The Abyss

The television and film industries heavily influence popular conceptions of events in the medical and nursing worlds. Unfortunately, misconceptions are predominant (see, Zen and the Art of IV Maintenance).

Many TV shows and movies have "medical advisors" whose job it is to create realistic re-enactments of medical and nursing processes. However, to a trained nurse (or doctor) even shows like "ER" fall short. Often, it seems, realism suffers, taking a backseat to drama.

To wit, I recently saw the movie The Abyss. However much the viewer must willingly suspend his or her disbelief in order to make the movie enjoyable, a resuscitation scene near the end of the movie is just so incredibly wrong concerning the reasons for and effects of defibrillation that I wondered whether or not the director even made an attempt to present a more accurate depiction.

The scene reiterates the common misconception that when a person's heart stops, it can be jump-started with a defibrillator.

Briefly, the movie is about deep-water divers in crisis due to an accident. The resuscitation scene occurs after a diver brings an apparently "drowned" and severely hypothermic individual (his wife) up into an underwater work chamber. The patient is unresponsive, not breathing, and has no pulse. CPR is initiated and the first other thing the rescuers do is "shock" the patient. After three shocks and no response, the rescuers stop their efforts. Everyone is sad.

The husband, however, refuses to give up, and after slapping the corpse around a bit, resumes CPR and shouts "Shock her again, dammit!" After this fourth shock, she spontaneously revives. Cue the dramatic music! Love, hugs, and kisses all around! Everyone crying in joy!

Why is this a problematic misconception?

One problem we experience in the ER is that family and friends of patients who come in dead don't seem to understand why the patient usually leaves dead. People seem to think that we can re-start hearts, mostly they seem to think we can do this with a defibrillator. Why do they think this? Well, they see it on TV and in movies like The Abyss.

Your heart is not a car battery. We can not hook it up to jumper cables and shock it into working again. Defibrillation is used to augment and hopefully correct lethal cardiac rhythms, not create electrical and muscle activity that isn't already there. If you come to the ER without a heartbeat, a.k.a. in "asystole" (i.e., without cardiac activity), we initiate CPR and administer heart stimulating drugs. We do not defibrillate that which is not there.

In the movie, it IS realistic for the rescuers to initiate CPR. Using chest compressions and rescue breathing for a person who is unresponsive, not breathing and pulseless, is a reasonable first-line resuscitation intervention.

As well, warming a hypothermic patient (something they did not do in the movie) may allow for the patient's heart to beat spontaneously on its own again. The old-adage, "a person is not dead until s/he is warm and dead" applies. But no professional nurse or doctor would use defibrillation in this case.

In the emotionally-charged setting of a resuscitation attempt, it is reasonable for on-lookers to expect us to do everything we can to save a life. It is not reasonable, however, for on-lookers to expect us to do things we know will not help. TV shows and movies encourage the public to expect just that.