This PSA is about Admiral Richard E. Byrd and Operation Deep Freeze. The great Alex Toth is listed as the artist on this page.

For conspiracy fans, there seems to be some legitimate controversy whether or not Byrd flew over the pole as he claimed. For even bigger conspiracy fans, there’s a (highly ridiculous) claim that Byrd found an opening to the hollow earth, but had his reports confiscated by the government.

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Be warned that nursing is only a small part of the story this time, as this is a clearly a message comic, and a rather heavy handed one at that. Still, it’s a good topic to visit, even now — maybe even especially now — fifty-three year later.

Friday Nurse Day:
Three Nurses #21 “Color Her White”

Student nurse Lee Barry is having trouble in nursing school again. Nurse Johnson, one of the instructors, seems to be unfairly picking on her and has even tried to provoke Lee into hitting her.

Frustrated, Lee leaves the class only to encounter Dr. Chris Hobart in the hospital hallway, a young intern with whom she’s been flirting. They chat for a while before the hospital Chief of Staff comes around, introducing Dr. Evans, a visiting cardiac surgeon who has developed a new cutting edge surgical technique. Discovering that the esteemed Dr. Evans is black, Chris makes several horribly racist statements and storms away. Unfortunately, he’s not watching where he is going and runs right into a surgical nurse carrying a tray of equipment, and collapses, his heart pierced by a scalpel.

As luck would have it, Chris’s life-threatening heart injury is just the sort of situation Dr. Evans designed his surgery for. He, along with Linda and the Chief of Staff, jump into action, and quickly get Chris into emergency surgery. Though it is touch and go, Dr. Evans is able to save Chris’s life.

After another encounter with Nurse Johnson, Lee gets one of her friends to surreptitiously look through Johnson’s personnel file in an attempt to find out what she has against Lee. Strangely enough, Lee leans that Nurse Johnson is from her own hometown. Puzzled, she calls her mother to see if she knows Johnson.

Later that day, Chris wakes up from surgery. Realizing the error of his ways, he humbly apologizes to Dr. Evans.

Lee tracks down Nurse Johnson and confronts her. It turns out that Johnson is from a light-skinned black family and is “passing” as white. She has been trying to get Lee to quit school and leave, convinced that Lee recognizes her, knows her history, and will tell everyone her secret. Lee promises she won’t tell, but then berates Nurse Johnson being ashamed of her race.

Vitals:

Published: November, 1963 by Charlton Comics

Cover price: 12¢

Time Capsule: In addition to the pervasive prejudice and racism in the story, Dr. Evans calls for adrenalin (we now call it ephinephrine, at least in the United States; it’s still called adrenalin elsewhere). Also, one of the other surgeons requests plasma, something rarely used anymore during surgery or emergency fluid resuscitation.

Most progressive moment: Lee is not afraid to her beau’s racism, and she stands up to — and for — Nurse Johnson as well.

Inexplicable: First, why is someone carrying a tray of loose scalpels through the crowded hospital hallways?
Second, Dr. Evans is clear that time is of the essence in heart surgery: “Therefore extended surgery is almost always certain to prove fatal! This technique is designed to to drastically shorten surgery time!” Then he spends four panels lecturing.

With winter finally getting started in much of the nation (though no snow here in southern Illinois, much to my son’s disappointment), this seems like a good time for the first of two Antarctica PSAs. Today, “Antarctica – The Frozen South,” from Dell Four Color #845: The Land Unknown.

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Today I’m going to look at the initial story from the first issue of Three Nurses (which is actually issue #18, as Three Nurses continued the numbering from an earlier comic, Confidential Diary).

Friday Nurse Day:
Three Nurses #18 “Confidential Diary of a Student Nurse”

Lee Barry as always wanted to be a nurse, as she puts it in her diary, “to me the nursing profession is the finest and noblest way of life a woman can achieve!”

Unfortunately, when Lee actually starts nursing school, she has problem after problem after problem — she can’t figure out how to wear the uniform, she is unable to manage hospital corners, and she falls asleep in class.

Then, while watching her first dissection during anatomy class, she faints.

When Lee awakens, she decides that she’s not really cut out for nursing school. “Maybe for Bess, for the others, but not for me! I can’t take it! I can’t take any more! I can’t spend my life dealing in misery, pain and death!”

Lee packs up her bags and leaves the school, running out into the rain (because of course it’s raining).

Suddenly, a car crashes into a tree in front of her. She runs to help along with a nearby police officer and a passerby. Despite dispensing poor medical advice (a tourniquet, really?), the others defer to her experience (such as it is) and she’s delighted when they call her “nurse.”

