Doctor Reacts To The Pitt S2 Ep10 w/ Supriya Ganesh

Time to react to season 2, episode 10.

And I had to bring in a special guest, Dr.

Moan in the house.

Sabria Ganesha.

You ready to take on this challenge?

>> Um, I don't know.

>> See, let's do it.

>> Structural collapse at the water park.

Two victims coming in via helicopter.

ETA 5 minutes.

>> Time to rally the troops.

>> We'll get environmental to clear and prep the trauma rooms.

>> I'm going restock the crash carts to take the latest script to the

drug cage. when this impending doom is happening,

do you feel it on set?

Is it does it affect you emotionally?

>> Um, I mean, it's interesting cuz like yes, like during the scene,

but I think as a cast we're pretty good about like

if we want to break in between we usually do,

so we tend to talk or whatever.

I will say watching this,

what's so impressive to me is >> the choreography

that our directors have to do to film a scene this big with

so many lines and

so many people saying lines.

Now I'm watching I'm like, "Oh my god, they cut that so well."

They like >> like they

that was really smart how they like move the camera around.

It's actually >> It's a huge set.

I I was fortunate enough to visit

and I saw how expansive it is

and the glass walls

and the options for >>

which by the way is like absolutely not normal for um a medical show.

Like I've I've worked on other medical shows

and like it the set's like not

as continuous as our ours is.

>> It's pleasant probably to experience.

>> So it's it makes our life easier as actors for sure.

>> I can increase the morphine drip to manage the pain.

>> But that could also slow down your breathing.

>> You will likely feel very drowsy.

You may lose consciousness and it could cause you to stop breathing altogether.

When we give morphine to a patient who is on hospice,

we have to be very cognizant of the fact

that morphine can be used for pain,

but it could also be given for air hunger.

So when patients start dropping their uh oxygen saturation

because they're nearing the end of life,

it's very uncomfortable.

And what we're treating in a hospice patient is their comfort,

not necessarily prolonging their life.

Mhm.

>> So if we were to give morphine for extensive pain at a very

high dose that we normally wouldn't give to a patient,

we're accepting those side effects for the benefit of the patient,

it's it's a very different shift in medicine where you're going away from treating

for extension of life

and more so for the comfort of life

and obviously difficult to talk about especially with the entire family in the room.

But it's important to be as transparent as possible.

It's so interesting you say

that cuz like I I also started looking into pallet of care

because of Samira because

so many people said things like she'd be better in pallet of care

and I you know have experience with like premed stuff

and so when I looked into what

that is and how different the principles are compared to what what you're told

as as a premed student

or you know medical student I I just I it was interesting

but it makes total logical sense >> of course

and what happens in our society is we end up spending a huge portion

of our healthcare budget on the last few days of life for people who

are not only not benefiting from it

but are potentially being harmed by

that excess treatment.

>> Oh wow.

>> So it's it's this fine line of having a conversation,

making sure the goals are met, making sure people are comfortable,

but at the same time not feeling like, oh, they're giving up on me.

>> Yeah.

>> So it's a it's a very fine line to draw.

I'm sure you've experienced that in discussing that on the show.

>> Yeah.

I think I in season one we did a pretty great I would say

we did a pretty good job of discussing end of life care

and I think that's something they deal with really well on the show.

So >> Dr.

Mohan, it's your mother.

>> She sounds pretty upset.

She says she really needs to talk to you.

>> You're me.

Um tell her I'm not available.

You know, I worked in an ER before up in Vermont

and we had MBAs

and ODS,

MIS, >> but this place is relentless.

>> He is such a good actor.

I mean, I haven't watched the second season, but I mean,

I've seen I've seen the work he does, obviously,

and it's I think it's easier for me to like process who Olie is

and see him as an extension of Lucas cuz,

you know, we'll do this this scene

and then he'll break

and then we'll like talk

or whatever.

But like watching this, I'm like, who the is that?

>> Yeah.

Yeah.

>> Like that is not Lucas.

>> He's so much more calm and pleasant.

>> He's so kind.

Like we just went out dancing like two days ago.

And like who the is that guy?

Like he just sounds so different.

Jesus Christ.

>> I think we have a very different idea of normal.

>> Not for everyone.

I'm not sure it's healthy for anybody.

>> Here's your leg.

>> Jesus.

>> Is Dr.

Abbott still around?

We need to get some sleep before his night shift starts in a couple

hours.

Okay.

I should have planned this better.

I was hoping he'd write me a letter of wreck for an elective

so I could have a shot at a fellowship next year.

>> Which one?

>> Whichever will take me.

Did the electives fill up a while ago?

Don't remind me.

I'm going to throw myself at the mercy of the court.

Beg for them to take me anyway.

>> Just kill me now.

>> The frustration is is palpable.

>> Well, she's she's trying to stay in Pittsburgh.

Like she's trying to get a fellowship.

>> And this is realistic.

When people are looking for electives, sometimes it's a hustle.

Sometimes it's about connections

and it's frustrating when you know you might be a better candidate than someone,

but perhaps you're not friends with those people.

>> You might not get the spot.

>> Yeah.

Like the social dynamics of it were very interesting

when I was doing my research.

And also what's interesting for her is

that she already accepted like a fellowship in Jersey to be close to her

mom and now her mom's like >> offering her new boyfriend,

I guess, on this cruise.

And so like I think she just is like, "Wait, I have nothing there.

I have more things here.

I'm trying to stay.

So, she's like really spending this whole shift trying to figure out who's going

to write this recommendation letter for her for this fellowship,

this elective.

>> What she's doing, I don't think is quote unquote good or or ideal.

Like, you shouldn't be thinking about your electives in the middle of your shift.

>> But because it's not good that makes it so real >> because humans get irrational.

They make weird choices in real life that you're like,

"Why are you talking to me about your elective in the middle of July

4th hospital shift?"

But that's exactly what would happen.

That's one of the things

that I really like wanted to do with her cuz like I I I

love playing characters that are complex

and I think she's really great with patients.

I think she knows exactly what to do.

She's almost following like

that HR manual in her head of how to be like the perfect doctor.

