- We've only watched one
episode of "Chicago Med" in the past, but there's some extreme
episodes we're about to watch. Huge thanks to AirUp for
sponsoring this video. Let's get started. - You concur? - Atrial septal defect, but you feel it's an emergency? - Well, the patient's
already anesthetized. - Atrial septal defect is a defect within the upper two
chambers of the heart. Remember, the heart is
made up of four chambers - ventricles on the bottom,
atrium on the top. And if there's a defect in the wall that separates the two atria, that's called an ASD. Why am I looking at that camera? I'm looking at the wrong
camera the whole time. (high-pitched tone) If you have circulation returning a clot back into the right side of the heart, it can then, instead of shooting into the lungs - which obviously would be a problem, be a pulmonary embolism - it could go from the right
atria to the left atria and then from the left atria go into the left ventricle and get shot out into the systemic portion of the blood flow instead of the lungs. So it bypasses the lungs and ends up in the
brain, causing a stroke, a blockage. And that's obviously
incredibly detrimental. - This is Mr. Shay from
the Chinese Embassy. - Dr. Rhodes. - Mr. Woodfield, the
director of the Chicago Zoo. - Doctor. - And the chief veterinarian. - Why are there zoo animals? - Uh, zoo? - Your patient. - Is... A gorilla? - Meet Su Lin. - A panda! They literally are just making
(censored) up as they go now. - So this was your idea. - Dr. Choi volunteers at the zoo. - Okay. That's great. But you know what is
even more interesting? When a real patient... A real patient. When a human patient needs surgery and the doctor's busy with the panda, good luck explaining it
to the patient's family. "You see, we know your husband's
heart problem's complicated but panda." - He's a panda. You're a panda. (TV static) - 'You see, Ms. Cheney, your husband's heart
problem's complicating.' That's an Eminem lyric. (high-pitched tone) - Well, that's fine, but
I'm not a veterinarian. - She needs a cardiothoracic surgeon. - You've done this procedure many times. - No! He has not on a... It's a different species! They didn't even give him like something similar. Is a panda even remotely
similar to a human? (keyboard hitting desk) (high-pitched tone) - I guess I would have to take her up to the cath lab and close the defect with a balloon. - This is done in humans. A cath lab is a catheterization lab. It's where you go from
peripheral blood vessels, either in the arms or in the femoral area, and you gauge up a wire. You gauge a catheter, which is basically like a little mini hose, over a wire. And that catheter can
have some tools on it, like a balloon. You can open up blood vessels. You could put stents in, etc., etc. But to do this on a animal and a species that you've
never done it on before, I think that's just ridiculous. - Are we sure that we're all
comfortable spending our time and the hospital's resources to save an animal? - Dr. Rhodes, zoos rent pandas from
the Chinese government for $1-million a year. Why? Because people love pandas. (Mike laughs) - How is that an explanation? - If we save this one, it's a public relations
coup for this hospital, one which will lead to
much-needed donations to save human lives. - I had a struggle with my hospital getting behind the public relations of supporting a doctor who's doing well on social media. And this hospital's willing to support operating on a panda for a PR story. - I've learned that there
are less than 2,000 pandas left in the world. - So get a panda surgeon. Not even a vet. Don't go to the vet that
treats cats and dogs. Go to the vet that operates
on hearts of pandas. - I think you're a little posterior. How's it looking fluoro? - [Mike] The fluoro is basically a real-time radiologic device that allows you to see
certain blood vessels, especially if you're injecting dye. - Hold on.
(alarm beeping) Heart rate's spiking. - I can't continue if she's this tachycardic. - How do you know what is
tachycardic, even, for a panda? Like, if you ask me right now, "What is a fast heart rate for a panda?" I'm making it up if I tell you. - Give her six milligrams of adenosine. - On its way. - They're gonna stop the panda's heart? - No pulse. Heart's arrested. - Yeah, that's what it's supposed to do for humans. (flatline alarm) - She's gonna come back, right? - Humans do. But this is the first time that I've given adenosine to a panda. (Mike laughs) - Okay, I don't know why
I'm entertained by this. - Got a pulse. - See, this story would become cooler if they just started
having the panda go crazy and turn into a superhuman because they gave it like atropine and atropine side effect on pandas it makes them like really strong and resistant to sedating agents. That would be cool. - She has an effusion around the heart. - Yeah, low pressure bleed. Damn. I must have nicked
the right atrial appendage during the occlusion. - Basically what they're saying is the panda's bleeding into the... Why do I know about panda heart anatomy? (high-pitched tone) I'm assuming it's similar to the human heart. There's a pericardium
that covers the heart. It's the lining that covers the organ. And if you have a slow bleed, it can leak into that area, which actually becomes problematic 'cause if it leaks long enough, you can have cardiac tamponade, where the heart can't even expand fully, and just the pressure
essentially chokes the heart out. - We've gotta relieve the pressure. - And we shouldn't open her up? - No. Can't risk the blood loss. - They're gonna do a pericardiocentesis. - Okay. I'll needle her, put in a drain, and hopefully, the bleed
will stop on its own. Gimme the PERIVAC kit. - Yes, Doctor.
