Doctor Reacts To The Pitt S2 Ep10 w/ Supriya Ganesh

0:00 Time to react to season 2, episode 10.

0:03 And I had to bring in a special guest, Dr.

0:05 Moan in the house.

0:07 Sabria Ganesha.

0:08 You ready to take on this challenge?

0:10 Um, I don't know.

0:12 See, let's do it.

0:16 Structural collapse at the water park.

0:17 Two victims coming in via helicopter.

0:19 ETA 5 minutes.

0:20 Time to rally the troops.

0:22 We'll get environmental to clear and prep the trauma rooms.

0:24 I'm going restock the crash carts to take the latest script to the drug cage.

0:27 when this impending doom is happening, do you feel it on set?

0:31 Is it does it affect you emotionally?

0:34 Um, I mean, it's interesting cuz like yes, like during the scene,

0:38 but I think as a cast we're pretty good about

0:40 like if we want to break in between we usually do,

0:45 so we tend to talk or whatever.

0:46 I will say watching this, what's so impressive to me is

0:50 the choreography that our directors have to do to film a scene

0:54 this big with so many lines and so many people saying lines.

0:57 Now I'm watching I'm like, "Oh my god, they cut that so well." They like

1:00 like they that was really smart how they like move the camera around.

1:03 It's actually

1:04 It's a huge set.

1:05 I I was fortunate enough to visit and I saw how

1:07 expansive it is and the glass walls and the options for

1:10 which by the way is like absolutely not normal for um a medical show.

1:13 Like I've I've worked on other medical shows and like

1:16 it the set's like not as continuous as our ours is.

1:19 It's pleasant probably to experience.

1:21 So it's it makes our life easier as actors for sure.

1:24 I can increase the morphine drip to manage the pain.

1:28 But that could also slow down your breathing.

1:30 You will likely feel very drowsy.

1:33 You may lose consciousness and it could cause you to stop breathing altogether.

1:39 When we give morphine to a patient who is on hospice,

1:43 we have to be very cognizant of the fact that morphine can be used for pain,

1:47 but it could also be given for air hunger.

1:49 So when patients start dropping their uh oxygen

1:53 saturation because they're nearing the end of life,

1:55 it's very uncomfortable.

1:57 And what we're treating in a hospice patient is their comfort,

2:01 not necessarily prolonging their life.

2:02 Mhm.

2:03 So if we were to give morphine for extensive pain

2:06 at a very high dose that we normally wouldn't give to a patient,

2:09 we're accepting those side effects for the benefit of the patient,

2:13 it's it's a very different shift in medicine where you're

2:15 going away from treating for extension of life and more

2:18 so for the comfort of life and obviously difficult

2:21 to talk about especially with the entire family in the room.

2:25 But it's important to be as transparent as possible.

2:26 It's so interesting you say that cuz like I I also

2:29 started looking into pallet of care because of Samira because so

2:32 many people said things like she'd be better in pallet

2:34 of care and I you know have experience with like premed stuff

2:37 and so when I looked into what that is and how

2:41 different the principles are compared to what what you're told

2:45 as as a premed student or you know medical student I

2:48 I just I it was interesting but it makes total logical sense

2:51 of course and what happens in our society is we end

2:54 up spending a huge portion of our healthcare budget on the last

2:58 few days of life for people who are not only not

3:01 benefiting from it but are potentially being harmed by that excess treatment.

3:05 Oh wow.

3:05 So it's it's this fine line of having a conversation,

3:08 making sure the goals are met,

3:10 making sure people are comfortable, but at the same time not feeling like,

3:12 oh, they're giving up on me.

3:15 Yeah.

3:14 So it's a it's a very fine line to draw.

3:16 I'm sure you've experienced that in discussing that on the show.

3:19 Yeah.

3:19 I think I in season one we did a pretty great I would say we did a pretty good

3:23 job of discussing end of life care and I think

3:26 that's something they deal with really well on the show.

3:29 So

3:29 Dr.

3:29 Mohan, it's your mother.

3:32 She sounds pretty upset.

3:34 She says she really needs to talk to you.

3:37 You're[ __] me.

3:37 Um tell her I'm not available.

3:44 You know, I worked in an ER before up in Vermont and we had MBAs and ODS, MIS,

3:50 but this place is relentless.

3:54 He is such a good actor.

3:57 I mean, I haven't watched the second season, but I mean,

4:00 I've seen I've seen the work he does, obviously,

4:03 and it's I think it's easier for me to like process

4:06 who Olie is and see him as an extension of Lucas cuz,

4:09 you know, we'll do this this scene and then

4:11 he'll break and then we'll like talk or whatever.

4:14 But like watching this, I'm like, who the is that?

4:17 Yeah.

4:17 Yeah.

4:18 Like that is not Lucas.

4:20 He's so much more calm and pleasant.

4:22 He's so kind.

4:23 Like we just went out dancing like two days ago.

4:25 And like who the is that guy?

4:27 Like he just sounds so different.

4:29 Jesus Christ.

4:31 I think we have a very different idea of normal.

4:34 Not for everyone.

4:35 I'm not sure it's healthy for anybody.

4:37 Here's your leg.

4:41 Jesus.

4:41 Is Dr.

4:42 Abbott still around?

4:43 We need to get some sleep before his night shift starts in a couple hours.

4:46 __] Okay.

4:46 I should have planned this better.

4:49 I was hoping he'd write me a letter of wreck for an elective

4:51 so I could have a shot at a fellowship next year.

4:54 Which one?

4:56 Whichever will take me.

4:57 Did the electives fill up a while ago?

4:59 Don't remind me.

5:00 I'm going to throw myself at the mercy of the court.

5:02 Beg for them to take me anyway.

5:04 Just kill me now.

5:05 The frustration is is palpable.

5:08 Well, she's she's trying to stay in Pittsburgh.

5:11 Like she's trying to get a fellowship.

5:14 And this is realistic.

5:16 When people are looking for electives, sometimes it's a hustle.

5:18 Sometimes it's about connections and it's frustrating when you

5:21 know you might be a better candidate than someone,

5:23 but perhaps you're not friends with those people.

5:26 You might not get the spot.

5:27 Yeah.

5:27 Like the social dynamics of it were

5:29 very interesting when I was doing my research.

5:31 And also what's interesting for her is

5:32 that she already accepted like a fellowship

5:35 in Jersey to be close to her mom and now her mom's like

5:39 offering her new boyfriend, I guess, on this cruise.

5:41 And so like I think she just is like, "Wait, I have nothing there.

5:44 I have more things here.

5:45 I'm trying to stay.

5:46 So, she's like really spending this whole shift trying to figure out who's

5:49 going to write this recommendation letter

5:50 for her for this fellowship, this elective.

5:52 What she's doing, I don't think is quote unquote good or or ideal.

5:56 Like, you shouldn't be thinking about

5:57 your electives in the middle of your shift.

5:59 But because it's not good that makes it so real

6:03 because humans get irrational.

6:05 They make weird choices in real life that you're like,

6:07 "Why are you talking to me about your elective in the middle

6:09 of July 4th hospital shift?" But that's exactly what would happen.

6:13 That's one of the things that I really like wanted to do with her cuz like

6:17 I I I love playing characters that are

6:19 complex and I think she's really great with patients.

6:21 I think she knows exactly what to do.

6:23 She's almost following like that HR manual in her head

6:25 of how to be like the perfect doctor.

6:26 But I think she's just socially really awkward and she doesn't know what to do.