But I think she's just socially really awkward

and she doesn't know what to do.

And I agree.

Why is she talking about this right now?

Everything's going to Like there's like, you know,

paper charts over there for God's sake.

Um but yeah, I agree.

>> Paper charts just makes me shudder.

>> You know, I can't read this handwriting. has 1,000 milligs of acetamophen orally,

4 milligrams of dentatron under the tongue, and trilocar fluids.

>> So, some Tylenol for pain/fever reduction, a dancron uh nausea medication,

and some fluids.

>> You're just doing this on the fly.

>> Well, it's like I am a doctor.

>> Yeah.

Yeah.

After we finish, I will be going into the hospital

and playing this this role,

but in real life.

>> What do we have?

Fall from 10 ft onto a metal fence right below the knee.

Good vitals.

>> Oh, it hurts.

My god.

>> What's she had so far?

>> 50 event repeated 25.

No meds, no allergies.

>> Where should I put this?

Just hang on to it for now.

On my count.

1 2 3.

>> So that's a commercial grade tourniquet

that she has on to prevent the arterial bleed.

Because if that tourniquet wasn't there

or if they did something silly like put a t-shirt

and they try and tie the t-shirt,

you could never generate enough force in order to actually clamp down the artery.

It takes way more force than people realize.

So on these commercial grade tourniquets,

you put it on

and then there's this ratchet mechanism

that actually puts enough pressure to shut down the flow of the artery.

>> Is it like literally creating like a physical plug?

>> Not even a physical plug, just like choking out the artery.

And it's very uncomfortable, very painful, but again, you're allowing that person to survive.

>> I have a question also.

Why is he holding on?

Should it be on ice?

>> Uh, actually, no.

Putting uh limbs, fingers, severed fingers.

Commonly people think throw it on ice.

But the ice can actually damage the tissue.

So, ideally, you'd want to uh take the organ

and cover it in some sort of moist paper towel

or some kind of moist covering

and then put creating some space from the ice

so it's not direct contact

because ice can actually burn tissue.

>> So, burns happen in both direction.

We saw it in an early episode with the uh dry ice >>

and you don't want to be damaging

that tissue because it's going to make it even more difficult for the transplant

team or the >> Yeah,

it makes sense that like cells might die in extreme cold.

Yeah, exactly right.

Yeah, that makes sense.

Donnie, primary survey, please.

>> Pupils equal and reactive.

>> What's your name?

>> My leg hurts really bad.

Did I break it?

>> Um, I I wouldn't say that it's broken.

Exactly.

>> We're going to get an X-ray to determine that.

Put that on the gurnie.

Line it up for X-ray.

Keep your mouth shut.

>> Good.

Long sliding right and left.

Airway patent.

Breath sounds bilaterally.

So they're doing this basic trauma evaluation to make sure

that the patient's head doesn't have a head injury with a bleed inside the

skull to make sure

that the lungs are functioning cuz sometimes during a trauma you can have a

rib break puncture the lung pumothorax

which has happened several times the show.

>> Does your belly hurt?

>> No into my leg.

>> Okay.

She's really moving here.

>> And yeah, we can't evaluate like this.

Okay.

Deep breaths.

Yeah.

>> Yeah.

Okay.

What a girl.

What's next?

>> He's saying deep breaths cuz he's worried about him fainting.

Cuz it's not uncommon for a med student

or someone who has limited medical experience to see blood

and have a vasovagal syncopy.

>> Which is um basically a neurocardiogenic form of syncopy where

as a result of seeing something stressful

or perhaps bearing down,

your body has this reaction of feeling like there's not enough pressure

and your pressure drops.

Not enough circulation gets to your brain, you fall.

Whoa.

>> So, this will happen with the elderly.

This will happen with people having bowel movements where they're bearing down really hard,

then they stand up real quick

or in scary situations like this where they see blood

and they have this panic.

>> And and why does your body think there's no pressure?

>> It's not that thinks it's no pressure,

it creates a drop in pressure

and that drop in pressure decreases the amount of blood flow that's able to

fight gravity and reach the brain

and therefore you end up >> going down to the floor.

>> Oh, and she's sedated. finish the efast plain x-ray check her back straight

to CT.

>> What if the cam wears off?

>> Right.

Uh we should do a popial nerve block before the CT anesthetize from the

knee down.

So this is basically what would happen in dentist's office.

Obviously in under less extreme circumstances where they would put uh numbing solution across

a nerve.

But in a dentist's office, they're rarely doing a full block.

Where in this situation, if you inject in the correct areas the lidocaine, uh,

xyloane, whatever uh, numbing medication they're using here,

you'll be able to cut off all sensation distally further away from that point.

So, you're creating like a literally a block of sensation.

>> What's the bullet?

>> 42-year-old male with 20 foot blunt chest trauma with hand injury.

>> Where's my son?

Where's my son?

Taki to 108, sass 98 on 2 liters, BP 122 over 84.

Well, pants can do due to mechanism.

You >> It's infib amputation.

Hoping ortho can uh give us a little hope for replantation.

Derek, where are you hurting?

>> Chest and my finger.

Did they find my son?

>> Did you hit your head?

>> Don't think so.

I need to find my son.

>> It's very interesting how they're ignoring a patient multiple times here.

>> Yeah.

Do you do Do you feel like you generally would say something in response

to that?

If a patient is being unreasonable,

I think you have to just continue on with the exam

and make sure that the patient is stable

and ask all the right questions.

But in this scenario,

he's asking a pretty reasonable question

and it's not that someone's answered him

and he keeps repeating it.

Answer it once at least >>

and then maybe he'll calm down

and you'll get a better exam.

>> Maybe they need a Dr.

Moan in there to answer the question >> with a good handwriting.

>> We'll find him for you, but we need to take care of you first.

And that's why she's my mentor.

That's why that is my mentor.

Respectfully, >> move both arms.

Look at your feet.

Good.

Any pain in your neck?

>> No.

>> Spleen looks good.

>> Start with this chest.

That's where he hurts.

>> And again, in a scenario like this,

you're just trying to make a quick calculation of where a possible extreme injury

might be.

