Polite Dissent

Streets of Gotham #20
Paul Dini, writer
Dustin Nguyen, penciler

In the “good old days” (i.e. back when Thomas Wayne was still a young single physician), a group of mobsters were trying to drive Dr. Leslie Tompkins from her free clinic. When the more direct method didn’t work, they hired “chemist” and mad scientist Karl Hellfern to accomplish the task.

Hellfern developed a quicker and more virulent strain of the disease Sodoku^{1, 2}, which he identifies as Asian Rat-Bite Fever. The incubation period of his modified disease is a mere twelve hours, with death at thirteen. He also breeds a more aggressive species of rat to spread the disease. These infected rats are then released near the clinic.

So far, so good. This is actually a fairly cleaver plan. Even if the rats don’t bite anyone, exposure to their urine and droppings can still spread the disease.

Then, the bad guys make an extremely bone-headed move. After the mobsters grab one of the local street urchins and beat him nearly to death, Hellfern purposefully has one of the infected rats bite him, stating that the need a “live disease carrier.” The unconscious and infected kid is then anonymously dropped off in front of the clinic. This is one of the stupidest things they could have done:
They already have live disease carriers, remember all those rats they released?
Humans cannot pass the disease from one to another, so there’s no point of infecting someone and sending him into the clinic.
There is a good chance this will alert the clinic that something is amiss.

Sure enough, Thomas Wayne quickly realizes the importance of the rat bite⁴, and a group of his friends — the Justice Society of America — are called in to help. The kid survives and the disease is eradicated.

Notes:
1. Sodoku is a real disease, and it is a form of rat-bite fever found primarily is Asia (Sodoku is the Japanese name for it). Sources differ on how long the normal incubation period is, from four days up to four weeks (2-4 weeks seeming to be the most common). The disease generally presents with a slowly healing bite and a recurrent fever, though a number of other symptoms such as rash and meningitis are possible. Penicillin is the treatment of choice, and they even had it back when Thomas Wayne was a young doctor³.

2. Note that this is Sodoku, not Sudoku — though I suspect that a bunch of rats sitting around figuring out a number puzzle might have made for a more compelling story.

3. By current reckoning, this story should be taking place sometime in the (hand waving) 1940s through 1950s. On the other hand, by original reckoning, this story would have to have been set around the turn of the 20th century, several decades before Penicillin.

4. As a side note, no self respecting doctor, even back in the “old days” would give a sedative to someone who was already unconscious, especially if they’d been beaten up and likely suffered a head injury. Remember, this was the era when it was recommended to regularly and repeatedly wake people up when they had suffered a head injury.

This week, we revisit Sue and Sally Smith, the Flying Nurses, first seen in Nurse Week #2: Fire Storm. The Smith sisters work for Emergency Corps, an organization that sends doctors and nurses to medical hot spots all over the world. In the first story, their destination was a forest fire in the Midwest; this time, it’s a typhus outbreak in Africa.

Sadly, no mention of the psychic link Sue and Sally share (in their first story, at least) is made here — which is a shame, because it really would have come in handy for them.

Friday Nurse Day #8:
Sue and Sally Smith, Flying Nurses #49 “Sahara Mission”

Sue and Sally Smith, adventure nurses, are sent to an unnamed North African country to help Dr. Higby treat a typhus epidemic affecting the local tribesmen as well as foreign oilfield workers. The foreign workers all stop by the clinic for their vaccinations, but the tribesmen do not. Sue decides to talk to the local sheik about the importance of the vaccine.

After listening to her, he convinces all of his tribesmen to get the vaccination by volunteering to go first.

The sheik seems smitten with Sue. Over tea one day, he casually mentions how his religion allows him to take more than one wife, and seems ready to ask her a more pointed question when Sally jumps in to bring the conversation to a premature conclusion. Later that night, she teases her sister about almost becoming a member of the sheik’s harem.

The next evening, the sheik comes thundering through the medical camp astride his horse, grabs Sue, and rides off into the Sahara. Once they realize what happened, Sally and Dr. Higby chase after the sheik, but he has quite a lead on them and knows his way through the desert.

Two hours later, they finally arrive at his remote camp. It turns out the sheik kidnapped Sue not to marry her, but for her to teach his wife how to wear Western-style clothes and makeup.

Vitals:

Published: January, 1963 by Charlton Comics

Cover price: 12¢

Time Capsule: The Arabs, particularly the Sheik, are portrayed in the very romantic early-20th century style — think Valentino’s The Sheik or Lawrence of Arabia. This is quite different then how they’d be portrayed now.

Most progressive moment: There’s really not much progressive going on here at all.

Inexplicable: Horrible spelling errors abound in this story, unless “institude” is actually a real word.

Previous Friday Nurse Days:

Incredibly busy weekend (involving among other things extra clinic shifts so I could have time off for C2E2, and a 5K that somehow managed to be run entirely against a headwind) precluded any sort of substantial post.

Instead, why not take a moment and check out my tumblr mini-blog, The Crash Cart, where I post random medical/comic book images I run across. They may not merit the full Polite Dissent treatment, but are still entertaining to peruse.

tetracycloide wins this week with an impressive 17 points. Jamie Pt was second with 14 points. Christoph and Crystal tied for third with 12 points, and Fred13 and George were fifth with 6 points.

Overall, Jamie Pt resumes the lead with 64 points, followed by Corien and Tippi both in second with 53 points. George and atg are right behind with 52 points. If your score is 43 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

An…interesting…episode with two patients: a depressed teen-age boy with a bleeding problem, and Cuddy. There were some clever moments (for instance, now I really want to see Hugh Laurie’s take on the emcee from Cabaret), but ultimately the medicine had too many mistakes and required too much handwaving to work

I. Ryan
Ryan is a 16 year-old adolescent who is admitted to the hospital after spitting up blood during a pick-up basketball game. His pulmonary and GI work-ups were negative, so he is admitted to House’s team for evaluation. Initial concerns include vasculitis (blood vessel inflammation), bronchiectasis (chronic airway damage and scarring), inhaled particles, or angiodysplasia (abnormal blood vessels in the gastrointestinal tract). House favors the latter, so he has the patient swallow a special camera to look for angiodysplasia. The study is negative. Meanwhile, Taub confronts Ryan about cutting, given the healing cuts on his abdomen. Ryan denies the cutting, telling Taub the wounds are from a skateboarding injury. Taub then points out that Ryan has many of the signs and symptoms of depression, which Ryan ultimately admits to. He also admits to smoking marijuana, which Taub thinks may have been contaminated with lead or formaldehyde, leading to the Ryan’s symptoms. A lead level is checked (and apparently normal, as it is never mentioned again).