6:30 And I agree.

6:31 Why is she talking about this right now?

6:33 Everything's going to[ __] Like there's like,

6:34 you know, paper charts over there for God's sake.

6:36 Um but yeah, I agree.

6:38 Paper charts just makes me shudder.

6:40 You know, I can't read this handwriting.

6:42 has 1,000 milligs of acetamophen orally,

6:46 4 milligrams of dentatron under the tongue, and trilocar fluids.

6:51 So, some Tylenol for pain/fever reduction,

6:54 a dancron uh nausea medication, and some fluids.

6:59 You're just doing this on the fly.

7:01 Well, it's like I am a doctor.

7:03 Yeah.

7:03 Yeah.

7:04 After we finish, I will be going into the hospital

7:06 and playing this this role, but in real life.

7:09 What do we have?

7:10 Fall from 10 ft onto a metal fence right below the knee.

7:13 Good vitals.

7:15 Oh, it hurts.

7:16 My god.

7:16 What's she had so far?

7:17 50 event repeated 25.

7:19 No meds, no allergies.

7:20 Where should I put this?

7:21 Just hang on to it for now.

7:23 On my count.

7:24 1 2 3.

7:28 So that's a commercial grade tourniquet that she

7:30 has on to prevent the arterial bleed.

7:32 Because if that tourniquet wasn't there or if they did something

7:35 silly like put a t-shirt and they try and tie the t-shirt,

7:38 you could never generate enough force

7:40 in order to actually clamp down the artery.

7:42 It takes way more force than people realize.

7:44 So on these commercial grade tourniquets,

7:46 you put it on and then there's this ratchet mechanism that actually

7:49 puts enough pressure to shut down the flow of the artery.

7:52 Is it like literally creating like a physical plug?

7:55 Not even a physical plug, just like choking out the artery.

7:58 And it's very uncomfortable, very painful,

8:00 but again, you're allowing that person to survive.

8:03 I have a question also.

8:04 Why is he holding on?

8:05 Should it be on ice?

8:07 Uh, actually, no.

8:08 Putting uh limbs, fingers, severed fingers.

8:11 Commonly people think throw it on ice.

8:13 But the ice can actually damage the tissue.

8:15 So, ideally, you'd want to uh take the organ and cover

8:19 it in some sort of moist paper towel or some kind

8:21 of moist covering and then put creating some space from the ice

8:25 so it's not direct contact because ice can actually burn tissue.

8:29 So, burns happen in both direction.

8:30 We saw it in an early episode with the uh dry ice

8:34 and you don't want to be damaging that tissue because it's going

8:36 to make it even more difficult for the transplant team or the

8:39 Yeah, it makes sense that like cells might die in extreme cold.

8:42 Yeah, exactly right.

8:42 Yeah, that makes sense.

8:44 Donnie, primary survey, please.

8:46 Pupils equal and reactive.

8:49 What's your name?

8:50 My leg hurts really bad.

8:51 Did I break it?

8:53 Um, I I wouldn't say that it's broken.

8:54 Exactly.

8:55 We're going to get an X-ray to determine that.

8:57 Put that on the gurnie.

8:58 Line it up for X-ray.

8:59 Keep your mouth shut.

9:00 Good.

9:00 Long sliding right and left.

9:02 Airway patent.

9:03 Breath sounds bilaterally.

9:04 So they're doing this basic trauma evaluation to make sure that the patient's

9:08 head doesn't have a head injury with a bleed inside the skull to make

9:13 sure that the lungs are functioning cuz sometimes during a trauma you can have

9:16 a rib break puncture the lung pumothorax

9:19 which has happened several times the show.

9:22 Does your belly hurt?

9:23 No[ __] into my leg.

9:25 Okay.

9:26 She's really moving here.

9:27 And yeah, we can't evaluate like this.

9:31 Okay.

9:33 Deep breaths.

9:33 Yeah.

9:34 Yeah.

9:34 Okay.

9:35 What a girl.

9:35 What's next?

9:36 He's saying deep breaths cuz he's worried about him fainting.

9:39 Cuz it's not uncommon for a med student or someone who

9:41 has limited medical experience to see blood and have a vasovagal syncopy.

9:46 Which is um basically a neurocardiogenic form of syncopy where

9:51 as a result of seeing something stressful or perhaps bearing down,

9:55 your body has this reaction of feeling like

9:57 there's not enough pressure and your pressure drops.

9:59 Not enough circulation gets to your brain, you fall.

10:02 Whoa.

10:02 So, this will happen with the elderly.

10:03 This will happen with people having bowel

10:05 movements where they're bearing down really hard,

10:06 then they stand up real quick or in scary situations

10:10 like this where they see blood and they have this panic.

10:12 And and why does your body think there's no pressure?

10:16 It's not that thinks it's no pressure,

10:17 it creates a drop in pressure and that drop

10:20 in pressure decreases the amount of blood

10:22 flow that's able to fight gravity and reach the brain and therefore you end up

10:26 going down to the floor.

10:27 Oh, and she's sedated.

10:28 finish the efast plain x-ray check her back straight to CT.

10:32 What if the cam wears off?

10:33 Right.

10:33 Uh we should do a popial nerve block

10:36 before the CT anesthetize from the knee down.

10:39 So this is basically what would happen in dentist's office.

10:42 Obviously in under less extreme circumstances where they

10:44 would put uh numbing solution across a nerve.

10:48 But in a dentist's office, they're rarely doing a full block.

10:51 Where in this situation,

10:52 if you inject in the correct areas the lidocaine, uh, xyloane, whatever uh,

10:57 numbing medication they're using here,

10:58 you'll be able to cut off all sensation distally further away from that point.

11:02 So, you're creating like a literally a block of sensation.

11:05 What's the bullet?

11:06 42-year-old male with 20 foot blunt chest trauma with hand injury.

11:11 Where's my son?

11:12 Where's my son?

11:13 Taki to 108, sass 98 on 2 liters, BP 122 over 84.

11:16 Well, pants can do due to mechanism.

11:18 You It's infib amputation.

11:20 Hoping ortho can uh give us a little hope for replantation.

11:23 Derek, where are you hurting?

11:24 Chest and my finger.

11:26 Did they find my son?

11:27 Did you hit your head?

11:28 Don't think so.

11:29 I need to find my son.

11:31 It's very interesting how they're ignoring a patient multiple times here.

11:36 Yeah.

11:36 Do you do Do you feel like you

11:38 generally would say something in response to that?

11:41 If a patient is being unreasonable,

11:44 I think you have to just continue on with the exam and make

11:46 sure that the patient is stable and ask all the right questions.

11:49 But in this scenario, he's asking a pretty reasonable question and it's not

11:54 that someone's answered him and he keeps repeating it.

11:56 Answer it once at least

11:58 and then maybe he'll calm down and you'll get a better exam.

12:00 Maybe they need a Dr.

12:01 Moan in there to answer the question with a good handwriting.

12:05 We'll find him for you, but we need to take care of you first.

12:08 And that's why she's my mentor.

12:09 That's why that[ __] is my mentor.

12:11 Respectfully, move both arms.

12:13 Look at your feet.

12:14 Good.

12:15 Any pain in your neck?

12:17 No.

12:17 Spleen looks good.

12:18 Start with this chest.

12:18 That's where he hurts.

12:19 And again, in a scenario like this, you're just trying to make

12:22 a quick calculation of where a possible extreme injury might be.

