Birds of Prey #1: A Brief Medical Annotation

May 13th, 2010

Filed under: Comics, Medicine

Black Canary is on a mission to rescue Katy, a five year old girl who has been kidnapped. It turns out there’s a slight medical complication:

scene from Birds of Prey #1

Katy suffers from a ventricular arrhythmia. In other words, her ventricles — the lower chambers of the heart — are beating abnormally. This can be a real problem because the ventricles are the workhorses of the heart: they do most of its work by pumping blood through the lungs (right ventricle) or throughout the body (left ventricle). If something is going wrong with the ventricles, it’s not good.

In particular, Katy has ventricular tachycardia (i.e. “V-Tach”), a condition where the ventricles are beating independently of the atria (the top of the heart) and beating way too fast. This is unfortunate for a couple of reasons: first, the ventricles are pumping so fast that they don’t have enough time to fill up before contracting, so blood is not getting moved around the body efficiently which can lead to heart failure (which probably explains why Katy is having shortness of breath. Well, that and being out in the freezing cold in her pajamas). Second, and more important, is that ventricular tachycardia is an unstable rhythm and can quickly degenerate into ventricular fibrillation or asystole (flatline). These rhythms, as my old cardiology instructor used to say, are “not compatible with life.”

So how do you treat ventricular tachycardia? If it comes on suddenly, like in a code blue situation, then you bring out the defibrillator paddles and shock the heart back into a normal rhythm (hopefully). For long term control, antiarrhythmic drugs are often used. As the name suggests, the medications keep the heart in a normal rhythm and out of arrhythmia. They can be nasty drugs with many side effects (including, ironically, causing arrhythmias) so they aren’t used unless absolutely necessary. In this case, Katie is on Flecainide to prevent her tachycardia from recurring.

This is based on a real case. Gail Simone, the esteemed writer of Birds of Prey, asked me to recommend a medical condition in a child that would be quickly life threatening if their medication were missed. I suggested the classics (severe asthma, brittle diabetes), and this situation. I’m pleased she went with the ventricular tachycardia because it’s based on someone I knew. Not a patient of mine, but a co-worker’s daughter who had frequent episodes of life threatening ventricular tachycardia. She was tried on a variety of antiarrhythmics but couldn’t tolerate the side effects of most of them. Only Flecainide worked for her, but she had to have her dose every twelve hours her symptoms would start up again. Last I heard, she was doing well and starting high school (and had managed to avoid being kidnapped, which is apparently a common problem for such children.)

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12 Responses to “ Birds of Prey #1: A Brief Medical Annotation ”

  1. Ashtur
    May 13th, 2010 at 12:58 am

    I take it that this condition isn’t compatible with a pacemaker?

  2. Dean
    May 13th, 2010 at 1:32 am

    which is apparently a common problem for such children

    Yeah, those slightly irregular hearts bring huge prices from collectors.

  3. Eric TF Bat
    May 13th, 2010 at 1:50 am

    It is so cool that they’re asking your advice for this sort of thing. Comic writers win!

  4. Ron
    May 13th, 2010 at 2:38 am

    I made the comment to one of your entries that if I ever wrote a comic, I would run all the medicine past you first. And now, Gail Simone is actually doing that!

  5. _flyer_
    May 13th, 2010 at 2:39 am

    Would suggest an AICD as a safety net in such a case

  6. Anonymous
    May 13th, 2010 at 8:39 am

    “It is so cool that they’re asking your advice for this sort of thing. ”

    Second that. Research, who would’ve thought of it? Gail Simone, that’s who. And boy, I’m glad to see Birds of Prey again.

  7. Bryan L
    May 13th, 2010 at 8:39 am

    Sorry, Anonymous was me. Forgot to fill in the fields.

  8. Allen Varney
    May 13th, 2010 at 9:13 am

    Okay, it’s good the medicine is right, but since when does Dinah Lance know about arrhythmia and Flecainide? Isn’t she, like, a florist? She’d just say, “Katy has some kind of heart problem and needs her medicine soon.”

  9. Gail Simone
    May 14th, 2010 at 7:33 am

    Scott is being totally humble. He hasn’t just been a help, he has SAVED MY REAR END numerous times and has always been a huge help with this stuff. He is my go-to guy and I have endlessly abused that kind generosity by asking him, at three in the morning, “Okay, say a guy’s foot is melted…”

    THANK YOU, SCOTT!

    Ps, he actually co-wrote a scene at one point in Bop, suggesting all the dialogue for the doctors in a surgery scene.

    I couldn’t live without him!

  10. Alberto
    May 14th, 2010 at 9:24 am

    Kudos to Dr. Scott for the advice and to Gail for asking for researching and asking for help.

  11. Boosterrific
    May 14th, 2010 at 7:32 pm

    I think it’s kind of funny that we’re all so pleased that a comic book writer would consult a real doctor for medical advice for a story. It’s partially because that sort of fact checking is so rare that we all enjoy PoliteDissent so much. So I agree with Alberto above: thanks to both Scott and Gail for going above and beyond in pursuit of enjoyable verisimilitude in fiction.

  12. Gail
    May 16th, 2010 at 8:15 am

    I agree that it should be just plain unheard of NOT to do the research for this type of thing but what pains me is when, even with Scott’s help, I STILL get this stuff wrong sometimes.

    It can be frustrating. Also, sometimes a slipup happens after scripting and there’s just no way to fix it.

    Then we deserve Scott’s scorn!

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