If Emma Frost (aka The White Queen) isn’t the most psychic nosebleed prone character, she’s definitely in the top three (I’d put Max Lord and Nate Grey — in his various incarnations — as the other top bleeders).
All previous Psychic Nosebleed Zen posts
I may pick on modern comics for bad examples of medicine, but comics of the so-called Bronze Age were just as bad, if not worse. Just take a look at this penultimate panel from the operating room scene in Werewolf by Night #32 (August 1975)*:
What’s wrong with this scene?
(To set it up: During surgery to repair wounds inflicted by “a wild animal,” the patient’s heart has stopped and the doctor has the team wheel out the defibrillator, or as they call it: the Cardiovascular Shock Unit.)
Ignoring the “shocking-a-flatline” error, I count three fairly significant mistakes (OK, one’s more of a nitpick).
And the “not-wearing-eye-protection” was normal at this time as OSHA would not make protective eye protection mandatory for several more years.
*Fair game for my criticism because it was reprinted in a recent issue of Moon Knight.
Previous picture quizzesThis transfusion comes from a Zatara story published in Action Comics #17 (October, 1939). For those unfamiliar with the character, Zatara was a magician who found himself involved in a variety of adventures. He had quite the sense of style, and was never without his top hat, even in the most extreme situations. He is the father of Zatanna, a former member of the Justice League, who shares his powers, if not his sense of style.
While on a boat to Europe for his annual vacation, Zatara encounters two old friends of his: Beth Jordan and her husband John. A short time later, strange characters try to grab Beth, but Zatara saves her. A few days after that, at dinner in a Paris café, another attempt is made — but once again Zatara saves the day (in this case by turning the assailant into a statue — which Zatara then uses to decorate his apartment. I told you Zatara had style.). The third time, the enemies have wised up and several of them jump and hogtie Zatara while other kidnap Beth and her husband.
The mysterious assailants load Beth and John on a boat for Africa. Remember the part where I said the bad guys had wised up? It seems I spoke too soon, as the villains also load Zatara on the same boat. Zatara decides not to escape, but to play along and see who is behind the kidnapping. Once the boat arrives in Africa, the trio are loaded on a plane and flown deep into the heart of the continent — to the fabled lost city of Ophir.
The Jordans are dragged before the ancient Queen Setapa, ruler of Ophir, who reveals her secret: she is an ancient sorceress originally from Atlantis who had been kept young through magic elixirs. But now her blood is so old the potions no longer work. She has decided that she needs new blood, and has kidnapped Beth Jordan because “the blood of the ancient race” runs in her veins.
John is chained in the dungeon and Zatara hoisted over a giant fire while Beth is hustled off to an operating room where her blood is transfused into the Queen. As predicted, the transfusion restores Setapa’s youth, but Beth is left a shrunken old woman.
Zatara escapes the Queen’s death trap, regains his top hat, and rescues John. Together they rescue Beth. Zatara then confronts Setapa in a magic duel. In the end, Zatara’s magic proves stronger: Beth’s youth is restored and the Queen once again becomes old and wizened. She vows revenge, but Zatara just blows it off as he and the Jordans leave Ophir.
A couple of thoughts on the transfusion seen in this story:
Other Comic Book TransfusionsI’ve fallen a little behind in my medical reviews of manga, so here’s my annotations for the second volume of Apothecarius Argentum, a manga that takes place in a fantasy medieval kingdom. That may sound fairly cliché, but in this case, the main character is a skilled pharmacist and physician.
As Apothecarius Argentum, Volume 2 starts, Argent is getting set up in his new shop as the official “Royal Apothecary” and has reluctantly taken on a young apprentice. The Princess seems to stop by daily, and her father the King is still wary of his true intentions. The first chapter concerns an old woman with a strange ailment. The second and third chapters are flashbacks to shortly after Argent first came to the kingdom to serve as Princess Primula’s food taster. These chapters are rife with palace intrigue and political plotting. The final chapter of the volume manages to bring some of the intrigues forward to the modern day as the Princess heads out on her own to determine if she is fit to be a ruler.
While the story is captivating, I still find the art a little sketchy, particularly the backgrounds. It can be hard at times to distinguish characters, especially during the flashback scenes – which take up half the book. The characters are becoming more fully formed this volume and don’t seem as two dimensional, especially the King who has some dark secrets which are revealed in the final chapter. The Kingdom of Beazol is becoming a little better defined with this volume as well, though it still borders on the generic.
There is not quite as much medicine, per se, in this volume as the first because most of the stories revolve around the use of various poisons — though at least they’re “all natural” and “organic” poisons.
Arsenic was first recognized as poison during the Roman ages. It was the favorite poison of the infamous Borgias. It was a popular poison because when mixed with food or drink, it was impossible to detect.
