Doctor Mike Reacts To The Good Doctor | Compilation

[Music] good hand washing technique could be a surgeon i don't know yet oh oh oh well calling for help is the right thing that's the first thing you want to do in these types of situations is juggling been cut does anyone have a clean cloth how does he know it's the jugular vein that's pretty impressive that's great putting pressure on a wound like this is the first thing you need to do outside of obviously calling for help anything you can do to stop the bleeding put pressure on the site is important in order to help that person survive you're killing him i'm saving his life he was bleeding out now you have it in the wrong place i think i remember enough of anatomy 101 to know where the jugular vein is you would be in the right place if you were an adult he's not an adult he is a boy which means you're also putting pressure on his trachea which means he's not currently breathing i can't really see where his hands are but it's good advice [Music] don't take it out some glass don't take it out you'll be fine yeah who are you hello i'm dr sean murphy i'm a surgical resident at san jose st bonaventure hospital well hello dr sean nice to meet you by the way just so you know if you have an object inserted into your object i know that sounds kind of weird if you get stabbed with a knife if some glass goes inside of you if a nail goes inside of you never pull it out make sure you call 9-1-1 let the paramedics decide what to do let them take you to the nearest hospital because a lot of times what that object is doing is preventing you from bleeding out because it's putting pressure on the spot where the artery or vein was cut a special meeting of the board of directors as much as i love you all questioning one of my hiring decisions did you bother to look up the definition of president while you were skimming the dictionary you're hiring him to be a surgical resident my department over my objection the bureaucracy that you're seeing here is real there are board members there's presidents there's employees there's uh trust funds so these things exist they put a lot of pressure on doctors and presidents to make certain decisions yes he has autism but he also has savant syndrome genius level skills in several areas he has almost perfect recall he has spatial intelligence and he sees things and analyzes things in ways that that are just remarkable in ways that we can't even begin to understand those are assets undeniable assets for any doctor particularly a surgeon i'm not gonna lie i agree with the president on that as a surgeon it's more important to have very good spatial ability to be able to have perfect recall to understand the anatomy perfectly than it probably is to explain the complexity of a specific case and be able to communicate well with people most of the time when you're a surgeon your patient is not awake that being said i think it is still important for surgeons to be able to improve their communication skills to be able to talk to patients help them understand the risks and benefits of operations and make sure that they don't force patients to go into the knife when they don't have to you seen her no now go away and turn off the light sure resident beef resin and beef oh i need you to um i heard it and here i thought this was gonna be an all medical show no grey's anatomy drama at least where i practice medicine there's different on-call rooms for males and females there are times where one of their call rooms may be unavailable and you do have to have a male and a female sleeping in a room together usually it's not a problem but this is unprofessional folks it's gonna lead to drama lots of drama we don't have a relationship we have sex but you have a sexual relationship [Music] i wish i had vision like that that's impressive venous distension is caused by increased intrathoracic pressure inside the chest cavity he's basically saying the veins in the arms are swollen so he thinks there's some extra pressure going on inside the the chest cavity can be because of uh cardiac tamponade which means that there's blood usually in a traumatic sense like this inside the pericardial tissue which is the lining of the heart and there could be blood in there and it makes the heart unable to beat properly the veins in the boy's left arm are popping is that bad i don't see intrathoracic oh his chest is rising he's breathing the the chest is moving paradoxically paradoxical chest movement is a consequence of something known as flail chest if you get a trauma where a section of your ribs break from the rest of the ribs that part of the rib cage doesn't move normally when you take a deep breath in and deep breath out so the the chest sort of moves paradoxically that's what he's talking about happens during a pneumothorax one of the lungs collapses or sometimes both of the lungs collapse and you can't oxygenate that area meaning that when you breathe no oxygen goes to that area it causes increased pressure the life-saving treatment for this is to literally insert a needle in order to release some of that pressure who here has a sharp knife oh played five inches or longer no body is he gonna go into the second or fourth intercostal can't be back here oh i need a knife he's going to tsa a knife sure anything else i do also need a narrow six foot tube and high proof alcohol and gloves and baggage handling tape but i'm going to get the alcohol from the duty-free store and the tube from the back of the soda machine he's going to put a chest tube for a traumatic pneumothorax [Music] looks like he's going to a party with all that jim bean he reminds me of zac efron a little bit i know it's a weird thought to have in the middle of this medical emergency but i don't know i always found that blowing to the glove thing really obnoxious how much bacteria do you have in your mouth probably even more than your fingers you're blowing it inside the glove but you're getting some of that bacteria on the outside of the glove that you want clean or relatively clean when you're gonna go insert a chest tube into a young boy he's gonna clean his hands with the jim bean but that's not perfect [Music] incision should take place two ribs down second intercostal space my man [Music] he's actually following proper technique because you want to stay in the mid axillary line meaning in the middle of your armpit that way you have a lower probability of hitting the heart when you go in with the scalpel or whatever you're going in with okay well why the bottom the air will continue to leak and accumulate until the damage can be properly repaired the tube allows the air to get out the water in the bottle stops the air from coming back in a homemade one-way valve he's breathing he saved his life he saved his life attention pneumothorax you can literally put a needle in that can release some air and that equilibrium does enough of a job you didn't need all of this fancy technology here i need to get to san jose st bonaventure hospital that's where we're going good one of the classic signs that someone has autism or may have autism is they don't make great eye contact they're not great at picking up social cues if you find out that your child has autism you can start them in these early intervention programs where they teach them how to mimic some of these social cues where they're not looking to make eye contact with you like we do normally because we have good uh physical recognition and body language recognition but they do so because they're trained to do so to make conversation seem more normal early intervention has shown some very promising results for those with autism we'll find another school no we won't because nothing's gonna change they can't handle them i don't blame them because obviously we can't handle them either what the hell happened this time what happened [Music] what did you do those who have autism and grow up with pets actually have better results moving forward in terms of communication in terms of interpersonability so if your child