12:26 So, you're doing very gross testing.

12:29 Do your feet move?

12:29 Do you feel this?

12:31 You're not making sure that he's going to be

12:33 perfectly ready to go play football the next day.

12:36 It's just about stabilizing him and making

12:38 sure that anything life-threatening is attended to, right?

12:40 In order to like send him up to the O and stuff, right?

12:43 Okay.

12:43 I have a really embarrassing story.

12:44 I just remembered about about this.

12:46 So, this specific scene, not this specific scene,

12:48 but just generally this idea of like stabilizing the patient

12:51 and then sending it up to sending them up to the O.

12:54 I it was like the first episode where we were doing like the open

12:58 the open the chest cavity thing and we were doing the pulmonary lung flip

13:03 and like I mean I think I like logically knew that like we are just

13:08 trying to stabilize the patient but I was like part of that lung flip and we

13:11 get the higher flip going.

13:12 We got the highland flip going and then

13:14 I remember I asked the doctor on call there.

13:16 So the lung just stays like that forever.

13:19 And she was like, "No, you're sending temporary.

13:23 It's temporary.

13:24 You're you're stabilizing the bleed and then you send

13:26 them up to the AR and they flip it back.

13:28 It's not like he just stays there with an inverted lung." And I was like,

13:30 "Oh, I feel really dumb right now." Uh, I don't see much lighting there.

13:35 His name is Jack.

13:37 He's seven.

13:38 Pumorax.

13:38 Set up for a chest tube.

13:39 Not yet.

13:40 Uh, let's go posterior lateral.

13:42 Look for fluid first.

13:43 Traumatic pneumthorax.

13:44 We should prep the chest.

13:46 Not necessarily.

13:47 He's hemodynamically stable.

13:50 Hey, does that look like some fluid there?

13:52 Hard to say for sure.

13:53 Okay, he's tacocartic humanthorax.

13:55 He needs a chest tube.

13:56 BP and SATs are fine.

13:58 We can wait for CT.

13:59 If it's small, it'll resolve on its own.

14:00 We observe and reimage.

14:01 I agree.

14:01 He's stable for now.

14:02 Let's wait for the scan.

14:03 Dr.

14:03 Santos,

14:04 this is what happens when you run into uh a young,

14:07 very excited doctor who hasn't quite learned the art of medicine,

14:11 which is treat the patient, not the imaging.

14:14 And that also holds true.

14:16 Treat the patient, not the lab value.

14:18 Um, this happens quite often in my residency program where a resident

14:21 will get a result and the result is off the charts,

14:24 but the patient looks totally calm.

14:26 And I remind them sometimes there are laboratory errors.

14:28 Sometimes something can happen as a false flag and you have to repeat the test.

14:32 So before rushing to treat,

14:34 evaluate clinically what's happening with the patient.

14:36 So here, if the patient is stable,

14:38 why rush to intervene if there's a potential that it can heal on its own?

14:41 So, and so would you just sort of like flag that, keep an eye on it,

14:46 and monitor consistently to make sure it doesn't like they don't die?

14:50 Yeah.

14:50 Okay.

14:50 Well, I mean that makes sense because like surgery is like incredibly invasive.

14:54 Invasive.

14:54 And if in in general in an ER setting,

14:58 if you can move a surgery from being an e surgery to an elective one,

15:02 perhaps a few days later,

15:04 the outcomes improve

15:07 because anytime you're performing something under emergency situations,

15:10 there's always less preop testing.

15:12 The patient isn't medically optimized.

15:14 They're higher risk.

15:15 So, ideally, you want to move things from the e setting

15:17 to the more elective setting if it's safe for the patient to use.

15:20 That is interesting.

15:21 Okay, let's order a CT.

15:23 Chest, abdomen, pelvis, and X-ray.

15:25 Left hand.

15:28 Whoa.

15:28 Major deep gloving.

15:29 Focus on the primary.

15:31 Dr.

15:31 Langden's correct.

15:31 We need to log roll him.

15:33 So, this happens quite frequently when a ring

15:35 gets caught in some kind of uh mechanism.

15:39 I've seen this with uh horse injuries like where they're holding on to the god

15:43 reins of the horse.

15:44 Do they not notice it's happening?

15:47 They do, but it usually happens as a result of a quick force.

15:50 like you fall, the rains get caught on you or you're

15:54 falling and you reach for something and the ring gets caught.

15:56 It it's it's usually happens with not just a skin

16:00 injury but also an avulsion of the entire finger.

16:03 So quite dramatic.

16:04 Never wearing rings again.

16:06 I guess golf already wish my mom every time

16:12 I get a second of service another dozen text.

16:15 How much longer do I have to wait?

16:17 I got a broken leg here.

16:18 Someone will be with you shortly, sir.

16:20 Well,

16:20 am I allowed to use the bathroom?

16:22 I really have to go.

16:23 I don't know, ma'am.

16:24 I am not your doctor.

16:25 It says right there, doctor.

16:27 Yes, but I'm not your doctor.

16:28 But if you go back to your room, a nurse will come find you.

16:31 I wasn't in a room.

16:35 Dr.

16:35 Mohan, the sister in Dr.

16:36 Quan.

16:37 Kevin, how long has your leg been swollen, Helen?

16:40 Uh, it's been getting worse over the past week.

16:42 So, in a scenario like this, you're worried

16:45 when a patient comes in with unilateral leg swelling.

16:48 for a clot.

16:49 Uh this is called a DVT.

16:51 The danger of a DVT is not so much

16:53 the problem that it can cause locally in the leg,

16:55 but more so if that clot dislodges and goes upwards in the circulation

17:00 and gets lodged in the smaller blood vessels which are in the lungs,

17:04 also known as a pulmonary ambism,

17:06 medical emergency because that part of the lung

17:08 will not be getting circulation and dying.

17:11 Dr.

17:11 M, your mom called again.

17:12 She said you don't back

17:15 with a patient.

17:16 It's like moral injury happening before.

17:18 Yeah.

17:18 Something something's all right.

17:21 Did you Did you fall or hit your leg?

17:25 No.

17:25 Is that real sweat?

17:27 Yeah.

17:27 Sweat on command.

17:29 Yeah.

17:29 No, it was a thing that

17:30 I mean I thought this was like part of the acting method.

17:33 What is it called?

17:33 The main There was there was a Twitter account.

17:35 There was a Twitter account that saw these photos and they

17:37 started making I mean I like kindly they were lying

17:41 that I could like sweat on command and like do all

17:44 kinds of things on command and I like played into it.

17:47 I was going to say if they like dowsted you with fake sweat that's high level.

17:52 Let's just keep going.

17:55 Have Have you ever had a blood clot before?

18:00 No.

18:00 I'm worried about you more than I am the patient at this moment.

18:04 Excuse me.

18:04 Do you need to sit down?

18:06 Oh, no.

18:06 Patience like the patient's concerned about you.

18:12 What?

18:11 No, it's just um it's really hot in here and uh and uh you need to sit down.

18:18 I'm good.

18:19 Oh my god.

18:20 Are you going to have a vaso veagal syncopy that we just talked about?

18:23 Maybe.

18:23 Excuse me.

18:23 One second.

18:31 Based on the hand position, the symptoms, I'm worried about the heart.

18:37 I'm worried about a panic attack.

18:40 Maybe a gallbladder situation on the right upper quadrant.

18:43 We'll see what happens.

18:45 I've been waiting in front of

18:49 Oh my god.