Acute (high dose) arsenic poisoning causes abdominal pain, bloody vomiting, and diarrhea. Seizures, coma, and death will often follow. Chronic (low doses over a long period of time) arsenic poisoning can show a variety of symptoms including headaches, fatigue, peripheral neuropathy (pain and numbness of the hands and feet), a skin rash, lines on the nails, kidney and liver failure, and heart damage. A garlic-like smell can sometimes be detected on the breath of victims of arsenic poisoning.
Over the years, arsenic has been used as a treatment for a number of medical conditions including diabetes, syphilis, psoriasis, and cancer, but is rarely — if ever — used today for such purposes. In the Victorian era, it was also a common ingredient of cosmetics.
Datura stramonium is a widespread plant with a variety of common names including Jimson Weed, Thorn Apple, Stinkweed, Loco Weed, Devil’s Apple, and Devil’s Trumpet. As the latter names suggest, it is a plant with a bad reputation. Datura can be used as a medication or a hallucinogen, but the line between a safe dose and toxicity is paper thin and fatal overdoses are common — even the pro-hallucinogen sites recommend against it.
In the past, Datura was used to treat a variety of ills including asthma and hemorrhoids. The plant contains the compounds atropine, scopolamine, and hyoscyamine — medications which are still used today (just in small, purer, better controlled doses).
The symptoms of Datura poisoning are anticholinergic in nature: dilated pupils; dry mouth; warm, red skin; racing heart; and memory and coordination problems. There’s a little mnemonic medical students memorize for anticholinergic toxicity; here’s the version I learned: “Mad as a hatter, blind as a bat, dry as a bone, red as a beet, hot as a hare.”
Datura flowers have a sweet fragrance, but the rest of the plant has a foul odor (hence the name stinkweed). Thus when Argent is able to detect the fragrance, the villains must have been using the flowers (or else it’s a mistranslation and “strong odor” was meant instead of “strong fragrance”).
The name “Wolfsbane” can refer to several plants within the Aconitum genus (part of the buttercup family). Other common names include Monkshood, Blue Rocket, and Devil’s Helmet. All the plants share similar properties and all contain the alkaloid Aconite.
Symptoms of wolfsbane poisoning begin with numbness of the mouth and skin. Abdominal pain and severe vomiting follow. Next, paralysis of the lower than upper extremities occur. Finally, the pulse weakens, the breathing muscles tire, and convulsions begin. Death usually occurs within 2 hours of poisoning.
Wolfsbane and other Aconitum species have been used in both Western and Eastern medicine. It was used as a pain killer, a diuretic, and an anti-inflammatory. The root contains the most Aconite, though the young flowers also contain a substantial amount.
Wolfsbane was thought to be one of the ways to detect a werewolf in humanform. If you held the flower up to someone’s chin and it cast a yellow shadow, then they were a werewolf.
The bark of the willow tree has been used medicinally since Sumerian times. It contains salicylic acid, a chemical very similar to acetasalicylic acid, better know as aspirin. As such, it is good for treating pain, fevers, and inflammation. It is more irritating to the stomach than aspirin and nausea and stomach pain are common side effects. The bark can also be used to make a topical astringent as it contains high levels of tannins.
Superman Beyond #1
Grant Morrison, writer
Doug Mahnke, penciler
This comic issues a clarification, of sorts, from Clark’s previous statement:
Superman Beyond #1: My infrared massage is all that’s keeping her heat alive after the shrapnel was removed.
I’m not sure the clarification actually makes things any clearer. How does one massage the heart with heat vision? (I have this vision of Lois in a towel, the lights down low, Barry White on the stereo, and Clark whispering, “Let me massage that for you Lois, with my heat vision…”) Is Clark suggesting he’s been using his heat vision on Lois ever since surgery? And can infrared light even penetrate to the heart without damaging the tissues above it?
I suspect that Grant Morrison is referring in his own oblique way to photobiomodulation, the use of specific light wavelengths to help the body with healing, but at this point it’s an emerging science and has no known cardiac uses. Plus, as I mentioned above, the heart is well inside the chest cavity, how can the infrared affect it without cooking everything else around it?
Batman appears in the Gotham General Emergency Room carrying an unconscious Joker. During the battle, the Joker accidentally inhaled his own Smilex and has collapsed. Batman needs him revived as soon as possible to reveal the location of the third bomb.
Dr. Koslowski (narrating): Dr. Singh decided to inject 5ccs of Adrenalin directly into the Joker’s heart. It was our only chance to save thousands of lives.
Injecting medication directly into the heart, despite what you may have seen in Pulp Fiction, is not a good idea. It’s too easy to lacerate a coronary artery (causing a massive heart attack) or inject the medication into the heart muscle (causing a fatal arrhythmia). It’s not done anymore.
