Doctor Reacts To The Pitt S2 Ep 6 w/ Sepideh Moafi

0:00 We're about to watch and react to episode six of "The Pitt",

0:03 but for this episode, I need to call a consult from the one and only, Dr.

0:07 Al-Hashimi, Sepideh Moafi.

0:09 Are you ready to take on episode six of "The Pitt"?

0:12 Let's do it!

0:12 Yeah?

0:13 Born ready, baby.

0:13 Okay, let's do it.

0:14 (Sepideh chuckles) And huge thanks to Zocdoc for sponsoring this video.

0:20 [Dr.

0:20 Langdon] I'm in.

0:21 Bag him.

0:22 (chest compressions thumping)- I am

0:26 notorious for pointing out chest compressions

0:30 not being done (Sepideh laughs) or being done perhaps not perfectly.

0:34 Okay.

0:34 How's Robby doing?

0:35 So, I'm a bit of a stickler for form.

0:37 Okay.

0:38 [Doctor Mike] Only because, what I've come to realize in my years

0:41 of practicing medicine and making YouTube content, people learn from television.

0:47 Yes.

0:47 [Doctor Mike] On what they should do, what they shouldn't do.

0:49 Yes.

0:49 What they think is correct.

0:50 So I would love to see the chest compressions be a little bit deeper.

0:53 But otherwise, it looks great.

0:54 Yeah, yeah, yeah.

0:54 It's hard because-- It's a real person.

0:56 When they teach, it's a real person,

0:57 so you're having to keep your arms straight and sort of push your chest forward.

1:03 Right.

1:04 And kind of act with your shoulders.

1:06 And so it's a very sort of artificial movement.

1:08 But yeah, it's, it's actually harder than it looks.

1:12 I think it's really smart in the way that they manipulate the camera angles.

1:16 Yeah.

1:16 Yeah yeah yeah.

1:17 Because honestly, it doesn't let me give critique.

1:19 Yes.

1:19 'Cause it's like, "Oh, we're just seeing the shoulders bounce."- Yes.

1:22 And that looks good already, because most people are doing stuff like this.

1:25 Yes.

1:25 You should text Noah though,

1:26 and let him know that he needs to brush up his game.

1:28 No, he's doing a good job.

1:28 I'm just kidding.

1:29 'Cause then poor Louie over there is gonna start...

1:31 I know.

1:31 Really feeling it on his ribcage the next morning.

1:33 That's right.

1:35 Okay.

1:35 Holding compressions.

1:36 (machine beeps)- [Nurse] Good square line on the end-tidal CO2.

1:39 V-fib.

1:39 Charge to 200!

1:42 Charged!

1:43 Clear!

1:45 (paddles thud)- Stand by with epi.

1:51 So that's very concerning.

1:52 We're starting to see blood enter the ET tube,

1:55 signaling that there's some kind of bleeding process going on, and, I

1:59 believe this patient is one who's come in multiple times for alcoholism,

2:03 and already has fluid building up in his abdomen.

2:06 They had to do a paracentesis.

2:08 In those patients, they have scarring of their liver.

2:11 That increases blood pressure in the portal venous system.

2:15 And what happens there is the body tries

2:18 to decrease this pressure by shunting blood in different directions.

2:22 But the problem is, the venous system is not meant to be a high-pressure system.

2:25 They're thin-walled, and they don't respond well to pressure.

2:29 So when that blood flow starts getting redirected to areas like the stomach,

2:32 the esophagus, those blood vessels that are thin start becoming wider.

2:37 They are more susceptible to rupturing.

2:39 Any amount of slight friction, pressure, ET tube going in.

2:43 All of that can risk bleeding.

2:46 And in general, patients who are end-stage

2:50 liver disease also have issues with platelets,

2:53 clotting factors, 'cause a lot of that happens from the liver.

2:57 A lot of problems with bleeding in these patients.

3:00 So, very tough to see a situation like this, where it's already terrible,

3:04 'cause we're in cardiac arrest, and now there's problem on problem on problem.

3:08 And this is a character that we,

3:11 as an audience, have grown so attached to, Louie.

3:14 This is, yeah.

3:15 Yeah.

3:16 Suction that tube.

3:17 (devices beep) You're not in the esophagus, are you?

3:21 Definitely not.

3:21 I passed right through the cords.

3:23 Good breath sounds.

3:24 End-tidal CO2 confirmed.

3:26 [Nurse] His lungs are filling up with blood.

3:27 [Dr.

3:28 Robby] I know.

3:28 This never gets easy, by the way.

3:29 Watching this amount of blood and-- Are you squeamish of blood, in general?

3:33 I didn't think I was squeamish, but yeah,

3:35 my first day, we did the clamshell procedure from episode one.

3:40 And so I, yeah, I felt like I was getting a bit lightheaded,

3:45 'cause the full-body prosthetics, they look so real!

3:47 So real!

3:47 Yeah, exactly.

3:49 Every detail, every (indistinct), is accounted for, so, I do,

3:52 I still, and watching the show, like during the clamshell,

3:55 even though I was in the room for however many days that took,

3:57 it was hard for me to watch.

3:59 Are you filming a scene like this straight through?

4:02 Or are there stops for angle swaps, camera changes, et cetera?

4:07 No, we actually have less downtime than most film and television.

4:10 Oh, really?

4:11 Okay.

4:11 Yeah.

4:12 Shows and films, because the light is already prefixed

4:15 into the, so it's basically hospital lighting that we're using,

4:19 and there's a switchboard where they, yeah.

4:20 There's very little downtime between setups.

4:23 But we do take a good amount of time to rehearse the trauma procedure.

4:27 So we have a med tech advisor for every episode.

4:30 Yeah.

4:31 Usually I call them and bother them for as long as they'll talk to me,

4:35 and let me pick their brain.

4:37 So on the day of the procedure, we'll go through,

4:39 they'll talk to each one of us individually,

4:41 sort of give us the lay of the land,

4:43 and then put it all together, run it at 25% speed,

4:47 50%, 75, and then bring it up to speed.

4:49 And once, you know, they feel it's ready, then we roll.

4:52 And yeah, like I said, there's very little downtime between shots.

4:56 Yeah.

4:56 This 25, 50, 75, 100 approach, is very similar to the "see one,

5:00 do one, teach one" that has been discussed on the show.

5:03 [Sepideh] Yeah.

5:03 It allows you to get more and more comfortable.

5:05 [Sepideh] Yes.

5:05 Without feeling like you're gonna make a mistake,

5:06 and it comes off perhaps less genuine.

5:09 Yes, yes, yes.

5:10 Absolutely.

5:11 But I mean, once you get in that flow state,

5:13 once you're in the pocket, it's thrilling.

5:16 I mean, I'm glad there are no lives actually at stake here for us,

5:19 but, but it really is, because it's,

5:22 it's the sort of co-dependence or interdependence of your colleagues,

5:25 of your scene partners, and everything, we just rely on each other so heavily.

5:30 [Dr.

5:31 Robby] Hold compressions.

5:32 (machine beeps)- [Dr.

5:34 Langdon] Asystole.

5:34 Resume CPR.

5:35 Another amp of epi.

5:37 [Nurse] Needs more suction.

5:38 (machines beep) (body squelches)- Pulmonary hemorrhage from liver failure.

5:43 Is he going to make it?

5:46 See, it's hard to know if, at least for me, watching,

5:49 if this is a pulmonary hemorrhage or, as Noah mentioned in the scene,

5:54 was this a situation where the ET tube was inserted incorrectly?

5:58 [Sepideh] Mm.

5:59 [Doctor Mike] Because of those fragile blood vessels

6:01 that can occur from advanced liver failure in the esophagus,

6:05 if you insert there, and you injure one of those blood vessels, you can't tell,

6:09 is this bleeding from the mouth coming from the esophagus or from the airways?

6:13 [Sepideh] Mm.

