What Does "Scrubs" Have to do with Sinusitis?Wednesday, March 7th, 2012, 2:52 am
The TV show, Scrubs, was as accurate as any medical drama I've watched, but take a look at the opening sequence.
Well, let me first say that I loved the show Scrubs. Despite the tongue-in-cheek attitude, it captured the life of residency better than most shows, including--I would argue--ER, particularly in its later years. So why am I bringing it up? Well, it's what happens in the very end of the opening credits. If you look at the x-ray that is put up by Zach Braff's character, you may recognize it as a chest x-ray (CXR). What's interesting about this is the position of the heart.
Most people understand that you put your hand over your heart on the left side of your chest. That's because while the heart mostly sits in the middle of the chest the apex of the heart faces to the left and you can feel the heartbeat there the most easily. If you look at the CXR, the heart is facing to the L of the picture which is on the R of the patient. When you look at a CXR correctly, it's similar to looking at someone standing in front of you so that the stuff on the R in the CXR is on the patient's L.
Here's what a normal CXR looks like:
In this the apex of the heart is on the R side of the picture or the correct L side of the patient. So did the Scrubs crew put their CXR up backwards? The following CXR is correctly oriented:
In this image, it looks like the backwards CXR in the Scrubs opening sequence.
So what's the deal?
Here's what Wikipedia reports:
The chest X-ray featured at the end of the title sequence was hung backwards for most of the first five seasons. Bill Lawrence has stated that having the X-ray backwards was intentional as it signified that the new interns were inexperienced. During Zach Braff's audio commentary on "My Last Chance", he states that the error was actually unintentional. The error became somewhat infamous and was even parodied in "My Cabbage".
An attempt was made to fix the error in the extended title sequence that was used at the beginning of season 2 that included Neil Flynn, but the extended sequence (including corrected X-ray) were soon scrapped at fan and network request. Finally, in "My Urologist", Dr. Kim Briggs steps into the credits and switches the X-ray around, saying, "That's backwards; it's been bugging me for years". At the beginning of season 8, when the series switched to ABC, the chest X-ray was once again backwards.
The ninth season features a new title sequence with a new version of the theme song "Superman." The new title sequences features the four new characters–Denise, Lucy, Drew and Cole, as well as Dr. Cox and Turk, while J.D. is seen at the end placing the chest X-ray. In all season 9 episodes that do not feature J.D., he is absent from the title sequence and Lucy is the one placing the X-ray. The X-ray at the end of the sequence is also not backwards and the subtitle Med School appears at the end of the sequence.
It appears even on the show there's some disagreement whether it's correct or not. However, as I stated, the last CXR is not incorrect. The heart is clearly seen on the R side of the patient.
This is a condition called dextrocardia. There are 2 main types. The first occurs as the result of what's called embryonic arrest where the heart is situated in the R chest, but is otherwise oriented correctly--the apex of the heart still points toward the L side of the chest. The other type of dextrocardia produces organs that are a mirror image of the normal--much like your hands are mirror images. One reason for this is that a particular component of certain cells, the cilia, do not move normally. Their movement is required to position the heart correctly within the chest and if they don't work, the heart doesn't rotate into position correctly, resulting in the mirror image.
The natural question, then, is why would an ENT blog talk about it?
Well, those cilia that are responsible for rotating the heart are also responsible for helping the sinuses stay clear. Cilia are small hairs on the surface of some cells. They are crowded together and look like a shaggy carpet under a microscope as seen below.
And a video of how they work follows. This is a fantastic video on cilia that really you can't find better anywhere on the web. I applaud the creators.
From the video, you can see that if those cilia don't beat, you can have a tremendous problem with the inability to clear mucus. The result in the ENT world is chronic sinusitis. Fortunately, the condition is rare, but even a sitcom can make for an interesting discussion.