Friday, November 20, 2009

Coding ET

[I tried to embed scenes from the movie from YouTube. Of course these have been removed due to copyright violation. But probably if you look it up, someone else will have posted it.]

I was at home on my own, watching TV post-call after an ICU shift. Nothing was on, and I landed on the middle of "ET: The Extra-Terrestrial". Before you know it, government agents are surrounding the family home; soon, as ET gets sicker and sicker, a medical team starts coding ET.

When I watched this movie as a kid, I saw it through the child's eyes, and the government agents were totally terrifying. Now I see the physicians among them as basically benign, though surely misguided: in trying to save ET's life; they're running a by-the-book Advanced Cardiac Life Support code algorithm.

Apparently, there were real emergency medicine physicians involved in this scene, and although some things have changed in the way we run the same algorithm now (betrylium? huh?; and what is with those lousy chest compressions?), much is the same. You could argue with the technique: a light-hearted series of letters in an emergency medicine journal at the time went over the code. One pointed out, for instance, that ET had 6 beers earlier in the movie, and this might have induced hypoglycemia given his small size; another pointed out that perhaps an overdose of endorphins related to ET's abandonment on earth meant that he could have benefited from naloxone.

A letter in Annals of Emergency Medicine defended the scene: "As one of the physicians responsible for resuscitating ET in Steven Spielberg's movie, ET, The Extra-Terrestrial, I read with great interest the letter in your August 1983 issue entitled, "Use of Naloxone in CPR" (August 1983;12: 519-520). In that letter Drs Wasserberger and Ordog suggested that the resuscitation effort of ET might have benefited from the use of 'high-dose opiate antagonists.' I would like to inform my colleagues in emergency medicine that ET received every drug known to our specialty in our resuscitation attempt. Unfortunately, many of the drugs used, the correct dosages administered, and the procedures performed on ET were destined for the cutting-room floor of the editing department...

"I am pleased that our efforts did not go unnoticed by those with knowledge to judge and evaluate the scene. Although the process of editing changed the details and order of the events in the scene, we hope the flavor of the management of a true cardiac arrest came through on the screen." (A. Lampone, Ann Emerg Med 2 February 1984)

The emotional punch of the scene of ED being coded comes because the scene does look like a real code. Because it looks like a real code, it also looks like a form of madness in the emotional context of the children's relationship to ET. Nearby, (not shown in the excerpt above) little Elliott, who feels what ET feels, shouts, "You're killing him! You're killing him!" And poor little Drew Barrymore, then a small child, is flinching and crying as she watches the code team apply shocks to ET's chest.

Elliott is not upset because they're not giving Narcan to ET, or because the chest compressions are too weak and too slow by today's standards. He's upset because the process of coding ET seems barbaric; and totally beside the point. Most of the audience, I'm sure, identifies with Elliott. I can't help but identify with the doctors; and yet, I also recognize the emotional resonance of the scene from the Elliott point of view. There are plenty of times when we start moving forward with some high-intensity intervention, coding someone because that's our job, putting a line inside someone, whatever it is--and at the same time inside of us, some little Elliott is screaming, "Stop! Stop! Please stop!"

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