6:14 There are obviously situations from this pressure buildup,

6:16 the coagulopathy that happens as a result of liver

6:18 failure that could lead this to be alveolar bleeding.

6:23 So like the smallest little pockets, air sacs,

6:26 within the lungs that can cause bleeding, but very difficult to know.

6:29 And in an ER setting, it almost doesn't matter,

6:31 'cause you're trying to do your best to bring this person back.

6:34 But in a scenario like this, there's just, it feels very far gone.

6:39 Should we give PCC?

6:41 Too late for that.

6:43 And he's not an ECMO candidate.

6:45 Nothing else we can do?

6:46 (machines beep)- No, I think we're done.

6:54 (sighs) (machine flatlines) Oh, Louie.

7:00 (machine flatlines)- 12:07.

7:08 Why do I need to see a psychiatrist?

7:10 Jada, why do I need to see a psychiatrist?

7:13 It's gonna be okay, Jackson.

7:14 Dr.

7:15 Jefferson says he can help.

7:17 [Javadi] Do you know how you got here?

7:20 The medics brought me.

7:22 I don't really remember.

7:23 I was in the library.

7:25 [Dr.

7:26 Jefferson] What were you doing there?

7:28 I was studying.

7:31 I was trying to study.

7:34 But then they wouldn't stop talking.

7:36 [Dr.

7:36 Jefferson] Who wouldn't stop talking?

7:38 They don't want me to pass the bar.

7:39 Who doesn't want you to pass the bar?

7:41 That's what they told me.

7:42 This is a situation where paranoia is entering the equation,

7:45 because there may have been no other people actually interrupting his studies.

7:50 Schizophrenia is a possible diagnosis,

7:52 especially in this age demographic, is when it can start.

7:55 And the interesting part about schizophrenia is,

7:58 sometimes it's brought on by some acute stress state where

8:01 we cannot even predict why it started at this moment,

8:06 but something happens in someone's life,

8:07 something very stressful, a critical illness,

8:09 and then full-on schizophrenia begins,

8:11 where before that, there were no signs of the schizophrenia.

8:14 Very interesting.

8:15 I was fascinated by that, in talking to our tech advisors, our medical advisors,

8:20 that this is apparently very common for young males in their early twenties,

8:26 in college, high-stress environments,

8:28 and especially with marijuana, when they're smoking marijuana.

8:31 [Doctor Mike] Yes.

8:32 [Princess] Everything okay, Roxy?

8:33 (curtain pulls)- I can't get off the bedpan.

8:37 Oh, that's what I'm here for!

8:44 Your husband seems like a saint.

8:47 How long have you been married?

8:51 Too long.

8:53 (chuckles) Almost 20 years.

8:57 I always find it tough in scenarios like this, where

8:59 a patient is obviously in a lot of pain,

9:02 is going through final stages of their life,

9:05 it's a hospice situation, so, you wanna approach this situation with reverence.

9:08 You wanna be serious, you wanna be compassionate.

9:12 At the same time, it's so important to also interject some happiness,

9:17 some humor, some joy.

9:20 But then it's very easy to cross that line.

9:22 [Sepideh] Yeah.

9:23 [Doctor Mike] And finding that line with each patient is,

9:25 I think, the most valuable part of being a clinician.

9:28 I was just admiring Kristin's work,

9:30 because she's so beautiful and alive and real

9:34 and just present in everything that she does.

9:36 I think she's just such a beautiful, brilliant actor.

9:39 But it's a cast of people like her who are

9:42 just making really smart choices with the script that we have,

9:45 which is so well-written and loaded and really kind of like a treasure chest,

9:50 or a minefield, and you just continue to mine as an actor and you

9:54 get more and more and, these moments of levity that you're talking about,

9:58 yeah, I was, I was thinking as we were watching it,

10:01 the way that the camera is panning down to the bed and then up to them,

10:04 it makes you feel like you're inside of the room with them,

10:07 like you're experiencing it, and it creates this other dimension of humanity

10:12 and authenticity for the show that makes you then,

10:16 in these quiet moments, relate even deeper to these characters,

10:20 whether it's the patient or the nurse.

10:22 This feels like I'm shadowing a nurse for the day to see what they do.

10:26 Yeah yeah yeah, yeah.

10:27 There is no difference between this and what I experienced in the hospital.

10:30 Mhmm, mhmm.

10:31 So, I think that's a testament.

10:32 I believe this one's directed, if I'm not mistaken, by Noah.

10:35 [Doctor Mike] Oh, really?

10:36 Okay.

10:36 Yeah.

10:36 So it's always interesting, you'll see this season,

10:38 Shawn directs an episode too, episode nine.

10:40 This kind of, like, this level of detail

10:43 is so important for them because they're actors.

10:46 They come at this from the inside out.

10:48 Whereas a director that comes from maybe

10:50 a photography background or a filmmaking background,

10:53 it's more of an outside in approach.

10:54 And both are right.

10:55 Both are equally as effective.

10:57 Yeah!

10:57 But I think as an actor, it's really satisfying working with somebody

11:01 who understands it from the inside out,

11:03 and cares, like, pays attention to these details,

11:06 because they know that the audience will feel them.

11:10 Sure.

11:10 Let's discuss our incarcerated patient, Gus.

11:13 Prison infirmaries tend to be short-staffed, so we need to be thorough.

11:17 What's in a differential diagnosis for malnutrition?

11:20 Inadequate intake.

11:22 Methamphetamine use.

11:24 Severe alcoholism.

11:25 ADHD medication.

11:27 [Dr.

11:27 Al-Hashimi] What else?

11:28 Cancer of the oral pharynx, esophageal strictures, prior strokes, malabsorption,

11:32 inflammatory bowel disease, none of which were in his medical record.

11:35 I don't think it was noted, also past bariatric surgeries.

11:39 Mm.

11:40 So patients who have a bariatric surgery sometimes have

11:42 a malabsorption syndrome where they don't get their nutrients as well.

11:44 And this type of questioning happens very often.

11:47 In the "House MD" days, they would be in front of a whiteboard.

11:50 And that's so not realistic, with the exception of if you're doing like

11:54 a, we have these rounds called M&M rounds,

11:56 morbidity and mortality rounds, where,

11:58 if someone dies, or someone's very sick, at the end of the month,

12:01 we collect these cases, we present them and then write on a board.

12:03 But when we're actually taking care of a patient,

12:05 this is the exact way that they're done.

12:07 And we sneak in little, you know, drink or food breaks to kind of, you know?

12:12 Make sure the audience knows that we're not-- People eat.

12:14 [Sepideh] Yes, that doctors need to eat too.

12:16 Let's start with a nutrition history once he's back from CT.

12:19 What is the story with your incarcerated patient?

12:22 Gus Varney, three rib fractures, with normal O2 sats currently.

12:25 Waiting on CT results.

12:26 Okay.

12:26 If he's stable at the two hour mark, I'd say he's good to go.

12:28 Let's get the ball rolling on discharge.

12:29 Let's wait on the CT results.

12:31 We can move him outta trauma one, at least.

12:33 Yes, we can.

12:33 What's open?

12:34 13 and 14 will be discharged soon.

12:35 15, once we can move Louie to the viewing room and get it cleaned up.

12:39 Our paracentesis patient, Mr.

12:40 Cloverfield?

12:41 V-fib arrest.

12:42 We'll do a debrief when we know how many patients we gained from Westbridge.

12:45 So Gus goes to 13, 14, or 15.

12:48 I kinda wanna keep him in plain sight.

12:50 What about BH2?

12:51 [Nurse Dana] Sold.

12:52 Why not give him some privacy?

12:53 Everyone can see him in BH2, like he's a monkey at the zoo.

12:57 Because he came in with an orange jumpsuit

12:58 and we need to think about patient and staff safety.

13:01 Safety first.

13:02 BH2 beats a prison cell.

13:03 [Dr.

