Doctor, don’t heal thyself

“Scrubs”

April 22, 8 p.m.

Episode: “My Cuz”

The premise

Dr. Bob Kelso was the chief of medicine at Sacred Heart Hospital until he retired. Now he comes to visit. He eats in a nearby cafe and finds out after he eats that the pastry maker was just admitted to the hospital with a “highly contagious intestinal virus.” The cafe is closed, but it is already too late. Kelso goes to the hospital, where he vomits on the floor. He admits himself to the hospital and tells the nurse, “I’m sure I’ve got an enterovirus.” He asks for 40cc of an anti-emetic but doesn’t want to wait for it, so he puts in his own IV to give himself fluids and injects himself with the medication to stop the nausea.

Medical questions

What is an enterovirus, and how common is it? Would an enterovirus be easy to transmit in food, and would it lead to closing a cafeteria? Do enteroviruses cause vomiting and require hospitalization? Would the treatment be intravenous rehydration and anti-emetics? Would these treatments be off-limits to a doctor turned patient? How long does it take to develop symptoms after being infected with such a virus?

The reality

Enteroviruses include polio, coxsackie and echo viruses. They cause a variety of illnesses (paralytic polio, aseptic meningitis, rashes, heart infections) with at least 10 million to 15 million symptomatic infections in the United States every year and many millions more that are asymptomatic. But they rarely cause diarrhea or vomiting and are not generally transmitted by food, says Dr. Shawn Skerrett, infectious disease expert and associate professor of medicine at the University of Washington. But Eric Delwart, director of molecular virology at the Blood Systems Research Institute at UC San Francisco, points out that since enteroviruses are fecal contaminants, food handlers who don’t wash their hands can transmit them. The vast majority of enteroviruses, including polio, are asymptomatic infections, Delwart says. These viruses are found everywhere and commonly infect infants who develop a fever and runny nose but don’t generally get very sick.

The case described is much more typical of Norwalk (norovirus) virus infection, which is a major cause of food-borne disease. The abrupt onset of nausea, vomiting and diarrhea are also characteristic of a Norwalk virus, but the incubation period is one to three days, whereas the show is suggesting just a few hours. “Nausea and vomiting that occur within a few hours of eating contaminated food results not from a virus but from preformed bacterial toxins,” says Skerrett. “Most often the toxins come from the common bacteria Staphylococcus aureus or Bacillus cereus.”

The show is correct that treatment of an acute vomiting syndrome would include hydration and anti-emetics.

Finally, patients who are physicians should be treated like any other patient and would not generally be permitted to self-administer medications. It is absurd to think that a hospital would allow them to insert their own IVs, even a hospital in a slapstick show like “Scrubs.”

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Siegel is an associate professor of medicine at New York University’s School of Medicine. [email protected]