MASH

I’m probably one of the few people in America who will admit to not liking MASH, one of the most popular shows in the history of television. Although it was ostensibly about a Mobile Army Surgical Hospital in the Korean War, the subtext was Viet Nam, an era in American history when we all decided to become a bunch of pussies. Just another achievement in the legacy of the baby-boomers, perhaps the most self-centered and pampered generation in American history.

All war movies and television shows rely on mythology to make a point. I prefer movies like “The Sands of Iowa Jima” and the “Green Berets” which glorify the American fighting man, not pictures like “Platoon” or “Born on the Fourth of July” which at best potray him as a vicious murderer but usually end up depicting him as a coward, a bum, or some drugged-out, crazy victim of The Man. MASH, a television show inspired by a movie of the same name, on one level was a cheap anti-war comedy that regularly trotted out all of the subjects that even in the seventies were already becoming clichés,

Hey, you have your heros, I have mine. My Company First Sergeant for example, back when I was a young Private First Class in the Marines, had won the Silver Star in Viet Nam for killing a half-dozen Viet Cong with nothing but his entrenching tool, the blade of which he had (with admirable foresight) sharpened to a fine edge. He was a modest, unassuming guy and I’ll take that kind of courage over someone with the courage to sob and moan about their experiences and how the fire of battle had ruined their life.

While I’m sure MASH is a perfectly decent show and will be in re-runs until the cows stop coming home, and while I have seen as many episodes as anybody who is not really a fan, I can never watch it anymore because it bores me to tears. They have maybe five standard plots which are recycled over and over. And then, towards the end when every television show begins to eye the shark swimming in the tank, the show became extremely preachy and serious, finally dying a weepy, silly death but not before millions of people for whom the show had been their only experience of war and the military had their MASH parties.

I get close to 100 channels. There is always something better on. Maybe the show wasn’t really that good. Back when it came out there were, after all, only four networks (yes, kiddies, believe it or not) and there was no television at all after midnight except for Creature Feature which came in really fuzzy on obscure UHF channels. I wonder how MASH would do today up against, say, Iron Chef or MythBusters?

Besides, the sitcom is dead. It’s a wasteland after they cancelled Seinfeld and Frasier.

ER

I watched ER long before I ever even thought about going to medical school and I like it today as much as I ever did. It is probably the best medical show ever produced from the point of view of plot, character development, and premise. The best thing about ER is that you can miss it for a few years and jump right back in with no disorientation whatsoever, except perhaps that the writers have added a few new characters while you were away. On the other hand, sometimes they kill or otherwise get rid of characters who you hated, like the crippled lesbian attending who had a baby with her lesbian paramedic friend, so it’s a wash. The characters don’t matter. The ER is the character and the actors are just vehicles to carry the story of grit and angst forward. I confess I was a little disoriented when I turned it on after a long absence and somehow Dr. Carter was in the Sudan with a highly annoying French chick and some African doctor who opined constantly about the lack of American troops who, being too busy defending Middle-eastern oil, could not be bothered to whip some justice on the local warlords. After a few flashbacks, however, and some nihilistic dialogue I quickly regained my bearings.

You just don’t have to know that much to enjoy ER except that it is, like most televsion shows, a sounding board for muddled knee-jerking of the left. I have no doubt that if we ever sent to troops to the Sudan, the same African doctor, perhaps in a cameo appearance, would complain that the Marines were violating the human rights of the Warlords who are, after all, merely the George Washingtons or Simon Bolivars of their people.

But hell, that’s entertainment.

Even though I am an Emergency Medicine resident and know a little about the subject, I am not one of those doctors who yells at the television when things are not realistic. I appreciate that the show only runs 45 minutes a week (subtracting commercials which we do thanks to magic of DVR, the most important invention of the last 100 year) so all of the traumas and codes have to be time-compressed. The interventions, as far as I can tell, are perfectly reasonable, the script reflects the condition of the patient accurately, and everybody looks like they know what they are doing. Obviously, the show listens to its medical consultants although I’m sure by this time most of the longest-lived actors could probably talk their way though a real trauma, assuming they could handle slowing things down a bit.