13:04 Al-Hashimi] Not by much.

13:05 You guys have a lot of tension going on there.

13:07 There is some tension.

13:08 There is push and pull.

13:09 I think friction can be generative, though.

13:11 And I think that's what's interesting about the dynamic that Dr.

13:15 Al-Hashimi has introduced into "The Pitt".

13:18 It's a different tune.

13:19 It's a different melody.

13:21 It's clearly a well-established culture, ensemble, ecosystem,

13:25 and she sort of steps in, and brings something kind of radically different,

13:32 and tries to harmonize as best she can,

13:35 but there are some clashes sometimes between her and Robbie.

13:39 And I think, just as an audience member, at this point, in episode six,

13:44 if they can find a way to work together,

13:47 I think they could be an unstoppable team.

13:49 And I think what they represent is, you know,

13:52 more of this old-school, hands-on, intuitive approach Dr.

13:55 Robby, and Baran Al-Hashimi, who represents this newer, more progressive,

14:03 you know, the modernization of medicine, what could be.

14:06 (door opens) (curtain pulls)- [Dr.

14:10 Langdon] I'm sorry, man.

14:11 We didn't have time to find you.

14:14 What happened?

14:16 He was apneic and pulseless.

14:19 We started CPR and intubated him.

14:22 He had a massive pulmonary hemorrhage.

14:23 Robby called it.

14:24 Could have been as simple as, because he has this liver failure,

14:28 and he has the high capacity for bleeding or high risk for bleeding,

14:31 and doing chest compressions, you break a rib, punctures the lung.

14:35 That alone could have caused this.

14:37 Never cleaned a dead body?

14:39 (curtain pulls) Probably never seen one, either.

14:43 No one tells you what it looks, feels,

14:45 or smells like, but you get used to it over time.

14:49 This is mostly for dignity purposes,

14:51 to have the patient be available for someone

14:55 to view before sending them to the morgue.

14:57 But you're not doing like, an embalming process here, so.

15:00 We pull off the gown, wipe 'em down with towels, and we'll roll him on his side.

15:06 Clean his back, stuff the sheet under him.

15:08 Pads for mucus and other bodily fluids that might come out after the fact.

15:13 Usually, we leave the ET tube in for the coroner,

15:16 but Louie was a chronic alcoholic with end-stage liver disease.

15:20 Not a coroner's case.

15:22 Yeah so, usually, we would call the coroner, as residents, present the case,

15:27 and they would decide whether or not this was

15:29 necessary to be a coroner's case or not.

15:31 The most difficult part is, this doesn't happen as much in the ER,

15:34 but when someone's admitted to the hospital and someone dies,

15:37 you go in, as the resident,

15:40 and you have to formally diagnose the patient as dead, deceased.

15:44 You're looking for certain reflexes, pupillary, corneal,

15:48 listening for extended periods of time for lung and breath sounds.

15:52 And the whole family's there.

15:54 So you're trying to be respectful.

15:56 You're talking to them about the process of what will happen in the coming days.

16:01 And there's times where you're talking, but you just know none of it's landing.

16:04 [Sepideh] Yeah.

16:05 So you just have to be there.

16:06 Ask, a lot of times, if they have questions, and suspend talking,

16:10 and listen more, even though your job is to talk.

16:13 Mhmm.

16:14 Because, in that moment, the information's not landing.

16:17 It's not valuable.

16:18 So.

16:18 And it's a way, I mean this is,

16:20 reminds me of, you know, how we approach our work as actors.

16:25 Sometimes you have the language on the page, or what you're saying,

16:29 you're taking this family through this process,

16:31 but you're really communicating something else.

16:33 You're communicating love and care and presence with this language.

16:37 And so often, as actors,

16:38 we have the language in the script that we're communicating so much more.

16:43 [Doctor Mike] Right.

16:44 With, so.

16:45 [Nurse Dana] So what's up with Evel Knievel?

16:46 Brandon Lee, 52.

16:47 Fell off a motorcycle pyramid at 25 miles per hour.

16:49 Motorcycle pyramid?

16:50 You recruiting?

16:51 Got a fellow rider in your midst.

16:52 [Mr.

16:53 Lee] No kidding.

16:53 How high up were you?

16:54 On top of a three-two-one.

16:55 But the bottom guys are sitting down, driving the choppers.

16:58 I'm fine.

16:58 I don't need all this.

17:00 Were you wearing a helmet?

17:01 [Mr.

17:01 Lee] Of course!

17:02 Oh, what do you know?

17:02 They're still in style!

17:04 Good vitals, tender right wrist, and big left knee lac.

17:07 Hey Joy, Perlah?

17:07 Trauma two.

17:09 Who else can I have?

17:10 Santos and Whitaker are in with Louie.

17:12 Yeah, gimme Whitaker.

17:13 He could use a distraction, and Santos has been ducking traumas all day.

17:15 She's behind on her charting!

17:17 Who isn't?

17:17 (record scratches)- If I'm being honest...

17:20 Yes.

17:20 I'm currently very behind on my charting.

17:21 Are you?

17:22 (Sepideh laughs)- Yeah.

17:23 I'm getting messages right now about it.

17:25 I can feel my phone getting the vibration alerts.

17:28 But interestingly, my hospital is beta testing an AI system.

17:33 Okay!

17:33 Okay.

17:33 To try and figure out how to make this more clean,

17:38 quicker, more effective, with the concern from every doctor that, "Oh,

17:42 will we now be seeing double the amount of patients

17:46 because we have this AI system?"- That's a slippery slope.

17:49 But it feels like, yeah, most people that I've talked to, most

17:53 doctors that I've talked to, welcome this change,

17:55 because especially people who are of a sort of like,

18:00 in maybe, I'm assuming we're kind of in a similar age bracket,

18:02 and older, because you've trained with hands-on, you know-- For sure.

18:08 Medicine and, and you know how to use this as a tool, not as a replacement.

18:13 My biggest thing when I was in residency training,

18:15 I would get in trouble because I refused to do,

18:17 the rule was do your note in the room with the patient.

18:20 Mhmm, mhmm.

18:21 And I would just refuse to type when I wanted to interact with a person.

18:25 Yes!

18:26 I just, I couldn't be that keyboard warrior, and that meant, after hours,

18:30 I would be sitting and doing notes and trying to catch up.

18:33 But now, with these AI tools, perhaps we can just have something on the desk

18:37 that is no longer creating a barrier to communication.

18:40 [Sepideh] Yes!

18:41 [Doctor Mike] And it kind of stays out of the way.

18:42 Well, and it strengthens the bond between physician and patient, right?

18:45 Because there's that psychological emotional attunement, and they feel,

18:50 and you earn their trust that way,

18:52 and people who are coming, whether it's a checkup or for some sort of illness,

18:57 there is this power dynamic of, you know, you guys are,

19:01 we're coming to you for your expertise and you have the answers.

19:04 And so when you do see your provider locked

19:07 in and sort of at the same place with you emotionally,

19:11 mentally, it makes a world of difference, and then you feel like,

19:15 okay, anything you say, I'm happy to do.

19:18 Yeah.

19:18 I'm happy.

19:19 You know?

19:19 Rather than having to fight to earn the trust.

19:21 I don't even like getting to the point where a patient feels that they

19:25 need to make the decision to do what I'm telling them to do.

19:28 Mm, mhmm.

19:28 I want for it to be an educational experience,

19:32 where I'm explaining what the options are.

19:35 Perhaps giving recommendations.

19:36 [Sepideh] Yeah.

19:37 But ultimately, it should be their choice.

19:39 [Sepideh] Yes.

19:40 To want to or not want to do something.

19:42 Good lung sliding bilaterally.

19:43 Pupils equal and reactive.

19:45 [Dr.

19:45 Robby] What do you ride?

19:46 [Mr.

19:46 Lee] The bullet.

19:47 Oh, royal infield, ankle breaker, Thumper!