does have autism getting them a pet early on definitely serves a benefit [Music] it changed the boise cg changed it's the same 86 bpm no it used to be higher no usb 86 is still 86. it used to come up to here that's not the right way to do it you have to be seated you have to have calipers you have to be looking at the strip and comparing the little boxes on the screen maybe this guy he has superhuman powers it's possible but in reality you need to be a lot more careful because this isn't just a game it's people's lives at risk eight-year-old healthy voice status post encounter with a shadow glass sign numerous lacerations echo get them set up in trauma three with an ekg full blood work and a pan scan so far very accurate i'm very impressed the way that the paramedic told the history very very accurate adam needs an echocardiogram no behave yourself or you'll be removed from the building i don't know what to make of this guy i like him because he's super human and knows everything but it's just so unrealistic it's crazy [Music] is this the same security guard who knows everywhere he's going to go maybe this guy's a savant too do an echo sir the boys would open it's going to take a while good that'll give me time to figure out why the hell we're doing an echo dr brown you're with me we're gonna go find your weird guy keep him stable surgeons just don't go and look for another doctor or someone else on the street that wanted to give them a recommendation on how to treat this patient i noticed that there was a slight reduction in the intensity of the electrocardiogram the electrical flow i noticed that too the heart rate was the same but the amplitude dropped pericardial effusion reduced cardiac output would stress other organs causing them to shut down yes just to break that down pericardial effusion um peri means surrounding the heart the tissues surrounding the heart sometimes there's fluid there and when there's fluid there that makes it difficult for the heart to beat and you get cardiac tamponade that's what i was talking about earlier again again there looks normal to me it's not normal four doctors are looking at a scan they don't believe there to be an issue this guy comes in sees an issue with the skin that no one else sees and now all of a sudden they're starting to believe him that maybe it could be that if you're looking at the scan it either is or it isn't i don't know what they're debating about the concavity that's open to interpretation i've never seen a situation like this the youtube clip already has over 200 000 views it's pretty good 200 000 views the more i think about what he did there uh in the airport the more i think it's inappropriate there is a good samaritan law that's in place to help with basic emergencies pulling some out of someone out of a burning car and in the process you hurt their back but you were trying to save them but performing an advanced medical procedure like putting in a chest tube especially a makeshift chest tube like that man unless he saves the boy and it's a hundred percent safe there's gonna be malpractice and lawyers involved in that case so the good doctor strikes again you saved that boy's life oh good his name is adam traumatic pneumothorax i'm hungry sean dr melendez's team is going into surgery i mean if you're interested i mean how about getting him to sign all the paperwork and disclosures and hipaa forms and making sure he has identification put your mask on put your mask on sean i saw a lot of surgeons in medical school [Music] you're much better than them i have a lot to learn from you [Music] you're very arrogant matter of fact do you think that helps you be a good surgeon does it hurt you as a person is it worth it [Music] and there you have it first episode of the good doctor things i definitely enjoyed about the show number one it's fairly medically accurate the drama in the show is interesting it kept my attention and i wanted to see more what would happen i really dig the fact that it gave an inside look into how hard living with autism can be you know you can have abuse of family you you have bullying that's happening dealing with autism is a difficult situation and i appreciate that the show highlights that i will say however that they almost make him look super human and that's not realistic so that's definitely a con in my book but i understand that it needs to they need that factor to make the show work it does not look like a comfortable sleeping position i wish i was this happy when i woke up early in the morning what is he measuring where to san jose saint bonaventure hospital i'm a surgical resident today's my first full day on that floor i like the show i don't know it gets me happy it just puts me in a good mood this is mitchell brand i reviewed his chart he's 55 years old from chicago divorced with two children you did a radical prostatectomy on him yesterday this is actually very accurate uh in a post-op unit you will get visited by the attending physician the head physician who's usually the main surgeon and they will have their residents following them along here in this case the patient had a radical prostatectomy which is a removal of the entire prostate gland i have a whole video on the prostate and how things can go wrong with it so if you want to check that out on my channel the thing about the radical prostatectomy why it's a difficult surgery is because there's a lot of nerves in the region of the prostate amongst other structures that are very anatomically important including your urinary system your semen duct going in to perform that surgery you want to make sure that anatomically you're very careful not to damage its surrounding structures but as we know things can go wrong and things happen you're late five minutes we've all been on your first day no less it is your responsibility to be here if you are not you have failed in your responsibility which makes it your fault okay how can it be my fault i did nothing wrong the bus this is gonna work out great the board clearly made the right choice in hiring you thank you i think the attending is being mean but on the other hand i think he's right as a doctor it's very important to be on time there should be no excuses because ideally you should be there early being a good resident it's ideal to get places early so you can review the charts beforehand get all the information so that when you are rounding with your attending you know all the information it's definitely abutting the aorta in the left kidney renal angiomyelolipoma you see an extensive blood supply no god i wish i could do this she has a sarcoma a malignant tumor malignant that means it's killing me right yes i get that it may have features of a malignant sarcoma but to know instantly uh without a proper biopsy it it could be several things so that's it you just accept my answer at face value why you're very arrogant arrogant people don't think they need to lie how long will this be seven minutes without any complications it takes seven minutes to do a discharge examination properly dr dunsmeir has already cleared him to go and we need the bed okay protocol requires that the surgical department also clears him why is a patient that has an ear infection admitted into the hospital and question number two why is a patient that has an ear infection being treated by a member of the surgical team what are you doing down here i'm waiting for her to fart but i'm using the word fart in front of the patient to be more casual but you're the president of the hospital so i'll say flatulence to you well i appreciate that why are you doing that she had her deviated septum repaired before we can release her we have to be sure she isn't suffering from post-operative illness post-operative ilias is when the muscles of the intestines don't move correctly uh and basically it's like a frozen intestine meaning that the the gut is not moving the food and its remnants and the stool further down and allowing it to pass this can happen sometimes uh one of the first things you wait is for