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Becker ran from 1998 to 2004 and featured Bronx based general practitioner John Becker, a heavily flawed but lovable human being played by Ted Danson. The show had 129 episodes.

Posted on April 06, 2014 at 7:17 AM


Joyce, thanks for your question. Here are a few pearls to help you when writing about paramedics. First, you need to be careful of terms. The term “paramedic” is often mistakenly used to refer to all emergency medical personnel who respond to events outside of a hospital setting. In the USA there are generally three types of Emergency Medical Technicians (EMTs): basic, intermediate, and paramedic. As you might guess, paramedics are the most highly trained type of EMT, and usually serve as team leaders in the field. Besides managing the EMT team, paramedics diagnose and triage victims, analyze EKGs and perform resuscitation (CPR) and advanced life support (ALS), defibrillate, give dozens of medications, intubate airways and support breathing, establish IV access, give IV fluids, bandage injuries to control bleeding, immobilize spinal fractures, splint fractures, and sometimes use needles and tubes to decompress lungs, and if needed, deliver babies. They may perform additional procedures in some jurisdictions when directed by a physician via telemetry and a remote voice link. In those situations, paramedics may function as the eyes, ears, and hands of a doctor who is managing the scene from a remote base, usually a hospital ER. A paramedic will function as the “captain of the ship” and assume the ultimate authority at the scene, unless otherwise being directed remotely by a physician.

There are many life saving drugs and procedures that are not available to paramedics in the field, and delay for treatment in the field must be weighed against the need for rapid transport to a better-equipped facility. Paramedics often make life or death executive decisions to delay treatment in order to get to the ER fast, a practice referred to as “scoop and run.” Due to the recent, widespread use of blood thinners, accident victim survival times have decreased up to 20% in some studies, due to blood loss. This is a hot topic for paramedics today. Paramedics are not able to give blood transfusions in the field, and IV fluids alone are often not adequate to sustain life in trauma victims.

If you are writing a mystery or crime story, remember that in most cases paramedics will not enter a conflict zone or crime scene until it has first been secured by the police. Also, paramedics will usually be careful to minimize contamination of a crime scene and preserve the chain of evidence.

H.S. Clark, MD

Posted on February 20, 2014 at 11:26 PM


"Ducky" is played by David McCallum, Sr., (born 1933) is a Scottish actor who played a Russian trained secret agent on "The Man From U.N.C.L.E" with American trained secret agent co-star Robert Culp (1930-2010) in the 1960's. The "UNCLE" spy vs. spy show was a type quite typical of that era. He currently stars on NCIS, one of the most popular crime and action series on TV.

H.S. Clark, MD

Posted on February 07, 2014 at 2:40 PM


Brian, Thanks for the interesting question. Near death experiences have figured prominently in many fiction books (such as Bliss) and movies (such as Flatliners), as well as in non-fiction memoirs (such as Dying To Be Me). In your particular story, you’ll want your character to have a swift demise, and a rapid recovery to a near healthy state. If you are far from medical help, you’ll need a condition that can be easily reversed by the intervention of a non-physician, a Good Samaritan. The key to a near death experience is lack of oxygen supply to the brain, causing disorderly firing of brain cells, neurons. Scientifically, the sensations experienced at near death, such as “moving toward the light” can be explained as brain cell shutdown phenomenon related to internal, cellular suffocation. Metaphysically, these sensations have been experienced and interpreted as having all sorts of personal, religious, and cosmic explanations.

An allergic reaction, known as anaphylaxis, could set the scene for your character. Up to 2% of the population will get anaphylaxis during their lifetime. Away from medical help, you character could get a bee sting or eat a peanut to set off a series of allergic events. Anaphylaxis is a rapid, hyper-immune, inflammatory response to a substance in contact with the body. It starts with itching and rash, and can progress rapidly to low blood pressure, fainting, and unconsciousness. A cascade of toxic substances released from white blood cells, and mast cells in body tissue, attack every organ system at once. Tissue swelling is dramatic, especially of the head and neck. Ultimately, swelling causes blockage of air passages in the throat (airway edema) and suffocation. Partial airway blockage can cause several minutes of mild oxygen deprivation in the brain, where brain cells start to shut down, but do not die. Complete airway blockage causes total oxygen starvation in the brain, followed by brain death 5 minutes later. Once complete airway blockage starts, you’ve got less than 5 minutes to administer a cure. And the cure is an injection of adrenaline (epinephrine), easily administered by a passerby who (not uncommonly) happens to be carrying an EPI-pen, a unit dose injector, pen-like device for treatment of severe allergic reactions. Many people known to be at high risk of allergic reactions carry EPI-pens as a precaution. One quick stab with the EPI-pen will cause almost immediate, dramatic reversal of the allergic reaction, the anaphylaxis, so your character lives to tell the story of their near death experience.