So, you're doing very gross testing.

Do your feet move?

Do you feel this?

You're not making sure

that he's going to be perfectly ready to go play football the next day.

It's just about stabilizing him

and making sure that anything life-threatening is attended to,

>> right?

In order to like send him up to the O and stuff, right?

Okay.

I have a really embarrassing story.

I just remembered about about this.

So, >> this specific scene, >> not this specific scene,

but just generally this idea of like stabilizing the patient

and then sending it up to sending them up to the O.

I it was like the first episode where we were doing like the open

the open the chest cavity thing

and we were doing the pulmonary lung flip >>

and like I mean I think I like logically knew

that like we are just trying to stabilize the patient

but I was like part of

that lung flip and we >> get the higher flip going.

>> We got the highland flip going

and then I remember I asked the doctor on call there.

So the lung just stays like that forever.

And she was like, "No, you're sending temporary.

It's temporary.

You're you're stabilizing the bleed

and then you send them up to the AR

and they flip it back.

It's not like he just stays there with an inverted lung."

And I was like, "Oh, I feel really dumb right now."

Uh, I don't see much lighting there.

>> His name is Jack.

He's seven.

>> Pumorax.

Set up for a chest tube.

>> Not yet.

Uh, let's go posterior lateral.

Look for fluid first.

>> Traumatic pneumthorax.

We should prep the chest.

Not necessarily.

He's hemodynamically stable.

>> Hey, does that look like some fluid there?

Hard to say for sure.

Okay, he's tacocartic humanthorax.

He needs a chest tube.

>> BP and SATs are fine.

We can wait for CT.

If it's small, it'll resolve on its own.

We observe and reimage.

>> I agree.

He's stable for now.

Let's wait for the scan.

Dr.

Santos, >> this is what happens when you run into uh a young,

very excited doctor who hasn't quite learned the art of medicine,

which is treat the patient, not the imaging.

And that also holds true.

Treat the patient, not the lab value.

Um, this happens quite often in my residency program where a resident will get

a result and the result is off the charts,

but the patient looks totally calm.

And I remind them sometimes there are laboratory errors.

Sometimes something can happen

as a false flag

and you have to repeat the test.

So before rushing to treat, evaluate clinically what's happening with the patient.

So here, if the patient is stable,

why rush to intervene

if there's a potential

that it can heal on its own?

So, and so would you just sort of like flag that,

keep an eye on it,

and monitor consistently to make sure it doesn't like they don't die?

>> Yeah.

>> Okay.

Well, I mean that makes sense because like surgery is like incredibly invasive.

>> Invasive.

And if in in general in an ER setting,

if you can move a surgery from being an e surgery to an elective

one,

perhaps a few days later,

>> the outcomes improve >> because anytime you're performing something under emergency situations,

there's always less preop testing.

The patient isn't medically optimized.

They're higher risk.

So, ideally, you want to move things from the e setting to the more

elective setting if it's safe for the patient to use.

>> That is interesting.

Okay, let's order a CT.

Chest, abdomen, pelvis, and X-ray.

Left hand.

>> Whoa.

Major deep gloving.

>> Focus on the primary.

>> Dr.

Langden's correct.

We need to log roll him.

>> So, this happens quite frequently

when a ring gets caught in some kind of uh mechanism.

I've seen this with uh horse injuries like where they're holding on to the

god >> reins of the horse.

>> Do they not notice it's happening?

>> They do, but it usually happens

as a result of a quick force. like you fall,

the rains get caught on you

or you're falling and you reach for something

and the ring gets caught.

It it's it's usually happens with not just a skin injury

but also an avulsion of the entire finger.

So quite dramatic.

>> Never wearing rings again.

I guess golf already wish my mom every time I get a second of

service another dozen text.

>> How much longer do I have to wait?

I got a broken leg here.

Someone will be with you shortly, sir.

Well, >> am I allowed to use the bathroom?

I really have to go.

>> I don't know, ma'am.

I am not your doctor.

>> It says right there, doctor.

>> Yes, but I'm not your doctor.

But if you go back to your room, a nurse will come find you.

>> I wasn't in a room.

>> Dr.

Mohan, the sister in Dr.

Quan.

>> Kevin, how long has your leg been swollen, Helen?

>> Uh, it's been getting worse over the past week.

>> So, in a scenario like this,

you're worried when a patient comes in with unilateral leg swelling. for a clot.

Uh this is called a DVT.

The danger of a DVT is not

so much the problem

that it can cause locally in the leg,

but more so if

that clot dislodges and goes upwards in the circulation

and gets lodged in the smaller blood vessels

which are in the lungs,

also known as a pulmonary ambism,

medical emergency because that part of the lung will not be getting circulation

and dying.

>> Dr.

M, your mom called again.

She said you don't back >> with a patient.

It's like moral injury happening before.

>> Yeah.

Something something's all right.

>> Did you Did you fall or hit your leg?

>> No.

>> Is that real sweat?

>> Yeah.

Sweat on command.

>> Yeah.

>> No, it was a thing

that >> I mean I thought this was like part of the acting method.

What is it called?

The main >> There was there was a Twitter account.

There was a Twitter account

that saw these photos

and they started making I mean I like kindly they were lying

that I could like sweat on command

and like do all kinds of things on command

and I like played into it.

>> I was going to say

if they like dowsted you with fake sweat that's high level.

>> Let's just keep going.

>> Have Have you ever had a blood clot before?

>> No.

>> I'm worried about you more than I am the patient at this moment.

>> Excuse me.

Do you need to sit down?

>> Oh, no.

Patience like the patient's concerned about you.

>> What?

>> No, it's just um it's really hot in here

and uh and uh you need to sit down.

>> I'm good.

>> Oh my god.

Are you going to have a vaso veagal syncopy that we just talked about?

>> Maybe.

Excuse me.

One second.

Based on the hand position, the symptoms, I'm worried about the heart.

I'm worried about a panic attack.

Maybe a gallbladder situation on the right upper quadrant.

We'll see what happens.

>> I've been waiting in front of >> Oh my god.

>> Look out way.

>> Get in.

