victim’s optic nerve. This woman has been dead for hours; there’s no electrical activity in those nerves left to speak of.
Apparently her eyes have no extraocular muscles.
Why the bridge? It wasn’t the last thing she saw — that would be the killer and his “father” — nor was it the last thing she saw when she was injected with the medication — that would be the killer.

3. Defibrillation
You don’t shock a flatline. It doesn’t work, and may make things worse.
In a situation like this: 1) stop the anesthetic — it’s short acting, that’s why it has to continually run during the procedure. 2) provide CPR until the drug wears off.

Truly one of the most bizarre comic book transfusion stories ever, this one comes from The Brave and the Bold #141, “Pay or Die!”

Two Gotham City businessmen mysteriously explode, and the Batman is quickly on the case. He determines that both businessmen had defaulted on loans from a new loan shark in town, the mysterious Mr. Longreen. Using his famed detective skills, and the help of a seamstress with poor English,Batman realizes that the reclusive Longreen is none other than his arch enemy, the Joker.

Despite his vaunted investigative skills, the Batman has no clue where the Joker’s hideout is, so he enlists Alfred, his faithful butler. Alfred puts the word out on the street that he is badly in need of a loan and soon Mr. Longreen comes calling. He brings Alfred to his lair in an abandoned funeral home and provides him with the cash he needs — Alfred will just have to repay the load whenever asked, plus interest. The two of them drink a toast of wine to their business arrangement.

Upon Alfred’s return to Wayne Manor, Batman performs an extensive physical, but can find no evidence of explosives. Things start to go sour the very next day, when the Joker calls Alfred, demanding the payment of interest on his loan. Then he calls again, demanding payment of interest on the interest.

Finally, Batman is able to deduce the full nature of the Joker’s plot: he has adulterated the wine with specially timed chemical explosives so that whoever he drinks a toast with will explode a day or two later. The Joker remains safe because he took an antidote before he drank the tainted wine.

Just as the Joker and his henchmen are chortling about the butler’s impending demise, Alfred crashes in through the window and grabs the Joker, proclaiming that if he explodes, he’ll take the Joker with him. But wait! It’s only the Batman pretending to be Alfred, and now that he has the Joker in custody, he forces him to give Alfred a transfusion so that the antidote will protect Alfred as well. No more loans, no more explosions, and the Joker is off to Arkham (and as far as I know, Alfred never repaid the money, so he still has $50,000 of the Joker’s loot).

I know this story exists in the anything-can-happen world of Earth-B (a place where continuity — and often the laws of science –are ignored), but it seems to me there are some serious flaws in both the Joker’s and Batman’s plans:

1. How did the Joker know how to time his explosives? How did he know when — and if — his clients were going to default? The story tells us that one of the businessmen had been paying off the loan for six months before he finally defaulted. Did he have explosives in his blood the whole time? Or maybe he received a gift bottle of wine in the mail (except that the story states that the Joker always drank with his victim)? I’d think it was done by remote detonation if it weren’t for the Joker looking totally panicked when he sees Alfred in his lair, knowing that Alfred is going to explode in just a few minutes.

2. Transfusing the Joker’s “chemically tainted blood” into innocent Alfred seems cruel and unusual punishment for years of loyal — if at time sarcastic — service. Better hope the Joker is the same, or nearly the same, blood type as Alfred. And better hope the antidote is still in the Joker’s blood stream and still functions after the transfusion. Why not just get the Joker to reveal where the antidote is, and give that to Alfred?

Other Comic Book Transfusions

Just how much of a badass is Batman?
 
He donates blood to vampires…voluntarily.

scene from The Brave and the Bold #195

The context: Batman is hunting gangster Johnny the Gun, and Andrew Bennett (aka I…Vampire) is hunting his ex-lover turned evil vampire Mary. Their paths cross when they discover that Mary has turned Johnny the Gun into a vampire gangster. A fight ensues, and Bennett takes the bullets meant for Batman (that, of course, just happened to be silver). Batman repays Bennett’s actions by donating enough blood to keep the vampire alive. I’d make my usual comment about blood types now, but do vampires even have blood types?