Ryan now has developed some red spots — small hemorrhages — in his eyes. This is his second bleeding-related symptom, so the team now considers an acquired coagulopathy or a Staph infection. House thinks the infection is more likely, so Ryan is started on Nafcillin (a good anti-Staph antibiotic). Despite the new treatment, Ryan’s symptoms worsen. He starts seeing blood in his urine, and a subsequent kidney scan reveals a mass of some sort. The differential diagnosis now consists of antiphospholipid syndrome or a heroin-induced nephropathy (kidney damage caused by heroin use). To House, the first seems the more logical choice, so Ryan is started on plasmapheresis. Taub and Foreman search Ryan’s home and find no illegal drugs, but do find that he has defaced his yearbook with threats to kill half his class. The two return to the hospital when they learn Ryan’s right arm has gone numb. Foreman now suspects that instead of a bleeding problem, Ryan actually has a clotting problem. He gets an angiogram of the brain and sure enough, it shows a clot. Ryan is started on Streptokinase (a thrombolytic, or “clot busting” drug), but doesn’t improve. The team decides to proceed with an embolectomy — advancing a catheter into the arteries of the brain to remove the clot — but the clot disintegrates in the middle of the procedure just as Foreman reaches it. To complicate the situation, Taub has found videos of Ryan’s that show him detonating pipe bombs while making threatening comments. He is unsure who in authority, if anyone, he should tell.

Ryan continues to get worse. Out of nowhere, he’s now in a coma, on a mechanical ventilator, and his liver is failing. Because House is obsessing over Cuddy, the team is on their own and looking at such diagnoses as AIP (acute intermittent porphyria) and fucosidosis (an inherited enzyme deficiency) before settling on type II citrullinemia (another enzyme deficiency — in the case of type II citrullinemia, almost entirely exclusive to Japanese patients). They start him on sodium benzoate to treat the suspected high ammonia levels (which would be easy to test for, hint, hint). Across the hospital, House is having a conversation with Cuddy when he has his Eureka! moment. He realized that Ryan has a Staph abscess, and while the antibiotics given earlier treated the bacteria in the blood, they did not reach the ones still protected in the abscess. Taub takes it a step further and realizes that the likely source of the abscess is the pipe bombs Ryan had been making, and the cuts on his abdomen are shrapnel wounds, not skateboarding injuries. Some PVC fragments got in his body, picking up Staph along the way, and developed into abscesses. Apparently these abscesses now are somehow breaking apart, and sending septic clots throughout the body, causing all Ryan’s other symptoms. After some surgery to open the abscesses and remove the shrapnel, and loads more antibiotics, Ryan should be good as new — physically.

II. Cuddy
Out of the blue one morning, Cuddy sees blood in her urine. Next thing that morning, she has a cystoscopy performed, which shows nothing abnormal. She proceeds to a renal (kidney) ultrasound — performed by Wilson (who is apparently an ultrasound tech and radiologist in addition to being the New Jersey’s top oncologist) – which shows a mass in her kidney. A biopsy of the mass is obtained, but it is inconclusive. Further radiology shows enhancing lesions in her lungs, which makes everyone suspicious for metastasized renal cancer. Now she definitely needs a surgical biopsy. The mass is removed and turns out to be a benign oncocytoma. The masses in her lungs? Those were an allergic reaction the antibiotics she was on. All’s well that end’s well — physically.

As usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:

Except for a rare condition or two that combine clotting and bleeding (DIC — disseminated intravascular coagulation, comes to mind), clotting disorders and bleeding disorders are distinct entities and very different (and you’ll notice they never tested for DIC or anything similar). Bleeding disorders do not present as clotting disorders and vice versa.

Streptokinase is a first generation thrombolytic — in a cutting edge hospital, why would Foreman choose to use it instead of a newer agent, especially when he is a Neurologist and should know streptokinase has been shown not to be beneficial (and thus not approved) for use in strokes.
Contraindications to the use of streptokinase include recent bleeding problems. Ryan has a condition which has caused at least three unexplained bleeding episodes, and now they want to give him a drug which will likely cause him to bleed more? It’s not an absolute contraindication, just a relative one, but still, they should have at least mentioned it, or gone straight to the embolectomy.
If streptokinase doesn’t work, you don’t just “increase the dose.”

Taub is correct that most PVC — unless specially treated — will not show up on x-ray or CT scan. However, the abscesses themselves still should.
The PVC would, however, show up on ultrasound.

I’m unclear how the abscess is breaking apart enough to cause clots elsewhere in the body. If it is walled off enough to prevent antibiotics from reaching it, it shouldn’t be breaking up into the blood stream.

Cuddy’s sleeping pill label read “Zolpidem, 200MG.” Zolpidem is better known as Ambien — the maximum dose of which is 10MG. She is taking twenty times the maximum dose (and no, it doesn’t come in 200mg capsules — only in 5 and 10MG pills).

Antiphospholipid Syndrome is a clotting disorder, not a bleeding disorder.

For the first time all season, they never checked blood cultures?

Ryan is so depressed he’s playing pick-up basketball games?

Plasmapheresis is not the first-line treatment for antiphospholipid syndrome.

This week’s medical mystery started a little bland, but picked up speed, but then they started throwing everything at it (out of nowhere a coma! And liver failure!). I give it a B-. The final solution was a stretch and the writers are trying to have it both ways: the abscesses are walled off and protected from the body, but no they’re causing problems in the body — everywhere! I give it a C-. The medicine was sloppy (confusing a clotting and a bleeding disorder?) and conveniently neglected tests they’ve run in every other single episode. It also earns a C-. The soap opera was certainly inventive, which I give them credit for. It also advanced the overall plot, which I appreciate. I give it a B+.

The review of the previous episode of House
A list of all prior House reviews

I’m a week late, but to celebrate National Brotherhood Week, here is a clearly dated public service ad from the 1950s. It’s Buzzy’s Special Brotherhood Week Quiz — how will you score?

Though awkwardly written, this PSA’s heart was in the right place. I doubt we’d see an ad celebrating such national diversity today. Maybe a week for this ethnic group, or a day for this group, but I’d be surprised to find a modern celebration of so many different backgrounds in what seems to be an era of forced homogeneity.

This PSA was published first in DC comics from April 1954 and then released again in comics from march 1954. As with every DC PSA of this era, the script was by Jack Schiff. The art in this instance was by Reuben Moreira.