18:51 Look out way.

18:54 Get in.

18:54 It's like that meme.

18:55 Get in.

18:56 We're going shopping.

18:57 We're going to get you checked out.

19:02 Excuse me.

19:03 Coming through.

19:05 Out of my way.

19:06 We were going down the water slide and the bottom just fell off.

19:10 I grabbed Zach's arm and I tried to hold on to the sides,

19:12 but my hand slipped and my ring got stuck.

19:14 There's also very specialized tools that we have that function

19:17 as ring cutters in order to protect the patient underneath their tissue,

19:20 but then can cut through the metal.

19:22 Hello, sir.

19:22 I'm Dr.

19:22 Garcia from the trauma service.

19:25 Need the ring cutter.

19:26 That's a ring critter.

19:29 Possible flexor tendon injury.

19:32 Try to bend up your ring.

19:34 Oh god.

19:37 Let's go with the block.

19:39 I'm going to feel a pin prick and some burning.

19:41 A lot of times when you give numbing medication,

19:43 the obviously the pin prick is uncomfortable, but also the medication as a side

19:46 effect initially very briefly causes a burning sensation.

19:50 Mr.

19:50 Foster got separated from his son Zack at the water park.

19:54 We can call for you.

19:55 My wife Angela.

19:57 Dr.

19:57 Santis, will you escort Mr.

19:58 Foster to CT?

20:04 They're so good at like showing the interpersonal dynamics

20:09 between them by saying medicine.

20:12 Yeah.

20:12 I mean, that's something we really try to work on on the show.

20:14 It's like how can we Well, yeah, cuz like when you read it on the page, like

20:19 it reads like a a medical textbook, which is what makes it brilliant.

20:23 Like I'm not shading that whatsoever.

20:24 But then also as an actor, you want to make sure that like something else

20:28 is also being communicated to the average viewer that doesn't,

20:31 you know, like understand everything we're saying.

20:34 Yeah, that's I'm actually quite curious about this.

20:36 How does one like yourself live uh

20:41 24-hour shift over the course of three months?

20:44 Is that weird?

20:46 It is

20:46 because you're living living hour by hour, but it's really week to week.

20:49 It's more like 7 months and it's a it's a 15 hour shift.

20:55 Okay.

20:54 Well, yeah.

20:54 But yeah, it is like the the weirdest thing in in the world.

20:58 Like I especially cuz we're in LA,

21:00 so the weather essentially stays the same when we're filming.

21:03 I really lose all track of time.

21:06 Really?

21:06 It's really cuz like you you leave

21:08 like and everything's in a certain place and then you come

21:10 back the next day and it's like everything's exactly the same.

21:13 Is that Groundhog Day?

21:14 It really is.

21:15 It's like I can't I can't explain to you like how like I think somewhere

21:18 in my head like it's like maybe been like a year since I booked the show.

21:21 Like it's just very it's very odd like the way

21:24 what happens if someone gets like a pimple or a cold sore or something.

21:28 Does that like break all continuity?

21:29 I mean they say they VFX it.

21:31 I don't know.

21:33 Okay.

21:32 It's true.

21:34 Back to the show in just a second.

21:35 But first, I want to tell you about my sponsor, Zach Do,

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22:52 All right, let's get back to the pit.

22:55 Help.

22:55 Need a hand here?

22:57 What the hell happened?

22:58 I think I'm having NMI.

23:00 My chest is so tight I can barely breathe.

23:02 Okay, I got to get a swab.

23:04 Pearla, can I get an assist here?

23:06 Yeah, I'm on it.

23:07 So, in a situation like that, obviously you need the EKG,

23:10 some blood work to rule out having an MI.

23:12 It's interesting how often the pit is needing to treat their own staff.

23:16 It's not the first time doing great.

23:18 No, we're all falling apart.

23:20 And you know, treating an MI and deciding whether it's an MI

23:24 or a panic attack is really interesting because to the patient,

23:28 they can feel one and the same.

23:30 For doctors, because they present very similarly to us and we're

23:34 trying to learn subjectively what's happening

23:36 with the patient through their eyes,

23:38 their own interpretation of the symptoms.

23:40 It can be very easy to misread the situation

23:42 and make the patient feel like you're not on their team.

23:45 Mhm.

23:46 where imagine the EKG looks normal, the tropponins come back negative,

23:50 the blood test that would signify heart damage.

23:52 And as a doctor, you're like, "Okay, well, look, there's no heart attack.

23:55 I'm okay.

23:55 I'm going to treat this as a panic attack." But if

23:58 you don't communicate that in the right way to the patient,

24:00 they could leave feeling very unseen, unhappy,

24:04 dissatisfied with their care because they're not coming in to rule out an MI.

24:08 They're coming in for a diagnosis to know what's going on with them.

24:12 Yeah.

24:12 And if we just rule out an MI, we may have done our jobs.

24:16 It could be hard to be like that's all in your head.

24:18 It's all it is.

24:19 It is.

24:19 Wait, I also have a medical question.

24:21 I've always wondered this and you explain things really well.

24:24 So like the troponin is like a muscle pro proine, right?

24:28 Um why would that be in the blood test an indicative of like a heart attack?

24:32 So when the heart is having an an infuction,

24:35 what's happening is the heart itself which

24:38 supplies blood to everywhere in the body,

24:40 it also needs to supply blood to itself.

24:43 So it does so through the coronary arteries.

24:45 When there's a blockage in those very small coronary arteries,

24:48 the heart muscle itself starts getting choked out of blood, therefore dying.

24:53 That's what a heart attack is.

24:54 And when that muscle is dying, it starts releasing this protein.

24:58 Correct.

24:58 Yeah.

24:58 Into the blood.

24:59 And what's interesting and why we get what are known as serial

25:03 troponins is we get them every two hours to see how they're behaving.

25:07 So it's not usually enough to just get one set.

25:10 You want to get every two hours to see

25:13 is the muscle damage improving with the treatments

25:16 that you're giving the patient or is it

25:18 a particular unique MI called a type 2 MI.

25:22 You're just wanting the heart to perform so much that it

25:25 doesn't have the demand capacity to give itself enough circulation.

25:29 So not because of a blockage but because you're asking

25:32 it to do too much where it starts dying off.

25:35 And in those situations you see a big tropponent

25:38 number and then it starts improving as the demand decreases.

25:42 Interesting.

25:42 Whereas with a typical MI, like an ST elevation MI,

25:46 there's a full blockage and the tropponent number just keeps going up up up

25:49 and you know you need to get this person to the Kath lab as quickly.

25:52 See, now I want to go home and figure out

25:54 how they figured out troponin would be a good problem.

25:56 Yeah, exactly.

25:57 For like a heart attack.

25:59 You'd be surprised.

25:59 Like the the amount of scientific knowledge that doesn't make

26:02 sense to me how they knew to check for this enzyme,

26:05 for this protein, for this biioarker is truly impressive.

26:08 So I was talking to someone about this recently.

26:10 She's like um she's a she's an executive at a company that I

26:13 really love and she comes from a family of like scientists and um

26:17 mathematicians and she said this thing to me which is like artists

26:21 and scientists are actually so similar because

26:23 you believe in this thing that isn't real yet

26:26 real real yet and you have to prove it.

26:29 Um, and like that really really just made me go like, whoa,

26:32 I I I kind of like see the parallels of how how I'm

26:36 in both of these because like I mean I I know when I when I

26:39 was like studying neuroscience and stuff like

26:41 a lot of the studies and everything

26:43 we did like all of it was just like we don't really know many things.