As she arrives with the patient back at the hospital, she decides to give nursing school another try.

A few nights later, she is having dinner out with her fiancé Jim when he drops a bombshell, informing her that if she wants to marry him, she needs to quit nursing school. Among other things, he tells her, “I don’t want my wife to work, and especially as a nurse — bringing home all kinds of germs, exposing herself to disease!”

He gives her a week to make up her mind.

Lee returns to the school where she has been assigned to the maternity ward. One of her patients has a rough delivery, and at first it looks like the baby didn’t survive, but Lee is able to successfully resuscitate the baby. The doctor compliments her on her skills, telling her that she will make a “fine nurse.” This seals her decision; she meets with Jim and tells him she’s staying in school and the wedding is off.

Vitals:

Published: May, 1963 by Charlton Comics

Cover price: 12¢

Time Capsule: Residential nursing schools for RNs aren’t very common anymore — there’s maybe one left in St Louis where there were once at least half a dozen. Now, most RNs earn their degrees at a four year college, or at least a community college.

The delivery scene was a sign of the times, for sure. The father, though mentioned, was nowhere to be seen. Then, when the mother was understandably nervous and frantic after the difficult delivery, the doctor knocks her out with a sedative rather than letting her see — or even hold — her own child.

Most progressive moment: Nothing very progressive here at all, I think the opening diary scene actually set things back a few years.

Inexplicable: The delivery scene. We’re told the mother is in “violent labor” and yet the doctor is nowhere to be seen. Lee enters the room herself, bends mysteriously over the bed — and the by the time the doctor walks in, the baby is cleaned, swaddled, and apparently has had his cord clamped. That’s the easiest “difficult delivery” I’ve ever seen.

This has got to be my new favorite classic comic book ad. Accordions? Was there a really enough demand for accordions to place a half-page ad in, of all things, a nurse romance comic?^1,2

1. Three Nurses #23 (Charlton, March 1964)
2. Probably not, because this is the only comic I’ve ever seen the ad in.

I. DR. STRANGE’S INJURY
The heart is surrounded by a tough fibrous membrane called the pericardial sac. This membrane fits tightly around the heart, with just a few milliliters of fluid in between the two. If extra fluid gets into the pericardial sac, say blood from a stabbing injury, then a situation known as “tamponade” occurs. Because the pericardium is too tough to expand, all the extra fluid instead pushes down on and compresses the heart. Compressed, the heart is unable to expand, or even beat, leading rapidly to an emergency situation. Clinically, tamponade presents as acute heart failure with Beck’s triad¹: distended jugular veins, muffled heart sounds, and pulsus paradoxus (a large drop in blood pressure during inspiration).

The treatment for tamponade is to drain the extra fluid out of the pericardial sac, but it’s a tricky procedure because the heart is hidden behind the rib cage, and even in tamponade situations, the pericardial sac is not separated from the heart by much. The doctor needs to get the needle into the pericardium and drain the fluid without damaging the heart in the process. A needle can be slowly advance through the chest under fluoroscopic (i.e. x-ray) guidance, but this takes precious time to set up and not every hospital has access to the equipment. Cardiac tamponade is a life-threatening situation and time is of the essence. Emergency physicians needed a way to get the needle to right spot quickly and with equipment already on hand; they came up with an ingenious solution: a long needle is attached to a syringe and an electrical lead is attached to the back end of the needle and plugged into the heart monitor already attached to the patient. The needle is pushed into the chest and slowly, ever so slowly, advanced towards the heart. When the needle just barely touches the heart, there will be a noticeable blip on the heart monitor. The needle is then pulled back just a smidge so it is no longer touching the heart — at this point it should be in the pericardial sac². The syringe is then used to remove the blood filling the pericardium.

You’ll notice this is just what Dr. Palmer did to treat Dr. Strange’s tamponade: she got a syringe with a long needle and attached an electrical lead to it³. But then, before she could get much farther, Strange used his magic to make his skin translucent, so she could actually see what she was doing and was able to drain the fluid and relieve the tamponade.

At this point, Strange’s heart flatlines, and Dr. Palmer grabs the paddle and shocks it. I hope you all yelled (or at least thought), “Don’t shock a flatline!” Tamponade can certainly cause asystole (a flatline) but you treat it by relieving the tamponade, which she had already done, not by shocking the heart. Again, don’t shock a flatline — then she did it again! Admittedly, the reasons were story driven and not medical, but still she’s taking a chance, shocking a heart that’s beating normally — she could cause a dangerous heart rhythm, or a flatline, or even directly injure the heart. I’d also worry about the metal in the Eye of Agamotto causing a nice electrical arc, but maybe sorcerous metal isn’t conductive. The settings she used, 200 and 360 Joules, were reasonable — if you were shocking an actual fibrillation and not a flatline.