More PSAs

Tags: comics brotherhood buzzy jack schiff ruben moriera

Thunderbolts #148
Jeff Parker, writer
Declan Shalvey, artist

Ghost, supervillain and conspiracy-monger, has some thoughts about the food served at the supermax prison “The Raft”:

Saltpeter, also known as potassium nitrate, is one of the main ingredients of gunpowder and is also commonly used in fertilizers. Traditionally, it was used to preserve meats, but more modern nitrates have replaced it that regard. Potassium nitrate was also once used as a medicine for asthma, arthritis, high blood pressure, and heart conditions, but it had some nasty side effects and newer and safer medicines have replaced it.

For years there have been myths and urban legends that saltpeter is secretly placed in the food in the army/prisons/boarding schools to decrease libido, but as great a conspiracy as that would be, it’s all bunk. Saltpeter is not added to food to lower libido. First, multiple studies have shown that potassium nitrate has no effect on sex drive or performance. Second, saltpeter has some significant side effects, which is why we don’t use it as a medicine any more. Why risk giving that to soldiers/students/prisoners? For example: hypotension — low blood pressure. What good is it to have an army recruit who keeps fainting because of low blood pressure?

(As a side note, soporific = a medicine that causes sleepiness)

Of course, it could be that I’m just one part of a vast global saltpeter conspiracy (as are Snopes and The Straight Dope). That’s what Ghost would think, I’m sure.

Along with the nurse- and medical-centric stories in the old medical romance comics, you can find a number of ads clearly targeted on the book’s audience (or more likely, the book’s perceived audience). Common ads included weight loss gum, weight loss garments, celebrity pictures, and the latest hit 45’s. There were also quite a few ads for nursing schools — though not the nursing schools we’ve seen in the various stories, where students spend several years in classes and the hospital — the ads are all for home study courses. It’s a little bit of a bait and switch, because all the nurses shown in the comics are Registered Nurses, while the ads are for schools for Practical Nurses, a significant difference.

Another “Nursing School” Ad
A Stethoscope Ad

A rather uninspired episode of Fringe this week. The lighter-than-air thievery concept had some legs, but unfortunately got short shrift because of the focus on the Fringe über-plot.

The Plot: A scientist inadvertently discovers that by alloying two very dense elements, osmium and lutetium, he can create a lighter than air compound. He injects this new compound into willing volunteers so that they can steal some more osmium and lutetium. There is a method to the scientist’s scheme: his son has a form of muscular dystrophy that has left him in a wheelchair and the scientist sees his new discovery as a way of giving his son a more normal life. The accomplices he has recruited also have muscular dystrophy and he offers them a chance of leaving their wheelchairs behind as well. Unfortunately, his experiments have their problems, and most of his subjects end of dead. One is shot while robbing a metal depository and almost floats away — that’s when the Fringe Team is called in.

Walter finds himself unable to figure out precisely what is going on because everything he sees defies the laws of physics. The Fringe Team figures out, more or less, what the scientist is up to and where he’ll strike next. Then, in a rather anticlimactic end to this particular storyline, he is captured in the act of stealing meteorites (a source of lutetium) from a local museum.

The scientist/metal thief storyline may take up the most minutes in the episode, but the main story is really about the members of the Fringe Team themselves.
Peter and Olivia are disgustingly couple-ish (a thought that should give their boss Broyles serious pause).
Walter realizes the fact that the osmium/lutetium alloy works despite breaking the laws of physics is proof the universe is breaking down.
Peter comes clean to Olivia about his experiments on the shapeshifter memory disks – and how he obtained them.
Walter suspects that William Bell was able to carry out his plan utilizing a soul magnet – a device that will call his soul back to Earth to inhabit the body a previously prepared subject. When Walter activates the magnet, Bell’s soul possesses Olivia.

1. 4 8 15 16 23 42
So Hurley got off the island…and ended up at Massive Dynamic

2. Where’s Watson?
I would’ve expected a scientist named Crick (”Krick” in the closed captioning) to be a biologist or chemist.

3. The roaming charges must be astronomical
The soul magnet can call Walter Bell’s soul across from the other universe?

4. Osmium Jones
I seem to remember Osmium being mentioned on the show before, in one of the earliest episodes (”Arrival” — the one with the subterranean torpedo). That projective was eventually identified as iridium, which gives Karl’s theory a nice “completing the circle” feel.

5. Comic Book Fans Will Get the Allusion
I’m willing to accept the osmium/lutetium alloy was lighter than air because “the universes are breaking down” (this is Fringe’s version of Superboy punching the wall, isn’t it?), but injecting a metallic sludge into someone’s body is a quick way to kill them (gumming up the arteries, veins, heart valves, etc) — no matter what the new laws of physics say.

6. Cognitive Dissonance
Walter makes a big deal about how he can’t abide the breakdown in the laws of physics, and then in his next breath he talks about summoning a soul.

7. 1 Table QID PO
Os is not only the symbol for osmium, but is also a medical term (from Latin) for “opening” “mouth” or “door”.

Not a bad episode, just a very slight one. There’s simply not enough here to move the Fringe Doomsday Clock either way.

This week’s Fringe cipher was: EARTH.
A list of all previous Fringe reviews is available here.
Karl ’s has more to say, particularly about the anachronisms, over at his blog.

Chritoph led this week with 5 points. KingKha, Legault, and steve a were second with 4 points.

Overall, the top five standing and points are unchanged. Jamie Pt resumes the lead with 64 points, followed by Corien and Tippi both in second with 53 points. George and atg are right behind with 52 points. If your score is 43 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

Frankly, a bad episode. The medicine was incredibly sloppy with imaginary tests and key symptoms that appeared and disappeared at random. The soap opera aspect was better, but still not enough to redeem the episode.

At a rodeo, a bull rider — coincidentally named Lane — finishes a successful eight second ride, and is standing, celebrating, when he spaces out for a second. Unfortunately, this is just enough time for a bull to knock him down and trample him. He is admitted to the hospital and House’s service. According to Foreman, there are two concerns: first, Lane has a ruptured diaphragm, cracked sternum, broken nose and partial hearing loss attributable to the bull injury; and second, some sort of neurological disorder along with fever and muscle weakness. M³ suggests the hearing loss may be related to an inner ear disorder and not the rodeo injury. She wants to test calorics and an ENG (electronystagmogram). The tests are normal, but House tells them this is because Lane is a bull rider with better-than-average balance. He says they need a better test, which they concoct, but it is normal as well (though surely his muscle weakness have affected this test).