19:49 BP 138 over 80.

19:51 Pulse 94, pulse ox 98.

19:53 So far everything's very reassuring, and he's all mentally there,

19:56 being able to memorize or call back the name of his motorcycle.

20:02 So, reassuring.

20:03 Does anyone have any trauma scissors?

20:05 I'll check the knee.

20:06 Not yet.

20:07 Why not?

20:08 [Dr.

20:08 Robby] Dr.

20:09 Santos?

20:09 Primary survey means rule out the life threats.

20:11 Don't get distracted by lacerations or fractures.

20:14 No free fluid in the belly.

20:15 Airway, breathing, circulation are fine.

20:18 Okay.

20:18 That's ABC.

20:18 That just leaves two letters.

20:20 DE.

20:21 (both laugh)- Disability.

20:23 Wiggle your toes, sir?

20:25 Any pain in your arms or legs?

20:27 [Mr.

20:27 Lee] Not really.

20:28 [Dr.

20:28 Whitaker] Does it hurt when I push here?

20:29 No.

20:30 Okay.

20:30 No midline tenderness.

20:31 Nexus negative.

20:33 No obvious brain injury or spinal cord injury.

20:35 That just leaves E.

20:37 Joy?

20:38 Can I buy another vowel?

20:40 [Dr.

20:40 Robby] Dr.

20:41 Whitaker?

20:41 [Dr.

20:42 Whitaker] Exposure.

20:43 AKA, strip and flip.

20:44 Cut off his clothes, and we'll log roll him.

20:46 A lot of times in the hospital,

20:47 that is one of the most anger moments from the patient.

20:50 'Cause they're like, "This is my favorite shirt!

20:52 This is, don't cut it!

20:53 I'm fine!"- Oh really?

20:54 (laughs)- Yeah, but they've experienced a serious trauma.

20:56 You don't wanna miss something,

20:57 'cause there have been instances where someone comes

21:00 in, adrenaline rush because they got into a fight, they got shot as a bystander,

21:06 and they don't realize they have a bullet

21:08 hole in their leg that went through their tissue,

21:10 and had we not exposed their full body, we would've never seen it, so.

21:13 Oh my gosh.

21:14 Very important to check the entire body.

21:16 Would you, have you, do you ride a motorcycle?

21:18 No.

21:19 Would you ever?

21:20 I've crashed a motorcycle.

21:20 (laughs)- No!

21:22 Interestingly enough, when I was really young.

21:23 And I haven't rode since.

21:24 And ever since you, yeah.

21:25 But I do race cars.

21:26 [Sepideh] And you wouldn't.

21:27 So.

21:27 Oh, you do race cars.

21:28 But that's different, right?

21:29 I mean, you still crash.

21:30 I guess it's just safer.

21:32 Sure, sure.

21:33 Helmeted motorcycle acrobat.

21:34 Eight foot fall standing on top of five riders.

21:37 Primary survey normal, eFAST negative.

21:40 So in a scenario like this where the exam seems fine,

21:43 it's tempting to not do imaging.

21:45 [Sepideh] Mm.

21:46 However, one of the criteria that we use to decide whether

21:49 or not someone should get imaging stems from also the mechanism of injury.

21:53 [Sepideh] Mm.

21:54 [Doctor Mike] And an eight foot fall at speed is

21:56 a pretty serious mechanism of injury that would usually warrant imaging.

22:00 Another motorcycle accident.

22:02 [Dr.

22:02 Garcia] Hello, sir.

22:02 I'm Dr.

22:03 Garcia from surgery.

22:04 Hello.

22:05 Okay, we will roll him in, three, two, one.

22:12 They closed the drape!

22:13 (both laugh) I'm always talking about the drapes not being closed,

22:17 but I assume it's for filming purposes, right?

22:20 Yeah.

22:21 Okay.

22:21 Most of the time.

22:22 Yeah, yeah, yeah.

22:22 Because a big part of what I do and what I train residents is,

22:25 they'll walk into the exam room, they'll do everything perfectly correct,

22:28 like, before, let's say a pap smear.

22:30 And they'll introduce to the patient what they're about to do.

22:33 They're very calm, very kind.

22:35 And they're about to start the procedure, and I'm like, "Hold on a second.

22:37 If someone opens this door right now."- Yeah.

22:40 The patient is fully exposed.

22:41 Yes.

22:41 You have to close the secondary drapes.

22:43 I'm always yelling that at them.

22:44 Do they ever tell you, "Well they don't on 'The Pitt',

22:46 and everything on 'The Pitt' is-"- Yeah, yeah.

22:48 (both laugh) No, they don't do that yet.

22:49 Back to the show in just a second,

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24:06 All right, let's get back to "The Pitt".

24:09 [Nurse Jesse] Gus here is wondering if he's clear to eat.

24:12 As long as it's a liquid diet.

24:14 We have the results of your CT scan.

24:17 Your jaw should heal without surgery, which is good news,

24:20 but it will be a few weeks.

24:22 Before I can eat?

24:24 [Dr.

24:24 Mohan] Solid foods, yes.

24:26 We have a calorie-rich supplement drink called Ensure.

24:29 Comes in chocolate, vanilla, or strawberry.

24:33 Chocolate, please.

24:34 [Dr.

24:35 King] Good choice.

24:35 How many can I have?

24:36 Two a day is recommended.

24:38 I'll get it for you.

24:40 You have an appetite.

24:41 That's good.

24:42 (door buzzes)- Mr.

24:44 Varney, your blood tests indicate low levels of protein and vitamins.

24:48 This actor, John Lee Ames, I think is his name.

24:51 He was so detail-oriented and so specific about his pain.

24:59 I mean, you, he broke your heart.

25:02 I couldn't watch him on my coverage because I'm supposed to be tough,

25:06 and I would just crumble.

25:07 I'd start crying.

25:09 I love that they've sort of folded

25:11 this case into the conversation that, you know,

25:15 because it really makes us reflect on who gets care,

25:19 who deserves care, who's afforded care, what kind of care do they deserve?

25:23 'Cause he looks, initially,

25:25 they made him look like kind of a serial killer or something.

25:28 [Doctor Mike] Right, yeah.

25:29 You know?

25:30 He looks the part.

25:31 But there was a softness, this childlike quality about him, that even though,

25:36 when she says chocolate, he says chocolate, his eyes light up.

25:39 It just broke your heart.

25:40 So again, going back to what the show does

25:43 beautifully is it reveals the humanity in all of us.

25:47 Yeah.

25:47 At the surface, we might judge somebody like that.

25:49 But then you see he's just a kid who wants to eat.

25:53 Yeah.

25:53 Who wants to be taken care of.

25:54 Which, there should be no barriers for anyone to get care.

25:57 Criminal, not criminal, person who wants care, who can't afford care.

26:02 Like the idea is we should be giving care,

26:04 especially in an ER setting, to everyone at the highest level.

26:08 CT's ready for Brandon.

26:09 As soon as we take a look at this knee.

26:13 Ooh.

26:14 Whoa!

26:14 Through the deep fascia.

26:15 How's it look?

26:16 Definitely gonna need stitches.

26:18 [Mr.

26:18 Lee] How many?

26:19 A lot.

26:19 It could be an open joint.

26:20 We'll do a saline load after CT.

26:24 Lever sign negative.

26:25 ACL intact.

26:26 Okay, ready to roll.

26:27 I'm not gonna lie.

26:28 It's really tough to know if the ACL's intact from doing

26:31 that sign test (laughs) when the knee is in that shape.

26:36 When there's that much damage.

26:37 During global swelling like that, it's very

26:40 difficult to have clear tests, with the exception, if there's a full, full tear,

26:44 and there's just full laxity when you're doing certain special tests.

26:47 But in general, it's tough to point that out.

26:50 We need to admit our incarcerated patient, Gus.

26:52 What did the CT show?