the patient to pass gas and then in some cases if you had something more complicated like a uh an abdominal surgery you wait for them to have a stool before sending them home i think that was it [Music] you don't have to smell it i don't think so i'll wait a little longer this is important no it's not the procedure is called a laparotomy um your heart sounds good i don't know what she was listening to her heart for that was definitely just an add-on for the show but when we listen to the heart uh we listen in multiple areas when you're listening to one area you're listening to one part of the heart then you move the stethoscope around and you're getting the other part of the heart which gives you more information and then you move it to the other side of the chest where you're listening to separate arteries so you can hear what the aorta is doing when you can hear what the pulmonary valve is doing my husband died in a car accident a couple of years ago mark is our only child i can't die right before sweating i can't you're not gonna die making promises like that i've said it before it's not wise we have only so much control over certain things especially they don't know the grade of this tumor they don't know the spread of the tumor a little girl has a tummy ache because mommy and daddy won't stop fighting this isn't a medical issue send them home could be intestinal male rotation which could quickly become fatal and every patient in this hospital could have malaria but it doesn't mean we're going to go around testing for every condition we think they could have ordering random tests just to make sure that a patient doesn't have that condition is certainly not smart and i agree with the senior attending here what you learn from experience is when you go on a hunt and you start ordering a bunch of tests certain tests will come up positive mostly because a lot of those tests have the high possibility of coming back as false positives which then encourages you to order more tests which has several effects the patient gets anxiety second some tests carry risks for example if you start ordering cat scans on every patient you're exposing the patient's unnecessary radiation on top of that you may find on a cat scan some kind of nodule some kind of node which will need further testing sometimes a biopsy biopsies carry risks you see where i'm going with this from now on you don't run any tests you don't have to run how do i know if a test is needed until after i run it tell you nurses actually have a lot of experience in knowing what tests to run which tests are excessive which tests are very important in fact when residents of my hospital ran uh rapid responses the nurses from the icu were so experienced they already knew what medications to pull up at what dosages even more so than some of the young residents i'm dr claire brown i'm first assist today and i'll be leaving the timeout patient's name stephanie willis scheduled surgery excision of an indeterminate retroperitoneal tooth oh now we don't anticipate any complications with the surgery thank you dr brum that timeout actually happens it's basically we confirm all of the information generally we do it while the patient's awake so they can confirm all this information and then we do it one more time before we start including this may surprise you discussing the site of the operation because it has happened unfortunately horribly that we've operated on the wrong side of a patient's body there's been a lot of things put in place procedures put in place that prevent us from making that horrible mistake with the timeout being one of the most important ones it might be infected it's not there is some discoloration he's 82 years old everything is discolored [Music] blood pressure 122 is 70. already 60. she's home steady i've opened the fascia you know what you guys should do you should screenshot this little scene where she says i open the fascia and send it to gabby hanna because she tweeted me not so long ago saying that she can't believe that after we operate on organs and we put them back are they just like floating around in our bodies and i told her that everything is interconnected with fascia and she had no idea what fascia looks like so send her this picture on her twitter she's gonna love it i thought you want to see it it looks like puke no no no it's not the regular color your peek is a regular color it has a bit of an unusual color we could order some i'm sending you and this is home good part of medicine and a big part of medicine and something that i learned and teach my students is that a big part of what we do is reassure because people worry and there's a lot of anxiety that comes with people's bodies uh fluids start coming out of random places uh fluids change color we bleed uh body aches our heads hurt our vision changes a cough occurs upset stomach as soon as you go on the internet and you look at any one of these websites you can fall down into a wormhole thinking that your headache is caused by a tumor like this claire tell me you got something i've got nothing this tumor is way bigger than i looked on the scans hence why we don't diagnose people just by looking at skin i can't even see her aorta that's a problem the tumor is encasing her aorta meaning it's fully surrounding it engulfing the aorta which serves to be the main blood supply to the bottom of the body dr melendez sent you a biopsy when will the results be ready when i get to it it's very important they're all very important let me see the other test orders i'll tell you which ones are most important and you can do them in that order i'll be honest and fair in complex surgeries like this we not only have the pathology lab on standby but you could also even have a pathologist in the room with a microscope ready to make the call immediately especially when a patient is under sedation you don't want to extend the patient's time under sedation just because the pathologist is busy with other cases there is one possibility if we remove the left kidney we might be able to get a good enough you to successfully move the mass until you have a healthy kidney to get a better view that's insane the tricky part with this is that if they're not successful she could die if they're somewhat successful she could be incredibly disabled and have horrible disability from the surgery and her last six weeks to live with this horrible tumor are going to be awful as opposed to if they just suture her up now and then she can enjoy her last few weeks of life even if the surgery is a major success does that mean that they were able to get the entire tumor out and now she's completely cured it could be spread all across the peritoneum which is the inside of the abdominal cavity to me this sounds too risky and too much of like a cowboy move but then again i'm not a surgeon nor surgical oncologist that's why i would ask someone who's more of a sub-specialist which i don't think any of these people are am i healthy probably you're a doctor you're you're supposed to know no we're not nobody knows anything for sure anybody could drop dead of a heart attack at any time who is this guy am i am i going to have a heart attack first of all don't do this in an open space like this because if he starts yelling it's not going to look good for anybody i have these conversations all the time patients come in and they man to know that they're healthy and there's nothing wrong with them you can't promise that what i can do is answer a specific question they have about their health doctor my ear hurts why do you think that is and i could say well i looked in your ear and i found that you have an ear infection let's treat it and see what the outcome is you give them reassurance that it's likely to pass but you tell them if the symptoms continue if the symptoms are to worsen if new symptoms appear please return so we can do a further evaluation that's it the small bowel is twisted around the superior mesenteric artery martine needs surgery immediately we need to confirm what dr melendez