Lane now develops bloody sputum. Chase suggests a salivary gland tumor, while Taub suggests a gastrointestinal bleed. Both are tested for, and both tests are negative, though now Lane suddenly shows yellow sclera (a sign of jaundice, and thus a problem in the liver). An x-ray suggests a mass in the liver, but it is hard to tell for certain with the various pieces of hardware (from his previous rodeo injuries) in the way. To get a better look at the mass, they surgically examine the liver, but no mass can be found. House suggests a tapeworm or tapeworm cyst, but the team tells him they’ve tested for it. House points out the intermittently swollen lymph nodes (which the team appears to have overlooked, but how House knows since he’s never laid eyes on the patient isn’t clear), which M³ interprets to mean infection, probably of the brain, given his neurological symptoms. Due to his head injury (but isn’t it an old injury, not a recent one?), she doesn’t think a spinal tap is a good idea because it might cause a herniation, so House tells the team to proceed with a ventricular puncture (getting cerebrospinal fluid from the brain itself) — which ends up being normal. However, during the procedure, Lane develops respiratory distress. They try to intubate him, but the airway is blocked, so they end up giving him a tracheotomy. During the procedure they also realize that Lane has extremely smelly feet. House suggests that these may be a sign of diabetes, athlete’s foot, or gangrene. He then points out that a fungal infection of the feet may have allowed infection to enter the body causing abscesses to form. The team thinks the heart and brain are likely places to look for these abscesses.

A heart MRI is obtained, but shows no abnormalities. A head CT is the next step, but to get a good one would require removing the titanium plate in Lane’s skull, a risky idea. To prove the need for the surgery, House proves to the team that Lane does not have hearing loss, but is instead having multiple brief absence seizures. This convinces them of the need go ahead with the CT, which is, of course, normal. House now decides that they need to take another look at the heart. He suggests increasing the pressure on the heart and aorta by ramping up the blood pressure until it is dangerously high. If the aorta ruptures, then it is a sign of a Bartonella infection and he is right. He points out that it is better for an aortic rupture to happen on an operating room table than a bull ring, and the team ultimately agrees. Cuddy confronts him, but backs down, and the test proceeds. Lane’s chest is cracked and his heart and aorta monitored while his blood pressure is increased. Soon enough, an aortic leak (then a full spray) is detected, proving that House is right. With deft surgical skills (especially important since the suture is several sizes too large), Chase is able to repair the aorta and Lane will live another day.

As usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:

This is the sloppiest (medical) writing I have seen in a House episode in a long time, if not ever. Of the three presenting symptoms, two are never mentioned again and the third isonly brought up by House again 2/3 of the way through the show.
Fever is mentioned as one of the presenting complaints, but is never mentioned again through the entire show – even when infection is suspected later on. On every other episode this season, we’ve been assured that fever=infection.
He is clearly having some sort of seizure on the bull ring. House is aware of this fact. Yet the team ignores this important symptom until House brings it up again.

High blood pressure doesn’t just affect the heart, it affects every other organ system as well. The brain, kidneys, and liver are particularly vulnerable and we already know that Lane is having trouble with two of those. This is just another way to say that increase-the-blood-pressure-until-he-explodes idea was very, very wrong.

Bartonella is not an opportunistic skin infection that would work its way into the body through tears in the skin of the feet. Bartonella is transmitted through an arthropod bite vector, or in the case of cat scratch fever, a cat bite or scratch from a cat infected by an arthropod bite.

A gastrointestinal bleed is not going to give you bloody sputum, but then nor is a salivary gland tumor (it might give you bloody saliva, which is different).

The ENG and caloric testing checks the function of the inner ear, not the patient’s balance per se. Lane may have great balance, but a screwed up inner ear would still show up on these tests.

A good physical exam would have detected those nasty feet long before surgery.

An abscess large enough to cause recurrent seizures over the course of several days is not going to show up on CT scan?

His respiratory distress and airway blockage miraculously healed?

This week’s medical mystery was actually interesting, if only they’d only stayed with it rather than chasing every new symptom. It earns a B. The final solution, I guess, kinda, sorta, almost fit if you ignored all the reasons it didn’t make sense or fit the symptoms. I give it a C-. The medicine was incredibly sloppy on every level, a real disappointment. I give it a generous F. The soap opera was the only interesting part, but even that felt a little flat: B.

The review of the previous episode of House
A list of all prior House reviews

With spring just around the corner, I thought this would be the perfect time for an outdoor themed public service ad.

This particular PSA features Dunbar Dodo and Fennimore Frog, two of DC’s more popular funny animal characters. As far as I know, this is their only appearance in a PSA, unlike fellow funny animal character Peter Porkchops who appeared in quite a few. Since the demise of their own comics in 1957, the Dodo and Frog haven’t been seen much — their last “modern” appearance was in the original run of Captain Carrot and His Amazing Zoo Crew.

What’s the point of Fennimore’s appearance rather than to lend the title his marquee value? He doesn’t solve the problem — and what exactly was his plan? Gang up on the kids with an extinct bird and some local wildlife?

I can see the girl picking up trash, but what are the two boys burying in the back? The bodies of the last animals that tried to gang up on them? The only clues that could connect them to Mr. Brown’s disappearance?

This PSA was published in DC comics from September 1950, including Action Comics #148, the source of this scan. The script — as always — was by Jack Schiff with art by Rube Grossman.

More PSAs

Tags: comics medicine psa frog dodo jack schiff grossman

I don’t know if that’s a nurse or a doctor (or a patient), but I do know that they have no idea how to wear head mirror (or clothes, apparently)

The Nurses was a prime time medical drama that ran on CBS for the 1962-1963 season. The following year, the name was changed to The Doctors and The Nurses and it ran for two more years. After that, the name was changed back to The Nurses and it ran as a daytime soap opera for another two years. The series followed wise Charge Nurse Liz Thorpe and young Student Nurse Gail Lucas as they went about their business at Alden General Hospital.

Gold Key published a comic on the show in 1963 that lasted for three issues. Today’s post covers the third story in The Nurses #2 (the first story, despite it being in a comic called The Nurses, was all about doctors, and the second story was a filler story about paramedics).

Friday Nurse Day #10:
The Nurses #2 “Give Me My Baby”

The nurses of the maternity ward are shocked to hear that a mother has given birth at home. A doctor and ambulance rush to the apartment to bring the mother and baby to the hospital, but the mother refuses. Grabbing two nearby police officers as witnesses, the doctor reports that the child’s life is in danger and declares the mother mentally incompetent and unable to make decisions. He then sedates her and has her and her baby brought to the hospital.

When the mother awakens at the hospital, she accuses the nurses of kidnapping and trying to kill her baby.

The staff psychiatrist is called and diagnoses her with post-partum depression, but he reports that her case seems more severe than usual. Meanwhile, the baby is discovered to have neonatal jaundice — too much bilirubin in the blood. He will need an exchange transfusion where is jaundiced blood is replaced with fresh blood a tiny amount at a time.