- PERIVAC. (Mike chuckles) See? I could be a panda doctor, too. - Blood has stopped draining. BP and heart rate have normalized. - We've dialed back on the sedation. We'll see how she responds. - How she responds? She's gonna wake up and kill all of you. Pandas are ruthless. (keyboard hitting desk) (high-pitched tone) (panda growls) - She's coming around. (Mike laughs) - Alright. - The writers have to to be on strike when this episode was written. (TV static) Back to the show in just a second, but first, I want to talk to you
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of staying hydrated throughout my entire flight, which helps keep my mucus membranes moist and my skin feeling soft. So visit the link in my description. Use code "Doctor Mike" - remember, Doctor is spelled
out and has a space - to get 15% off your order and smell the delicious water. Alright, let's get back to the video. - Good morning. I'm Dr. Choi. You must be Dennis. - The one and only. And this is my girlfriend
and partner Aviva. - Say hi to Dr. Choi, you guys. - We don't allow recording
in hospitals like this, mostly because it also records
other patients in the area and that's HIPAA. - You're live in front of 800,000 people. - What's UrTheJudge.com? - Mind taking a seat so I can examine you? - Well, I don't know. Can I take a seat? - I'm not following. - Not you, Dr. Choi. He's talking to our followers. They're voting. (phone notification sound) (Aviva mimics buzzer) Sorry, dude. - Okay, that's not good because, A, if you're trying
to do a proper abdominal exam, the abdominal muscles
are gonna be tightened up because the person's standing. Therefore you're not gonna be able to palpate the organs properly, so... - It's in the name - UrTheJudge.com. Our followers vote on all
of Dennis's decisions. - Look, if you won't let
me treat you properly, you should see another doctor. - Well, I don't mean any disrespect, Doc. Please don't send me
back to the waiting room. My stomach is killing me. - See? This is all illegal 'cause you're filming other patients. - Abdominal pain? - Yeah, it's definitely food poisoning. They made me eat a ton of
discount sushi last night. Ow! - You don't perform abdominal exam (Mike vocalizing) like you're giving a low five to someone behind your back. - You're warm and your
belly's obviously tender. I'd like to get a CT scan to rule out anything serious. I'll be back. - I will say that is really accurate. A lot of ER doctors are like, "Oh, you're warm and your belly's a little sore? Here's a CT scan." (Mike laughs) I'm like, "Can we investigate
a little bit more? Maybe do some special tests?" - Turns out you didn't
have food poisoning. You have appendicitis. - I told you guys this pain was real! Ah! - Luckily, we caught in the time. We can get you up to an
operating room to remove it before it bursts. - @MooButter's asking, "Is there
an alternative to surgery?" - Yeah, you can give IV antibiotics, but depending on how bad it is, waiting could be bad or it could be okay. - In some cases, it can be
managed with antibiotics. But surgery is the standard. - Surgery's a no-go. (Mike laughs) - It's a serious medical decision. - So they can they be
held liable for murder? - Make it for you. If your appendix ruptures, there's a good chance you'll die. - I'm sorry. The decision's made. - We're going with the antibiotics. - Doris, order one gram ceftriaxone and 500 milligrams flagyl for my patient in four. - For most intra-abdominal infections, we go cipro flagyl, not ceftriaxone flagyl. I wonder why he did ceftriaxone. - Dr. Choi showed me your website. It's pretty... pretty interesting stuff. - His name tag legit
says Chief of Psychiatry. I'm gonna get thrown in the loony bin if y'all keep punking me with these votes. - So Dr. Choi and I just
wanna make sure you understand that by opting out of the surgery that you are putting your life in danger. - This is the team trying to understand if he's capable of giving consent to see if he understands
consequences of actions, what he's saying no to, what he's saying yes to. And if someone cannot give consent because they're out of
their right state of mind, you can have someone
recommend treatments for them, either a family member
or the doctor in charge. - He clearly understands
the decision he's making. - Yeah, but he's not making the decision. - True. But he's willingly allowing other people to do that for him. - He's denying surgery to
boost his online following. How can we say he doesn't
pose a risk to himself? - Just 'cause he's reckless