nope dr melendez is in surgery part of martinez bowel is dying and killing her with it no you cannot make these calls on your own dr melandez was very clear he was very clear it's past midnight which means it's tomorrow which means you're no longer my boss is this the or scheduler yes this is dr murphy prepare nowhere for surgery as feel good as this is an intern can not just book an or can't schedule their own surgery no one would ever allow this to happen actually this could be grounds for expulsion from a surgical program why do all surgeons look so frail in these shows him mcdreamy i mean i get you're operating all the time but come on a little deadlift and bench press never oh he got a mattress look at that upgrade i think you may need a new mentor i'm dying oh dad took a turn i know i only watched the first two episodes with you guys now i'm on the 18th and it feels like i'm skipping around like crazy but this was voted the number one episode by episode ninja so i feel like i had to check it out don't judge me i'm excited 12 to 18 months and i'd appreciate it if you didn't tell anyone i want to know the diagnosis i will in my own time okay have you had a full workup yes of course it could be a secondary tumor metastasized to your brain from somewhere else it could be a primary tumor which means that it originated in the brain or it could be a secondary tumor let's say a lung tumor that started in the lungs through the lymphatic system or the blood went into the brain and then created a secondary tumor you should get a second opinion sean i've been a neurosurgeon for 30 years i think that qualifies as a second opinion you know what's interesting about being a doctor who's practiced 30 something years as a neurosurgeon you actually make really bad decisions when it comes to your own health it's notorious that doctors are really bad patients and i totally agree with this i'm the worst and in fact if i have a patient that i'm treating i know is a doctor i know i'm gonna have to take extra time i know i'm gonna have to do a little arguing with them in order to get them to take care of themselves properly well given the degree of the rotation and the fact that the break is almost compound i say we're dealing with a by malleolar trimaleo fracture very good what else um color blood flow is restricted it's what's dying oh no so they're talking about this ankle fracture when there's lack of blood flow that means there's pressure being put on the arteries or veins in that area which is very dangerous because that's called a vascular compromise meaning not enough blood is going to that area and that area is necrosing or dying i'm gonna have to reset it now hold his leg when they say resetting it's exactly what you think it is just gonna take a second i need you to count to three one one two i think that was kind of accurate i don't know even my scream match thing shouldn't i be asleep for this well your blood alcohol level complicates anesthesia and we think you have a concussion so we want to keep you responsive we did give you a regional nerve block so you shouldn't feel anything this is actually similar to what we do when we do a c-section uh the mother is not asleep we do a regional block just like this we need the mother conscious in case we need to make decisions so that she can help facilitate the process if anything happens i had a friend a neurosurgeon at sf muni she looked at the scan she came to the same diagnosis sean i have an inoperable glioma glioma is a type of tumor when we say a tumor is inoperable usually that's because the area where it's found uh how encompassing is it you know if a tumor is spread throughout the entire brain how are you going to operate you can't take out the entire brain sometimes if we're very lucky and it's localized to a specific region we can just take that part out but even then we're at risk at harming the surrounding structures of the brain and leaving someone with neurological deficits you can imagine how awful that could be like yeah okay take out my tumor help me live but then i can no longer speak horrible horrible situations be reasonable piggy potter be reasonable i have no idea what you're talking about well it'll be clear what the hell happened to kid i don't know he twisted his ankle you lied to me before you're lying to me now you spoil your little coward hey hey be reasonable his friends hurt you scared and you're freaking him out good cop bad cop the reason good cop bad cop works so well is exactly uh based on the principle that i've told you before in some of my wednesday checkup videos so if you want someone to see your point of view you want to influence someone in a positive way it's not ideal to put a stone in between you it's not ideal to just stay your argument and be confrontational about it because that person won't want to change their beliefs but now on the other hand if you can get that person to see that you're on their side that you have the same intentions you're also a human and they can be see eye to eye with you you're more likely to convince them of something and good cop backup is a fast track to achieving that goal we were pledging and there's there's this wheel of torture thing you got to do for initiation but it's mo it's mostly stupid stuff dude it's like they drink a cup of olive oil or eat a tablespoon of sugar or jump off a room and water decay didn't land on laundry you had to do laundry no like like you had to uh eat those laundry things oh my god type as much as you could in 30 seconds detergent eat to touch it and how many did he have i don't know like six maybe seven i feel like i shouldn't be here even on a medical channel explaining to you why that's bad i mean it's like don't eat knives don't eat forks and don't eat tide pods the only time that i'll say that someone may accidentally ingest a tide pod is like if you have a child very young who's not aware and they see a colorful pod and they think it's candy and they swallow it but if you're an adult or an adolescent and you're eating tide pods come on you can do better i know you can that's my spiel the trauma sod is asking for you and or number two we got an emergency thoracotomy don't give me the remaining steps for closing cut anchoring sutures clear laps and reposition the valve remove clamps from the duodenal resection site keeping clear of the underlying aorta when he says clearing laps what he's talking about are those pads that we use to control the bleeding or to put pressure or to clean the site so that we can actually see what we're doing when a patient has some blood in place the nurses that are there with us the assistants that are there with us are counting each one of those laps because if we leave one of those in horrible situation ill fester bacterial infection all this stuff so yes we count every tool we make sure everything is in everything is out we even have like a little wall of pockets almost like a shoe organizer where we put each one of the things and then we count them out afterwards while you run the bell for me okay when we say run the bow what we're doing is we're looking for any injuries to the bowel most commonly this happens in a gunshot wound if it get if someone gets shot in the abdomen right away the first step in the trauma situation is to open the patient do an explorative laparotomy which means that you cut the stomach open you run the bowel you see if there's any injury anywhere because if there's a lot of blood pooling in the abdomen the patient could die very quickly and you have to run the bowel quickly but effectively to make sure that you find the area that's bleeding [Music] sean is everything all right what happened this time it's gonna bleed somewhere i want a capsule endoskeleton to check the entire length of the bowel for bleeding and leaks and give me a complete coagulation of metabolic profile a capsule noscope is when you take a pill that actually has a camera in it and it takes about 24 hours to go through the system and you get quality photos it consistently photos and video