The most unrealistic thing about ER is how much everybody knows. Even the medical students can rattle off a differential diagnosis as detailed as it is exhaustive which is a far cry from real life where pimping questions from the attending are usually met with the lonely sound of crickets chirping. Not only that but they argue all the time on ER and take patient advocacy to ridiculous levels. It just ain’t like that in real life, folks. Generally, unless the attending urinates in the patient’s IV bag we’re all pretty much going to do what he tells us. He might even be able to convince us that it is some novel form of pre-renal electrolyte replacement therapy, the details of which will be appearing shortly in JAMA.

So between the sharp-as-tacks medical students, the residents who never find themselves with their thumbs up there asses out of ideas and looking for salvation, and the attendings who are so proficient that they feel comfortable telling the hematologists and nephrologist where they can stick their complicated plan of care, well, you might get the idea that doctors are a lot smarter than we really are.

The other thing the show does not adequately explain is why all of the Emergency Medicine residents are so unhappy. I suppose it is not common knowledge among the public but matching into Emergency Medicine is like hitting the jackpot. Once you get done with intern year (which on ER seems to last anywhere from three months to five years) you are on easy street. Sure you work shifts but it’s not that bad. The ER residents act like they’re working surgery hours which is not even close to how it is in real life. In fact, part of the fun of our job is laughing at those sorry bastards in Surgery and Medicine and watching them sleepwalk through the admissions we throw ’em after we get bored of working up the patient.

They also have impossible career mobility. One of the characters started as a nurse, went to medical school, quit medical school and went back to nursing, and then apparently finished medical school on the self-study track, popping in and out of rotations where her expertise must have been insufferable to everyone around her. She graduated, or didn’t graduate because of a technicallity, but thankfully matched into Emergency Medicine on graduation day. Another character started in Medicine, switched to Emergency Medicine, and is now a surgery resident performing at the attending level.

I wish it were that easy. It took me a year of incredible effort to switch residencies.

Emergency 

Although it seems like prehistory, as late as the 1970s when someone was in a motor vehicle accident no attempt was ever made to stabilize the cervical spine, at least that’s what I remember from watching the landmark television series “Emergency” which debuted in 1972 and did for paramedics what ER did for Emergency Physicians.  As difficult as it is to believe, up until that time ambulances were usually white station wagons with sirens into which the injured patient was thrown and driven as quickly as possible to the nearest hospital.  Speed was the only real intervention and to this day, my mother-in-law still calls paramedics (who are now highly trained medical specialists) “ambulance drivers” because that’s what they were back then and could only be differentiated from hearse drivers because they didn’t wear black suits.

In that age of paternalistic medicine when the doctor was king and nurses dressed like porn actresses, the sticking point was the reluctance of physicians to allow ambulance drivers to perform interventions.  It seems strange today but back then, giving a liter of fluid (or a “quart” if we’re going get technical), something I don’t remember seeing a lot of on the television show, was considered a major undertaking and they weren’t going to allow a bunch of firemen to do it, no sir. 

The pilot for the series, and again I’m pulling this from memory, detailed the reluctance of the authorities to let the paramedics act independently in any capacity.  Eventually the legislature is convinced and from then on, Firefighters Roy DeSoto and Johny Gage spend the next five seasons thrilling us with feats of medical derring-do that only doctors had ever previously attempted.  But they still had to run most things by the old patrician, Doctor Bracket at Rampart Emergency Hospital who stayed in contact through the stunning high technology of a remote cardiac montitor and a radio telephone.

Episodes usually included some banter with the vulpine Dixie McCall, RN, who knew her place even if she did joke with the boys a little. 

I watched an episode recently and it still works.  It’s true that the plots were of the “Jimmy has fallen down a well” variety but the show was more than just action, it was a weekly buddy movie interspersed with old-fashioned heroics and predictable but funny comic situations.   As the years go by, the 1970s seem stranger and stranger.  The cars are starting to look like 1926 Packards must have looked to people in the fifties watching old movies.  Leisure suits were everywhere, woman all wore heavy makeup with their big hair, and the hospital was a black box into which sick patients were fed to emerge completely cured of the simple medical problems that were the bread and butter of our distant ancestors.