H.S. Clark, MD

Posted on January 26, 2014 at 9:22 AM


Chicago Hope ran from 1994 to 2000 and was noted for its melodramatic, soap-opera style. Mandy Patinkin’s performance as a surgeon on Chicago Hope won him an Emmy and a Golden Globe.

H.S. Clark, MD

Posted on January 26, 2014 at 8:52 AM


M*A*S*H ran from 1972-1983. Alan Alda played an army surgeon in the 4077th Mobile Army Surgical Unit during the Korean War. Alda's character, Hawkeye, was the only character who appeared in all episodes. The final episode had 125 million viewers, the most for any TV show in history at that time.

Posted on January 16, 2014 at 1:28 PM


ER played from 1994-2009, won 10 Emmys, a Golden Globe, cost over 10 million dollars per episode to produce, and some episodes had over 40 million viewers. George Clooney has since starred as a leading man in numerous blockbuster films.

H.S. Clark, MD

Posted on January 15, 2014 at 1:52 AM


Great question Robert! This is a vast and confusing topic, with many key facts still open to debate. I’ll try to set down some helpful guidelines for the crime or fiction writer, to help you make your stories realistic. Here are some tips:

Distance from the shooter: Contact wounds will show soot and skin lacerations, close wounds will have soot, but not the lacerations, distant wounds create only a hole.

Penetration: A bullet must maintain a velocity of 200 fps to penetrate human tissue. Variables are firing distance, length and diameter of the gun barrel, kind of gunpowder, angle to the target, cartridge construction, caliber, wind, heat, rain, clothing, deflection (as off bone), and density of the tissue (as in lung vs. muscle). Most bullets are made to deform, remain in the body, and do not produce an exit wound. Full metal jacket and rifle bullets (traveling at over 2,000 fps) resist deformation and often produce an exit wound.

Determining direction from forensics: Bone will “cone” away from the line of fire. Two points of penetration inside the body may determine a trajectory. Multiple shots from the same shooter may have different trajectories within the body because the victim is moving (as in falling down). X-ray, CT, and MRI scans may be helpful to reconstruct bullet trajectories and recover bullet fragments in victims both living and dead.

Damage created: A bullet has 3 initial chances to cause damage. First is the main tract, limited to a narrow area. Second is the pressure wave that is created along the main tract and damages a wider area. Third, bullet fragments that break off and go their own way will create additional tracts and more damage. Soft bullets designed to minimize collateral damage may actually make a victim’s injuries worse. A shot to the head kills instantly 75% of the time. The heart and major blood vessels can burst from a direct hit, also causing instant death. Bleeding and lung damage may cause delayed death minutes later.

Shotguns: Beyond 5 yards, multiple projectiles from a shotgun will spread out and act independently. Tough clothing can slow down individual pellets. Pellets that do penetrate skin leave an entrance wound the same size as the pellet. Slugs will deform, leave a large entry wound, and proportional damage.

Suicide by gun: I thought to mention this, as it’s a common theme in mystery and crime stories, and must be ruled out in many police procedurals. About 70% of these suicides are done with a handgun, and 30% with rifles and shotguns. The right temple is the usual handgun target, while most who kill themselves with a rifle or shotgun prefer the mouth. About 97% of gun suicides will show the classic signs of a contact wound as I described above.

I recall being at a lecture on improving gunshot wound survival at a Northeast conference, and during Q&A, a Texas MD said, “We don’t have a gunshot wound survival problem in Texas. We use big caliber and kill ‘em where they stand!” The moral is, to keep your fiction realistic and storyline simple, just give your shooter a very big gun.