Medically, we don’t call it “Adrenalin” in the United States, but instead use the term “Epinephrine”. That’s the third British medical term showing up in Gotham Central ER — definitely a British writer.
Speaking of Adrenalin, 5cc is too large of a dose.
Dr. Koslowski: At which point the Joker flatlined.
So what does the medical team do? They defibrillate him.
Once again repeat after me: Do not shock a flatline. It is a bad idea. It may work in comic book (like it does here), but in real life it doesn’t work and may actually make the situation worse.
Batman figures that the Joker’s abnormal physiology is messing with the antidote and the adrenalin, which caused him to develop an extremely high blood pressure and suffer cardiac arrest. Batman decides to lower the Joker’s blood pressure with medication and then try the treatment a second time. (No criticism here: it’s as good of an idea as any.)
Once again, the Joker suffers a cardiac arrest . This time, Batman himself jabs the Joker in the heart with a syringe full of Adrenalin. The second time’s a charm and it works! The Joker returns to consciousness and promptly escapes…which was all part of Batman’s plan; he wanted to trick the Joker into leading him to the third bomb.
Let’s count the medical errors in a mere eight pages: the Joker flatlines and is subsequently defibrillated, not to mention injected twice directly in the heart with an overdose of Adrenalin.
Note to self: Do not seek emergency medical care in Gotham City. Hold it until you reach Metropolis.
Medical criticism aside, Batman: Legends of the Dark Knight #200 is a good story. I like the idea of a night in the Gotham General ER told through the eyes of an intern, and the story handles this aspect well. I’d like to see more of Dr. Koslowski and Gotham General.
Batman: Legends of the Dark Knight #200 “Gotham Emergency”
Eddie Campbell and Daren White, writers
Bart Sears, artist
This comic’s a few years old, but it was just re-released as part of the Batman: Going Sane collection, so it’s fair game to discuss again. When it first came out — other than the unexplained use of a British medication name — I thought the medicine was good. However, on second review, while the authors do an excellent job conveying the feel of a hectic night in the ER, the medicine leaves a lot to be desired.
I’d like to thank emergency physician Grunt Doc for his help parsing a couple of scenes in this comic. Any medical mistakes are mine, not his. Grammatical errors would be mine as well.
It’s a busy night in the Gotham General Hospital emergency room, and things get even worse when the Joker becomes involved. This story is told mostly through the eyes of Dr. Natalie Koslowski, an intern on the first day of her Emergency Room rotation.
Paramedic #1: Gunshot wound to the mid sternum, exit wound to back of the right shoulder. Blood pressure 100/50, Pulse 158, Respirations 36.
Paramedic #2: Unconscious upon our arrival.
Dr. Koslowski: Resuscitation. Establishment of airway and restoration of hemodynamics.
That’s a good start, Dr. K. But don’t forget the B of the ABCs of resuscitation (Airway, Breathing, and Circulation). Just getting an airway is not enough; you have to make sure the patient has good (or at least adequate) air exchange.
Dr. Koslowski: Symptoms suggest serious blood loss. Unless treated aggressively and in a timely manner it can lead to hypovolemic shock.
True, but take a look at those vitals. He’s already in hypovolemic shock.
Dr. Singh: OK. Let’s tube him, get blood gases, and 2 liters of O Neg.
Intubation is good — it establishes the airway mentioned by Dr. Koslowski (though frankly the paramedics probably should have intubated the patient before he got to the hospital).
Blood gases aren’t going to tell anything useful and are not going to improve the care of this patient one whit. Not to mention he’s being tubed, so his respiratory situation is changing (hopefully for better) and this will alter those blood gases.
Starting a blood transfusion is appropriate, but blood comes in units, not liters, in the United State. I suspect this is a second Britishism creeping into this American ER.
Finally, those paramedics didn’t do a good job at all. Looks like they wrapped the patient in a sheet, lashed him to a stretcher, and came to the ER. He should be intubated and have a couple of IV lines started already.
Cop #1: Help us. Look like Sam’s inhaled Smilex.
Dr. Singh: Rose, quickly get up to toxicology on the fourth floor. They have an antidote but it must be injected as soon as possible after inhalation.
Cop #2: Does this stuff work, man? Sam’s got kids.
Dr. Singh: It works if we can administer it quickly enough…If we get to the victim within the hour, we normally expect a coma for twenty four hours. Much beyond that it’s touch and go.
If time is of the essence, why is the antidote being stored in a closed department on another floor? Wouldn’t it make more sense to store it in the ER — at least at night, when the Toxicology department is closed?
This is only story I can recall where Joker venom is considered treatable, and one of the few where it’s called “Smilex.”
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