Other Comic Book Transfusions

Today’s Public Service Ad features a quiz about good behavior, so let’s see what you’ve learned from all the past PSAs I’ve featured here. (Hint: Try thinking like you were born in 1950.)

The quiz has the answers printed upside down, but if that’s too difficult for you, here they are, printed right-side up (but no peeking until you’ve taken the quiz).

Just like last week, this PSA was written by Jack Schiff with art by Bernard Baily. It was popular enough to be printed twice, first in the DC Comics of May 1960, then again five years later in May 1965. This particular PSA was scanned from Action Comics #264.

More PSAs

A low scoring week, with LA getting the week’s top score with a whole 3 points!

Overall, Ash continues to lead with 23 points. Estella is in second with 18 points. George in is in third with 12 points, and DrBoy and Gerrit tie for fourth with 11 points.

Full scores are available here.

This was not so much an episode of House as it was a parody of an episode of House — and a parody which seemed to be written by someone who’s heard about the show, but never actually seen it.

Apple, a young high school math teacher, is one of six patients who received transplanted organs from the same donor. In the past eight months, four of these patients have died suddenly and one is hovering near death — though all from different causes. Apple is the only one still alive. She is admitted to the hospital so the common cause of these deaths can be found, and in Apple’s case, prevented.

A donor infection that slipped by screening is suggested, but discarded. Autoimmune disease, vasculitis (specifically Henoch-Schönlein Purpura) and cancer are also suggested as possible diagnoses. House focuses on the cancer diagnosis. However, when he goes to talk with Apple, she starts to hallucinate.

This neurological symptom makes him wonder if the common cause of the deaths might be a neurological disease instead of cancer. One of the dead patients was a mixed martial artist, and House suspects that he was showing neurological symptoms (a temporal lobe seizure) right before he died. This would lend credence to his neurological-cause theory. A brain biopsy would give the best information, but brain biopsies are risky, so therefore House decides it would be best to biopsy Frank — the nearly dead patient. In the midst of trying to obtain consent from his wife, Frank suffers a respiratory arrest, then a cardiac arrest, and dies. A brain biopsy performed at autopsy is negative, so House goes back to his cancer diagnosis.

Kutner counters with some nonsensical suggestion that it might be an “intestinal perforation.” He postulates that normal intestinal bacteria got into the bloodstream though an abnormal blood vessel in the intestine. Then, once into the bloodstream, these bacteria would affect other organs, and this is what caused the problems in all the patients. It sounds at first as if he is suggesting a blood borne infection that slipped by screening, but if that’s the case, it wouldn’t explain the Apple since (as Thirteen pointed out earlier in the show), the corneal transplant was bloodless (and corneas have no blood vessels). Then there’s a suggestion this intestinal flaw is hereditary, and the team goes as far as giving the organ donor’s illegitimate four-year old daughter a colonoscopy (which is negative). Even if it is hereditary, how does it affect the transplant patients? Did their transplants somehow affect their intestines? This entire train of thought and how it was handled was — well — ludicrous is far too kind a word.

Apple now develops a rapid heart rate, difficulty breathing, but her colonoscopy(!) remains normal. Multiple sclerosis is suggested but then quickly discarded. House is back to thinking it’s cancer, so he starts her on chemotherapy. Apple starts to improve; her heart and lungs return to normal (as do her previously unmentioned amylase and lipase, two pancreatic enzymes). But now House is back to thinking it isn’t cancer because he has discovered that Frank was on methrotrexate, a drug that is used to treat some cancers. Since Frank died anyway, House decides it must not be cancer.

House tries to talk with Wilson so he can have one of his usual last minute epiphanies, but Wilson slams the door in his face. Commiserating afterward with the private eye he hired to spy on Wilson, he finally has his flash of insight. He decides that the organ donor had cancer stem cells. These spread out from the transplanted organs through the transplant patients’ bloodstreams and then differentiated into abnormal cells in various organs. Not cancer cells, per se, but non-functioning cells so that the affected organs became weakened and suddenly failed. He believes that Apple has these cells in her brain and wants to perform brain surgery on her. (House believes the cells are in her brain because even though she had a corneal transplant, she still thinks the world look ugly. House suspects that her eye are seeing correctly, but the brain is interpreting the results wrong.) Cuddy says no, but House is able –with the help of his new private eye assistant — to make it look as though Apple is sicker than she is and brain surgery is her only hope. The surgery is carried out, and sure enough, House is right. The abnormal brain tissue is removed and Apple is once again healthy and able to see well.

