Polite Dissent

Batman: Gotham Knights #74 “Payback, part 2“
A.J. Lieberman, writer
Diego Olmos, writer

Spoiler Warning
The Joker knocks Hush out with a dive bombing pigeon. When he wakes up, Hush confronts the Joker, only to discover that he’s been sedated for three weeks, not just a few minutes, and the Joker had a physician implant one of the WayneTech pacemakers into him while he was sedated. The Joker is more than happy to demonstrate to override Hush’s heart.

Hush at first decides to cut out the pacemaker himself, but then decides it would too risky (but not before anesthetizing himself with heroin). He comes to Bruce Wayne for help. Bruce agrees to help, but only if Hush checks himself into Arkham. Reluctantly Hush agrees and the pacemaker is removed. He then escapes the asylum and goes looking for the Joker. Batman confronts him and suggests that maybe the pacemaker was never removed; maybe Batman has changed the rules henormally follows. As the story ends the reader is left to wonder whether or not the pacemaker was removed or not.

Sadly, there are quite a few glaring medical errors in this issue of Batman: Gotham Knights.

1. Hush grabs his right side when he’s having heart pain. [pages 6, 11]

2. A pacemaker surgery is not the major heart surgery the writer makes it out to be. It is a fairly minor same-day surgery that takes about 3 hours. An overnight stay in the hospital is rarely required. [pages 6, 20]
From the Healthy Hearts site:

The procedure is performed with mild sedation and a local anesthetic. Patients are not put to sleep. A 2 inch incision is made parallel to and just below a collar bone. Pacer wires are then inserted into a vein that lies just under the collarbone and advanced through that vein under fluoroscopic guidance into the heart. The other end of the pacer wires are connected to a “generator” that is implanted under the skin beneath the collar bone. This generator is about half an inch deep and one and a half inches wide. The skin is then sutured closed and the patient leaves the hospital later than same day or the following day. Incisional pain is mild and transient and usually responds to Tylenol. It is possible to feel the pacer generator under the skin and a slight deformity of the skin can be visually noticed.

3. Why did Thomas Elliot, a neurosurgeon, study under David Gilmour, a cardiac surgeon? (And did David Gilmour become a surgeon before or after Pink Floyd?) [page 5]

4. According to the story, the Joker had the pacemaker implanted via the femoral artery so Hush wouldn’t discover it. It’s theoretically possible I guess, but then the pacemaker unit would be in the thigh with long wires leading up to the heart (and Hush would definitely be able to tell a deck-of-card-sized piece of metal was in his leg). In the x-rays shown in the comic, the setup is completely backwards of what is described, with the pacemaker unit in the chest and wires running down the leg. [page 10]

• And since when does the femoral artery go all the way to the foot? [page 10]
• I know I complimented the artist on his well-drawn pacemakers last issue. No so this issue. Did he lose the reference? [page 10]
• The x-ray is taken wrong as well. Hush is leaning against the machine, but there is no film cartridge behind him. He’s radiating himself for nothing. [still on page 10]

5. Hush, a brilliant neurosurgeon, is not smart enough to realize that 3 weeks have passed instead of mere minutes, and that now he has a chunk of metal in his body and a 2-inch scar on his leg? [pages 5, 6]

6. Why would Hush even consider using heroin as an anesthetic? I’ll grant you that it is a morphine derivative and would kill most of the pain, but he would be far too impaired from the drug to perform surgery. [pages 10, 11]

• In an earlier issue, Hush used the fancy anesthetic narcopropaline to kidnap Alfred. Why not use it now?
• Hush is injecting the medication into an arm bent at more than a 90-degree angle. That’s going to make the vein nearly impossible to find. Think about it, whenever you have blood drawn, give blood, have an IV placed, or inject medication the arm is always held straight. Any doctor, nurse (or junkie, for that matter) knows better than to try it with the arm bent. [page 11]

Tags: comics medicine joker hush batman autopsy pacemaker x-rays heroin