H.S. Clark, MD

Posted on December 30, 2013 at 8:17 AM


Jeff, thanks for the great question! Total amnesia of uncertain cause, in an otherwise healthy individual, with amnesia reversal at the end of the episode, as is often portrayed in sitcoms and on TV, is almost non-existent. Drugs, primarily tranquilizers and sleeping pills, often in combination with other recreational drugs and alcohol, cause the vast majority of true temporary amnesia. People under the influence of some sleeping pills can sometimes awaken, walk, drive, and more, for several hours, with no recall of events. Deliberate drug induced amnesia, such as with Rohypnol, the “date rape drug” also called “roofies,” has been used realistically as a major plot point in crime fiction.

Major psychological trauma, such as rape and PTSD, can produce amnesia that is usually limited to the traumatic event. Rape victims, soldiers, or murder witnesses often have delayed recall. Victims may not report crimes for many years, especially childhood trauma, due to amnesia. Witnesses may be unable to identify a suspect, or recall a crime, until years later, complicating arrest and trial. Amnesia induced by psychological trauma is often used as a major plot point in mystery and detective fiction.

Disease can cause specific types of amnesia. TGA, or Transient Global Amnesia, is a rare disorder that causes 12-18 hours of short-term memory loss, with preservation of most long-term memories. TGA patients can only remember the last 15 minutes, but still have most long-term memories intact. Brain damage from trauma, tumors, seizures, stroke, and chronic conditions like Alzheimer’s and senile dementia, cause profound, long term amnesia that is usually progressive and irreversible. Rarely, limited brain damage can produce strange and very specific types of memory disorders; a fact exploited nicely in the movie “50 First Dates.”

Major psychiatric disorders, such as bipolar disease and schizophrenia, can create a dissociative state, where the individual is not aware of self, suffers visual and auditory hallucinations, and takes on new personality traits. This is not actually amnesia, but can lead to a “Dr. Jekyll and Mr. Hyde” situation, with gaps in self-awareness that occur during the psychotic episodes.

Science fiction often uses memory erasure or implantation as a plot point, as with artificial childhoods for humanoid Replicants in the classic “Blade Runner.” The technology to erase memories or create artificial memories does not exist today, but it’s not beyond the realm of possibility for the distant future. Medical fiction and detective fiction should probably stick to known manifestations of amnesia, but I’d certainly give sitcoms a lot of leeway.

H.S. Clark, MD

Posted on December 16, 2013 at 6:52 PM


Mike, you’ve asked a major fiction-writing question that’s been the subject of great debate, and for which there is no easy answer. Many articles and writer’s panels have addressed this and related issues. It’s about the role of science in all fiction, detective and crime fiction in particular. I think the key for any medical or science fiction is to respect all the usual protocols of good writing: story, characters, plot, etc. Science may be a necessary element, but it shouldn’t change the basics. Science in fiction must always move the story forward. I use beta readers as a final check on my writing, and I give them a set of specific questions. One question is whether the science is accessible and comprehensible, or dense and overwhelming. Here are a few related references I found helpful on this issue:

H.S. Clark, MD

Posted on December 11, 2013 at 12:32 PM


Consider Pancreatic Cancer, fourth largest cause for death in the USA, eighth worldwide. Peak age is 75, but it’s not uncommon in 50 year olds. There’s some speculation that 20% of Pancreatic Cancers may be related to smoking, but this is not certain, and you can make your character a non-smoker. No other preventable causes have been found, so your character cannot be held responsible. A family history of Pancreatic Cancer is felt to be a risk factor, but this cancer is not a genetic disorder. At the time of diagnosis, most patients have only 6-12 months to live. The 1 year survival rate is 25%, and the 5 year survival is 6%. Treatments are limited, and mostly ineffective. Pancreatic Cancer would provide a wonderful set-up for a character to re-evaluate her world in the final tragic months of life.
H.S. Clark, MD

Posted on December 07, 2013 at 7:08 AM


Brian, you are so correct. It’s unfortunate that drug addiction is treated so poorly in medical entertainment media. We need more dedicated writers like you who will take the time to get it right. Take a look at this NIH MedlinePlus article and also the three links provided at the end of that article. This should get you off to a good start. I’d like to hear back from you and others with additional good sources of addiction information for writers and readers.

NIH MedlinePlus link:

H.S.Clark, MD

Posted on December 07, 2013 at 6:31 AM


The doctor is IN to answer your questions on writing medical fiction and anything in medical entertainment media.
H.S. Clark, MD


Posted on December 07, 2013 at 5:31 AM
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