Medical Shows Need to Get a Goddamn Consult

A Critique of B Positive Episode 1 “Pilot”

I’m a nephrologist, a kidney specialist. So, when my husband brought my attention to the pilot trailer of B positive, a medical sitcom about a newly divorced father of a 12-year-old girl learns he’s in kidney failure and the ditzy “train wreck” high school acquaintance who offers to give him one of her kidneys, I just rolled my eyes and walked away.

Since I’ve been a physician, I just can’t with TV and movies centered around something medical, because they get so much wrong, it’s no longer entertaining. I never watched Grey’s Anatomy, ER or House. And I’ve kept my contempt for scenes like when Denzel’s intubated son talks in the movie, John Q and when Morgan Freeman’s character in Going In Style has to be rushed to the hospital for a transplant after collapsing because “dialysis was no longer working” to my own circle of friends. But when the nurse in Knives Out could sense the difference in viscosity between liquid morphine and a different injectable medication but didn’t suspect she hadn’t really injected the patriarch with 30 times his prescribed morphine dose when he was wide awake and slashing his throat to protect her an hour or so later, I felt compelled to tweet. They took it too far.

At the time B Positive’s pilot aired, I entertained the idea of writing about it — even wrote the idea on a post-it note — and then went on to work on other things. But when my husband pushed me to watch roughly 30 seconds of the recently aired its 11th episode (which is all it took for my eye-rolling to begin), I decided I just couldn’t keep quiet anymore.

So, I know I’m very late to this party, but this show is hitting way too many nerves too close to home. But don’t misunderstand. My intention is not to just shit all over the show. I honestly think it’s a beautiful thing for “Hollywood” (i.e., all things movies and television) to represent kidney disease, dialysis and transplant. But it’s not enough to be funny. It’s important that it’s done right, too.

In her 2017 TED Talk, Shonda Rhimes said 87% of people get most of their medical information from medical television shows. Fair or not, that breeds responsibility. B positive is highly rated and popular, making it a fair target. Somebody has to say something to get Hollywood to stop spewing misleading and just plain wrong medical information: it shapes how people understand and think about health care, prompting f*cked up decisions. For example, studies have shown that the majority of non-medical people think CPR will lead to a person who had a cardiac arrest (heart stopped working) to leave the hospital 75% of the time, when that really only happens about 10% of the time. Hollywood gave that impression.

And, as far as I’m concerned, there is no one more qualified than I am to be the somebody to say it. I’m a primary care doctor turned kidney donor turned kidney specialist. When I started dating my husband 17 years ago, I was a primary care doctor and he had been on dialysis for about 5 years. As I was opening my heart to him, he exposed me to a side of the kidney transplant system I wasn’t privy to in the primary care world. The bullshit I saw (and of course my love for him), prompted me to give him my left kidney and continue my medical training to specialize in nephrology, where I was introduced to a-whole-nother batch of concerns. I wrote a book about it all — Hundreds of Interlaced Fingers: A Kidney Doctor’s Search for the Perfect Match. Next month will be our 16th transplant anniversary, marking 16 years that he has been free of dialysis.

Without further ado, here are the top inaccuracies/absurdities in order of appearance explained and rated on level of eye rolling induced, from B positive “Pilot”:

1. The episode starts with a medical assistant escorting Drew, the main character, to a chair in the doctor’s office. The primary care doctor walks in moments later and asks Drew if he has had “any luck with your peeing. Drew’s response that no, he’s not had any luck, standing, sitting, or even in the shower prompts the laugh track. What’s wrong with this?: While most patients with kidney failure severe enough to be on dialysis will eventually stop peeing, a new inability to pass any urine in a hydrated person is a sign that something is blocking its passage, aka obstruction. (I specify ‘hydrated’ because the kidneys will not make any pee, holding on to every drop of water possible, if the body is very dehydrated.) An obstruction could be a big kidney stone, tumor or prostate blocking the urethra (pee tube) and can be easily diagnosed with imaging like an ultrasound or CT scan. I would consider this a medical emergency, because the longer the obstruction is there, the more kidney dies. Definitely not something I’d just tell a patient to go home and keep trying to pee. Rating: 🙄 🙄 🙄 🙄 🙄 😒 (as in off the eye roll chart).

2. Drew is a thin guy and has no other symptoms. What’s wrong with this?: Someone with full-on kidney failure who hasn’t peed in days would be visibly sick. Like swollen, vomiting and short of breath sick. I mean, I get it’s a sitcom and looking at a really sick person isn’t funny. But damn. Rating: 🙄 🙄 🙄

3. As Drew is about to reach the office door to leave, right after the doc has told him that he is in kidney failure and needs to see a nephrologist, the doc adds that he “should start thinking about donors.” What’s wrong with this?: First, this is a serious statement; not something I would bring up when somebody’s got their hand on the doorknob. Second, if the doc had actually taken action to find a potentially reversible obstruction, a conversation about donor might be irrelevant. Third, he said start looking for donors as if a kidney transplant could happen next week. In reality, it tends to take 6 months for the donor to get approved and the surgery scheduled. Rating: 🙄 🙄 🙄 🙄 (primarily for having so many violations in one sentence)