doesn't mean he's suicidal. - It's an acceptable level of risk. Patient autonomy. - That's it? Hmm? If the antibiotics don't take, we just watch him die? - No. If he gets really sick, maybe he could change his mind and then go for surgery. It won't be a better surgery. In fact, surgery that is more emergent actually is much more dangerous, which is why, in some cases, if the appendicitis is quite mild, we treat with the IV antibiotics, let it calm down inflammation-wise and then do an elective appendectomy. - What's happening to him? - Ultrasound. - I'm gonna guess it perforated. - Alright, your appendix
is nearly perforated. We need to get you into surgery now. - Babe. - It won't take long until
your appendix bursts. When that happens, it may
be too late to save you. - Crew kept saying you
should put him on a medicine called Cialis. - Cialis is an erection medication. Actually, Cialis is also used for BPH - enlarged prostate. - What are we doing up here? - I figured out how we
can double your followers in an instant. - I don't think you get how this works. It took us over a year
to get to a million. - I think I know exactly how this works. - He's gonna say, "Should
we throw him off the ledge?" and they vote and they say yes and then he doesn't want to do it. And then they say, "Oh,
so you want the surgery." - Slow down, egghead. - I want you to ask your
followers a very simple question. Should you jump off this roof right now? - Oh, 'cause if he says
yes, then he's suicidal. Then they can Schedule 8 him or whatever it's called and keep him and do the medical treatment. - You said your followers love you, right? They don't wanna see anything
bad happen to Dennis. You got nothing to worry about. (dramatic music)
- Oh, man. (dramatic music) - Good strategy, psychiatrist. 'He's suicidal! We have to treat him.' - How's he doing? - The appendectomy went well. - Yay. - The surgeon expects him
to make a full recovery. - Most appendectomies are
done laparoscopically, which means they're minimally invasive. So they kind of put a few small holes inside your body in order to put the
tools in that they need, including a camera. And then they just either glue up or sew up the holes and you're good to go. We do have you sign a release, though, when you're going for surgery that it may become open depending on if there's a complication, at which point we do need to create the surgical opening. - Okay. Shep, I'm Dr. Choi. What brings you in today? - About six weeks ago, I was diagnosed with GBM. It's a terminal...
- Terminal brain cancer. - Glioblastoma Multiforme. GBM is a very fast-growing and it's one of the more
common brain cancers. And what's unfortunate about it is the prognosis is very poor. It actually stems from
these specific cells in your brain called astrocytes. These are nerve-supporting cells. It can cause problems, mostly due to mass effect because it starts putting on pressure on different areas of your brain, actually even pulling
away blood circulation and bringing circulation to itself. Surgery, radiation, chemo, all options, obviously, depending where it is in your brain. But even if you do treat it, the recurrence rate is quite high. - The phone call I just made was to a company called CCI. They're gonna preserve me until a cure can be
found for my condition. They're on their way here now. - To freeze you? - It's called vitrification, but, yeah. - You understand you have
to be declared dead first. - The cocktail I've been drinking contains amitriptyline, lorazepam, and 200 milligrams of amphetamines, which will put me to sleep
in a little over an hour and arrest my heart sufficiently for you to declare me dead in about five. - Why did he smell it as if any of those things
have a scent to them? - Doris! Come here. We gotta pump his stomach. - Stop! I refuse treatment! - Don't listen to him. - This doctor keeps touching me. - If you're suicidal, you cannot refuse. - Have you had a chance to review Mr. Shepard's
medical records, Sam? - Yeah. He's terminal. I mean, I could go in and do a resection and aggressively radiate, but it'd buy him 12 to 15 months tops. - So he should be on hospice. - Where are we with cryonics, Sam? I mean, is it possible to freeze the brain? - No. - Yeah, sort of. But that's the easy part. Hard part's thawing it out again and having it still work. - Exactly. What they are testing, actually, right now with NASA, right now, one of the biggest problems when you send astronauts to space is that they require room to move, extra nutrients 'cause they're awake and moving around. But if you can cause them
essentially to hibernate for like 14 days, that might make it easier on them, less expensive, less room on the space shuttle, and therefore make it more reasonable to send astronauts into space. The way they're doing this is by trying to create