26:54 Moderate pulmonary contusion, three rib fractures, no intraabdominal bleeding,

26:58 an oblique fracture in the body of the mandible, anterior to the angle.

27:02 All favorable for healing.

27:03 What's the treatment plan?

27:04 A pain-- Security!

27:05 (people clamor)- Pain medication, antibiotics, liquid diet,

27:11 a pulse ox a few times a day, and then also dressing changes for the laceration.

27:16 Which he can get at his correctional facility.

27:18 Or, he stays here for a few days and we get him on the right track to healing.

27:23 Why don't you two go check on your patients?

27:25 Got it!

27:26 Sure thing.

27:29 What am I missing?

27:30 That's a great question!

27:31 I was expecting conflict, but he's admitting that he might be missing something.

27:35 That's very disarming.

27:37 Do you think that's enough information for him to have to admit the patient, or?

27:41 In a situation where, in "The Pitt",

27:44 they're already overloaded, beds are premium.

27:47 Scarce, yeah.

27:48 You have to be aware that you need space.

27:52 Yes.

27:53 So you try and decrease the need for people to spend time at the hospital,

27:57 in addition to thinking about the fact that every

27:59 time you bring a patient into the hospital,

28:01 you're risking them getting a hospital-associated infection.

28:06 And in a hospital, traditionally, you're not resting well,

28:09 the lights are always on, people moving around.

28:11 Maybe correctional facility isn't comparable to home,

28:14 but if you've spent years there and you're comfortable there,

28:17 maybe you're resting there as well.

28:19 But, if he's not aware of something, some risk,

28:23 some healing factor, perhaps this will change his guidance.

28:27 He's not getting enough to eat at his correctional facility.

28:30 The portions are tiny.

28:31 Too many carbs, not enough fruits or vegetables.

28:33 He's lucky he hasn't developed a chronic illness.

28:37 We don't have any inpatient beds.

28:38 He would board down here for three days.

28:39 We're still getting runs from Westbridge,

28:41 and we cannot tie up behavioral for that long.

28:44 Also, based on his presentation, it would be very unique to understand why he's

28:49 so advanced in his malnutrition as a single individual.

28:53 Like are they not feeding him specifically?

28:55 Are inmates stealing his food?

28:58 Some further questioning would be helpful here, because if that's the case,

29:02 you can have social work actually begin the process

29:04 of investigating the correctional facility and asking them questions.

29:08 Why don't I call the prison doctor

29:09 and find out what they're working with over there?

29:11 Thank you.

29:12 My pleasure.

29:12 But see, in a scenario like this, it would

29:14 be great to pawn this off to a med student,

29:16 or perhaps a social worker, not the director of the ED, so.

29:21 What do you say, kid?

29:23 Ready to go home?

29:27 How's your pain Mrs.

29:29 Hamler?

29:30 It's the same.

29:32 We're gonna write you a script for Keppra.

29:34 You'll take that to prevent seizures once a day starting tomorrow.

29:37 Between your broken leg and the bruises from your seizure,

29:39 the pain will probably get a little worse.

29:41 Yeah.

29:42 The most important thing is to let others help you.

29:43 You'll need assistance showering and getting to the bathroom.

29:46 [Mr.

29:46 Hamler] Yeah, no problem.

29:47 I won't leave her side.

29:48 In a scenario like this, giving the plan is smart, but then asking the patient,

29:52 "Does she have any concerns about going home?" 'Cause it seems like...

29:56 [Sepideh] There's a, yeah.

29:57 There's some kind of hesitation there.

29:58 [Sepideh] Tense dynamic, yeah.

29:59 All right, fill me in.

30:01 This is Harlow Graham.

30:02 She was seen in triage.

30:03 CBC and CMP came back normal.

30:05 IT was supposed to bring the VRI down, but they're slammed.

30:08 I know a bit of sign language.

30:10 Harlow, this is Dr.

30:12 Santos.

30:15 Hi Harlow.

30:16 How are you feeling?

30:20 [Princess] She has a headache.

30:22 Okay, what else?

30:28 What is she saying?

30:30 I think she had a stomach ache, and she might have passed out?

30:34 This is getting into not great territory,

30:37 because when you're trying to understand someone who

30:40 speaks in sign language or communicates in sign language,

30:43 or perhaps even just a different language,

30:45 there's this temptation to take a shortcut

30:47 of, have someone who kind of knows the language.

30:50 [Sepideh] Yes.

30:51 To interpret.

30:52 But there is a fine line between

30:54 presenting accurate information and dangerously inaccurate information.

30:58 Mm.

30:58 Mhmm.

30:58 So in a scenario where someone's not sure,

31:00 it's better to communicate by writing in a scenario like this.

31:03 It's actually why a lot of channels on YouTube

31:06 will have their content dubbed in a different language.

31:09 We have not yet done that in many languages.

31:12 We've done professional transcriptions in Spanish, but not dubbing.

31:16 Why?

31:17 Because if someone is to dub my voice in a different language,

31:21 and slightly change the inference of what I'm saying,

31:25 that can lead someone to making a bad

31:27 healthcare choice for themselves or their family members,

31:30 in a different country,

31:32 and it's very expensive to have a medical professional actually do that dubbing.

31:36 So we have held off on that.

31:38 Wow.

31:39 But interesting to show how nuance really matters in healthcare communication.

31:42 Absolutely.

31:43 Yeah.

31:46 I'm not a hundred percent sure.

31:47 Okay.

31:48 We're just gonna need to wait for an interpreter,

31:50 'cause I need to ask a million questions and I can't do it this way.

31:53 So just call me when IT comes down.

31:54 Talk to the patient though.

31:55 (Sepideh chuckles) Like?

31:58 Yeah.

31:58 Ortho assessment.

31:59 Palpate all long bones, starting with the clavicle.

32:03 Got it.

32:04 We'll take the lower extremities.

32:09 (Mr.

32:10 Lee winces) Distal radius tender.

32:12 No deformities.

32:12 Needs an X-ray.

32:13 No bony tenderness down here.

32:14 No laxity of the knee.

32:16 Any concern about that knee leg?

32:19 It's an open joint.

32:20 He'll need a washout in the OR.

32:22 We could try a fluorescein injection?

32:23 Okay.

32:23 We'll need a Wood's-- Wood's lamp, 1% lido with epi,

32:26 sterile saline, sterile basin, sterile fluoro strip.

32:28 18 and 27 gauge needles, five and 60 CC syringes.

32:32 Interesting what they're doing.

32:33 I guess they're trying to figure out if

32:35 the potential opening has gone into the joint itself,

32:40 because the skin and the superficial tissues there,

32:44 the fascia, they can experience some infection, some bacteria,

32:48 but if it starts entering the joint, that requires IV antibiotic treatment.

32:52 [Sepideh] Mm.

32:52 So what they do typically is insert this dye that actually has

32:57 been used in a previous episode to check for a corneal abrasion.

33:00 Similar premise, just with saline,

33:02 to see if it actually starts entering the knee joint.

33:05 If it does, high risk for infection, so you wanna be prepared for that.

33:10 [Sepideh] Mm.

33:11 Lights out, Wood's lamp on.

33:12 (devices beep) Okay...

33:18 Might wanna use some of that on Halloween.

33:20 That is 250 CCs of sterile saline

33:22 with one small touch of a sterile fluoro strip.

33:27 We are going to inject this fluid into your knee, Brandon,

33:30 and if there's anything glowing in your wound, we know we have a leak.

33:35 This could also be done to check for fistulas.

33:37 If there's an abnormal connection somewhere in the body,

33:39 you can inject into one part of the body and see

33:42 if it transports there because of this new path that's created.

33:45 And sometimes fistulas and these abnormal

33:47 connections form just from friction within organs.

33:50 So, this is pretty wild,

33:51 but you can actually develop your colon rubbing against your bladder,

33:57 to the point where you can create a fistula where feces end up in the bladder.