4. Similarly, Gina (the ditzy train wreck who offers to donate her kidney while under the influence of wine, weed, and “whatever that pink pill was,” consumed moments after a wedding in which she was a bridesmaid) informs Drew that they are a match the same day she went in for a blood test. What’s wrong with this?: Again, it never happens this fast. Finding out if one is a compatible blood type (type O donors can potentially donate to anyone, while type O patients can only get a kidney from a type O donor), is just the first step in the process. Then a bunch of other tests need to be done to make sure someone has no signs of kidney disease, has nothing that might cause kidney disease later, is healthy enough to go through the surgery, and isn’t being coerced into doing it. Rating: 🙄 🙄 🙄 (in part, for making me have to repeat myself)

5. Drew’s initial reaction to Gina’s offer to donate is to politely refuse because “he’s got some feelers out for potential donors.” Then they show several flashes of said potentials’ responses: “I already gave away both of mine,” says a woman holding a yoga mat. “I’d rather just stick to doing your taxes,” says an accountant. “Does it have to be a human kidney?” says a guy who looks like he might live in the park and hears voices that others don’t. What’s wrong with this?: Sure, there are people who will donate a kidney to a casual acquaintance and even strangers, but I resent the portrayal that asking somebody for a kidney is easy. While I joke that my husband approached women before me with, “Hey girl, what’s your blood type,” instead of the old stereotypical “what’s your sign” line, in truth he asked no one. Most people in his life didn’t even know he was on dialysis. And because it was so heartbreaking when the people before me who offered to donate were rejected or changed their mind for whatever reason, he got to a point where didn’t even want to know if people were considering it. Rating: 🙄 🙄

6. After informing Drew that they are a match, Gina says she won’t be allowed to donate unless she stops drugs and alcohol for 3 months. What’s wrong with this?: Most transplant centers require that the patient abstain from cigarette smoking and illegal drugs for at least 6 months before even considering them for a transplant. Honestly, I don’t know if donors are placed on some kind of time-out versus being outright rejected for doing things (like cocaine and cigarettes) that would hurt the remaining kidney. Rating: 🙄 (because maybe this could happen in real life).

7. The next day, Drew visits Gina to bring her healthy food, only to find her passed out after a night of unhealthy activity, judging by the mirror with cocaine powder on it, lots of empty liquor bottles, the bong, and the man whose name she can’t remember who answered the door. He goes off; yelling that he knew he couldn’t count on her and that she was a train wreck high school and was still a train wreck. What’s wrong with this?: OK, this one not about medical information and maybe this does happen, but it’s definitely a bitch-ass-asshole-how-dare-you move that induced off the scale eye rolling disgust for me. Rating: 🙄 🙄 🙄 🙄 🙄 🖕🏽

I’ll stop there, because the rest falls below the minimal disgust threshold and could just be attributed to sad attempts at being funny. And just so no one can say that I didn’t present a balanced review…here’s a list of things they got right, in order of appearance and rated for how much it pleased me:

1. The primary care doctor looks in Drew’s chart and tells him his “creatinine is through the roof!” and that he wants to refer Drew to a nephrologist. What’s right about this?: Creatinine is a basic blood test that is used to estimate how well the kidneys are functioning. A super high creatinine is a sign of kidney failure. If it has increased by a lot over just days, that’s a big ass hint that an acute (new) problem is going on and needs to be referred to a nephrologist urgently or maybe even be sent to the ER. Rating: 🙂 (mainly because it’s a pebble of right in a pond of wrong, see 1st absurdity above).

2. While Gina is getting tested, Drew is lying on his couch at home having doubts. “This is never gonna work,” he says. “Even if she gives me a kidney, I’ll probably reject it…. I’m gonna die.” What’s right about this?: It’s real. Kidney failure is a big deal and none of the treatments, whether it be dialysis or transplant, is perfect, so sometimes things don’t go as we hope. To face this reality is scary. Rating: 🙂 🙂 🙂

3. Drew calls a transplant center about getting on the registry for a deceased donor kidney. As part of his begging Gina to forgive him for his bitch-ass-asshole-how-dare-you move and give him her kidney, he tells her that the wait for a deceased donor kidney is 10 years. What’s right about this?: The fact a patient can’t refer themselves to get on the waiting list aside (a nephrologist has to initiate that referral), it can take up to 10 years to get a deceased donor kidney depending on one’s blood type and where one lives. That’s why dialysis is the best readily available treatment option for most people with kidney failure. And the vast majority of patients have to spend at least some time on dialysis before a kidney becomes available. Rating: 🙂 (points off for the getting the referral process wrong and oversimplification, because the wait can be as short as 2 years and some get on the wait list early enough to get a pre-emptive (as in no dialysis time) transplant).

That’s all for now. Critique on episode 2 soon. Screenwriters and producers: I’m available for consultation.