>> It's like that meme.

Get in.

We're going shopping.

We're going to get you checked out.

>> Excuse me.

Coming through.

Out of my way.

>> We were going down the water slide and the bottom just fell off.

I grabbed Zach's arm and I tried to hold on to the sides,

but my hand slipped and my ring got stuck.

>> There's also very specialized tools

that we have that function

as ring cutters in order to protect the patient underneath their tissue,

but then can cut through the metal.

>> Hello, sir.

I'm Dr.

Garcia from the trauma service.

Need the ring cutter.

That's a ring critter.

>> Possible flexor tendon injury.

>> Try to bend up your ring.

Oh god.

>> Let's go with the block.

>> I'm going to feel a pin prick and some burning.

>> A lot of times when you give numbing medication,

the obviously the pin prick is uncomfortable,

but also the medication

as a side effect initially very briefly causes a burning sensation.

>> Mr.

Foster got separated from his son Zack at the water park.

>> We can call for you.

My wife Angela.

>> Dr.

Santis, will you escort Mr.

Foster to CT?

>> They're so good at like showing the interpersonal dynamics >> between them by saying medicine.

Yeah.

I mean, that's something we really try to work on on the show.

It's like how can we Well, yeah,

cuz like when you read it on the page,

like >> it reads like a a medical textbook, which is what makes it brilliant.

Like I'm not shading that whatsoever.

But then also as an actor,

you want to make sure

that like something else is also being communicated to the average viewer

that doesn't,

you know, like understand everything we're saying.

>> Yeah, that's I'm actually quite curious about this.

How does one like yourself live uh 24-hour shift over the course of three

months?

Is that weird?

>> It is >> because you're living living hour by hour,

but it's really week to week.

It's more like 7 months and it's a it's a 15 hour shift.

>> Okay.

>> Well, yeah.

But yeah, it is like the the weirdest thing in in the world.

Like I especially cuz we're in LA,

so the weather essentially stays the same when we're filming.

I really lose all track of time.

>> Really?

>> It's really cuz like you you leave >> like

and everything's in a certain place

and then you come back the next day

and it's like everything's exactly the same.

>> Is that Groundhog Day?

>> It really is.

It's like I can't I can't explain to you like how like I think

somewhere in my head like it's like maybe been like a year since I

booked the show.

Like it's just very it's very odd like the way >> what happens

if someone gets like a pimple

or a cold sore

or something.

Does that like break all continuity?

>> I mean they say they VFX it.

I don't know.

>> Okay.

>> It's true.

>> Back to the show in just a second.

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All right, let's get back to the pit.

>> Help.

Need a hand here?

What the hell happened?

>> I think I'm having NMI.

My chest is so tight I can barely breathe.

>> Okay, I got to get a swab.

Pearla, can I get an assist here?

>> Yeah, I'm on it.

>> So, in a situation like that, obviously you need the EKG,

some blood work to rule out having an MI.

It's interesting how often the pit is needing to treat their own staff.

It's not the first time doing great.

No, we're all falling apart.

And you know, treating an MI

and deciding whether it's an MI

or a panic attack is really interesting

because to the patient,

they can feel one and the same.

For doctors, because they present very similarly to us

and we're trying to learn subjectively what's happening with the patient through their eyes,

their own interpretation of the symptoms.

It can be very easy to misread the situation

and make the patient feel like you're not on their team.

Mhm. >> where imagine the EKG looks normal, the tropponins come back negative,

the blood test that would signify heart damage.

And as a doctor, you're like, "Okay, well, look, there's no heart attack.

I'm okay.

I'm going to treat this as a panic attack."

But if you don't communicate that in the right way to the patient,

they could leave feeling very unseen, unhappy,

dissatisfied with their care because they're not coming in to rule out an MI.

They're coming in for a diagnosis to know what's going on with them.

Yeah.

And if we just rule out an MI, we may have done our jobs.

>> It could be hard to be like that's all in your head.

It's all it is.

It is.

Wait, I also have a medical question.

I've always wondered this and you explain things really well.

So like the troponin is like a muscle pro proine, right?

Um why would that be in the blood test an indicative of like a

heart attack?

So when the heart is having an an infuction,

what's happening is the heart itself which supplies blood to everywhere in the body,

it also needs to supply blood to itself.

So it does so through the coronary arteries.

When there's a blockage in those very small coronary arteries,

the heart muscle itself starts getting choked out of blood, therefore dying.

That's what a heart attack is.

And when that muscle is dying, it starts releasing this protein.

Correct.

Yeah.

Into the blood.

And what's interesting and why we get what are known

as serial troponins is we get them every two hours to see how they're

behaving.

So it's not usually enough to just get one set.

You want to get every two hours to see is the muscle damage improving

with the treatments that you're giving the patient

or is it a particular unique MI called a type 2 MI.

You're just wanting the heart to perform

so much that it doesn't have the demand capacity to give itself enough circulation.

So not because of a blockage

but because you're asking it to do too much where it starts dying off.

And in those situations you see a big tropponent number

and then it starts improving

as the demand decreases.

>> Interesting.

Whereas with a typical MI, like an ST elevation MI,

there's a full blockage

and the tropponent number just keeps going up up up

and you know you need to get this person to the Kath lab

as quickly.

>> See, now I want to go home

and figure out how they figured out troponin would be a good problem.

>> Yeah, exactly.

>> For like a heart attack.

>> You'd be surprised.

Like the the amount of scientific knowledge

that doesn't make sense to me how they knew to check for this enzyme,

for this protein, for this biioarker is truly impressive.

>> So I was talking to someone about this recently.

She's like um she's a she's an executive at a company

that I really love

and she comes from a family of like scientists

and um mathematicians and she said this thing to me

which is like artists

and scientists are actually

so similar because you believe in this thing

that isn't >> real yet >> real real yet

and you have to prove it.

Um, and like that really really just made me go like, whoa,

I I I kind of like see the parallels of how how I'm in

both of these because like I mean I I know

when I when I was like studying neuroscience

and stuff like a lot of the studies

and everything we did like all of it was just like we don't really

know many things.