34:04 And you end up urinating feces, fecal material.

34:06 No!

34:07 Yeah.

34:07 So imagine how scary that is to a patient-- I don't want to imagine.

34:10 When they start experiencing that.

34:12 Yeah.

34:12 And they present that way and they go,

34:13 "What is going on?" Recurrent UTIs, foul smell, et cetera.

34:17 That's why you need to always think

34:18 about potential fistulas as part of your diagnosis.

34:21 You'd have to surgically operate.

34:23 Correct.

34:24 Like you'd have to...

34:27 That looks good.

34:28 Laceration did not enter into the joint space.

34:31 Surgery not needed.

34:33 Excellent.

34:33 I can get back to the prix.

34:34 No, we'll still need to stitch you up and splint your wrist.

34:37 Hanging a gram of ancef.

34:38 Wait, he has a penicillin allergy.

34:40 [Kim] No, PEN-FAST was negative.

34:41 We're okay.

34:43 My mom said I got a rash with amoxicillin when I was two.

34:46 90 plus percent grow out of their penicillin allergies from childhood.

34:49 So a lot of people come in saying they have a penicillin allergy

34:52 and sometimes we do some testing to rule out if they still do.

34:56 Because if they don't, it's better to use a medication like penicillin,

35:00 which has lower rate of side effects,

35:01 and is more targeted to the type of bacteria that we expect to find,

35:05 therefore creating less bacterial resistance to antibiotics.

35:08 Yeah.

35:09 Probably not a true allergy.

35:10 Go ahead and give it, Kim.

35:12 But have epi and Benadryl standing by, right?

35:13 [Dr.

35:13 Robby] Yes, to be on the safe side.

35:14 (record scratches)- Well, it's the ER.

35:16 I'm hoping that there is epinephrine and Benadryl.

35:19 Most people who think they have a penicillin

35:20 allergy actually don't- Always listen to the nurses.

35:24 They run the ER.

35:25 We just try and stay outta their way.

35:27 Facts.

35:27 (Sepideh chuckles) And in general,

35:29 when people tell me they have a drug allergy, many times it's something like,

35:33 "Oh, my stomach gets upset when I

35:34 take this medicine." It's not exactly an allergy.

35:37 And it's important to differentiate between the two because look,

35:40 having an upset stomach but decreasing the risk

35:43 of a complication might be worth it,

35:45 versus someone has anaphylactic shock as a result of a medication.

35:50 Way different proposition, so.

35:52 Hey, I just got word that the at-home morphine pump is gonna be delayed.

35:55 Hospital pharmacy has to mix it, and then deliver it later today.

35:59 Well, should we keep her here until it's ready?

36:01 No, you can give her a 200 milligram tablet of MS Contin.

36:04 200 milligrams?

36:05 Biggest pill they make.

36:06 Releases over 12 hours for patients with opiate tolerance.

36:09 Got it.

36:10 I'm surprised they're not doing fentanyl patches

36:12 for her, because that is a much more potent medication,

36:15 but it's a patch, so it doesn't have to be taken by mouth,

36:17 and you can get really high doses.

36:20 Which is why fentanyl could be so dangerous, but for someone who's, as he said,

36:24 opioid tolerant, meaning they've taken huge doses,

36:26 their body has become accustomed to those doses.

36:29 Hmm.

36:30 You gave us a clozapine ileus about an hour ago.

36:32 Your resident reported no surgical history,

36:34 but the chart says they've had an appendectomy.

36:36 We're not admitting the patient without a surgery consult.

36:38 Who called it in?

36:39 [Dr.

36:39 Campbell] Dr.

36:40 Trinity Santos.

36:41 Dr.

36:42 Santos!

36:42 You had an ileus patient.

36:44 You neglected to mention a history of appendectomy.

36:47 There was no history of appendectomy.

36:49 It was in your note.

36:50 I may have forgotten to proof check it.

36:53 I was using the app that Dr.

36:54 Al-Hashimi suggested to catch up on my charting.

36:57 Wonderful.

36:57 Ah!

36:57 Dr.

36:58 Al-Hashimi.

36:59 Yes.

37:00 [Dr.

37:00 Robby] Dr.

37:00 Santos was just using your AI tool.

37:02 Oh, that's!

37:03 That can't be blamed on you!

37:04 You have to proofread the notes!

37:05 I said it!

37:06 (Doctor Mike laughs)- It hallucinated a history of appendicitis.

37:11 As I mentioned to Dr.

37:12 Santos, generative AI is not perfect.

37:14 We still need to proofread every chart it creates.

37:17 The patient also has a history of headache, followed by Dr.

37:20 Park from urology.

37:21 That should probably be neurology.

37:24 Unless urologists are now treating migraines.

37:26 Another example that should have been caught by proofreading.

37:29 AI's 2% error rate is still better than dictation-- Yeah,

37:31 I don't really give a shit whether or not you wanna use robots down here.

37:35 I need accurate information in the medical record.

37:37 Understood.

37:38 You know what I will say?

37:40 We're having all these wars about this 2% accuracy.

37:43 When I was on wards, you should have seen the handwriting of the specialists.

37:51 Yeah.

37:51 Yeah, yeah, yeah.

37:52 Completely illegible!

37:53 Completely!

37:54 In fact, there were some, it wasn't even worth looking at the note.

37:58 You would just know that they were there,

38:00 because their note was semi-present, and you have to page them every time.

38:04 And you know what's weird?

38:05 They were so sweet!

38:06 And they would explain everything that happened.

38:08 But why do you want the call?

38:10 Since you're already writing it, make it legible!

38:14 Yes.

38:14 [Doctor Mike] If they knew how we practiced medicine 20 years ago, when-- Yeah.

38:17 [Doctor Mike] There were no computers involved.

38:19 [Sepideh] Yeah, yeah.

38:20 This is a miracle!

38:21 [Sepideh] Yes.

38:22 Compared to that.

38:22 And, I mean, a friend of mine who is a doctor,

38:25 specializes in end-of-life care, he says that, I mean,

38:28 he's the most hypervigilant, obsessive perfectionist.

38:33 And he's terrified of making a mistake!

38:35 Yeah.

38:36 'Cause you're human!

38:37 Of course.

38:38 You know?

38:38 You deserve to have a bad day.

38:39 You deserve to be sleep-deprived.

38:40 The fact that that could affect someone's care

38:42 or someone's diagnosis or, so he is team AI,

38:46 because it can reduce human blind spot at the end of the day.

38:50 But needs strict supervision.

38:53 [Doctor Mike] Right.

38:54 I just got off the phone with the physician assistant at the prison.

38:57 They've got a 16-hour-day infirmary with NP and PA coverage,

39:00 giving everything that we need, and they've got an RN for overnights.

39:03 Even so, he's here because they're ignoring his basic needs.

39:08 He's here because somebody kicked the shit out of him.

39:10 I think you're missing the point.

39:11 We have more to offer.

39:13 Robby.

39:14 Got four more coming our way.

39:15 Okay.

39:16 Got it.

39:16 What you're trying to do is very noble.

39:18 We don't have the resources to spare.

39:19 Okay, then why admit the unhoused man, Digby?

39:22 Why not send him back to the street with antibiotics and a roll of gauze?

39:25 Because Digby lives on the street, and your incarcerated patient has a mid-level

39:28 provider and a nurse looking after him.

39:30 We both know the quality of care is not the same.

39:33 Sorry, are you waiting for me?

39:34 No.

39:35 Dr.

39:35 Al-Hashimi?

39:35 For the patient in seven.

39:37 A few days here could make a world of difference for Gus' health.

39:40 We are a safety net, but nets have holes.

39:42 We are not admitting him because this is not about social justice.

39:44 (Dr.

39:45 Al-Hashimi stammers)- Everything I've done in my career

39:49 is an effort to improve the system.

39:51 Just because you know it's broken doesn't mean you stop trying.