it records its way through the gi system which allows you to see if there's any bleeding anywhere in my past experience what i've seen is that if someone is bleeding and we suspect it's from an upper gi source meaning from the stomach uh the esophagus what we do is we do an endoscopy where you put the camera in the mouth and you try and find where that bleed is coming from and you can control that bleed in a number of ways if you think it's from a lower gi bleed you could do a colonoscopy which is just another form of endoscopy where you put a camera up the butt not sure if they're doing a capsule endoscopy here just to look cool for tv or because they don't feel comfortable taking him for an endoscopy because he's in a critical state now he's getting lab work that is legitimate because when you take detergent it can mess up the acid-base balance in your blood it can mess with the electrolytes of your blood and if it messes with them too much it can kill you our patient has disseminated intravascular coagulation can anyone tell me why that is very bad blood clots form throughout the blood vessels and rapidly deplete the body's clotting factors thereby causing a systematic bleed it's also a catch-22 if we treat the clotting he might end up with a terminal bleed so dic is actually a very rare condition it's life-threatening the last time i saw it was probably my residency when i was at the intensive care unit and it's a condition where you have excessive clotting going on within the blood vessels so it's intravascular and when that happens you can have organs die think stroke uh pulmonary embolism in the lungs just think of it simply put as a clotting condition where your body's clotting a lot and because it's clotting a lot it's using up all of its clotting factors and platelets which then makes you more susceptible to bleed you could have a cross injury from his ankle or a bacterial infection he picked up before during surgery it might have been set up by drug use or we did this to him and by we i mean sean he spaced out on the or when he was closing kind of like he is now i'm listening comforting he wasn't focused he got some bad news about what it's a personal matter sean was distracted by a personal issue what did leah come back she have a new boyfriend does cable get cut off i have an inoperable glioma 18 months there were some surprises on your images the previous diagnosis was incorrect you have a glioblastoma which is working in your ponds i'm sure i don't need to tell you this but it's the most aggressive form of brain cancer oh we estimate three maybe four months oh someone's in trouble do you need me to listen to you anymore no sean you should go hope is irrelevant for me hope is painful i don't want to spend what's left of my life chasing my tail around in a circle see i disagree with him a little bit on the hope aspect i understand what he's feeling and it's it's part of the process but hope is really important in the medical community hope is very important when you have a disease because when you have hope you can have a more positive mental state and a more positive mental state will give you the best chances irrespective of what illness you have if you have a cold you'll feel better sooner if your mental state is better if you have pain you'll feel less of it if your mental state is better so i think maintaining hope is one of those ways nature allows us to have a natural relief of whatever suffering we're going through so i like to hold out hope your tumor is located at the base of your skull and open cranial biopsy would tell us what's wrong but there are blood vessels in the way the biopsy would cause an aneurysm or a bleed but if we go through your nasal crib reform plate we can cross the tentorium on the contralateral side and avoid all those blood vessels we can do a biopsy through your nose caden is still alive and if we can keep it that way there won't be an m m review which means no one will be asking questions and no one will have to give answers eminem is a morbidity and mortality conference that happens if someone gets really sick or dies we take some of the most complex cases during these meetings and you have all the residents there all the doctors that participated in the case some specialists that are required to attend this and basically we dissect the case from the beginning to end trying to figure out what we can do better learn from our mistakes use it as a learning opportunity and i've seen these be incredibly educational but i've also seen them backfiring see doctors get into near fist fights is that from an iv you did the biopsy i did i have a low-grade glioma not a gbm i told you cancer sean it's still cancer i have to undergo brain surgery which is really scary because i'm not the one performing it five days a week for six weeks of radiation 10 more weeks of chemotherapy and then [Music] and then with a little luck you and i can go to the super bowl next season yay [Music] the patient is pulmonary hypertension the only treatment is medication which reduces the lung blood pressure but not enough her heart's failing due to the extra strain so pulmonary hypertension is exactly what it sounds like pulmonary meaning lungs hypertension meaning high blood pressure but it gets really tricky when you have high blood pressure within the lungs because then it puts a lot of strain on your heart to be able to beat against that pressure within the lungs oftentimes once medication fails the last approach becomes surgical intervention which is what i expect to happen here when i say surgical intervention it means a transplant what about a fix isn't it just a transplant nope there's nothing inherently wrong with melanie's heart it's healthy just needs a little bit of help so we're gonna leave her current heart inside and slot in another one to support it well it's still a transplant you tricked this man i obviously don't take surgical cases like this this is outside of my wheelhouse but it is interesting to hear that this is even a possibility you can have two hearts beating simultaneously to give it a little bit extra support you probably would have to be on blood thinning medication immunosuppressive medication because you have more turbulent blood flow you have an other organ inside of you that your body will probably react to unless you have immunosuppressant medication on board i can see a huge challenge coming up here do you live in a tent [Music] i lived in a tent too it wasn't very good so i moved to a bust you should move to a bus you will be much less likely to develop all sort of tinia pedes tineapedis or pettis as he says it is a fungal infection of the feet when it becomes very severe you can have ulcerative fungal infection where you actually have breakages in the skin and you can get infections on top of the fungal infection you already have present it's basically like the worst form of athlete's foot treatment for this usually requires oral anti-fungal medication because topical would not have the enough strength to cover it just keep it dry and clean and we'll give you some would you rather we continue to discuss this inside we are discussing things with the patient that are potentially sensitive we're done with the patient he's actually really right here even though the fact he's usually bad at picking up social cues you should not talk about sensitive issues in front of other people with a patient like this even if it's as simple as putting up too little curtains to give them some privacy or at least a sense of privacy will make the conversation go a lot smoother and allow the patient to take in the information without feeling like all eyes on them good job sean excuse me please oh excuse me please thank you for keeping me waiting we doctors are busy important people hold on a second is that dr cuddy from house is this like a crossover event that's happening right now look dr blair's i am like any other patient entitled to have say in my own treatment but unlike any other patient i have spent my entire adult life digging