The mother remains convinced that the hospital is trying to kill her baby. In the middle of the night, she grabs her child and sneaks out of the hospital. Desperate to find the sick baby, one of the student nurses, Nurse Lucas, goes on TV to appeal to her.

A short time later the mother calls the hospital and arranges to meet Nurse Lucas who arrives to find the baby feverish and the mother frantic. We finally learn why the mother is so scared of hospitals: her first child died at the hospital shortly after birth — the reason is never explained — and her husband made her promise not to take this baby to the hospital, and then he shipped out with the merchant marine. Nurse Lucas convinces the mother to bring the child back to the hospital. The exchange transfusions resume and the baby will soon be healthy enough to go home.

Vitals:

Published: July, 1963 by Gold Key Comics

Cover price: 12¢

Time Capsule: There are a number of things that mark this as a story 40 years old:
1. Giving birth at home, while still rare, is more accepted today and would not stun the nurses with its audacity, they way it happens here.
2. The treatment of neonatal jaundice has seen substantial advances. It is now usually treated with special lights — bili-lights — that help the body break down and clear the excess bilirubin faster. These lights can be in the form of a special blanket, or for more severe cases, several banks of lights. Bili-lights weren’t introduced to America until 1968, five years after this comic was published. Currently, exchange transfusions are only used in the most severe cases of neonatal jaundice.
3. Maternity wards are the most secure places in any hospital. You can’t even go near an exit door holding a baby without setting off an alarm. Not to mention there are CCTVs at every exit. There’s no way the mother would be able to sneak out with her baby like that.
4. In the story, ten days is considered a normal length of stay in the hospital after delivery. Nowadays, you hope for twenty-four hours.

Most progressive moment: Sorry, there’s nothing progressive at all in this story.

Inexplicable: Every doctor in this story is a real ass. First, the doctor in the apartment decides with no proof that the baby’s life in danger, and then declares the mother mentally incompetent — with no proof other than she disagrees with him (for a good reason, we later learn) — and then to add insult to injury, he sedates her just to shut her up. Then the psychiatrist is incompetent as well. The mother is angry and scared, maybe more than normal, but shows no signs of depression. He sedates her too — I think I see a pattern here.

Previous Friday Nurse Days:

I am out of town at C2E2 so this week’s Fringe Review won’t be up until Sunday evening. Karl should have his up on time…probably.

I apologize for the delay in posting this week’s Fringe episode evaluation. An unexpected confluence of sick kids and accident-prone family members led to multiple trips to the doctor and a general gumming up of the works.

This week was good because we got to see our universe’s version of Agent Lee, but bad for about everything else. Poor science, unnecessarily creepy soap opera, and a continuing of the trend toward predestination and away from science spelled doom for this episode.

The Plot: This episode takes up shortly after last episode ended, with William Bell’s soul in control of Olivia’s body. Together, s/he and Walter are trying to find another body for the permanent housing of Bell’s soul. At one point, they even consider putting Bell’s soul in Gene the cow.

Meanwhile, the Fringe Team is called to investigate the case of a pair who committed suicide together by plunging of a tall building. The man died, but the woman walked away with minimal injuries. Another FBI agent appears – our universe’s version of Lincoln Lee – and tells the team that he’s been tracking this woman for months. Her name was Dana Gray and she was shot and killed along with the rest of her family in a home invasion eighteen months ago, but her body disappeared from the morgue. Since then, she has been witnessed walking away from at least four double suicides.

The tem first hypothesizes that she is a “soul vampire,” using the souls of the suicides to prolong her life. Later, after discovering that she is working at a suicide hotline and is their best employee, personally saving nearly forty people, the team suspects that she is instead trying to hitchhike on the soul of someone else who is dying. At one point, a suicidal man tells her that he has placed a bomb on a train, and tells her specifically where. She decides to catch that train and sit in the specific seat, so that either/or she’ll be blown to little bitty pieces, or there will be more souls to catch a ride with. Regardless, the Fringe Team is able to figure out where she is and stop the train. She escapes with the bomb. She drops it in a field and runs away – but not far enough, as she’s found shortly after the bomb explodes – dead.

1. 22 Grams
Remember the end of V: The Final Battle where Elizabeth, the magical hybrid girl, saves the day with her strange mystical powers? While that ending may have tied off all the appropriate plot strings, it left no one satisfied. I fear Fringe is going that route since they seem to replacing most of the science (even the bad science) with talks of “fate” and such similar mystic concepts for the couple of episodes.

2. Nice Sine Waves
Bellivia (I’ll go with Karl’s portmanteau here, it was better than my own concoction of “Olivilliam”) was wearing at least a dozen EEG electrodes, so there should have been at least that many tracings, not just two. Each particular electrode just measures the summed electrical activity detected at its particular location by showing a flat line (neutral activity), an upward deflection (electrical activity toward the electrode) or a downward one (electrical activity away from the electrode). Since each electrode, and the EEG as a whole, just detects summed activity, it is impossible to split out two components, as seen in the episode.

3. It’s Electric, Boogie Woogie Woogie
EEGs detect electrical activity in the brain. This is entirely different that actually reading someone’s thoughts.

4. There Is Nothing Like a Broad
Yes, it is true that electromagnetism plays a role in biology. However, Bell and Walter so grossly overspimplify, overgeneralize, and mangle their description of its actual role to render their entire description meaningless.
If Dana’s molecules want to remain attached to each other, why has she not died long ago of some sort of nasty clot, such as a pulmonary embolism, heart attack, or stroke. If you prefer to remain at the purely molecular level, she’d still be dead. For example, she would have died from status epilepticus from all her neurotransmitter molecules adhering together and permanently sticking to their receptors.
Ions play an important role in the body’s cellular processes. Many pathways exist to remove these excess ions. If these pathways are overwhelmed by too many ions, then bad things happen, such as lethal heart rhythms that occur with hypercalcemia or hyperkalemia (too many calcium- and potassium-ions, respectively).

Too much talk of “fate” and “destiny” and too much bad science. The Fringe Doomsday Clock moves a minute closer to midnight.

This week’s Fringe cipher was: ERODE.
A list of all previous Fringe reviews is available here.
Karl has more to say, as always, over at his blog.

Gary and Udabac led this week with 6 points.

Overall, Jamie Ptremains in the lead with 64 points. Gary and Tippi move into a tie for second with 58 points. Corien drops to fourth with 53 points. Fran and atg are in fifth with 52 points. If your score is 43 points or higher, you are in the top 10%.

Click here to see the full scoreboard.