a hibernation process by rapidly cooling people's bodies. We do something like this, actually, in the medical arena where someone has a cardiac arrest and their heart stops. We actually do therapeutic
cooling of a patient in order to decrease
that metabolic demand, therefore buying them time and potentially decreasing damage from their cardiac arrest or their heart failing and not being able to circulate blood. - If the hospital across
the street could cure me, wouldn't you feel ethically compelled to send me there for treatment? - I would. - Well, that's what I'm doing - sending myself to a better hospital. Only the hospital I'm
going to is in the future. - Finding somebody
doesn't have the capacity to make an informed decision, I mean, it's a high hurdle. - He's committing suicide. He's a danger to himself by definition. Just put him on a psych hold. - Yeah, but if you follow his logic, he's not committing suicide. - Why are you following a person who's trying to
commit suicide's logic? With the amount of medicines he took, there's no way he's sitting up and talking and being normal. Like, he's just taken way too many psychoactive substances to be calm and fine and normal and rational. Just not realistic. - They're withdrawing support. - My wife and I decided we're going to honor our son's wishes. - This way, maybe someday
we'll get our son back. (dramatic music) - What is that? Is that the thing that
does chest compressions? They probably just said,
"What device looks cool?" and they threw it on. That literally looks like that device that does chest compressions for you. I forgot what it's called. - Mr. Patrick, I assure you we did everything we could. - He couldn't breathe. Do you know what that's like? I want you to know how it feels. This is your... (both yelling) - There's a toxic spill. Evacuate the ED now! - Code Orange! Everyone out right now! - So in hospitals, we
have different color codes for different situations. For example, Code Blue means
someone's heart stopped. Code Red usually means fire. Code Black, a terrorist emergency. Each hospital kind of has their own. And on the back of our ID badges, we actually have all the codes written in case we forget so that they're always handy. - This is Maggie Lockwood. Toxic exposure to ED. I repeat, toxic exposure to ED. - I don't know why they don't
all put on N95 respirators 'cause we generally have those, and those don't allow particles in for most substances that could be harmful. - What are you doing? - This room has positive
pressure ventilation. - Oh.
- We're safe as long as we stay in here. - That's true. We actually use a lot of
those rooms with Covid. - His pressure's dropping. Derrick, are you feeling dizzy? - A little. What does that mean? - That means you're still bleeding. - Oh, no. - Tear in your spleen isn't
clotting like I'd hope. - A tear in the spleen
is really problematic 'cause it can cause a lot of bleeding. And if you lose your spleen, that puts you at a really high risk for certain infections. Specifically, bacterial infections with encapsulated bacteria. That's why when someone is
about to go for a splenectomy or a spleen removal, generally, before, we try
to get them vaccinated. If not, if it's an emergency, we do it after. We even have a strong protocol in place for individuals who are
considered high risk to take antibiotics daily as a preventive, or to make sure that everyone
who doesn't have a spleen has antibiotics at the ready so that if they show
signs of an infection, a fever, etc., they just take the first
dose of the antibiotic and then go right away to the ER. - We can remove his spleen. - We can't open him up. He'll lose too much blood and we don't have any to give him. - I'm a universal donor. - That's insane. The surgery will take too long. - Unless you have a better idea, I suggest you stop making excuses and get started. - Also, you want to test her and make sure she doesn't have
any communicable diseases. How does she know she doesn't? I mean, she might've
gotten tested a month ago, but maybe now she has something. So it's ridiculous. - Stay with me. And... Ava? Hey. Ava. - Oh, yeah. Take off the mask while he's still open and cough inside his wound now that he doesn't have a spleen. That's gonna go well, sir! - Did we do it? (Connor laughs)
- Yeah. - 'And now I'm getting
him even more sick.' (people cheering sound effect) The spleen might be some
people's favorite organ but check out my favorite organ as well as some of your
favorite social media docs. Click here to check that out. And again, huge thanks to AirUp
for sponsoring this video. As always, stay happy and healthy. (energetic music)