26:47 So we're using you know like we would use sleep as a proxy to like study

26:52 consciousness because you're unconscious while you sleep.

26:54 Yeah.

26:54 It's just so interesting like how we have

26:56 to like think about things in a thought.

26:58 Here's something that will potentially blow your mind,

27:01 potentially give you anxiety.

27:03 As an artist, you have to create things that are not there.

27:06 Correct.

27:07 Uh-huh.

27:07 Right.

27:07 Because you're creating from scratch.

27:10 Yeah.

27:09 What medical condition does your mind create things that are not there?

27:15 I don't schizophrenia.

27:18 Higher rate of schizophrenia in artists.

27:21 Are you trying to tell me something?

27:23 No.

27:24 Okay.

27:24 Just food for thought.

27:24 Interesting, right?

27:25 how the line of if you have control over this creativity,

27:29 it's great and you're an artist and you're a human,

27:31 but if you don't have control over it and your brain's just

27:34 doing it and you're hallucinating now

27:36 suddenly it's a medical diagnosis and pathology.

27:38 Don't get me started on like pathologizing mental illness.

27:40 I can like go on forever and like maybe get myself canceled.

27:43 So, let's just keep going.

27:49 Get Robbie.

27:53 Okay.

27:53 Right here.

27:53 So like you see me breathing actually like I wish they kind of kept it in.

27:58 So we were in between I mean do do you have theories on what is happening to me?

28:02 I'm assuming you're overwhelmed then it's a panic attack.

28:06 Should I spoil it?

28:08 I mean I you can't my my differential is obviously you want to rule

28:13 out the most dangerous things even though they're not the most likely because

28:16 you're a younger person.

28:18 I'm assuming there's no underlying health conditions because

28:21 maybe we would have been told about them.

28:23 So that's why panic attack is higher.

28:24 But MI you need to rule out first because if you miss MI, you're screwed.

28:28 Okay, I'm going to spoil it.

28:28 It is a panic attack, right?

28:30 Good doctor.

28:31 Um, no, but I think it's important to reveal during this scene

28:34 cuz I I I we were talking so much about whether

28:37 they'd cut her shirt off cuz she's like a colleague and like

28:40 if you thought something was really really wrong by that point,

28:42 Langdon would have cut her shirt off.

28:44 But I think like at that point he kind of has gotten a sense that

28:48 that it's maybe I mean sort of like you know that it's like maybe not an MI.

28:52 Um and what I wish they kind of shown was

28:55 so Robbie comes in after the scene and I'm like pretty calm at that point.

28:59 And I think him like Patrick and I were kind of like

29:02 something needs to happen so that I've calmed down and you kind

29:05 of see it at towards the end of the scene where like

29:07 he started just totally improvising like breathing to like calm me down.

29:12 Got it.

29:13 um which I thought was such a smart move on his part.

29:16 It's very true because uh what happens when we hyperventilate,

29:20 we can actually blow off a lot of carbon dioxide.

29:24 And when we blow off a lot of carbon dioxide,

29:26 that can shift the pH balance of the blood

29:28 and make us feel uncomfortable and woozy.

29:31 So slowing someone's breathing or having them breathe into a paper

29:34 bag actually does work because you're reinhaling that carbon dioxide,

29:38 not breathing it off too quickly.

29:39 So there there's a there's a method to the method.

29:41 The carbon dioxide pH questions were always my favorite on the MCAT.

29:45 I was like, I understand this really well.

29:46 I can get these.

29:47 Oh my god, MCAT.

29:48 That gives me my panic attack right now.

29:51 CT's normal.

29:52 Why do we take down the tourniquet, Whitaker?

29:53 To give the residual limb blood flow.

29:57 Two little pumpers.

29:58 Couple of figure eights to take care of those.

30:03 Park the shark.

30:03 Orthopedic surgeon.

30:05 Is this a favorable amputation?

30:07 Pretty clean cut.

30:07 Flic through like a guillotine.

30:11 X-ray.

30:13 Not too bad.

30:14 A

30:14 lot of hardware necessary to put those bones together.

30:17 Clean wound.

30:17 No crush injury.

30:19 Rapid transport time.

30:21 Replantation is a go.

30:23 I'll book a noir.

30:24 Irrigate the hell out of this with three liters.

30:26 Three lers of saline.

30:28 Genius.

30:30 I'd cry.

30:31 Yeah, this so mean.

30:33 Look at the pause frame.

30:36 I knew he meant saline.

30:39 Dr.

30:39 Rodney, we need you in central sex.

30:41 Dr.

30:41 Mohamm may be having a heart attack.

30:44 What?

30:47 EKG is normal.

30:48 You sure?

30:49 Check it out.

30:49 You can be here on second opinion.

30:50 What's going on?

30:51 It's okay.

30:52 I'm I'm okay.

30:53 You don't look okay.

30:54 Yeah.

30:54 It's really funny cuz like you were talking about how they were

30:57 doing fake sweat so I can like It's literally so much fake sweat.

31:00 Really?

31:01 I was so lubed up.

31:02 It was embarrassing.

31:04 And then at this point someone would come

31:06 in and the Damian the director would just go like more

31:08 sweat more sweat more and like someone came

31:10 in at this point and was literally like spraying my face.

31:12 No, but that's so realistic.

31:14 Diapharesis happens in moments of panic attack.

31:16 So what happened?

31:18 I I don't know.

31:20 I just got really hot and I started having trouble breathing.

31:24 We should set up some labs just to be safe.

31:27 I agree.

31:28 Any chance you're pregnant?

31:29 Not sure I feel comfortable answering that.

31:33 No, she was tacky, but it's resolved now.

31:36 Have you eaten anything?

31:38 Yeah.

31:38 You staying hydrated?

31:40 100%.

31:40 Yeah.

31:40 I mean, a quick thing to check here

31:42 in a scenario like this would also be a finger

31:44 stick for glucose just to make sure that you

31:47 didn't bottom out your sugar levels for some unique reason.

31:50 I mean, she's probably not been eating.

31:51 Yeah, exactly.

31:52 And probably dehydrated.

31:53 And probably dehydrated.

31:55 I'm doing everything right.

31:56 It's everything around me that's alled up.

31:58 It's just my mom moving and calling me over and over again.

32:01 And and now me scrambling to find a job next year.

32:03 I had it all planned out and now everything's just out the window.

32:06 Wait a minute.

32:06 Is this a panic attack because of your mommy issues?

32:09 What?

32:09 No.

32:10 Jesus.

32:11 Do you need to go home?

32:12 You should go home.

32:13 No, I'm fine.

32:13 I don't need the[ __] liability.

32:15 Go home.

32:16 Wow.

32:16 That's so crazy watching it as an audience member.

32:19 That was so cold and unbelike.

32:23 Oh my god, that was so hard to watch.

32:26 I only really, I think,

32:28 realized how bad what he just did was after we filmed or like after he

32:33 left because I think I was so focused

32:35 on defending myself and kind of going like,

32:37 "No, I'm like I'm okay.

32:39 I want to stay.

32:39 I'm like good to stay." I think like when she's like having a second

32:44 to process is when I I think they have a cut of me after.

32:47 So, it's almost like everyone's experiencing

32:49 their own uh we call this vicarious trauma

32:52 where because of constantly feeling compassion for others

32:56 and seeing these terrible situations play out,

32:58 we can lose our compassion at times.

