I have a lot of admiration for Dr. Ryan McGarry and believe his film, Code Black, was the best documentary of 2014. But his suggestion in your recent article “Code Black Moves to the Small Screen” that the subsequent TV series of the same name is “unusually committed to authenticity” is a highly dubious stretch of the truth.

I work at a community hospital but am pretty sure even my cutting-edge academic colleagues have not recently “killed their patient to save them” by replacing their entire blood volume with ice-cold saline to induce metabolic hibernation. This lifesaving intervention was featured prominently early on in the show’s pilot along with an equally eyebrow-raising interaction:

When an elderly patient (Mr. Cleery) with CVA [cerebrovascular accident] symptoms and total expressive aphasia presents to the ED, the attending physician, with his junior resident, and the patient, with his family, have this exchange:

Attending: “Young squire, I heard you mention tPA. Is that what you’re thinking?”

Resident: “Yes. The symptom profile suggests MCA distribution.”

Attending: “I think so, too. Mr. and Mrs. Cleery, tPA is a kind of miracle drug that has the potential to bust the clot up and reverse the stroke…”

After a CT shows no intracranial bleed, the team moves forward with tPA…

Attending: “Come on, baby. Show us the magic. Mr. Cleery, I want you to try and speak.”

Mr. Cleery: (to wife) “I love you.”

Attending: “Yes! Abracadabra. That’s why we are here, young squire. Never forget that.”

I would love to think of myself and my colleagues as miracle workers and magicians. Obviously, the reality is not what will be portrayed in a TV prime-time series. As much as I admire that shows like Code Black feature the hard work of emergency physicians and nurses, we must remain mindful that, similar to direct-to-consumer pharmaceutical ads, these shows may lead to significant false expectations.

–Andrew Fenton, MD, FACEP
Napa, California

Dr. McGarry Responds

When Maureen Dowd’s New York Times editorial “A Stroke of Fate” irresponsibly questioned the role of the emergency physician in acute stroke management, I felt it was timely to showcase an overt clinical success in our pilot episode’s stroke case. The script is clear about tPA’s rate of efficacy versus its complication rate versus its more likely outcome of no benefit. I agree the therapy onset is ramped up for television. I agree that tPA remains a controversial treatment. More than anything, I agree that the American public should have the ultimate trust in its emergency physicians for neurologic emergencies.

The reviewer is correct in that the cold infusion technique featured is certainly not in use in community EM, but it is, in fact, real and under IRB-approved study in humans at the University of Pittsburgh School of Medicine and the Shock Trauma Center of the University of Maryland. In the show, the patient is only brought to the OR; we don’t suggest he’s had a meaningful survival.

I am frequently disappointed by physicians’ and physician organizations’ leverage of the media. It is commonly anemic and, at worst, self-serving. The real achievement of Code Black is that we constantly show our specialty as always open, always willing, and never discriminating with regard to patient financial status. What’s more, we do it at 10 p.m. on national television without a dark antihero, gratuitous sex, or violence. Not an easy sell in these times.

–Ryan McGarry, MD
New York City

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