into people's brains so if you think i'm gonna sit around and watch you're mistaken well if you think you can operate on yourself i'd happily add you to the list of potential surgeons today you're gonna be waiting and waiting and waiting test test test you've had them all before i want them again my versions it's actually really important what she's doing here is that she's not letting herself be bullied into making medical decisions based on just what he wants she's letting her own clinical experience her knowledge guide her to make the best decisions for his health very often this happens when you have a powerful patient a vip patient someone very wealthy that they say oh i want the absolute best care i want all the tests when in reality that's not in their best interest and it takes someone with a lot of guts to stand up to that so i applaud dr blaze dr cuddy what's your name hi harry these are my meds those pills aren't for people with chlamydia harry oh you're all the same see i i know better that's why i had to hide on the streets i i had to move next door to mr googly eyes i i trust him he's my friend why are doctors involved in this and not security staff like if i'm going to any kind of event they usually bring security with us because there's a lot of medical equipment here there's medications why are the doctors getting involved come on show get some diesel security dudes and gals and up in there just i trust him okay okay disorganized thinking paranoia and delusions i think you have schizophrenia harry okay this is my first time i'm gonna call bs on dr shawn as a surgeon perhaps he can look at someone and figure out the problem right away because it's a problem of plumbing anatomy what have you he can look at a scan you can't treat humans with mental issues like that say this patient is just high on methamphetamine and he's having all of this disorganized psychotic thinking is it schizophrenia no it's not so dr sean pump those breaks and let a non-surgical doctor take over here that's an abscess that smells very bad so the reason why abscesses smell bad is because you have an infection that already smells bad but then you have all these inflammatory cells that go in to fight off the infection and what your body does is it walls off that infection and essentially creates a bubble of pus and pus never smells good because of the dead bacteria the only treatment ind incision and drainage cut that bad boy open let it drain out get the infection out and then you could start thinking about antibiotics and all that but you have to drain it this will give me at least 10 more years should give you 10 more years yes elliot i understand your concerns and dr melendez is one of the best cardiac surgeons around dr andrews told us all about you when he convinced me to come here for surgery instead you spoke to dr anders and they've both already spent half the morning raving to the press ooh well that's that's very kind you spoke to the press he spoke to the patient my patient as i explained elliot and melanie the press attention is a necessary element for funding this surgery there's a fine line with doing this type of press and exposure and i understand that line very well because i try and balance my professional life as well as my life as a social media person very diligently to put it nicely sometimes medical systems forget about that line they forget about that the major mission that we're involved in is helping humans and while yes we want to get a better surgical center so we can help more people we want to create funding for a hospital notoriety for a hospital the question needs to be asked is at what cost do we discuss this with our patient are they on board with having this type of press happening is this fair to them are we taking advantage of them and only until you answer those questions only then you can go ahead and do all this press and notoriety for your hospital oh my god is he having meningitis it's stiff a stiff neck could be an early indicator of bacterial meningitis there are many possible explanations for a stiff neck most of which are much more likely than bacterial meningitis abscesses invaded the meninges of his brain it could be exacerbating his paranoia so bacterial meningitis is inflammation of the meninges the soft flow of padding that's found between your brain and the skull this is quite dangerous because the area inside your skull is very limited so that if you increase pressure you could actually harm the brain and do damage to the brain on top of that that infection can spread from the meninges to the actual brain to your blood and cause you to become septic it's a very dangerous condition that needs to be treated urgently the way you diagnose it is you go into the spinal cord through a lumbar puncture and you see and you study the the spinal tap so you see if there's white blood cells there if there's bacteria in there you do a culture if there's blood and it basically points you to if there is a meningitis what could be the possible cause of it and then right away you got to start being as proactive as possible starting all the treatments and backing down once you have the guidance as to what the likely cause of the meningitis is hey melanie has majority aneurysm two hours beating into that yeah not so good so i've talked about aortic aneurysms on this channel in the past but basically what happens is the aorta is the major blood vessels that comes out from the heart that allows it to bring blood to the rest of the body if you have an aneurysm you basically have a weakness within the wall that allows ballooning of the last layer of the artery which means what if you have more pressure meaning two hearts beating at the same time you could actually rupture the aorta and what happens you bleed out internally and you die perhaps they can fix the aortic aneurysm first and then do the procedure i don't know how critical this patient is right now it was my medical opinion that he could have bacterial meningitis and if you're right then i owe you an apology but if you're wrong then i will be on the phone to denver and i will make your life infinitely more complicated than you think you're making mine why is this such a manipulative situation for god's sakes there's a patient's life at stake who could have bacterial meningitis you're saying if the doctor is wrong by playing it safe you're gonna give them a bad review i feel that one of two things is gonna occur one it's gonna be viral or aseptic meningitis which can happen or two by bringing him in and doing all of these things they're gonna find out that he has another issue that had they not brought him in he would have passed let's see if my prediction is right mary has kaleidoscopic disintegration schizophrenia but he does not he has a brain tumor this is why you send patients to the er because in the er with all those symptoms in addition to getting a spinal tap they would have done a head ct and likely done it with contrast to see what's going on inside the brain and would have seen something like a brain tumor but i don't know what kaleidoscopic disintegration means even if he's right with the brain tumor this is a guessing game this is not how medicine is practiced kind of a shame to see this because in season one they were so medically accurate in making these diagnoses and how it happens but here just because he's finding some symptoms and he's getting these wild theories did you do a drug screen did you see if he's anemic did you see if he has a major thyroid tumor causing excess thyroid hormone and that's why he's bouncing around all over the place there's a lot of things that need to be ruled out sean have you seen harry he lives in we need to find here you don't so those who are diagnosed with autism uh sometimes have a condition where if there's over stimulation whether it's lights sounds even stress they can sometimes be overwhelmed like this i totally sympathize with sean what's happening here because he's trying to do the best for his patient but clearly it's a struggle