33:00 Mhm.

33:01 Especially for people I think that happens

33:02 with Samira a lot where like it's hard

33:04 for her to have compassion for people she's close

33:08 to in her life as opposed to her patients.

33:10 Like for whatever reason, it's safer for her to have that empathy there than

33:15 Yeah.

33:15 I don't know.

33:16 Hey, you going to go in and see your mom?

33:23 Cancer sucks.

33:28 Yeah.

33:27 Yeah, it does.

33:30 She didn't used to look like that.

33:35 Yeah, I get that.

33:41 But if you don't go in there and say goodbye and tell your mom

33:45 you love her, I think you might wish you had for a very long time.

33:50 I like that she prefaced it with you might

33:54 because it's very easy to think that you know

33:57 everything when you're in these scenarios and patients aren't.

34:00 But it it's true cancer changes everything.

34:03 Uh not just the cancer and the the disease itself, but also the treatments.

34:07 Sometimes the treatments take such a toll.

34:09 And I have personal experience with this.

34:11 I lost my mom to cancer and I'm so sorry.

34:14 Not actually cancer.

34:15 Interestingly enough, the cancer,

34:17 the doctor shook my hand just a few days before and said she's cured.

34:20 Now we just need to get her back on her feet,

34:22 but because the treatment made her so weak and hurt her immune system

34:25 that she got this mean infection and it's this exact scenario plays out.

34:29 And that's something I wanted to tell the doctors all the time too.

34:31 I don't know why that she didn't look like this before.

34:34 She was different before.

34:36 And that was like it's it's a part of their humanity

34:38 that I feel like we lose in healthcare sometimes.

34:41 Yeah.

34:41 So it's tough.

34:42 Do you have any personal experience with cancer in life?

34:44 Yeah.

34:44 I lost um I lost uh my uh sister-in-law

34:49 or cousin sister-in-law to it and it was very sudden.

34:52 It was um it was uh intestinal cancer.

34:58 Wow.

34:57 Yeah.

34:57 And it was just very sudden and we had no idea.

35:00 Um, and it's funny cuz even though she wasn't related to me,

35:03 I felt like she was like

35:04 the person in my family that like got me really the most.

35:07 Yeah.

35:07 She was like so cool.

35:08 She moved from like India to Japan with my cousin

35:11 and like like learn Japanese and like travel the world.

35:14 Yeah.

35:14 She was just really Sounds like had a full life.

35:17 She she did she did and she did this really beautiful thing where um

35:22 I think sometimes when you have cancer it's

35:24 really hard to talk to your kid about it.

35:27 Um, and she I I I forget how old her kid was at the time.

35:32 I think maybe like 10, 11, like not old enough.

35:34 And she really prepared him for her death.

35:37 Yeah.

35:38 I mean I mean it's just one of the reasons I thought she was so cool.

35:41 She was so like emotionally intelligent and mature and

35:45 Yeah.

35:45 Sometimes it's those darkest moments that bring that out.

35:49 Yeah.

35:54 Kenamine's wearing off.

35:58 I can't feel my leg.

36:00 I'm Dr.

36:01 Michael Rabinovich.

36:02 You're at a hospital and we gave you

36:03 a nerve block so that you can't feel any pain.

36:06 Why?

36:07 You were on a water slide that collapsed and did serious injury to your leg.

36:16 __] Is that my leg?

36:18 Is that my[ __] Did you cut my[ __] leg off?

36:20 Your leg was cut off in the accident.

36:22 Our surgeons are going to try for replantation.

36:24 I She needs more catammy.

36:26 Wrap up the leg.

36:27 Emily, I know that this is really hard.

36:28 I need you to focus on me right now because

36:30 we need to get your consent to proceed with the surgery.

36:32 I love that this leg is in the back shot of the entire clip,

36:35 no matter what angle we're in.

36:37 There's something so darkly about it.

36:39 Also, like this actress is doing an incredible job of like processing her.

36:44 Yeah.

36:44 Wow.

36:45 What did I miss?

36:46 Finishing irrigation.

36:49 It doesn't look like you lost any skin.

36:51 It's a little dusky.

36:52 Might not be viable.

36:54 There's intact skin on the dorsome.

36:55 More irrigation, then tack it down with one suture.

36:58 Okay, thanks.

36:59 Radiologist reports a 25% in the thorax.

37:02 Is that bad?

37:03 That is a partially collapsed lung that needs treatment.

37:06 I can put in a chest tube.

37:07 He doesn't need a chest tube.

37:09 Okay.

37:09 What do you want?

37:10 A pigtail catheter?

37:12 I was thinking a thor.

37:13 Why is the pigtail catheter like is it like an aggressive thing she's saying?

37:17 I I think it's not as aggressive as putting in a full chest tube.

37:21 This is outside of my scope to know

37:23 the differences between each one of these approaches,

37:25 but uh I I'm familiar with the pigtail catheter being a less invasive approach.

37:30 I'm curious why

37:31 I'm wondering if she was being sassy like what do you want like a hole?

37:36 It's not a bad idea.

37:37 No need for well suction.

37:38 If hand can operate today, you can go home tomorrow with a Thor event.

37:41 You can learn a lot from your senior residents.

37:44 I'm happy to teach Dr.

37:45 Santos.

37:46 Thank you, Dr.

37:47 London.

37:48 That was an unnecessary shade line right there.

37:52 Place the troar.

37:54 Pull back the uh adhesive wings

37:57 and advance until you see the red diaphragm move.

38:00 That means you're in the plural space.

38:02 Is that cuz the air is coming or like why is the diaphragm moving?

38:05 Yeah.

38:06 So he's talking about the diaphragm inside the device, right?

38:09 And it's because there's air inside the plura.

38:14 So this is a weird thing to visualize.

38:16 Air does not belong in your chest.

38:19 As weird as that sounds, it belongs inside of your lungs.

38:21 Well, that makes sense because the lung needs to expand.

38:24 Correct.

38:24 And the the reason that the lung expands is through the negative pressure.

38:28 So, when your diaphragm pulls down,

38:30 that negative pressure allows the lung to expand

38:32 and pull air in into the lungs themselves.

38:35 When the lung is damaged,

38:36 air starts escaping partially because it's only a partial uh pneumothorax.

38:41 air uh leaves the lung, ends up entering the plural space,

38:45 starts putting pressure on the lung,

38:47 therefore making it difficult to fully extend.

38:49 So this thing's removing So this thing is removing the air and that's

38:52 what allows the lung to heal and eventually refill.

39:00 Perfect.

38:59 Okay, now we can either uh hook up to wall suction

39:03 or we can use this one-way valve to repeatedly aspirate with a syringe.

39:06 Now

39:07 with all your vast experience, Dr.

39:08 Langdon, you should probably decide.

39:13 We can avoid wall suction if I pump manually.

39:16 How about at it, Doc?

39:17 Enough.

39:18 Apparently, decency and decorum need to be reintroduced to our R2 curriculum.

39:22 Interresident conflict like that is real and it happens.

39:25 I've had this with some of my seniors where they were getting

39:28 fed up with me and for things that were outside of our control,

39:32 uh, mishaps that happened, miscommunications,

39:34 and I literally remember walking down one

39:37 of the hallways yelling at my senior to come back

39:40 and please talk to me so we can get on the same page cuz we're on the same team

39:44 and we we we were able to do that thankfully.

39:47 But it's obviously very awkward when you're doing that on overnight

39:49 shift and you have to respond to constant emergencies.