So we're using you know like we would use sleep

as a proxy to like study consciousness

because you're unconscious while you sleep.

Yeah.

It's just so interesting like how we have to like think about things in

a thought.

Here's something that will potentially blow your mind, potentially give you anxiety.

>> As an artist, you have to create things that are not there.

Correct.

>> Uh-huh.

>> Right.

Because you're creating from scratch.

>> Yeah.

>> What medical condition does your mind create things that are not there?

>> I don't schizophrenia.

>> Higher rate of schizophrenia in artists.

>> Are you trying to tell me something?

>> No.

>> Okay.

>> Just food for thought.

Interesting, right?

how the line of if you have control over this creativity,

it's great and you're an artist and you're a human,

but if you don't have control over it

and your brain's just doing it

and you're hallucinating now suddenly it's a medical diagnosis

and pathology.

>> Don't get me started on like pathologizing mental illness.

I can like go on forever and like maybe get myself canceled.

So, let's just keep going.

>> Get Robbie.

>> Okay.

Right here.

So like you see me breathing actually like I wish they kind of kept

it in.

So we were in between I mean do do you have theories on what

is happening to me?

>> I'm assuming you're overwhelmed then it's a panic attack.

>> Should I spoil it?

>> I mean I you can't my my differential is obviously you want to

rule out the most dangerous things even

though they're not the most likely

because >> you're a younger person.

I'm assuming there's no underlying health conditions

because maybe we would have been told about them.

So that's why panic attack is higher.

But MI you need to rule out first because if you miss MI,

you're screwed.

>> Okay, I'm going to spoil it.

It is a panic attack, right?

>> Good doctor.

Um, no, but I think it's important to reveal during this scene cuz I

I I we were talking

so much about whether they'd cut her shirt off cuz she's like a colleague

and like if you thought something was really really wrong by

that point,

Langdon would have cut her shirt off.

But I think like at

that point he kind of has gotten a sense

that >> that it's maybe I mean sort of like you know

that it's like maybe not an MI.

Um and what I wish they kind of shown was >>

so Robbie comes in after the scene

and I'm like pretty calm at

that point.

And >> I think him like Patrick

and I were kind of like something needs to happen

so that I've calmed down

and you kind of see it at towards the end of the scene where

like he started just totally improvising like breathing to like calm me down.

Got it. um which I thought was such a smart move on his part.

>> It's very true because uh what happens when we hyperventilate,

we can actually blow off a lot of carbon dioxide.

And when we blow off a lot of carbon dioxide,

that can shift the pH balance of the blood

and make us feel uncomfortable

and woozy.

So slowing someone's breathing

or having them breathe into a paper bag actually does work

because you're reinhaling that carbon dioxide,

not breathing it off too quickly.

So there there's a there's a method to the method.

The carbon dioxide pH questions were always my favorite on the MCAT.

I was like, I understand this really well.

I can get these.

>> Oh my god, MCAT.

That gives me my panic attack right now.

>> CT's normal.

>> Why do we take down the tourniquet, Whitaker?

>> To give the residual limb blood flow.

>> Two little pumpers.

>> Couple of figure eights to take care of those.

>> Park the shark.

Orthopedic surgeon.

>> Is this a favorable amputation?

>> Pretty clean cut.

Flic through like a guillotine.

>> X-ray.

Not too bad.

A >> lot of hardware necessary to put those bones together.

>> Clean wound.

No crush injury.

Rapid transport time.

Replantation is a go.

I'll book a noir.

Irrigate the hell out of this with three liters.

>> Three lers of saline.

Genius.

>> I'd cry.

>> Yeah, this so mean.

Look at the pause frame.

>> I knew he meant saline.

>> Dr.

Rodney, we need you in central sex.

Dr.

Mohamm may be having a heart attack.

>> What?

>> EKG is normal.

>> You sure?

>> Check it out.

You can be here on second opinion.

What's going on?

>> It's okay.

I'm I'm okay.

>> You don't look okay.

>> Yeah.

It's really funny cuz like you were talking about how they were doing fake

sweat so I can like It's literally

so much fake sweat.

Really?

>> I was so lubed up.

It was embarrassing.

And then at this point someone would come in

and the Damian the director would just go like more sweat more sweat more

and like someone came in at this point

and was literally like spraying my face.

>> No, but that's so realistic.

Diapharesis happens in moments of panic attack.

So >> what happened?

>> I I don't know.

I just got really hot and I started having trouble breathing.

>> We should set up some labs just to be safe.

>> I agree.

>> Any chance you're pregnant?

>> Not sure I feel comfortable answering that.

No, >> she was tacky, but it's resolved now.

>> Have you eaten anything?

>> Yeah.

>> You staying hydrated?

>> 100%.

>> Yeah.

I mean, a quick thing to check here in a scenario like this would

also be a finger stick for glucose just to make sure

that you didn't bottom out your sugar levels for some unique reason.

>> I mean, she's probably not been eating.

>> Yeah, exactly.

And probably dehydrated.

>> And probably dehydrated.

>> I'm doing everything right.

It's everything around me that's alled up.

It's just my mom moving and calling me over and over again.

And and now me scrambling to find a job next year.

I had it all planned out and now everything's just out the window.

>> Wait a minute.

Is this a panic attack because of your mommy issues?

>> What?

No.

>> Jesus.

Do you need to go home?

You should go home.

>> No, I'm fine.

>> I don't need the liability.

Go home.

>> Wow.

That's so crazy watching it as an audience member.

>> That was so cold and unbelike.

>> Oh my god, that was so hard to watch.

I only really, I think,

realized how bad what he just did was after we filmed

or like after he left

because I think I was

so focused on defending myself

and kind of going like,

"No, I'm like I'm okay.

I want to stay.

I'm like good to stay."

I think like when she's like having a second to process is

when I I think they have a cut of me after.

So, it's almost like everyone's experiencing their own uh we call this vicarious trauma

where because of constantly feeling compassion for others

and seeing these terrible situations play out,

we can lose our compassion at times.

>> Mhm.

Especially for people I think

that happens with Samira a lot where like it's hard for her to have

compassion for people she's close to in her life

as opposed to her patients.