you have a neurological condition too but yours can be cured i appreciate the sentimental value here but he doesn't know that what if it's a malignant tumor you just need some surgery then you can be edward austin thomas again you just need some surgery just some some surgery nice someone pay attention to the monitors on the show she's flatlining there they haven't even made the incision yet and she's already flatlining edward has a right parietal brain tumor [Music] find dr lim you can have or number two that's not an emergency operation when you need surgery you can go one of two routes you can go planned or you can go emergent surgery for example if you come in uh with a level one trauma where you got shot or cut inside your abdomen and you need to find the source to bleed and shut that off that's emergent surgery you're not going to get a lot of pre-testing done to make sure the patient's capable to get through that surgery because they'll die otherwise so you want to just do as best as you can in a given moment but in this scenario this is not urgent this patient has lived for a while with this tumor and have been fine perhaps it's best to do some pre-surgical testing figure out if we can optimize them medically meaning get them on some medications lower their blood sugar control their blood pressure clean them up now we just have to wait to see who wakes up edward or harry see that is realistic there are certain tumors depending on where they're found inside your brain that can totally change certain aspects of the way you behave for example the frontal lobe is what's most important for decision making and control over your urges so it's not uncommon for a patient who has a frontal lobe tumor to start acting differently becoming more risk tolerant meaning that they're gambling more they're having more sexual relations unprotected cheating on their spouses and then no one knows what's going on only until they get properly examined so they find out they had this tumor the whole time it's just like playing surgeon simulator just drop it it's all good heart this episode of the good doctor is a made-up story about a real battle still being fought honor the heroes doctors nurses and other frontline workers many of whom who have given their lives do your part wear a mask great message i love the way they're showing the viral particles they're just spreading out everywhere that absolutely does happen that's why it's really important to dab when you cough to try and limit that spread we've seen it actually spray six feet away from you when you cough or sneeze and germs have hang time so you can walk into an empty room that someone just sneezed in and be exposed to those germs i don't know why i did that and there you go this is such a good example of how germs spread droplets meaning someone coughs or sneezes or speaks contact meaning they cough on their hands and they touch something they give it to somebody else when we talk about disinfecting your hands wearing a mask we're talking about decreasing droplet spread and contact spread have you seen my id badge no i had it last night but maybe it fell out of my back i lose my id badge all the time like not permanently lose it but have it in my car in my trunk in my suitcase in my home sometimes bear steals it sorry bear your temperature's almost 101. your other symptoms first it was a sore throat then my body started aching and then there's this cough i even had my flu shot unfortunately influenza is constantly mutating the shot always lags behind both very accurate statements in fact during this time frame in february i was working in my primary care office we knew covid was around but we didn't think it it was everywhere yet so a lot of patients were coming to my practice with upper respiratory viral symptoms just like this fever cough muscle aches and we thought they potentially had influenza we gave them antivirals for influenza the reality is even if you had your flu shot you can still get the flu but your case should be milder my daughter is very worried that i might have this virus from china what's it called have you been to china or been around anyone who's been to china recently those are the questions we were asking at that time i think we were referring it to ncov 19 right was it nco of 19. the virus has damaged your mother's lungs her body is working harder and harder to breathe but her blood oxygen levels continue to drop she definitely has corona we're doing everything we can to help her see that patient was actually in a negative pressure air room they were isolated from other people because at that point we were deciding whether covet 19 was only needed to maintain a droplet precaution where you just cover your face in the patient's face with a mask or do we need negative pressure room because covid was spread through airborne transmission where the virus just lived in aerosolized particles in the air all the time and what we came to realize is it's more of a droplet spread but there are some instances where it can be spread through air sliced particles especially during medical procedures like intubations you have covered okay now what now you go home that's it that's it there's no treatment stay away from people come back if you have trouble breathing goodbye i forget because i don't watch the show regularly how funny shawn is covet 19 is a viral illness so if your oxygen levels are not dropping drastically and you just kind of feel lousy and you have a mild fever your body is the one that has to fight this off like there's very little that we can actually do in the hospital systems and by keeping you in the hospital we're actually increasing the risk to healthcare providers and other patients 25 tests per day no just give me one of tomorrow's hello county health department i don't have time for them and apparently they don't have time for me i remember in march i had a patient who i suspected to have covid19 but i didn't have a test available so i was calling the department of health trying to secure a test for them eventually getting them a test finding out that they were in fact positive luckily everyone was wearing a mask at that point so we decreased the spread we cleaned the room sent them out the back door tried to do our best to limit the spread of this virus there's just a lot of things we didn't know in the beginning that we know now if i'm sick is my baby sick this disease doesn't really seem to affect children or babies like it does adults should we admit her she's probably safer at home once at home do you have a support system can anyone come help you should get worse it's just me and the little one good doctors always ask questions like this if i'm sending a patient home that i'm sort of questionable on and let's say they had a concussion i always want to make sure there's someone to keep an eye on them that if they become unconscious they have someone to call for help and to check on them if i come home do you want me living with you of course that's the point every night after 12 hours of covet patience to hang out with you and kellen and his asthma interestingly enough we've seen conflicting reports on how covid19 affects those with asthma now if it's just asthma alone it doesn't seem to be as bad as we expected it to be but those who are asthmatic and have other comorbidities like heart disease obesity those are the patients that seem to be experiencing worse symptoms and worse outcomes we do everything we can we hammer at official channels in every manufacturer's rep that we deal with and see what companies if any have unknown nuts or no nuts uh oh i'm sorry i'm i'm in the middle of a of a meeting with the board hey everyone i'm just making banana bread one of the most searched terms in the height of this pandemic was how to make sourdough bread go figure i've never made sourdough bread i've never googled it i don't know who's sitting at home googling it but apparently sourdough bread was the thing everyone was making not banana bread your husband's blood oxygen level is dangerously