39:55 I think in a scenario like that, fixing

39:57 the system could mean a lot of different things.

40:00 Maybe it's not about admitting this patient to fix the system,

40:03 but using that as an opportunity to create a line of communication and dialogue

40:07 with the prison system to find out why these holes in the safety net exist.

40:11 Because, in an ER setting,

40:14 I would have to agree with Noah here, in that, in an ER,

40:17 you're trying to stabilize a patient and either make

40:20 the choice that they need to be admitted for medical reasons,

40:22 or they need to go somewhere,

40:25 we call it "disposition", where they'll be looked after.

40:28 And if it's not a high complexity of illness,

40:31 we can send them to a different facility to get care.

40:33 But now if we feel like that facility's not doing a great job,

40:36 we can start an investigation, we could start a line of dialogue.

40:39 If you make the decision to universally bring people in, you'll

40:43 get to the point where you can't deliver care to almost anyone.

40:46 Just from a story perspective, and what this moment represents,

40:50 these two characters is,

40:52 they're both coming in with their, their experiences, their biases.

40:59 We'll learn a little bit later why Dr.

41:02 Al-Hashimi might favor the incarcerated patient in this instance,

41:06 but I think she's had experience where these kinds

41:09 of things are sort of pushed under the rug.

41:12 Yeah.

41:13 And that that's more the norm than anything else.

41:15 And it also just shows their position and their philosophies as doctors.

41:20 For sure.

41:21 That he's somebody, the hardship that she's experienced

41:23 that we'll learn more about has made her lean

41:26 in more and become more empathetic and want

41:29 to sort of refine and find creative solutions.

41:32 And for him, it's made him, in ways, more callous and more detached.

41:39 [Doctor Mike] Yeah.

41:40 And so, I think what this moment represents more is that the (indistinct)

41:45 or how they are coming at this from, in a diametrically opposed way.

41:50 They're just polar opposites.

41:52 I think it shows how, while healthcare is a science,

41:54 it's also an art, and two good doctors-- Yes.

41:57 Can have reasonably different plans for a patient.

41:59 Based on their experiences.

42:00 Yeah, exactly.

42:01 Yes, yes.

42:01 (knocks on glass)- Robby!

42:04 Pulse ox just dropped.

42:06 What happened?

42:07 [Nurse Jesse] I don't know.

42:07 I stepped out for a minute.

42:08 It's down to 85%.

42:10 [Dr.

42:10 Robby] You having some trouble breathing?

42:12 A little.

42:13 Start him on two liters oxygen nasal cannula.

42:15 Titrate to five.

42:16 Keep the pulse ox at 92 or higher.

42:18 Does he have a pneumothorax?

42:21 He's gonna have to stay.

42:23 For how long?

42:24 [Dr.

42:25 Robby] I'm not sure.

42:27 [Nurse Jesse] Sorry, boss.

42:28 I only stepped out for a second.

42:29 Lemme know if anything changes.

42:30 You were in the room when his pulse ox dropped?

42:32 I was.

42:33 What were you doing?

42:34 D, still can't get ahold of ortho.

42:35 Leave 'em to me.

42:38 What did, she put tape on it?

42:40 So it didn't catch a signal?

42:43 Can I assume that you've already called upstairs to get Gus Varney a bed?

42:46 Do you wanna tell me what you did?

42:49 I don't know what you're talking about.

42:51 His pulse-ox was steady.

42:52 We were about to discharge him.

42:54 Did Dr.

42:55 Al-Hashimi put you up to that?

42:56 Al-Hashimi?

42:57 No!

42:58 You know he's gonna go back to prison after they discharge him upstairs.

43:04 I thought you didn't go the extra distance for your patients anymore.

43:07 This is, this is a little bit disingenuous.

43:10 Okay.

43:10 (laughs)- Saying that she's going the extra distance faking

43:14 something for him is not necessarily going the extra distance.

43:17 Now he might be exposed to extra testing that he doesn't need.

43:21 [Sepideh] Mm.

43:22 Can also create side effects of that, and more problems for him.

43:25 Also, as an ER doc, you can call upstairs

43:28 for an admission from us in internal medicine or family medicine ward.

43:31 We'll come down, examine the patient.

43:33 If we don't feel like it's a good admission, it might get rejected.

43:36 Yeah.

43:37 Yeah, so.

43:37 You're creating some interpersonal conflict as well.

43:41 Sure.

43:41 [Sam] Could this, is this illegal, what she did?

43:43 I mean-- Allegedly?

43:44 No one will know.

43:45 [Sam] Okay.

43:46 That's the real answer.

43:47 In reality, all she needed to do was say, "Hey, his blood pressure was low,

43:52 his pulse ox was low." She didn't even need to create that scene.

43:54 And something to point out there is,

43:56 the pulse ox is such an imperfect device to capture someone's pulse.

44:01 So if they have their nails painted,

44:02 if their fingers are cold, it doesn't catch a good signal.

44:06 So often someone's pulse ox drops and we re-adjust it and it's fine.

44:10 The fact that his pulse ox dropped

44:11 for 30 seconds and readjusted and it was good,

44:14 and that's the reason why he's staying, is also a little bit-- Yes.

44:18 Overblown, perhaps.

44:19 Okay.

44:20 Found this with his stuff.

44:23 Who knew he was married?

44:28 That's Rhonda, Louie's wife.

44:30 High school sweetheart.

44:32 He never really wanted kids.

44:35 But Rhonda wore him down,

44:37 and when she finally got pregnant, he changed his tune.

44:40 He got excited.

44:45 And then about a month before the baby was due,

44:47 Rhonda and the baby were killed in a car crash.

44:54 Louie never really came back from that.

45:00 May his memory be a blessing.

45:03 [Woman] His memory be a blessing.

45:07 It's so important to have those moments

45:08 to not lose humanity for, not just the patients, but also for the providers.

45:13 It's so easy to get cold to death.

45:16 Yes.

45:17 And destruction and mayhem-- Yes.

45:18 When you're seeing it all day long.

45:20 Yes.

45:21 But at the end of the day,

45:22 there's always reasons for why things happen and, sometimes

45:25 we're not aware of them and we're quick to judge.

45:27 So moments of reflection like that are so powerful.

45:28 Yeah, and it's almost like a ritual, right?

45:31 It's a practice that becomes part of the humanity in care.

45:36 Interesting that, again,

45:37 in an episode that highlights the humanity of patients and providers,

45:42 we're also on one hand talking about how important it is to talk about humans,

45:47 but also AIs in this episode.

45:49 Yes!

45:49 Yes.

45:50 There are so many topics covered in this one episode.

45:52 It's really impressive!

45:54 It's what's so compelling about the show,

45:56 because on the surface, it's about a hospital.

45:59 It's about these healthcare workers.

46:00 But it really, in essence, it's about everything and everyone,

46:04 all of these societal issues that walk through the door,

46:08 from immigration, we'll see, in later episodes with ICE.

46:12 Episode with ICE.

46:13 And last season, gun violence.

46:17 You know, sex trafficking.

46:20 Grief, poverty, houseless community.

46:22 I mean, there's so many different things explored, and to, for example,

46:28 with the mass shooting last season, we see, unfortunately, in this country,

46:33 too often, these cases, we'll read about it,

46:36 or it'll be in the news cycle for a day or even a week, but then it's gone.

46:42 And what "The Pitt" has done, I think for the first time in history,

46:46 beyond documentaries, really showed not just the cost on patients,

46:52 but also on the healthcare workers, and how Robby, last season,

46:56 was housing this PTSD and grief from his mentor's passing.

47:00 But now, this season, they all have a shared collective traumatic experience

47:05 that they're holding and, like I said before,

47:07 this scar tissue that forms that just gets, you know,

47:11 harder and harder to get rid of, and-- Yeah,

47:13 there's some kind of metaphor to be had where scar tissue in the human body,

47:17 whether it's on the skin or inside the body, it helps you stay functional.