Like for whatever reason,

it's safer for her to have that empathy there than >> Yeah.

I don't know.

Hey, you going to go in and see your mom?

Cancer sucks.

>> Yeah.

>> Yeah, it does.

She didn't used to look like that.

>> Yeah, I get that.

But if you don't go in there

and say goodbye and tell your mom you love her,

I think you might wish you had for a very long time.

>> I like that she prefaced it with you might >>

because it's very easy to think

that you know everything

when you're in these scenarios

and patients aren't.

But it it's true cancer changes everything.

Uh not just the cancer and the the disease itself, but also the treatments.

Sometimes the treatments take such a toll.

And I have personal experience with this.

I lost my mom to cancer and >> I'm so sorry.

>> Not actually cancer.

Interestingly enough, the cancer,

the doctor shook my hand just a few days before and said she's cured.

Now we just need to get her back on her feet,

but because the treatment made her

so weak and hurt her immune system

that she got this mean infection

and it's this exact scenario plays out.

And that's something I wanted to tell the doctors all the time too.

I don't know why that she didn't look like this before.

She was different before.

And that was like it's it's a part of their humanity

that I feel like we lose in healthcare sometimes.

>> Yeah.

>> So it's tough.

Do you have any personal experience with cancer in life?

>> Yeah.

I lost um I lost uh my uh sister-in-law

or cousin sister-in-law to it

and it was very sudden.

It was um >> it was uh intestinal cancer.

>> Wow.

>> Yeah.

And it was just very sudden and we had no idea.

Um, and it's funny cuz even though she wasn't related to me,

I felt like she was like >> the person in my family

that like got me really the most.

Yeah.

She was like so cool.

She moved from like India to Japan with my cousin

and like like learn Japanese

and like travel the world.

Yeah.

She was just really >> Sounds like had a full life.

>> She she did she did

and she did this really beautiful thing where um >> I think sometimes

when you have cancer it's really hard to talk to your kid about it.

Um, and she I I I forget how old her kid was at the

time.

I think maybe like 10, 11, like not old enough.

And she really prepared him for her death.

Yeah.

>> I mean I mean it's just one of the reasons I thought she

was so cool.

She was so like emotionally intelligent and mature and >> Yeah.

>> Sometimes it's those darkest moments that bring that out.

>> Yeah.

>> Kenamine's wearing off.

I can't feel my leg.

>> I'm Dr.

Michael Rabinovich.

You're at a hospital

and we gave you a nerve block

so that you can't feel any pain.

Why?

>> You were on a water slide

that collapsed and did serious injury to your leg.

>> Is that my leg?

Is that my Did you cut my leg off?

>> Your leg was cut off in the accident.

Our surgeons are going to try for replantation.

I >> She needs more catammy.

>> Wrap up the leg.

Emily, I know that this is really hard.

I need you to focus on me right now

because we need to get your consent to proceed with the surgery.

>> I love that this leg is in the back shot of the entire clip,

no matter what angle we're in.

>> There's something so darkly about it.

Also, like this actress is doing an incredible job of like processing her.

Yeah.

Wow.

What did I miss?

Finishing irrigation.

It doesn't look like you lost any skin.

>> It's a little dusky.

Might not be viable.

There's intact skin on the dorsome.

More irrigation, then tack it down with one suture.

>> Okay, thanks.

Radiologist reports a 25% in the thorax.

>> Is that bad?

>> That is a partially collapsed lung that needs treatment.

>> I can put in a chest tube.

>> He doesn't need a chest tube.

>> Okay.

What do you want?

A pigtail catheter?

>> I was thinking a thor.

>> Why is the pigtail catheter like is it like an aggressive thing she's saying?

>> I I think it's not as aggressive as putting in a full chest tube.

This is outside of my scope to know the differences between each one of

these approaches,

but uh I I'm familiar with the pigtail catheter being a less invasive approach.

I'm curious why >> I'm wondering

if she was being sassy like what do you want like a hole?

>> It's not a bad idea.

No need for well suction.

If hand can operate today, you can go home tomorrow with a Thor event.

You can learn a lot from your senior residents.

>> I'm happy to teach Dr.

Santos.

>> Thank you, Dr.

London.

That was an unnecessary shade line right there.

>> Place the troar.

Pull back the uh adhesive wings >>

and advance until you see the red diaphragm move.

That means you're in the plural space.

>> Is that cuz the air is coming or like why is the diaphragm moving?

>> Yeah.

So he's talking about the diaphragm inside the device, right?

>> And it's because there's air inside the plura.

So this is a weird thing to visualize.

Air does not belong in your chest.

As weird as that sounds, it belongs inside of your lungs.

>> Well, that makes sense because the lung needs to expand.

>> Correct.

And the the reason that the lung expands is through the negative pressure.

So, when your diaphragm pulls down,

that negative pressure allows the lung to expand

and pull air in into the lungs themselves.

When the lung is damaged,

air starts escaping partially

because it's only a partial uh pneumothorax. air uh leaves the lung,

ends up entering the plural space, starts putting pressure on the lung,

therefore making it difficult to fully extend.

>> So this thing's removing >>

So this thing is removing the air

and that's what allows the lung to heal

and eventually refill.

>> Perfect.

>> Okay, now we can either uh hook up to wall suction

or we can use this one-way valve to repeatedly aspirate with a syringe.

Now >> with all your vast experience, Dr.

Langdon, you should probably decide.

>> We can avoid wall suction if I pump manually.

>> How about at it, Doc?

Enough.

Apparently, decency and decorum need to be reintroduced to our R2 curriculum.

>> Interresident conflict like that is real and it happens.

I've had this with some of my seniors where they were getting fed up

with me and for things

that were outside of our control,

uh, mishaps that happened, miscommunications,

and I literally remember walking down one of the hallways yelling at my senior

to come back and please talk to me

so we can get on the same page cuz we're on the same team

>> and we we we were able to do

that thankfully.

>> But it's obviously very awkward

when you're doing that on overnight shift

and you have to respond to constant emergencies.

>> Totally. boy.

Part of a water park accident thrown off the water side.

