Popular Mechanics talks about the science of Episode 201… by Erin McCarthy
Fringe Season Two Premiere Misrepresents Head Trauma
In the first season finale of Fringe, we left FBI agent Olivia Dunham in an alternate dimension where she was to meet with mysterious Massive Dynamic CEO William Bell. (His offices were located in the still-standing Twin Towers and, oh yeah, JFK is still alive. So are all of the Beatles … and they’re on a reunion tour.) In the second season premiere, “A New Day in the Old Town,” we didn’t find out just what Dunham and Bell talked about—but we did get a healthy dose of medical pseudoscience. Popular Mechanics talked to Justin Sattin, an assistant professor of neurology at the School of Medicine and Public Health at the University of Wisconsin and medical director of the UW Health Comprehensive Stroke Program, to separate the fact from fiction.
Two cars collide in the opening moments of “Old Town.” A man, bleeding, stumbles away from one car, but the SUV is more of a mystery. Supposedly, it was being driven by Agent Dunham, who is nowhere to be found. “No one saw anyone leave the SUV,” says FBI Agent Amy Jessup. “The doors are locked, the seatbelt is buckled, the airbag is deployed, but there’s no indentation—implying that no one was behind the wheel at the moment of impact.” As mad scientist Walter Bishop and his son Peter investigate the scene, the car’s electronics go wild—and suddenly Dunham comes crashing headfirst through the windshield and lands on the pavement. In the ER, doctors say she could potentially have brain herniation; the doctor’s final analysis is that Dunham’s injuries “were too severe. We were unable to restore any brain function. Patients who suffer this kind of head trauma simply don’t regain consciousness.”
An important part of a neurologist’s duties includes assessing whether a not a patient has brain activity after a devastating head injury, neurologist Justin Sattin tells Popular Mechanics. But Fringe’s analysis of Olivia’s condition—particularly the term “brain function”—is vague. “It doesn’t have a precise equivalent,” he says. “Usually when we say that the prognosis is poor after something like a head injury, it means that the person is unlikely to regain the ability to take care of themselves independently.” A poor prognosis has a whole spectrum of results, from people who can converse with their families but need assistance for getting into bed or using the lavatory to those who are in a persistent vegetative state. And then there’s brain death, where there has been “a cessation of all functions of the brain and the brain stem which is the part that does the automatic things like blood pressure,” Sattin says. In that case, patients are usually placed on a ventilator, which breathes for them. “When it’s clear that they have been so neurologically devastated by a trauma, the prognosis is poor, and the advanced directive states that they wouldn’t want ongoing medical treatment, then withdrawing medical care in that circumstance usually involves removing the ventilator.”
According to Dunham’s sister, Rachel, Olivia had a living will that stipulated no life support; doctors plan to remove it in the morning. But when we see Dunham, she isn’t hooked up to any equipment. She looks, instead, like Sleeping Beauty—a common depiction of comatose patients in pop culture that a study found impacts the public perception of coma. If Dunham’s brain was herniated, Sattin says, she definitely would have been on a ventilator. “Herniation refers to the situation where the pressure inside the head is increased due to brain swelling from trauma or stroke, or the addition of something that shouldn’t be there, such as a tumor or hemorrhage,” he says. “Because the brain is encased in the bony skull, there is only so much extra room, and eventually the brain will become deformed and squeeze into various crevices in an attempt to decompress. Squeezing of the brain in this way imperils the patient’s life and requires immediate attention with medications, mechanical ventilation and often surgery.”
Dunham also would have had a feeding tube, that provides her with food, water and medicine. Nurses insert the tube through the nostril, down the throat and into the stomach. “To be devastated to the point where you’re discussing end of life, but there is no ventilator, no feeding tube, she’s just lying there looking angelic—that doesn’t jibe,” Sattin says.
Of course, if Agent Dunham was hooked up to a ventilator, she wouldn’t be able to come to, speaking Greek. And that’s another reason why Fringe’s depiction of coma, though dramatic, isn’t at all close to real life. “This whole idea that people pop out of a coma is silly,” Sattin says. “People recover slowly from these kinds of injuries. But again, if you are at the point when you are talking about end-of-life care, the idea that you’re just going to defy the odds and suddenly open up your eyes is incongruous. That the woman in the show would have impending herniation but yet not be mechanically ventilated and then suddenly wake up normal is preposterous.”
The bottom line, according to Sattin, is that this kind of a depiction of coma is “a disservice to the public” and gives false hope to families who have to make gut-wrenching decisions about their injured loved ones’ care. “I think that when families have this idea, because they saw it on TV, that the doctors could be wrong, and that tomorrow she could just pop out of it … that really poisons the discussion,” he says. “There’s enough ambiguity as it is—will their final outcome be on the better end or on the worse end of the spectrum?—without this nonsense that suddenly she’s going to open her eyes and sit bolt upright and ask what month it is. Although it’s kind of funny how off it is, from the perspective of somebody who deals with families in this situation quite frequently, it actually hurts the cause by setting these unrealistic expectations.”