39:52 Totally.

39:52 boy.

39:53 Part of a water park accident thrown off the water side.

39:55 How far did he fall?

39:56 Maybe 6 or 7 ft.

39:57 Landed in a tree.

39:58 Had to wait for a ladder truck to get him down.

40:00 Major neck trauma.

40:01 Must have taken all the impact there.

40:02 Couldn't tube him.

40:03 Hard to bag.

40:04 So, because he was hard to intubate,

40:05 that signals that there could be swelling in the neck forming.

40:08 In a scenario like this, you'd want to be potentially

40:11 prepared to cut into the neck to create an airway.

40:14 And the reason why they're so insistent on asking the mechanism

40:17 of injury that helps us decide in our minds what is most likely

40:21 to have gotten hurt and how severe the injuries are will help

40:25 us decide whether or not we should just automatically pan scan the patient.

40:28 Possible langial fracture, hypoxic, brady cardic,

40:31 kidneys and airway before your wrist.

40:33 Bronzo tape cart setup suction.

40:36 Oh my god, is that Zach?

40:39 Oh, they look at me.

40:40 I always yell, why aren't the curtains wrong?

40:44 Is that because the cameras all need to be moving around?

40:48 Well, it's it's it's for dramatic effect.

40:51 Okay, got it.

40:52 Fair.

40:53 No response, no purposeful movement to pain.

40:55 That's a lot of bruising there.

40:57 And there's these cartilagynous rings that go around the trachea

41:00 that they can break and fracture and cause some bleeding.

41:03 Obviously, you worry about a full severance of uh the trachea

41:08 in those instances depending on how severe the trauma is.

41:11 Okay.

41:11 Uh a 30 of rock 50 can be you're going to paralyze.

41:15 Yep.

41:15 Well, if we can't intubate, we crank.

41:17 He's too young for a crank.

41:18 Needle crank.

41:19 Can't ventilate through that.

41:20 Sass on a 78.

41:21 11 blade Kelly and a ped's bougie.

41:23 One quick look and then we cut.

41:25 I can't tell if there's lung sliding, no movement, no air entry.

41:28 Way too administ.

41:29 I can't see the cords.

41:30 Yeah.

41:30 So, there's full swelling inside the throat there.

41:32 Once you can't visualize the cords,

41:34 you probably need to create an artificial incision.

41:36 Do this tracheosttomy.

41:38 Tracheotomy.

41:39 Okay.

41:39 Tell world between the shoulders.

41:40 Down to 49.

41:41 Headed to cardiac arrest.

41:42 The trick's going to take 20 minutes.

41:43 This kid's not going to last 60 seconds.

41:45 That's why we're doing a slash trick.

41:46 Don't know it.

41:47 Me neither.

41:50 Boss, show me what you got.

41:50 Oh, man.

41:53 Such an insane thing to say to her at that moment.

41:57 Pull up the trachea between your thumb and middle finger.

42:00 Vertical incision right over the trachea.

42:04 Okay.

42:04 Vertical, not horizontal.

42:05 Well, cuz there's a lot of blood vessels there.

42:07 Now it's a tactile procedure.

42:09 2cm incision through the tracheal rings.

42:12 Finger in the trachea.

42:16 Bougie into the airway.

42:19 Thoughts on what's next, Dr.

42:20 Whitaker?

42:21 Insert the ET tube into the trachea.

42:24 Suction.

42:24 Lots of blood in the airway.

42:27 Probably from the trauma, not from her incision.

42:34 Okay, back in.

42:36 Check the CO2.

42:38 Sounds are coming up in the 80s.

42:40 Bilateral breath sounds and tidal CO2 is 70.

42:43 That's crazy high.

42:44 It'll come down.

42:45 Tie down the tube.

42:46 Control all the bleeders.

42:47 Spray an amp of EPI on a stack of 4x4s.

42:49 So epi uh will constrict the superficial

42:51 blood vessels and decrease the superficial bleeding.

42:54 So good good little tip on her part.

42:56 Good.

42:56 CO2 is in the 50s.

42:58 Good heart rate.

42:58 You forgot the last step.

43:00 Change your underwear.

43:02 How many of these you done?

43:04 First one.

43:04 Are you serious?

43:05 What about you?

43:08 None.

43:08 I practiced in the sim lab when I was at Stanford.

43:10 What' I miss?

43:11 All the fun.

43:11 Slake.

43:13 Seriously?

43:13 Uh, fractured larynx.

43:14 Couldn't oxygenate.

43:15 Couldn't ventilate.

43:17 Use a meat cleaver on this kid.

43:18 ENT can revise the TRA in the O.

43:21 They'll be thrilled to clean up your mess.

43:24 Or maybe they'll thank us for not letting him die.

43:26 Tracheotomy is cutting in to put in the the tube.

43:30 tracheosttomy is now securing it and having this opening to allow

43:34 the child to breathe as the organs continue to heal.

43:37 Usually this will be done temporary.

43:39 Although you will notice that the nose is so important to breathe

43:44 through when you have a tra because the nose will warm.

43:48 It'll humidify the air.

43:50 Therefore, the lungs when you're on a tra

43:52 will develop more mucus from this cold non-humidified air more so than usual.

43:57 So it can be quite uncomfortable for those patients.

43:59 And so that's why suctioning is important.

44:03 Oh, Dennis Whitaker.

44:03 Meet my buddy Duke.

44:04 Uh, nice to meet you.

44:05 Any friend of Dr.

44:06 Robbie's a friend of mine?

44:08 Friend is a vast overstatement.

44:09 He's more just a pain in my ass.

44:11 Don't let his surely exterior fool you.

44:13 Deep down inside, he's just as grumpy.

44:15 Vitals look good.

44:16 What seems to be troubling you?

44:18 Ask him.

44:19 He's the one who made me come in.

44:20 He's had some horarsseness on and off for a couple months.

44:23 Okay.

44:23 Any history of tobacco or alcohol use?

44:27 Two of my oldest and closest friends.

44:29 high risk for cancers of the oral fairings but surprisingly on the rise

44:36 HPV related oral cancers from the HPV virus human papilloma virus

44:42 that was that's the one thing I'm like grateful to my mom for for getting over

44:47 her own sort of like cuz India can be

44:48 like really sexually conservative and like it's like really

44:51 weird when like I grew up in India so like like there's like a whole thing where

44:55 like parents won't vaccinate their kids against HPV

44:57 cuz they're like why the[ __] would my Yeah, because they wouldn't do that.

45:00 Because they wouldn't do that.

45:00 But like my mom actually like even though you know

45:03 it took her some time to like get over it,

45:04 she kind of was like, "No, I think I should like this." Yeah, I know.

45:07 I'm like so proud of her for like

45:09 it's like the one vaccine that reduces risk of cancer cancer.

45:12 Yes.

45:12 That's crazy.

45:13 And yet our Secretary of Health and Human Services, RFK Jr.

45:17 is anti- vaccines.

45:18 Well, I know he Well, I knew he was antivaccines.

45:21 I guess I He has actually still on his Twitter

45:24 that the HPV vaccine hurts more people than it helps,

45:27 which is a figment of his own imagination, but it's cancer.

45:31 Yeah.

45:32 Okay.

45:31 Bag a day smoker and lover of the drink.

45:34 You on any medication?

45:36 Uh blood pressure meds?