>> How far did he fall?

>> Maybe 6 or 7 ft.

Landed in a tree.

Had to wait for a ladder truck to get him down.

>> Major neck trauma.

Must have taken all the impact there.

>> Couldn't tube him.

Hard to bag.

>> So, because he was hard to intubate,

that signals that there could be swelling in the neck forming.

In a scenario like this,

you'd want to be potentially prepared to cut into the neck to create an

airway.

And the reason why they're

so insistent on asking the mechanism of injury

that helps us decide in our minds what is most likely to have gotten

hurt and how severe the injuries are will help us decide whether

or not we should just automatically pan scan the patient.

>> Possible langial fracture, hypoxic, brady cardic, >> kidneys and airway before your wrist.

>> Bronzo tape cart setup suction.

>> Oh my god, is that Zach?

>> Oh, they look at me.

>> I always yell, why aren't the curtains wrong?

Is that because the cameras all need to be moving around?

>> Well, it's it's it's for dramatic effect.

>> Okay, got it.

Fair.

>> No response, no purposeful movement to pain.

>> That's a lot of bruising there.

And there's these cartilagynous rings

that go around the trachea

that they can break

and fracture and cause some bleeding.

Obviously, you worry about a full severance of uh the trachea in those instances

depending on how severe the trauma is.

>> Okay.

Uh a 30 of rock 50 can be you're going to paralyze.

>> Yep.

>> Well, if we can't intubate, we crank.

>> He's too young for a crank.

>> Needle crank.

>> Can't ventilate through that.

>> Sass on a 78. >> 11 blade Kelly and a ped's bougie.

One quick look and then we cut.

>> I can't tell if there's lung sliding, no movement, no air entry.

>> Way too administ.

I can't see the cords.

>> Yeah.

So, there's full swelling inside the throat there.

Once you can't visualize the cords, you probably need to create an artificial incision.

Do this tracheosttomy.

Tracheotomy.

>> Okay.

Tell world between the shoulders.

>> Down to 49.

Headed to cardiac arrest.

The trick's going to take 20 minutes.

This kid's not going to last 60 seconds.

>> That's why we're doing a slash trick.

Don't know it.

>> Me neither.

>> Boss, >> show me what you got.

Oh, man.

>> Such an insane thing to say to her at that moment.

>> Pull up the trachea between your thumb and middle finger.

Vertical incision right over the trachea.

>> Okay.

>> Vertical, not horizontal.

>> Well, cuz there's a lot of blood vessels there.

Now it's a tactile procedure. 2cm incision through the tracheal rings.

Finger in the trachea.

Bougie into the airway.

Thoughts on what's next, Dr.

Whitaker?

>> Insert the ET tube into the trachea.

>> Suction.

Lots of blood in the airway.

>> Probably from the trauma, not from her incision.

>> Okay, back in.

Check the CO2.

>> Sounds are coming up in the 80s.

>> Bilateral breath sounds and tidal CO2 is 70.

That's crazy high.

>> It'll come down.

Tie down the tube.

Control all the bleeders.

Spray an amp of EPI on a stack of 4x4s.

>> So epi uh will constrict the superficial blood vessels and decrease the superficial bleeding.

So >> good good little tip on her part.

>> Good.

CO2 is in the 50s.

Good heart rate.

>> You forgot the last step.

Change your underwear.

>> How many of these you done?

>> First one.

Are you serious?

What about you?

>> None.

>> I practiced in the sim lab when I was at Stanford.

>> What' I miss?

>> All the fun.

Slake.

>> Seriously?

>> Uh, fractured larynx.

Couldn't oxygenate.

Couldn't ventilate.

>> Use a meat cleaver on this kid.

>> ENT can revise the TRA in the O.

>> They'll be thrilled to clean up your mess.

Or maybe they'll thank us for not letting him die.

>> Tracheotomy is cutting in to put in the the tube. tracheosttomy is now

securing it and having this opening to allow the child to breathe

as the organs continue to heal.

Usually this will be done temporary.

Although you will notice

that the nose is

so important to breathe through

when you have a tra

because the nose will warm.

It'll humidify the air.

Therefore, the lungs when you're on a tra will develop more mucus from this

cold non-humidified air >> more

so than usual.

So it can be quite uncomfortable for those patients.

And so that's why suctioning is important.

>> Oh, >> Dennis Whitaker.

Meet my buddy Duke.

>> Uh, nice to meet you.

Any friend of Dr.

Robbie's a friend of mine?

>> Friend is a vast overstatement.

He's more just a pain in my ass.

>> Don't let his surely exterior fool you.

Deep down inside, he's just as grumpy.

>> Vitals look good.

>> What seems to be troubling you?

>> Ask him.

He's the one who made me come in.

>> He's had some horarsseness on and off for a couple months.

>> Okay.

Any history of tobacco or alcohol use?

>> Two of my oldest

and closest friends. high risk for cancers of the oral fairings

but surprisingly on the rise HPV related oral cancers from the HPV virus human

papilloma virus >> that was that's the one thing I'm like grateful to my

mom for for getting over her own sort of like cuz India can be

like really sexually conservative

and like it's like really weird

when like I grew up in India

so like like there's like a whole thing where like parents won't vaccinate their

kids against HPV cuz they're like why the would my Yeah,

because they wouldn't do that.

>> Because they wouldn't do that.

But like my mom actually like even

though you know it took her some time to like get over it,

she kind of was like, "No, I think I should like this."

Yeah, I know.

I'm like so proud of her for like >> it's like the one vaccine

that reduces risk of cancer >> cancer.

Yes.

That's crazy.

>> And yet our Secretary of Health and Human Services, RFK Jr. is anti- vaccines.

>> Well, I know he Well, I knew he was antivaccines.

I guess I >> He has actually still on his Twitter

that the HPV vaccine hurts more people than it helps,

which is a figment of his own imagination, >> but it's cancer.

>> Yeah.

>> Okay.

>> Bag a day smoker and lover of the drink.

>> You on any medication?

>> Uh blood pressure meds?