The episode started good, but went off the rails quickly, then slammed into a brick wall with the ending. And monster trucks.

After a pair of boys accidentally set a homeless man’s arm on fire, he notes that his charred skin smells like licorice and then he collapses, unconscious. He is admitted to the hospital and then to House’s team because House finds the symptom of dysosmia (an altered sense of smell) intriguing. It is noted that the differential diagnosis of dysosmia is extensive, covering everything from environmental factors to early degenerative brain disease. House has the patient started on prednisone while having the team check out the park where he was living. The prednisone does nothing to alleviate his symptoms — the dysosmia continues. The search of the park turned up the patient’s backpack, which contains a syringe and several vials. The patient swears the vials are just vitamins he’s been giving himself, but the team is understandably suspicious of drug use. He refuses to divulge his name, but his backpack also contains several paperback books with the name Danny Jenkins in them, so the team decides that must be who he is. Danny suddenly starts complaining of stomach pain and his stained gown and sheets provide ample evidence of gastrointestinal bleeding. It turns out that the vials in his bag were vitamins, and his urine drug screen was clean. However, a drug test of his hair shows heroin use within the past five months. This leads most of the team and House to diagnose Danny’s symptoms as a result of hypervitaminosis A and snorting heroin (the high levels of vitamin A caused the gastrointestinal bleeding while the drug snorting caused the altered sense of smell). M³ disagrees, concerned that they may be overlooking a bowel obstruction. To appease her, House lets her x-ray his abdomen. There is no obstruction, but there are thirteen small sharp-edged masses within the walls of his colon. They don’t look like cancer, and parasite studies have been negative, so House suspects a fungal infection. He orders Danny started on amphotericin B, an anti-fungal medication. He also orders a colonoscopy which reveals thirteen small pieces of bone. M³ thinks he may have pica, but Danny admits that he ate the bone purposefully because sometimes one of the local chefs will give him actual food to eat if he acts like a carnival geek.

Danny now develops severe tunnel vision, telling the team that it’s like he’s looking up from the bottom of a well. With this new symptom, and disregarding the gastrointestinal symptoms of being a result of his bone eating, the differential diagnosis is now Western Equine Encephalitis (a mosquito-borne viral disease), or Foster Kennedy Syndrome due to a meningioma or plasmacytoma pressing on some of the cranial nerves. House favors the latter and an MRI is ordered. Danny becomes ill while in the MRI machine, but the team discounts it, explaining it away as a result of a panic attack from claustrophobia (and apparently they were correct). The MRI reveals two dark spots in his parietal lobe. They could be something he was born with, a sign of an old injury, or House suspects it is a sign that Danny has schizophrenia. Danny is started on Clozapine to treat the suspected schizophrenia, but doesn’t get better. As usual — on House at least — his condition worsens and now he complains of severe burning pain in his non-burned arm. This time the team suspects a regional pain disorder due to some as-yet-undiagnosed genetic disorder. House mentions that there are dozens of possibilities, but Parkinson’s, Huntington’s, and cortical basal ganglionic degeneration are name checked. Testing for them all would take too long, so he wants the team to track down Danny’s family and see if any of them have similar problems. They succeed in tracking down Danny Jenkin’s father, but unfortunately it turns out the real Danny Jenkins died of a drug overdose three months ago, meaning whoever their patient really is, he’s not Danny Jenkins.

House questions faux-Danny, but he still won’t give his real name. During their conversation, House notices that faux-Danny is exhibiting cerebellar ataxia, which narrows down the list of genetic maladies to one: early onset Parkinson’s disease. He has Danny started on levodopa, a Parkinson’s drug, and orders a DNA test for Parkinson’s. Later when faux-Danny is talking to M³, he complains of dizziness and then goes into cardiac arrest. He survives, but now has a “dilated and failing heart.” House is perplexed to the reason faux-Danny’s condition has steadily worsened since arriving at the hospital — much quicker than one would expect. He ultimately deduces that it is due to the healthy vegetarian diet faux-Danny has been getting at the hospital — better than anything he got while homeless. He realizes that he has Adult Refsum Disease, a genetic condition where his body cannot, according to House, break down the chlorophyll in plants. He is placed on plasmapheresis to remove the buildup of the toxic chemicals, and should improve by just carefully watching his diet.

For a better take on a doctor’s regret at saving the life of a serial killer, I strongly suggest the manga Monster, by Naoki Urasawa.

As usual, major complaints are in red, modest complaints are in blue, and nit-picking ones in green:

Refsum disease comes from having the particular genetic disorder and eating a diet high in dairy and beef — not vegetables (admittedly, the cattle get phytanic acid from eating plants, but we humans get it from them. We can’t get enough from plants to matter).
Regardless, the symptoms of Refsum Disease do not fit Danny’s presentation or symptoms.

Cerebellar Ataxia is not one of the movement disorders associated with Parkinson’s disease. It is associated with a host of other genetic diseases however.

Intestinal obstruction could explain the abdominal pain, and possibly the rectal bleeding, but M³’s idea was to tie all his symptoms together into one diagnosis. How does a bowel obstruction explain the dysosmia?

Clozapine is not a first-line agent to treat schizophrenia. It is very effective, but it has some all-too-common nasty and potentially fatal side effects that require regular testing, so it’s not something you’d give a homeless man.

How does running a genetic test in a hospital get the patient’s DNA entered in a national FBI DNA database? That’s a pretty significant violation of current privacy laws — the patient has not been convicted, or even accused, of committing any crime. Not to mention, the DNA testing for Parkinson’s and law enforcement DNA databases are quite different.

I mentioned this recently is a previous episode, but here it is again: levodopa is not given by itself. It is always used in combination with carbidopa to minimize the common side effects.

Though “polyneuropathy” was mentioned as a symptom, technically the patient only exhibited mononeuropathy – only his left arm was affected.

I can find a single study suggesting that help with certain aspects of hypervitaminosis A in rats, but nothing about it in actual humans.

Giving Zinc to someone with dysosmia is not a good idea, as zinc has a high chance of screwing up the sense of smell itself.

This week’s medical mystery started off well and managed to keep the mystery going through most of the episode. I give it an A. The final solution doesn’t fit the symptoms, or the purported cause. I give it a D-. The medicine was better than last week, but not better than average: it gets a C. The soap opera was stupid — you don’t have a greencard wedding by having everyone know upfront it’s fake. Unbelievable, even for House. I did like the monster truck, and bonus points for the Superman II quote. Still, the soap opera aspect earns a mere C-.