Major complaints are in red, minor in blue, nit-picking in green:

Kutner’s whole intestinal perforation theory just makes no sense (not to mention there is no actual intestinal perforation involved in it). Maybe it’s just me and I’m missing something, but the whole concept was an impossible dead end from the very beginning.

There is no “general” chemotherapy for that covers all cancers. There are many different types of cancer, and they require different types of chemotherapy. You need to know which type of cancer to select the right chemo. This is the second week in a row with this same mistake.
Speaking of chemotherapy, it shouldn’t kick in that fast, or wear off that dramatically.

You don’t shock a flatline! (In this case, Frank’s lungs had failed, and this is what led to the cardiac arrest. You won’t be able to correct the heart rhythm until you correct the underlying lung problem.)

Cancer stem cells don’t work quite the way House describes. Cancer stem cells may grow into different types of cells, but one of their hallmarks is that they form tumors, which should show up at autopsy or on a CT scan. And once again we’re back to the cornea, which is bloodless, so hematogenous spread wouldn’t get the cancer stem cells to the cornea (or from the cornea to the brain, for that matter).

Why no anesthesia for the poor kid? The “so we know when it hurts” is pure evil BS. Colonoscopies are scary and uncomfortable and the kid is 4 and her mom’s not with her, so it’s all going to hurt.

Why go straight to the tracheotomy? There was no reason not to attempt an intubation rather than go straight for the knife (and all the inherent risks) so quickly.

Methotrexate is not an “off label” arthritis drug. It is a classic and long-prescribed (and on-label) drug for autoimmune arthritides such as rheumatoid arthritis.

No eye protection during the brain surgery. And they did so well last week.

I know he didn’t get any other screen time, but since when is Chase a neurosurgeon?
And why is Taub — a plastic surgeon — doing the brain biopsy? If any of them has the necessary experience, it would be Foreman, the neurologist.

The medical mystery was very interesting and had great potential so deserves an A. The final solution was weak, and didn’t explain the main character so only gets a measly C-. The medicine, especially the “intestinal perforation”, was abysmal. I give it a D, and that may be generous. The soap opera was average, at best. There wasn’t much, and what there was focused on the new private eye character Lucas, who I alternately liked and disliked. I give the soap opera a C.

Last week’s House review
A list of all prior House reviews

This episode of Fringe, at least from the science and medicine point of view, was an improvement over the first two. Sure, it was still rubbish, but the cringe factor was less.

The Plot: A man boards a bus in Washington D.C. and makes eye contact with another passenger. When she puts the backpack she was carrying down on the ground, the man dons a gas mask and opens a capsule of mysterious gas. In the resulting confusion, he grabs the backpack and escapes the bus. After he leaves, the gas on the bus becomes a solid gel, completely filling the bus, suffocating and trapping everyone inside. Called to the scene, Dr. Bishop identifies the gel as a aerosolized silicon base that polymerized with the nitrogen in the air, and is able to recreate it in the lab.

Meanwhile, a mild mannered office worker named Roy McComb has been having Pattern-related visions for the better part of the past year. Dr. Bishop suspects that Roy is psychic. He ties it all in to an old project of his, the Ghost Network, which uses wavelengths “lying outside the range those already discovered” to transmit secret information. It turns out that Roy was one of Bishop’s experimental subjects twenty years before when he was trying to use “iridium-based organometallic compounds” to create a living receiver for the Ghost Network. Somehow, in the intervening years, those metallic compounds have multiplied and collected in Roy’s visual cortex (the part of the brain that translates visual input). Thus, when someone uses the Ghost Network, it gives him visions. Bishop wants to move the metallic compounds from the visual cortex to the auditory cortex so Roy can hear what is being said on the Network rather than see it in visions. Agent Dunham uses the information obtained through Roy’s abilities to capture (or at least attempt to capture) the people responsible for the bus attack. In the scuffle, she is able to recover the strange object they were after.