low that can't there can't be so one of the hallmark symptoms of cova 19 is decrease oxygen saturation in your blood where you're actually not getting enough oxygen from usually the edema or the scarring that's happening in your lungs as a result of the inflammation that occurs with this virus one of the dangerous parts of covid19 is not only are you infected with this virus that you're fighting off but some people have an overreaction or a cytokine storm where all these inflammatory cells come to the lungs and actually cause a bigger problem where you can't get enough oxygen going and being delivered to the rest of your body your vital organs your liver your kidneys your brain and so forth our solutions that was to ventilate meaning intubate all these patients and as we did that more and more often without treating them with proper medications like we have now and we know which ones work patients actually got worse on ventilators because we were over ventilating people and it's not because we're stupid or we were intentionally harming people but it was simply because it's a novel virus and we did not have guidelines on how to best treat patients with it we were learning about it on the go we have a surplus of ekg leads no we've got a shortage but that's a problem that can wait the ppe situation was really dire in the beginning of this pandemic because china was hit first and a lot of our manufacturing facilities are in china and because of that they actually redirected all of their shipments to their country because they needed them and as a result we were facing a lot of shortages for gloves for ekg leads for swabs for test kits antibacterial wipes the vials for injections the wiring and the tubing for ventilators there were so many shortages that were happening simultaneously it was a truly dire situation especially here in the new york city area him rubbing his ears like that is from the mask oh my god in the beginning just wearing the mask for countless hours my ears hurt so much i just remember being so sore but as we learned to use those little head pieces in the back where you could actually have the mask stay on there as opposed to on your ears it made the world of a difference and for those of you who haven't ever worn an n95 mask they're uncomfortable because they offer more protection they're more form-fitting you have to get them fit tested but they also put a lot of pressure on your face they leave marks that's why all those pictures were making the rounds of nurses doctors who were having bruising in that area from just wearing them day in and day out and a lot of times they were reusing equipment that was meant to be disposable you work in a hospital yes could you wait for the next elevator i appreciate you you know it's funny um in new york if you ever wore your scrubs out during that period everyone wanted to say thank you and was quite grateful and that's amazing but at the same time everyone wanted to keep their distance rightfully so i understand you don't want to put yourself or your family members at risk but it didn't feel good that you were being alienated like that so it's part of the process my mother is in there all alone hooked up to a machine i just need to see her and tell her that i love her there's a human toll that it takes on family members not being able to see your family member and if you're the one ill not seeing your family members i will also venture to say and i don't have evidence for this but i will say that hospital errors do go up if you do not have family members present in advocating on your behalf especially if you're unconscious now what we've learned from that is we're trying to keep families more updated trying to keep them involved if they're not there at the bedside through virtual care giving them scheduled regular phone calls because we realize that when we're in better communication with the family we actually get better outcomes for our patients pushing effie why is no one doing chest compressions i don't understand do some tricks clear do some chest compressions lose it now [Music] did you see those horrible chess comments she just put her hands on the chest didn't even compress 200 clear okay i don't know what these people have high-end experts on set you start chest compressions and then you use a defibrillation you know i have heard in the beginning of the pandemic because i wasn't in the hospitals uh i was seeing patients outpatient that they were decreasing the amount of chest compressions being done because they were worried about aerosolizing the virus i actually just looked this up from the red cross performing chest compressions while wearing proper medical protective equipment and 95 respirators or like how they have the whole body suit on still means you should do chest compressions like do them do them do them i don't know why they weren't doing them i was trying to make excuses for them they should have been doing chest compressions from the start any cough any fever no any shortness of breath sore throat loss of smell no no none of that just searing abdominal pain and runs i'm pretty sure it's my diverticulitis acting up my roommate is deeply into pandemic baking i've avoided coming in i don't want to catch covet so one of the biggest problems we faced during this pandemic was patients not coming into the hospitals and in the beginning when we were really overwhelmed that made a lot of sense but as we became safer for patients to come in we had different policies in place in order to decrease spread our testing improved our capacity improved our ppe improved we wanted patients to come back because a lot of times when patients delay care their diseases and conditions get more advanced and as a result become more difficult to treat patients who were having some signs of heart attacks were coming in much later and as a result some of our mainstays treatments weren't working as well and the recoveries took longer one of my main messages over the last two three months has been to encourage patients to call their primary care offices to call hospitals to come in for the symptoms that are bothering them and not wait it's pink active i'm breathing great [Music] in the midst of our research with covet 19 we actually found that there was limited spread from mother to fetus of covet 19 meaning that the mother could be testing positive cover 19 the baby was usually safe now it doesn't mean there was no spread there were some case reports of it happening but for the large majority we did not want mothers to panic because it wasn't happening and children in general seemed to fare better with this virus anyway the numbers of children below the age of 10 dying with cover 19 were spectacularly low that doesn't mean it's completely benign for them because they could also spread this virus and be vectors but it is reassuring for mothers especially with the levels of anxiety that they are facing for themselves please don't put your masks on the floor and then put them back on your face shawn you're a doctor buddy don't put it on the floor i talked about germs having hang time about the uh hanging out in the air but folks after they hang out in the air for those minutes or hours where they go right on the floor especially if you're walking around a hospital setting and then you come home with your shoes on guess what's on that mask man couldn't they just have me on set for one of these things could have helped make it so much more accurate

Channel: Doctor Mike

Views: 1,806,377

Keywords: doctor mike, dr mike, drmike, dr. mike, mikhail varshavski, doctor mikhail varshavski, mike varshavski, the good doctor, good doctor, shaun murphy, freddie highmore, doctor reacts, real doctor, real doctor reacts, doctor reacts to the good doctor, doctor mike reacts, dr mike reacts, drmike reacts, compilation, abc, greys anatomy, grays anatomy, gray's anatomy, grey's anatomy, medical shows, medical shoe, medical show, med drama, medical drama

Id: 67s0Wg9ZTI4

Length: 66min 52sec (4012 seconds)

Published: Mon Apr 10 2023