The review of the previous episode of House
A list of all prior House reviews

In the sixties, Gold Key comics included several public service ads they referred to as “information features.” “Collect the whole series for useful knowledge,” was their slogan. These features covered a variety of topics up to and including fish, and this particular PSA is number twelve in the fish series. I ran across it on the inside back cover of The Nurses #2.

As you might suspect from the title alone, this PSA is filled with dubious information and downright mistakes. To put it simply, this is probably the worst PSA I have ever seen.

1. First, the obvious: porpoises are not fish. Nowhere in the entire PSA does it mention this important fact, or even mention the word “mammal.”

2. Though purportedly about porpoises, all but one panel in this PSA are actually about bottle-nosed dolphins, a completely different species (not to mention a different genus and family as well).

3. There have been a handful of cases of humans killed by dolphins, though they pretty much can be attributed to accidents or aggression on the part of the human. I like the way they use the qualifying phrase “in the water,” because when you get them on land, those dolphins sure are mean bastards (actually, I suspect the phrase is there so they can ignore the cases where dolphins mistimed jumps over boats and accidentally crushed people).

4. I call utter BS on that last panel. There is no way that any reputable scientist actually believes that dolphins learned their whistling from humans.

More PSAs

Tags: comics medicine psa frog dodo jack schiff grossman

This is the third of three stories from the aptly names Three Nurses #19. The first was “Death Trap” and featured Student Nurse Lee Barry. The second, “Blindspot“, starred Registered Nurse Anne Allen. This final story concerns Visiting Nurse Nancy White — who provides nursing services to the local tenement.

Friday Nurse Day #11:
Three Nurses #19 “The Flat Next Door”

The story starts with a rather overdone introduction:

Visiting one of her patients in an old apartment building, Nurse Nancy White hears about Mrs. Kopek, the neighbor in the next apartment, a young woman who is pregnant and due to give birth any day now. Nurse White decides to stop by and she if needs any help.

Mrs. Kopek declines any offer of help, and also denies that she’s going to have a baby. Acting on a hunch, Nurse White stops by the police station and asks if there have been any recently abandoned newborns. Sure enough, a baby was left on the doorstep of a nearby orphanage a few days ago.

Nurse White heads back to the Kopek’s apartment where she overhears the young woman and her husband talking. They are desperate for money, and the husband fears he needs to turn to armed robbery to support them.

Nancy steps in and informs him that violence and theft are never the answer. She then calls one of her friends and arranges a job for Mr. Kopek, one that includes a salary advance. And if that wasn’t enough, since the Kopeks now have some money, she has the police bring by the newborn son they had left at the orphanage. The Kopek family is reunited and presumably lives happily ever after thanks to the nosiness intervention of Visiting Nurse Nancy White.

Vitals:

Published: July, 1963 by Charlton Comics

Cover price: 12¢

Time Capsule: I don’t know how realistic it was even for fifty years ago, but there’s no way child services would return a baby that quick to a couple who had abandoned it. Sure, they’d want to return it, and likely would, but there would be days of paperwork, parenting classes, and social worker visits — just the thing to jeopardize Mr. Kopek’s new job.

Most progressive moment: Nurse White is frequently nosy and pushy, but never particularly progressive.

Inexplicable: There is some particularly bad art in this comic thanks to the pre-Photoshop use of photostat (or lightboxing). The artist has only drawn three different heads for Nancy (frontal, left-side view, right-side view), and every panel has one of these identical images placed on her body — many of which are copies as well. (This is not the worst example of this I’ve run across, that dubious honor goes to Ben Casey #4)

For bonus inexplicable content, have fun with this stripped-of-context panel:

Back to the alternate universe to deal with Fauxlivia’s pregnancy. This episode had its share of “fringe” science and medicine and was clearly written to advance advanced the overall plot before the season ends. It was nice to see Agents Lee and Charlie finally getting a clue.

The Plot: Fauxlivia and her mother at the obstetrician, where Faux is being tested for viral propagated eclampsia (VPE), a disease which usually proves fatal to mother and child. Faux is at high risk for the disease because her sister Rachel had it.

After she gets home from the doctor, Faux is tasered and kidnapped and brought to one of those warehouse-turned-into-an-operating-room that television dramas love so much. Both she and the fetus are injected with a number of medications.

Agents Lee and Charlie take off to find Fauxlivia, but her implanted tracker – a big government secret – has been removed. Mentat Astrid points them in the direction of a suspicious car that’s been seen a lot near Faux’s apartment, which leads Lee and Charlie to cab driver Henry, from earlier in the season. He has nothing to do with the kidnapping, but he tells enough to the agents that they finally begin to realize the truth about the Olivia/Fauxlivia switch. Lee ultimately talks to Walternate about the situation, and he admits the switch, and also tells Lee that that Fauxlivia is carrying his grandson.

Back in the warehouse/OR, the medical team keeps feeding Fauxlivia sedatives and painkillers. They continue with their treatments, and it is soon obvious that somehow managed to advance her pregnancy, to that point that Faux now appears to be full term.
Resourceful as ever, Faux manages to escape from the facility and finds herself lost in Chinatown. She gets a call to Agent Lee, and he — with the assistance of Henry — manage to arrive just as she is going into labor. Henry delivers the child, and — miraculously — the treatments Fauxlivia received not only advanced her pregnancy, but managed to protect mother and child from VPE. As the episode ends, Walter stops by to visit Fauxlivia and his grandchild, and we learn that he and alternate-Brandon are somehow connected to the kidnapping.

1. That Is A Weird Shaped Baby
NURSE: “Abdominal circumference 160, head circumference 170, biparietal diameter 40”
I can’t speak for the accuracy of those numbers since they never mention the units involved (though I would guess millimeters), and we don’t know how “far along” Fauxlivias pregnancy was. However, I will note that the biparietal diameter is a measurement of the head circumference at its widest point so should not be less than the head circumference, particularly that much less.

2. Might As Well Stop Testing At That Point
If you’re testing your patient for wakefulness by checking her pupils and you have to tell her to stop moving, it’s a good indication that she’s awake.

3. They Really Didn’t Plan Very Well
If you’re so intent on sedating your patient, then putting a Foley catheter in place would make more sense that escorting her to the bathroom, especially if you’re on a strict timeline.

4. Building Blocks
I covered this in one of the first Fringe episodes, but all that mass for the baby to grow has to come from somewhere. That’s why mothers “eat for two.” The pregnancy timeline may have changed, but the baby’s requirements haven’t. Fauxlivia simply cannot support the pregnancy advancing that fast.

5. True Blood
Assuming that use the same units we do, then a hemoglobin of 6.7 is not borderline, it’s very low. Transfusing units of plasma won’t do a thing to correct it, because by definition plasma does not contain any red blood cells (and therefore hemoglobin). Twelve units is a helluva lot of fluid too.