1. The Jell-O Bus
Is that small an amount of silicon gas really going to fill the entire bus up with gel? No, not even if it combines with nitrogen. Sure, nitrogen makes up 75% of the air on the bus, but those molecules are spread out because it’s in gaseous form. If they did condense into solid form, the nitrogen molecules would take up dramatically less space because solids are much more condensed than gases. Even if you throw in the amount of silicon gas in that canister, there still wouldn’t be enough mass to fill the entire bus with gel.

2. Dr. Bishop, Pharmacist
Dr. Bishop takes his own homemade concoction of dextromethorphan, Klonopin, and fluoxetine.
Dextromethrophan is synthetic narcotic used as an over the counter cough suppressant (it is the “DM” in Robitussin DM), and can be hallucinogenic at high doses.
Klonopin (clonazepam) is an anti-anxiety agent and sedative. IT is a benzodiazepine, the same class as Valium.
Fluoxetine is the generic name for Prozac, an anti-depressant/anti-anxiety medication.
None of these are psychotics (or even anti-psychotics) as Peter suggests.

3. Ghosts or Visions
For the sake of argument, let’s say the iridium compounds in Roy’s brain did react to the Ghost Network. That still doesn’t explain why his brain would interpret the signals as exact visions or the exact words. It would more likely result in random auditory or visual hallucinations, or possibly a seizure.

4. Magnets
Wouldn’t the MRI, an extremely powerful magnet, already have shifted the metallic elements out of Roy’s visual cortex.? If Dr. Bishop’s little homemade magnetic machine can, then certainly the much stronger MRI would have.

5. Cleanliness is next to Godliness
If a mad scientist ever drills in my brain, I would hope that — unlike Dr Bishop — he (or she) would at least use sterile technique.

Apparently even on the scientifically advanced planet of Krypton doctors still wear head mirrors…

Superman Annual #11 “For the Man Who Has Everything”
by Alan Moore and Dave Gibbons

A few weeks ago, I was watching Imagination Movers on the Disney Channel with my son. The movers were trying to convince Warehouse Mouse that doctors were nice, so they put on a puppet show featuring a friendly duck who was a doctor. How do we know he was a doctor? He was wearing a head mirror, of course.

And yet another generation is inculcated into the “head mirror = doctor” conceit.

Speaking of both TV shows and comic book doctors, I caught an episode of the Spectacular Spider-Man cartoon last weekend (the one with Electro as the villain). I was pleasantly surprised when the head doctor at the hospital was named Dr. Bromwell. That’s a nice bit of continuity I wasn’t expecting.

Blue Beetle #31 “Boundaries, part three: Primum Non Nocere”
Matthew Sturges, writer
Andre Coelho, penciler

After several years of reviewing comics with bad emergency room scenes, it’s a pleasant surprise to find a comic which does a good job. Plus is has Dr. Mid-Nite, one of my favorite characters.

Since Sturges doesn’t give me much to criticize¹, I’ll take few moments to translate medical-ese into English, and add some thoughts of my own.

The Scene: The gang members Blue Beetle fought last issue are rushed to the hospital, nearly dead:

Paramedic: Pressure dropping fast despite wide open fluids and epi, 70/40 now. Bradying in the 30s. Apneic respirations.

The patient’s blood pressure is dangerously low (70/40). Hypovolemic shock (shock due to low blood volume — generally because of severe bleeding) is a common cause of low blood pressure, so the paramedics have pumped the patient full of IV fluids (i.e. running the IV “wide open”). The patient has also been given epinephrine (adrenalin), a medication which can raise the blood pressure³, but it’s had no effect.

“Bradying” refers to bradycardia, an abnormally slow heart rate — in this case a pulse in the 30s. Normal heart rate is 60-100, but can vary due to such things as athletic conditioning and certain medications. Regardless, a heart rate of 30 is bad in this situation.

Apneic respirations are ragged gasping breaths that occur in between long moments of no breathing at all⁴. Generally this is a sign of things going south⁵.

The paramedic mentions that the patient’s temperature is 110°F (43.3°C). At this point, the ER doctor steps in:

Doctor: Okay. Pan-culture him. Call I.D. just to be safe. Start vanco, Zosyn, cooling blanket and get me a stat echo.

