Most people by now have heard of the nuclear plant disaster which occurred in the Ukrainian Soviet Socialist Republic in 1986.

For those of you who haven’t, nuclear reactor No. 4 exploded on April 26th, 1986 at the Chernobyl Nuclear Power plant near the city of Pripyat. This explosion decimated the surrounding area, and the fallout caused spikes in cases of cancer in the surrounding region, including the surrounding countries.

Featured prominently in the 5 episode miniseries are depictions of radiation exposure, as well as the dramatization of what happens to the human body after acute exposure. This article will focus on the accuracy of such depictions in the show as well as briefly on the rationale behind the precautions taken by those exposed to the radiation. I will also discuss how the human body would be affected by radiation exposure and the prognosis for those exposed to such a disaster. Radiation exposure to the human body is a complex topic, the extent of which I cannot cover fully here. The information below has been simplified to help with its digestion.

What happens to you after whole body radiation exposure?

There are large gaps in our knowledge when it comes to what acute radiation exposure does to the human body. What is known has come from following Japanese victims of the atomic bomb dropped in 1945, as well as those exposed in the Marshall Islands in 1954 following US nuclear tests, and of course those in Chernobyl in 1986.

Acute radiation syndrome (ARS) or “radiation sickness” results from whole body radiation exposure (there are distinct long-term symptoms of radiation exposure – but I will focus on acute whole body exposure). This condition, which led to the demise of the those in the show, primarily affect 4 body systems:

Gut (gastrointestinal): Blood diarrhea with painful cramping after 5 days. These symptoms were not prominently featured in the show. I can’t really blame them as explosive, bloody diarrhea doesn’t make for compelling television.

Skin (cutaneous): Burns that lead to large bloody blisters on body and loss of finger and toenails in first 24 hours which can last unfold overseveral days. This is seen readily on screen, in the first few episodes with a plant worker pointing out his ‘red face.’ A more progressed form of the skin manifestations is seen later at the hospital in Moscow where the skin of the victims were peeling.

Initial exposure showing early stages of skin ‘reddening’

Brain circulation (cerebrovascular): Depending on the severity of exposure, the sac around the brain swells, vessels in it burst and seizures and death can result. With lesser levels of exposure, dizziness, confusion, blurred vision can result. I believe that Paul Ritter’s character, Anatoly Dyatlov, demonstrated these symptoms as he was carried to the ambulance in the hours following the explosion.

Paul Ritter’s character, Anatoly Dyatlov

Blood (hematopoietic): Changes in the number of your white blood cells and platelets (what stops you from bleeding out) appear and reach their lowest point after to 2-4 weeks. This was, understandably, not prominently portrayed in the show either. These changes are basically only seen on blood results.

What do those iodine pills do for you?

“Io-deen” pills as the British accents in this Soviet disaster series call it are still distributed to this day to folks who live in the vicinity of a nuclear plant. These prevent the absorption of radioactive forms of iodine (evil iodine), specifically iodine-131, from being absorbed by your thyroid (the gland at the bottom of your neck that is your body’s metronome). These come as KI (potassium iodide) tablets that should be started within 6 hours of exposure and taken every 24 hours afterward as long as exposure is ongoing.

Emily Watson’s character, Ulana Khomyuk holding a bottle of KI

So Doc, how long have I got?

It depends. Depends on your radiation dose and duration exposed to that dose. But it’s not good. The journey of our characters follow are in line with the 4 known stages of acute radiation exposure:

Prodromal phase (immediate symptoms): This is what happens in the minutes or hours following exposure. Remember the vomiting? So much vomiting. Additionally, headache, dizziness and skin changes are common at this stage.

Latent phase (symptoms temporarily go away): That scene in the Moscow hospital where the firefighters are up and playing cards is a perfect representation of this phase.

Firefighters seen in the Latent Phase of Acute Radiation Syndrome

Illness phase: The subsequent scenes of them back in bed, behind those plastic curtains that you see in grocery stores, represents the illness phase where things really ramp up. It can manifest as any (or all) of the 4 body systems above.

Death/recovery phase: This is pretty self-explanatory. As you would guess, the more significant the exposure the worse your prognosis.

So, how’d they do?

Before I review a script I have a discussion with the creator. I ask them about the degree of realism they are looking for; are we talking real world level realism? This would perhaps include a shot of technically accurate PICC line (thick gauge line that gets connected to a large vein usually in upper arm) insertion in a cancer patient. Or realism that would pass to a casually observing medical professional? A shot of the mere presence of such a line. To a casual but informed patient? This would mean a presence of an IV line (the smaller tube that goes in your elbow fold). Or is realism less the goal and more about getting a flavour of medical perspective? An example of this would depend on the creator’s intent and I would give them several propositions for how to show this.

Overall the depictions of the various effects of acute whole body radiation exposure were excellent. There were a few additional symptoms that could have been featured, but their absence certainly did not take away from the dramatic nature of the show’s depiction. They also included some of the illnesses down the road that could arise following significant radiation exposure including cancers and effects of radiation to a pregnant woman, the scope of which goes beyond this article.

4.5cc’s out of 5

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