6. HELLP
Eclampsia is a real condition, also known by its older name: toxemia of pregnancy. It generally doesn’t tend to occur until fairly late in the pregnancy and the definitive treatment is delivery. It is not viral.
VPE, as presented here, is a puzzle. Being viral suggests it is contagious, yet no mention is made of that face. There is a suggestion of a genetic link as well in that Fauxlivia’s risk is very high because her sister had it – yet clearly her mother never had it.
80% is weird risk number; it’s not something that usually shows up in biology, unless maybe it’s a genetic condition with variable penetrance. Which wouldn’t explain the viral part.

7. More Poor Planning
Pills take time to work, they don’t take effect instantaneously. Sublingual tablets are the fastest oral medication, but even they take some time.
All that advanced medicine and they don’t give her pain medication via injection? Not to mention that it’s hard to make sedated people swallow.

8. Alternotes
Apparently Typhoid is a still a risk as their are posters advising people to get their typhoid immunizations (which do really exist, they are just not used routinely in this county).
West Wing, season 12.
Opus the Pea-Hen, instead of Opus the Penguin (from Bloom County, and then Outland and then Opus). And apparently Berkeley Breathed is still writing newspaper comic there, rather than writing children’s books that turn into movies that bomb.
Coppola directed Taxi Driver instead of Scorsese.

An episode clearly designed to advance the uber-plot, and full of bizarre medicine and science, but still enjoyable. The Fringe Doomdsday Clock stays put.

This week’s Fringe cipher was: FATED.
A list of all previous Fringe reviews is available here.
Karl has more to say, as always, over at his blog.

UPDATE: It turns out the Opus the Peahen strip was actually written and drawn by Berkeley Breathed, so kudos to Fringe for pulling that off. Here’s a link to the full comic.

Now where have I seen this before? (Not that I’m suggesting anything untoward is going on here. It’s an old joke, made independently hundreds of times, if not more.)

While DC Comics was publishing their wide range of monthly comic book public service ads and Gold Key Comics was putting out their “Keys of Knowledge” PSAs, Charlton Comics had their own series of monthly PSAs — ultra-patriotic ones that dealt with American history.

I’ve posted a few of this series before (Pioneers! Immigration! The Cold War!), and here’s another one, this time on John Paul Jones. (The weird angle of the page is not bad scanning on my part, but the way it was printed. Charlton was infamous for skewing the pages.)

More PSAs

Tags: comics psa charlton john paul jones american history

I watched the pilot episode of Body of Proof last night. It’s the new hour long drama on ABC starring Dana Delaney as Megan Hunt, a neurosurgeon turned medical examiner.

Let’s be honest, there was no way I wasn’t going to watch it, because:
1. It stars Dana Delaney
2. It’s a medical police procedural
3. It stars Dana Delaney

So how was it? Fair. I think many of the problems were due to it being the pilot episode and will hopefully be better in later episodes. I’ll give the show at least another chance or two (did I mention Dana Delaney?).

More thoughts:

The show was trying way too hard to tug the heartstrings and most of the attempts at pathos were clumsy at best, painful at worst. That whole speech at the end about not knowing the patient because she didn’t know about a tattoo or old arm fracture? Ridiculous.

If the victim suffered anaphylactic shock then her airway would have closed off — meaning she would not have drowned when she fell in the water (she’d still be dead, just not drowned. That would have made for a better hook anyway: a dry drowning).

You can’t match Amoxicillin like that; it’s a common and relatively simple chemical. At best, they’d be able to tell that the victim had been exposed to Amoxicillin from the same manufacturer, or even possibly the same batch, as the one in the house – leaving lots of reasonable doubt – but they wouldn’t be able to pinpoint it that specifically.

The best attorney in Philadelphia is going to let police search his house without a warrant? Nonsense.

I don’t care if they’re old friends or not, giving Dana Delaney the lawyer’s name was a huge ethical no-no (not to mention a costly HIPAA violation). If he’s even just a halfway decent lawyer, it won’t take him long to figure out who provided her with the data. (She was seen in public having lunch with the lawyer’s Urologist and later that day accused the lawyer of murder, using the private knowledge of his vasectomy as proof. Hello, Urologist, meet big lawsuit and federal fine. $$$$)

If you don’t check electrolytes on someone suspected of having died from heat stroke, you shouldn’t be working in the medical examiners office.

The plot relied too heavily on coincidences, such as:
There’s only one attorney who had a vasectomy in an entire firm of lawyers.
There’s only one Urologist he would have gone to for the procedure, never mind that most general surgeons and family practitioners do it as well. It’s a simple twenty minute procedure with a low complication rate, not the sort of thing you’d need “the best” for.
The victim had a true anaphylactic allergy to penicillin, and not just a rash or some stomach upset or diarrhea (as the vast majority of most people who claim an allergy to penicillin actually have).

I did think it was clever that the murderer was able to deduce the penicillin allergy based on the fact the victim was on Erythromycin for Strep throat.

Neurosurgeon who can’t operate any more due to a hand nerve injury from a car accident? Megan Hunt must be Dr Strange.

I’m sure I’ll add more thoughts as they occur to me later. This was a show chock full of Fridge Logic.

Seeing a group of notorious smugglers chase and repeatedly attempt to capture a certain whale, Aquaman becomes suspicious. So he does what any right-thinking underwater hero and sometimes monarch would do: he builds his own x-ray machine.

First, he finds a large, completely transparent sea shell¹ and rubs it down with some silver nitrate². Next, with the help of a a thousand glowing ray fish³ and a bunch of electric eels⁴ he makes an x-ray emitter.

He places his improvised device against the belly of the whale and snaps a shot⁵.

After developing the x-ray⁶, Aquaman finds what he was expecting: a large diamond⁷. The whale had swallowed it and the smugglers were chasing the whale trying to recover their prize.

NOTES:
1. Convenient.
2. It’s nice that he was able to find pure silver nitrate on the ocean floor — and then was able to rub it on the clear shell — despite the fact that silver nitrate dissolves readily in water.
3. Not sure what these ray fish are, but I guess it’s theoretically possible that they could emit electromagnetic waves in the x-ray spectrum – though they wouldn’t be glowing visibly.
4. Nice try, but electric eels are fresh water fish.
5. Here’s the biggest problem: for an x-ray to work, you need the emitter on one side of the subject area and the plate on the other side. Aquaman has the emitter and plate on the same side of the whale.
6. Again, the chemicals used in developing film are water soluble making it hard to develop film underwater. At least they acknowledge the need for darkness.
7. That’s an impressively detailed image for an x-ray.