Because of the patient’s high temperature, the doctor suspects he has some sort of infection. All of his subsequent orders are based on this assumption.
“Pan-culture” basically means to run every culture available on every fluid accessible to look for an infection. This includes: aerobic and anaerobic blood cultures, urine culture, spinal fluid culture, and possibly a couple more.
I.D. refers to a specialist in Infectious Disease.
Vanco (stands for vancomycin) and Zosyn (piperacillin + tazobactam) are both powerful broad-spectrum antibiotics. Hospitals usually limit their use except in the most severe of cases, but since this patient could very well be in septic shock (shock related to an overwhelming bacterial infection), their use is appropriate here.
A cooling blanket will help to lower the patient’s temperature.
The stat echo⁶ (echocardiogram) is an ultrasound of the heart used to look for vegetations (bacterial growths) on the heart valves, a sign of bacterial endocarditis, a sneaky infection.

Notes:
1. There are a few nit-picks of course, duly noted. Plus, Dr. Mid-Nite speaks some destined-to-be-classic technobabble (tiny electromagnets! In cells!)²
2. But at least he mention ribosomes, so that’s worth a point.
3. Epinephrine is not commonly used as a pressor (a medication used to increase a patient’s blood pressure), and certainly not in the field by paramedics. It is a second- or third-line agent used to treat unstable bradycardia, and that may be the case here.
4. If the patient’s breathing is as bad as described, he should be intubated, or at the very least placed on oxygen.
5. Sleep apnea is somewhat similar (intermittent gasping breaths during long periods of not breathing), and while it is not healthy, it is not as bad as the apnea described in this scene.
6. Endocarditis usually presents as a long-term, subtle infection and doesn’t present acutely with a high temperature and shock like the patient seen here, so the echo seems overkill. On the other hand, acute bacterial endocarditis is common in intravenous drug addicts, so that may be the doctor’s reasoning here

.

Another low scoring week, with only 9 people scoring points at all, and most of those scoring a mere 1 point. This week, Kevin Lighton leads with 12 points, and Bbeth and The Erskine both earn 5.

Overall, Ash still leads with 23 points. Estella remains in second with 18 points. Kevin Lighton jumps to third with 15 points, and George drops to fourth at 12 points.

Full scores are available here.

A fairly ho hum episode of House, with far too many red herrings and not enough real medicine.

Brandon is, at best, a mildly successful artist. At the beginning of the episode, he is painting a portrait of a woman, but when the woman and her husband take a look at the finished product, they are shocked because the subject in the painting is horribly distorted. Even stranger is the fact that Brandon cannot tell that anything is wrong; the portrait looks completely normal to him.

Brandon is admitted to the hospital for evaluation of his acute onset visual agnosia. The initial differential diagnosis include stroke, brain tumor, drugs, or environmental toxins. An initial MRI was negative, but House wants an MRI with contrast. He also sends Taub and Kutner to search Brandon’s apartment for toxins. The search turns up nothing suspicious and the MRI is negative.

Toxins and drugs remain on the differential diagnosis, but a cavernous angioma of the brain (large, abnormally dilated blood vessels in the brain) has been added as well. When Brandon shows little emotion when told he requires a risky surgical biopsy, House deduces that he is hiding something. It turns out that he has had to make ends meet by enrolling in clinical trials of new drugs. He is currently a participant in three separate drug trials. House assures him that his symptoms were due to the experimental drugs, and since they should be out of his system by now, he’ll be discharged in the morning.

As usual, being discharged from Princeton Plainsboro is a sign of problems to come, and Brandon has a sudden seizure. By now, the team has discovered what drugs Brandon was being given: an anticoagulant, an autoimmune drug, and a statin (a cholesterol medication). They suspect the interaction of all three drugs is causing his symptoms and House elects to give him dialysis to clean all the drugs out of his system. It seems to work at first, but then Brandon develops massive swelling of the tissues of the head and neck occluding his airway. Foreman performs an emergency tracheotomy and Brandon is started on steroids. The differential now includes a thrombosis, Chagas disease (both of which would block the venous drainage, causing swelling), infection, or