While most of you have probably watched “The Pitt,” I was watching the reboot of another medical television show, “Scrubs,” which saw the return of Dr. John (J.D.) Dorian (now a concierge doc) and Dr. Christopher Turk (now the chief of surgery) to the small screen. “Scrubs” is by no means as weighty as its Emmy Award-winning competitor, despite the opening scene starting with a critical trauma patient in the emergency department. I still found some parallels to our current lives in medicine, much as I did when the original sitcom aired 25 years ago.

Generations Come and Go

As we prepare to welcome new PGY-1s to hospitals around the country, the team at Sacred Heart Hospital introduces us to their own new crop of interns—Blake, Sam, Asher, Dashana, and Amara. Somehow this fictional hospital still doesn’t have an emergency medicine residency, even though, in real life, residency programs seem to be cropping up all over the country.

The first episode brings back the sardonic Dr. Percival Cox, who, having endured an extensive career as an educator, and now as  the  chief of medicine  finds himself weary of the current generation of doctors who seem overly focused on work-life balance and protected by the “feelings police” from  his aggressive and sarcastic tactics.

In a touching moment (spoiler alert), Cox resigns, transitioning his duties to J.D., who returns to the hospital wards rather than languishing in the suburbs doing concierge care. In a subtle nod to the modern era of medicine, during the show’s introductory music, in the scene where they used to pop an actual physical chest X-ray up on the light board, (Who remembers those days?), the doctors now flip on a digital projection beamed from a tablet.

Even in Comedy, Burnout Is Real

Turk, now the chief of surgery, experiences the same sense of frustration that many of us might feel after decades of dealing with the same issues— patients who cannot or will not take their medications; chronic diseases that  we temporize only to return later in a decompensated state. He admits to J.D. that “there’s no joy” left in medicine.

Burnout is real, and although rates are improving overall, emergency medicine still leads the pack. I’ve got to admit, I too get frustrated after some shifts—the futility of being unable to fix everything, for everyone, especially on nights and weekends when the rest of the house of medicine is taking a well-deserved break from the hectic pace of our profession. For me, the fact that a specialty defined by variety now seems mundane after 20 years is what bothers me. So instead of the excitement of the ST-segment elevation myocardial infarction (STEMI) activation or the major trauma, I realize it’s the connections and interactions with coworkers that sustains me, not the cases we see or the diseases we thwart, or even the people we help.

Medical Mysteries Aren’t Solved in the Chart

One of the most hilarious episodes that parallels what’s either a great urban legend or perhaps the best true EMS story I’ve ever heard, involves a patient, Mr. Walton, who kept passing out every time his wife came into the hospital to visit him. Syncope is a symptom whose cause  remains mysterious  in one-third of cases. But, in this case, the answer wasn’t found after the admission to medicine through advanced testing, but instead (sorry, another spoiler) after a better history from the patient’s wife. She admitted to applying the patient’s hemorrhoid creams without telling the doctors—as a VIP patient it must be very embarrassing to talk about things down under, but mixing up hemorrhoid cream and anti-anginal paste is clearly a recipe for catastrophe.

Back to that urban legend, an EMS crew was called out once for an elderly man and woman who were unresponsive. Upon arrival they found the couple unclothed and covered in a white cream in a, let’s just say, very sensitive location—or as J.D. says to one of the other doctors, “the nether regions.”

Iatrogenic hypotension for the win.

Hospital Budgets: Education Versus Revenue

In an era during which education itself has become a product to be profiteered, it’s no surprise that when Dr. Elliot Reid (one of the hospitalists) and Turk were fighting over resources—a sim lab for the medicine residents versus a new robot for the surgical team—that the budget clash favored what improves the hospital’s bottom line.

It’s the same story for us in the emergency department too, isn’t it? Elective orthopedic or cardiac admissions get prioritized over beds for our emergency patients. And now that for-profit entities have entered the fray on residency training and physician staffing, can we expect anything else but the commoditization of resident training? As one who just learned that the faculty at his old university-based residency program have been bought out by the hospital’s publicly traded company, this is a space we all need to watch closely.

Bad News Is the Hardest Part of the Job

When Turk’s intern Dashana, a self-described “non-hugger, non-crier,” is tasked with delivering bad news to the Garcia family, she doesn’t feel comfortable. Many of us aren’t comfortable with it early in our careers. The delivery of bad news is never an easy task. I remember my first time in residency going into the family room with one of our senior faculty, Dr. Anthony Macintyre, to deliver that news, and whether it was the first time or the 1,000th, I’ve never gotten used to it.

Turk does what every good attending does; sits in the room to support his protégé while she practices this art. No matter how many patients we pronounce dead or how many times we diagnose someone with metastatic cancer, we must find ways to express empathy, support our trainees through the process, and then cope with the secondary trauma we experience from the process. Almost anyone else in any other profession might misinterpret these situations as personal failures; we simply consider it a Tuesday.

The Man Will Take Your Toaster Away

I think it’s safe to assume that every pit doc has a visceral disdain for accreditation organizations when they visit the hospital. Who hasn’t been told that we can’t have drinks in the doctors’ area? (Well, yes we can!) Or, do you feel like I do that the ridiculous detail with which we have to write for restraint orders is just a little bit over the top?

So, when there’s a cameo later in the series by J.D.’s arch nemesis, you might find it silly that his toaster gets confiscated. But as I recently discovered (or maybe rediscovered) during my hospital’s annual mandatory education, one of the biggest issues cited for hospitals by accrediting bodies deals with fires. Seriously! Who knew? But I’m curious, when was the last time you actually used a fire extinguisher in a hospital?

Laughter Is the Best Medicine

“Scrubs” isn’t a realistic show, but at times, it is the break from the reality of what we deal with during every shift. Even if there are micro-doses of true-life medicine inside, a good laugh is just what I need after a tough day at the office.

Disclaimer: The opinions expressed above are not those of the American College of Emergency Physicians.

Dr. Dark is an associate professor of emergency medicine at Baylor College of Medicine the medical editor-in-chief of ACEP Now.