45:37 Another thing uh that can predispose someone to have long-standing horarsseness,

45:41 uh mucus in the back of the throat,

45:43 a chronic cough, chronic sore throat that never really

45:45 seems to go away is a condition called LPR.

45:48 It's a mouthful.

45:49 Luringo fingial reflux, but it's quite simple.

45:52 Luringo larynx voice box fingial throat, ferinx reflux, acid reflux.

45:58 It's actually nicknamed silent reflux because only a small amount of acid

46:02 reaching the vocal cords or the throat can create longlasting mucus production.

46:08 Scarring of the area and create all

46:10 these unique symptoms that we get really worried about.

46:12 But once we put in a a little camera inside the nose and look at the vocs,

46:17 you'll see a characteristic pattern from LPR,

46:21 you treat that by controlling the acid, allowing it to heal,

46:25 doing some lifestyle changes, and boom, you start to feel better.

46:28 I am going to take this scope and I'm going to stick

46:31 it in your nose and we're going to check out your upper airway.

46:35 It seems like a lot of fuss for a sore throat.

46:37 Dr.

46:37 Brook, you want to explain to Duke why this procedure is absolutely necessary?

46:41 The scope is going to give us a better

46:43 view of your voice box and your vocal cords.

46:46 Here we go.

46:47 Obviously, polyps and all these other things,

46:49 anatomical variations, can also cause these symptoms.

46:52 Feel a little pressure between your eyes.

46:54 I am sorry about that.

46:56 Okay, just breathe through your nose.

46:58 This is going to help us see if

46:59 there are any abnormalities like inflammation, tumors, nodules.

47:04 That all looks pretty normal.

47:06 I don't see too much drainage.

47:07 Stick your tongue out for me.

47:08 All the way.

47:09 All the way out.

47:10 Good.

47:10 Now say E.

47:13 E.

47:13 Good.

47:13 Now again say E.

47:15 E.

47:16 Good.

47:16 Removing the scope.

47:20 Dr.

47:20 Whitaker.

47:20 What do you think?

47:21 Looks normal.

47:22 No abnormalities.

47:23 Told you it was nothing.

47:24 Yeah.

47:24 With your history of smoking, I'd like to do a chest X-ray.

47:28 Smoking and drinking predisposes him to Barrett's esophagus,

47:31 which is a condition that is a precancerous

47:35 condition that increases risk of esophageal cancer.

47:37 So if there are growths,

47:39 they can push against the recurrent langial nerve intermittently that can

47:44 paralyze one of the vocal cords and cause the horarsseness.

47:48 I'm surprised this is workup that's being done in the ER.

47:50 This is not an ER.

47:52 I mean, I think something's trying to be said about how much he likes Juke.

47:56 I think like he's like doing him a favor.

47:59 Maybe he's doing all this for this guy, but when you're having a panic attack,

48:04 he's like, "Get out of here.

48:05 Get out of my ER." What the hell was that with Samira earlier?

48:10 That was tough love.

48:11 You are her superior.

48:12 She was obviously struggling and your advice was go home essentially.

48:16 Yeah.

48:17 This is the ED.

48:18 It's not for the faint of heart.

48:20 It's not for the unempathetic either.

48:23 Samir's not having a panic attack because of her patient.

48:25 She's having one because of personal baggage.

48:27 What she needs to do is pull her head out of her ass and focus on the work.

48:29 What about you?

48:30 What do you need to get some basic human empathy back?

48:36 I don't know.

48:37 Something that gives me a little hope

48:38 this place won't fall to[ __] when I'm gone.

48:41 He's the one terrorizing everyone.

48:44 When you're experiencing all these negative

48:46 emotions during the panic attack and afterwards,

48:49 do you ever feel that as a person outside of being an actor?

48:53 That's such a good question because I think like Samira,

48:56 I had a really bad day this shift and I actually had

49:00 a really hard time letting that go towards the end of filming.

49:03 Yeah.

49:03 I mean, you I don't want to spoil anything, you'll see, but like

49:06 she has a pretty bad day and it was like really like I

49:10 I always prided myself as someone who was able to get out of character,

49:13 but yeah, it was hard.

49:15 Well, the human mind is so tricky in that when it experiences certain emotions,

49:22 whether real or viewed through another lens,

49:25 can actually impact physical sensations, physical um

49:32 levels of severity of pain, discomfort.

49:35 So, even like they say, if you smile, you could start to feel happy.

49:38 Well, the same goes true if you start to make yourself feel artificially sad,

49:43 you can actually end up feeling sad.

49:45 Totally.

49:45 And I think because it's like it's the same day and she had

49:48 to live in that headsp space for like I want to say 4 hours.

49:51 That was like 2 months of me really like

49:54 like really going why do I feel so bad all the time?

49:59 Wow.

50:00 Got a sec?

50:02 Sure.

50:02 How you feeling?

50:03 I'm fine.

50:05 Are you sure?

50:06 Yeah.

50:07 Trapon Dimer and TSH all normal.

50:10 Listen, I'm sorry about earlier.

50:11 I think I was being a dick.

50:15 I was going to say unprofessional, but probably that too.

50:18 Deserve it.

50:19 I'm sorry.

50:22 Thanks.

50:22 That's nice.

50:24 Yeah, kind of.

50:25 You keep going.

50:27 But now I kind of need you to stop

50:29 feeling sorry for yourself and focus back on your patience.

50:31 Think you can do that?

50:36 Sure.

50:34 Great.

50:35 It's like an apology, nonapology.

50:38 The fact it was a great choice that he did it without entering the room.

50:42 Yeah.

50:42 Yeah.

50:42 I agree.

50:43 I think that spoke volumes even though I agree.

50:45 I mean it it I think it would have

50:47 been like too too much to maybe in that moment.

50:50 Yeah.

50:50 I mean it's interesting in the in the moment

50:52 as the character I was like I feel better.

50:54 Oh no.

50:55 He still thinks I can't Yeah.

50:57 deal with this.

50:58 Fair.

50:59 With this extra dose and increased morphine from the pump,

51:03 your pain should subside.

51:05 Your breathing will slow down.

51:08 You may get very sleepy.

51:11 Paul, go be with the boys.

51:15 They need you more than I do now.

51:20 Later.

51:20 Right now, I'm exactly where I'm supposed to be.

51:31 Yeah.

51:33 Okay, here we go.

51:36 It's very interesting.

51:38 Is that the end of the episode?

51:39 Yeah.

51:40 It's very interesting that uh

51:43 it used to be viewed as crying in front of a patient was a bad thing.

51:47 Yeah.

51:47 Yeah.

51:48 And intrinsically a lot of doctors,

51:50 nurses feel that when in reality patients do not judge doctors for crying,

51:56 for showing emotion, especially when it's emotion that is in support of them.

52:00 So I think that is a major mindset shift

52:04 that needs to happen as one transitions throughout their healthcare journey.

52:07 Totally.

52:07 There there is like a boundary though like like

52:10 you can't break down to the point where you can't help practice medicine.

52:14 Yeah.

52:14 I feel like I would unfortunately like I

52:17 think that's why I didn't go down that path.

52:19 I don't I think I would like very much probably a little like

52:22 Samir or just take on a little a little too much, you know.

52:25 Well, maybe this role was written exactly for you.

52:29 That's what it seems like.

52:30 Felt like it.

52:30 Felt like it when I read it.

52:32 Talking about water park injuries, we actually reacted to some of those.

52:35 Click here and check that out.

52:36 And as always, stay happy and healthy.