>> Another thing uh that can predispose someone to have long-standing horarsseness,

uh mucus in the back of the throat, a chronic cough,

chronic sore throat that never really seems to go away is a condition called

LPR.

It's a mouthful.

Luringo fingial reflux, but it's quite simple.

Luringo larynx voice box fingial throat, ferinx reflux, acid reflux.

It's actually nicknamed silent reflux

because only a small amount of acid reaching the vocal cords

or the throat can create longlasting mucus production.

Scarring of the area

and create all these unique symptoms

that we get really worried about.

But once we put in a a little camera inside the nose

and look at the vocs,

you'll see a characteristic pattern from LPR, you treat that by controlling the acid,

allowing it to heal, doing some lifestyle changes, and boom,

you start to feel better.

>> I am going to take this scope

and I'm going to stick it in your nose

and we're going to check out your upper airway.

>> It seems like a lot of fuss for a sore throat.

>> Dr.

Brook, you want to explain to Duke why this procedure is absolutely necessary?

The scope is going to give us a better view of your voice box

and your vocal cords.

>> Here we go.

>> Obviously, polyps and all these other things, anatomical variations, can also cause these symptoms.

>> Feel a little pressure between your eyes.

I am sorry about that.

Okay, just breathe through your nose.

>> This is going to help us see if there are any abnormalities like inflammation,

tumors, nodules.

>> That all looks pretty normal.

I don't see too much drainage.

Stick your tongue out for me.

All the way.

All the way out.

Good.

Now say E.

>> E.

>> Good.

Now again say E.

>> E.

Good.

Removing the scope.

>> Dr.

Whitaker.

What do you think?

>> Looks normal.

No abnormalities.

>> Told you it was nothing.

>> Yeah.

With your history of smoking, I'd like to do a chest X-ray.

>> Smoking and drinking predisposes him to Barrett's esophagus,

which is a condition

that is a precancerous condition

that increases risk of esophageal cancer.

So if there are growths,

they can push against the recurrent langial nerve intermittently

that can paralyze one of the vocal cords

and cause the horarsseness.

>> I'm surprised this is workup that's being done in the ER.

This is not an ER.

>> I mean, I think something's trying to be said about how much he

likes Juke.

I think like he's like doing him a favor.

Maybe >> he's doing all this for this guy,

but when you're having a panic attack, >> he's like, >> "Get out of here.

Get out of my ER."

What the hell was that with Samira earlier?

>> That was tough love.

>> You are her superior.

She was obviously struggling and your advice was go home >> essentially.

Yeah.

This is the ED.

It's not for the faint of heart.

>> It's not for the unempathetic either.

>> Samir's not having a panic attack because of her patient.

She's having one because of personal baggage.

What she needs to do is pull her head out of her ass

and focus on the work.

>> What about you?

What do you need to get some basic human empathy back?

I don't know.

Something that gives me a little hope this place won't fall to

when I'm gone.

>> He's the one terrorizing everyone.

>> When you're experiencing all these negative emotions during the panic attack and afterwards,

>> do you ever feel that as a person outside of being an actor?

>> That's such a good question because I think like Samira,

I had a really bad day this shift

and I actually had a really hard time letting

that go towards the end of filming.

Yeah.

I mean, you I don't want to spoil anything, you'll see,

but like >> she has a pretty bad day

and it was like really like I I always prided myself

as someone who was able to get out of character,

but yeah, it was hard.

Well, the human mind is so tricky in that when it experiences certain emotions,

whether real or viewed through another lens, can actually impact physical sensations,

physical um >> levels of severity of pain, discomfort.

So, even like they say, if you smile, you could start to feel happy.

Well, the same goes true if you start to make yourself feel artificially sad,

you can actually end up feeling sad.

>> Totally.

And I think because it's like it's the same day

and she had to live in

that headsp space for like I want to say 4 hours.

That was like 2 months of me really like >> like really going why

do I feel so bad all the time?

>> Wow.

Got a sec?

>> Sure.

>> How you feeling?

>> I'm fine.

>> Are you sure?

>> Yeah.

Trapon Dimer and TSH all normal.

>> Listen, I'm sorry about earlier.

I think I was being >> a dick.

>> I was going to say unprofessional, but probably that too.

>> Deserve it.

>> I'm sorry.

>> Thanks.

>> That's nice.

>> Yeah, >> kind of.

>> You keep going.

>> But now I kind of need you to stop feeling sorry for yourself

and focus back on your patience.

Think you can do that?

>> Sure.

>> Great.

It's like an apology, nonapology.

>> The fact it was a great choice

that he did it without entering the room.

>> Yeah.

Yeah.

I agree.

>> I think that spoke volumes even though >> I agree.

I mean it it I think it would have been like too too much

to maybe in that moment.

Yeah.

I mean it's interesting in the in the moment

as the character I was like I feel better.

Oh no.

He still thinks I can't >> Yeah. >> deal with this.

>> Fair.

With this extra dose and increased morphine from the pump, your pain should subside.

Your breathing will slow down.

You may get very sleepy.

Paul, go be with the boys.

They need you more than I do now.

>> Later.

Right now, I'm exactly where I'm supposed to be.

Yeah.

Okay, here we go.

>> It's very interesting.

>> Is that the end of the episode?

>> Yeah.

It's very interesting that uh >> it used to be viewed

as crying in front of a patient was a bad thing.

>> Yeah.

Yeah.

>> And intrinsically a lot of doctors,

nurses feel that when in reality patients do not judge doctors for crying,

for showing emotion, especially when it's emotion that is in support of them.

>> So I think

that is a major mindset shift

that needs to happen

as one transitions throughout their healthcare journey.

>> Totally.

There there is like a boundary

though like like >> you can't break down to the point where you can't

help >> practice medicine.

Yeah.

I feel like I would unfortunately like I think that's why I didn't go

down that path.

I don't I think I would like very much probably a little like Samir

or just take on a little a little too much,

you know.

>> Well, maybe this role was written exactly for you.

That's what it seems like.

>> Felt like it.

Felt like it when I read it.

>> Talking about water park injuries, we actually reacted to some of those.

Click here and check that out.

And as always, stay happy and healthy.