As a final thought, you’ll notice she sewed up the skin laceration from the stabbing, but doesn’t appear to have done anything (or had the time to do anything) to fix the internal injury — the one that bled into the pericardial sac causing the tamponade. Strange is likely to develop a tamponade again quickly if this internal wound is still bleeding.

II. THE ANCIENT ONE’S INJURY
When the Ancient One crashed to the ground, she suffered either a subdural or epidural hematoma⁴. These hematomas are caused by damage to the arteries surrounding the brain, which causes bleeding into the area around the brain. The pressure from this bleeding can’t expand outward — the skull is there — so the pressure pushes down against the brain. This increased pressure can decrease blood flow to the brain, causing brain damage. If the pressure is raised high enough, it can actually push the lower part of the brain — the brainstem — down through the foramen magnum (the hole connecting the skull to the spinal column) severely damaging it in a situation known as a tonsillar herniation. As the brainstem plays an important role in, well, life (such as breathing, the heart beating, the nervous system transmitting, etc.), damage to it can quickly turn fatal.

The emergent treatment for an acute hematoma like this is to carefully drill a hole in the skull to relieve the pressure. Even with quick treatment, these injuries are all-too-frequently fatal, not just because of the bleeding around the brain, but because of all the other injuries that are usually suffered at the same time (look how far she fell — and through a glass awning too — you know she was smashed and broken all over, not just the brain).

III. MISCELLANEOUS THOUGHTS
I know wearing glasses or goggles hides the actors’ all important eyes, but everybody in an operating room needs to wear eye protection — OSHA is really firm on this. Hell, in one OR scene, Drs. Palmer and Strange weren’t even wearing surgical masks.

There is a set procedure of scrubbing before surgery (seroiusly: we had classed on this in medical school). It is purposefully designed so that a clean area never comes into contact with a dirty one. Masks on first, then scrub in the sink fingers down to forearms. Then into the OR. If you put the mask on after you’ve scrubbed, then you’ve touched an unclean area (the mask) with your cleaned hands and need to start over.

Transplant teams are carefully regulated and have numerous guidelines to follow. They don’t just swoop in as soon as the patient is declared brain dead — that’s the last thing they’d do. They work hard to foster goodwill with the deceased patient’s family.

Exactly what kind of doctor is Doctor West? Neurosurgeon? Hand Surgeon? Transplant Surgeon?

A glaring HIPAA violation or two, in sharing patient information with Dr. Strange when he’s not involved in the patient’s care.

Is Dr. Strange even on the hospital medical staff when he start to operate on the Ancient One? Exactly how long was he gone?

Notes:
1. Long before the internet, facebook, and listicles, doctors developed numbered lists of signs and symptoms for dozens and dozens of different diseases and conditions. Most seem to be triads, but there’s the occasional pentad just to keep things interesting. Think of Beck’s Triad as the listicle associated with cardiac tamponade. You won’t believe number two!

2. This “advance the needle until you’re just a little too far, then pull back” is a common technique in medicine. I use it when injecting steroids for tennis elbow or trochanteric bursitis. In those cases, it’s advance the needle slowly until you feel the bone, then pull back just a little and you’ll be in the right spot to inject the steroids. And yes, there is numbing medicine involved as well.

3. So kudos to whoever was the medical consultant for Dr. Strange for getting them to include this technique in the film.

4. There are several layers of membranes and blood vessels surrounding the brain — the level at which the injury/hematoma occurred gives the injury its name. There are some slight differences in cause and symptoms between epidural and subdural hematomas, but for the purpose of this post, either could be the cause.

Here’s a couple images regarding the dangers of smoking, which everybody already knows, right?

Then here’s my favorite picture of misplaced priorities:

Finally, here’s a couple of actual comic-book related smoking links:
PSA: Smoking is for Squares
Spider-Man, Storm, and Power Man Battle Smoke Screen
A post looking at Doctors and Smoking

Superman plays with his mineral collection in this scene from Action Comics #550.
Some great samples here, including amnesium, trolium, arsite, vrolite, and delite.

With the Presidential election tomorrow, here is an appropriate PSA from Justice League Quarterly #9.

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In Uncanny X-Men #17, Cyclops strands his students in tabula rasa, and Celeste (one of the Stepford Cuckoos) tries to read the mind of some of the local inhabitants with — shall we say — mixed results.

All previous Psychic Nosebleed Zen posts.