Mark Leyner - Why Do Men Have Nipples? Hundreds of Questions You'd Only Ask a Doctor After Your Third Martini

The amnesia that doctors see is very different than the big-screen version.

Amnesia is best defined as a failure to retrieve information or to place information in an appropriate context. Amnesia rarely erases memory of all past events. No one suffering from amnesia actually goes through the rest of his or her life without an identity or any knowledge of the past. Memory loss is usually temporary and only involves a short time span of the person’s life.

Types of Amnesia

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anterograde amnesia:

Inability to remember ongoing events after the incidence of trauma or the onset of the disease that caused the amnesia. Anterograde amnesia often occurs following an acute event such as a trauma, a heart attack, oxygen deprivation, or an epileptic attack.

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retrograde amnesia:

Inability to remember events that occurred before the incidence of trauma or the onset of the disease that caused the amnesia. Retrograde amnesia is often associated with neurodegenerative pathologies such as senile dementia and Alzheimer’s disease.

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emotional/hysterical amnesia (fugue amnesia):

Memory loss caused by psychological trauma such as a car crash or sexual abuse. Usually it’s a temporary condition.

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lacunar amnesia:

Inability to remember a specific event.

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Korsakoff syndrome:

Memory loss caused by chronic alcoholism.

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posthypnotic amnesia:

Memory loss sustained from hypnosis. Can include inability to recall events that occurred during hypnosis or information stored in long-term memory.

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transient global amnesia:

Spontaneous memory loss that can last from minutes to several hours and is usually seen in middle-aged to elderly people.

Here are some movies that Hollywood executives would like to forget: Gigli, Ishtar, Howard the Duck, The Postman, and The Adventures of Pluto Nash .

“No, you don’t gotta fucking stab her three times! You gotta stab her once, but it’s gotta be hard enough to break through her breastbone into her heart, and then once you do that, you press down on the plunger.”

— Lance (Eric Stoltz), Pulp Fiction

No, intracardiac injection is not recommended for routine use during CPR. Translation: ER docs don’t ever inject anything directly into people’s hearts. There is an uncommon procedure called a pericardiocentesis when a needle is inserted under the breastbone and into the sac around the heart to remove excess fluid. This is done when fluid or blood surrounding the heart is restricting its function. This is only done in serious emergencies.

In Pulp Fiction, John Travolta and Samuel L. Jackson are trying to save Uma Thurman from a drug overdose by injecting her with adrenaline. Instead, they should have given her an injection of a medication called Narcan to reverse the effect of the heroin. Adrenaline (epinephrine) is often given during cardiac arrest but only through a vein. Sorry, not as dramatic but definitely less painful.

In the movies and in the dictionary, “shock” can mean to strike with great surprise and emotional disturbance. In medicine, “shock” is a major medical emergency. When doctors talk about shock we are referring to the failure of the circulatory system to maintain adequate blood flow. This requires rapid treatment, otherwise it can lead to death.

There are a number of different causes of medical shock, including bleeding (hypovolemic shock), inability of the heart to pump enough blood (cardiogenic shock), severe infection (septic shock), and life-threatening allergic reactions (anaphylactic shock). People suffering from shock have low blood pressure, difficulty breathing, a weak rapid pulse, cold and clammy skin, decreased urination, and confusion.

So, the shock that we so often see on-screen should be more appropriately called freaked out.

If real life were a soap opera, then the answer to this question would always be yes. Unfortunately, coma is a very serious problem and although people do wake up, the longer they remain in this state, the less likely they are to return to consciousness. This is a very delicate question because doctors can’t really predict which patients will wake up and which will not.

If you look carefully in the original movie Coma, you will see Tom Selleck, that’s right, Magnum, P.I., in a state of suspended animation. Recent movies like While You Were Sleeping, Kill Bill, and Talk to Her also used coma in their stories. The medical story of coma isn’t as glamorous as Hollywood portrays.

To begin, there are several different categories of coma, or disorder of consciousness. Consciousness can generally be divided into two main components, arousal and awareness. Coma is defined as a state of unresponsiveness from which an individual has not yet been aroused. Patients in a coma are neither awake nor aware of their surroundings. On average, coma doesn’t usually last very long. After several weeks, most patients either regain some level of consciousness and if not are classified as being in a persistent vegetative state. Persistent vegetative state is characterized by complete lack of awareness of self or one’s environment. These patients can appear awake and even have their eyes open but are totally unaware of their surroundings.

Another category of consciousness is the minimally conscious state, an intermediate stage of consciousness, which indicates that a patient is somewhere in between a persistent vegetative state and normal consciousness. These patients can show intermittent signs of awareness.

The “locked-in” syndrome is a rare condition that must be distinguished from disorders of consciousness. It is characterized by complete paralysis of the voluntary muscles in all parts of the body except for those that control eye movement. These patients can think and reason but are unable to speak or move.

It certainly would be dramatic if we had our gunshot trauma patients take a swig of whiskey and bite on their belt as we removed the bullet with a knife that had been sterilized by heating over a fire. I also would love to ride a white horse to work every day but that doesn’t happen either.

In old Westerns, there is an urgency involved with removing a bullet, as if this is the life-saving maneuver. In reality, doctors are not concerned with the presence of the bullet but rather the damage that it does on its way in or out. We often see patients who get an X ray for another reason only to find a bullet from a previous injury.

There are some special situations when we worry about leaving a bullet in a person’s body. When bullets or fragments are near large blood vessels, nerves (especially the spinal cord), or in a joint, then they can migrate and cause damage. In these cases, bullets are usually removed.

People have also asked whether or not you can get lead poisoning from bullets that are left in the body. In general, lead fragments in soft tissue become surrounded by fibrous tissue and are therefore essentially inert. If a bullet is in a joint, there can be a problem with lead poisoning. A study in Los Angeles in 2002 looked at more than four hundred patients who had bullets retained in their bodies. They found increased levels of lead in a small percentage of patients. Bullets or shotgun pellets are 50 to 100 percent lead and people are more likely to have problems with lead poisoning if there are multiple bullets or multiple fragments in the body. Sorry to disappoint you spaghetti Western aficionados, but the old whiskey-and-leather routine is just for show.