47:23 Mm.

47:23 Because that's what its goal is.

47:24 Yes.

47:25 But at the same time, it doesn't replace the tissue that was there one to one.

47:29 Yes, yes.

47:30 And it does make you, from tensile skin strength, a little bit weaker.

47:34 Yes.

47:35 A little bit less effective.

47:36 So, it leaves its lasting mark on you.

47:39 Yes.

47:40 And unless you address it and know that it's there,

47:42 it's easy to think that, "Oh, you're fine." But in reality, it's not quite fine.

47:48 No, no.

47:49 You're functional, but that chronic stress can wear you down.

47:52 And, and the practice of post-surgery,

47:54 at least I know this from a dance injury that I had,

47:56 you know, you have to massage the point.

48:00 [Doctor Mike] Right.

48:00 You have to care for and take care of yourself.

48:03 [Doctor Mike] Right.

48:04 Consistently, or else that scar tissue forms, right?

48:08 And so I think all of these can be,

48:10 can be viewed as metaphors for, you know, our inner experience, too.

48:13 Our emotional lives.

48:15 And I can't let you go without pointing out that, speaking of societal issues,

48:20 you've been very vocal about what's going on in Iran.

48:23 First with protests, now with the war.

48:26 Any statement you wanna leave with the audience about what's important to you?

48:30 Correct me if I'm wrong, you were an Iranian refugee.

48:33 Yes.

48:34 Okay.

48:34 Yes.

48:35 So this must mean even more to you then.

48:36 It does, and I mean,

48:37 a big population of Iranians migrated before the revolution in '79,

48:44 and even more, I believe, if I'm not mistaken, after the revolution.

48:50 My family stayed and fought for democracy,

48:53 essentially, for as long as they could,

48:55 and were there during the Iran-Iraq war as well until they were forced to flee,

48:58 like most refugees, and lived in camps for a while.

49:03 I was born in a refugee camp, and so,

49:06 that experience and this medieval despotic regime has really

49:12 forged my worldview and my existence, like many Iranians.

49:18 And seeing this right now,

49:19 not only this uprising that's been repressed, brutally, as always,

49:25 we've seen this throughout the past 47 years,

49:27 where there's mass uprising met with violent repression.

49:31 [Doctor Mike] Yeah.

49:31 And so we saw, late December, early January,

49:34 there was a wave of protests that were

49:36 the biggest in Iran's modern history about,

49:39 you know, economic decline and inflation.

49:44 And so, bazaar owners, shop owners closed their shops and stormed the streets.

49:48 And then, as per usual, it's a similar pattern,

49:50 where the regime will cut out the internet.

49:55 So there's an internet blackout, still,

49:57 a few months in, and just, you know, ruthless execution.

50:04 There are over 7,500 confirmed dead from the regime, from those protests,

50:10 and another 15 or 17,000 bodies that haven't been

50:14 accounted for, but if history has told us anything,

50:16 it's, the number is often, it's so,

50:19 so much more, it's far higher than what we know.

50:22 They don't want reform.

50:23 They've tried reform.

50:25 They want a regime change.

50:27 And they want to have a voice in change.

50:29 There needs to be a regime that, that accounts

50:33 for the plurality that exists in Iran,

50:36 of ethnic backgrounds, political backgrounds, religious backgrounds.

50:41 And so, it's been a 47 year struggle.

50:44 It's been a century-long struggle in Iran.

50:46 It didn't start with this regime,

50:48 but it's certainly worse than anyone could have ever imagined,

50:52 and now with the war, obviously, things have intensified,

50:55 and I don't know of an example in modern history where,

51:00 where we've been able to bomb our way into democracy,

51:04 you know, from an airstrikes campaign.

51:06 [Doctor Mike] Yeah.

51:07 It's very complicated, but what's not complicated is the humanitarian cost,

51:11 and that people in Iran need our attention.

51:14 They need our voices to know that the world has not turned their back,

51:19 that they're not being killed and repressed in silence.

51:23 I think they arrested something like 50,000 protestors in a few days.

51:27 And all of these people, they don't get proper trials.

51:30 They're kangaroo trials, and they're given sentences like,

51:35 "you've created acts that disservice God",

51:38 or "an enemy of God" or some, bullshit, excuse me.

51:42 And then they're publicly hanged.

51:45 They're publicly executed, so.

51:47 Even some doctors are being held liable for giving care to the protesters.

51:50 That's right!

51:50 That's right.

51:51 That's right.

51:51 [Doctor Mike] I've heard stories about being pulled out

51:52 of their beds in the middle of the night.

51:53 It's just incredible.

51:55 That's right, and this new precedent of healthcare workers being targeted,

51:59 it's really horrific.

52:02 And so, you know, as best we can, we have to amplify and use our voices,

52:06 and there are international laws against this that are obviously ignored.

52:11 And you work with the IRC, right?

52:13 I do, yes.

52:14 The IRC.

52:14 International Rescue Committee, which is a refugee resettlement agency.

52:19 They provide services in 40 different countries

52:21 and all over the United States as well.

52:23 Do they accept donations?

52:25 Yes!

52:25 Yes!

52:26 Okay.

52:27 Yes, we'd love to-- Great opportunity.

52:28 Absolutely.

52:29 And, I'd love to donate $10,000 on your behalf.

52:32 Oh!

52:32 Doctor Mike!

52:33 For being such a great advocate.

52:34 Thank you so much.

52:35 For an important cause, so yeah.

52:36 That means so much, thank you.

52:37 Well, I think it's a small part where we can play a role.

52:40 There's people all around the world that are struggling in these terrible

52:44 circumstances where you wish you could be there to help everyone,

52:47 but perhaps a small token of just our attention.

52:50 [Sepideh] Yes.

52:51 [Doctor Mike] Can start...

52:52 And something, one last thing that I wanna layer in here that you'll see,

52:54 starting in the next episode with my character, it's not a spoiler.

52:58 [Doctor Mike] Okay.

52:59 But she worked with Médecins Sans Frontières, Doctors Without Borders,

53:02 as a humanitarian aid worker, as a doctor.

53:05 And right now, when we're living through, or we're witnessing,

53:10 unprecedented humanitarian crises, from global disasters,

53:14 I mean, climate disaster,

53:15 to war and displacement, to rising authoritarianism and, you know,

53:20 the shutting down of medical facilities, clinics around the world.

53:25 I think having a character like this adds

53:29 a certain gravity to the world of "The Pitt",

53:31 and an important representation or visibility that so many of, you know,

53:37 your brave colleagues go and fly across

53:39 the world to help in these war-devastated places,

53:44 and leave forever affected and forever scarred,

53:49 and forever indebted to be the voice of the people, their colleagues abroad.

53:54 Because medicine, as you know, it's a language,

53:56 and once you're a doctor in one place, you're needed everywhere.

53:59 And so, it's the same medicine, different dialects.

54:03 But I think that the practice, as we were talking earlier,

54:06 about the edge effect of, you know, diversity actually creates, is generative,

54:11 and can help us all improve and help our healthcare workers,

54:15 as we've heard from testimonies that people who are humanitarian

54:18 aid workers who serve as doctors in different crisis zones,

54:23 that it does only make us better to keep our eyes

54:26 open and use our platforms and our areas of expertise,

54:32 specialties, or anything we can do to help.

54:35 Yeah.

54:36 Yeah.

54:36 Well, I thank you for using your platform in that way, and-- Thank you!

54:39 We're gonna leave some sources in the description of this video-- Thank you.

54:42 To push people in that direction, so.

54:43 Thank you, Mike.

54:44 Thank you.

54:45 Thank you.

54:45 And if you'd like to see the interview with Dr.

54:48 Al-Hashimi's adversary, click here and check that out,

54:51 and as always, stay happy and healthy.

54:52 (chill beats music)