- It's time for my third
Grey's Anatomy review, but for this one, I brought a friend. (Soul music) Please welcome my
colleague Dr. Luis Espina, who I actually did residency with and he was my senior resident, so he taught me everything I knew. - Not everything, but yeah. - You ready? (squealing) We have to do that, by the way. - No.
- No, no, no, come on. - I'm not doin' it.
- No, you have to do it. - Bee whoop, bee whoop.
- Yeah. - [Meredith] You didn't
sign the divorce papers. Fine, I get it, end of discussion. - [Derrek] Meredith. - What! - I actually don't know anything about their romance and I know people in the comments are already getting
their bows and arrows out to hunt me down.
- It's okay, it's okay. - I don't think they're married, I think he's about to divorce wifey. - Ooh. - And she's trying to get him to do that. - Dr. Bailey, Henry Lamott, age 42, is scheduled with Dr. Shepherd for a spinal implant to control the pain of his herniated disc, is allergic to all pain medication. Is that?
- Porn. - Porn? As in porn? - All right, what are we watching. - Karev, go stand in the hall. - You have to be sensitive to the needs of the patient. - Yeah, but that's overstating it. Have you had a patient do that? - No, I don't think, I don't think the television can get CNN much less pornography.
(laughing) - Look, we can't have porn in here, this is a hospital. - It's for my pain. My doc says it releases
endorphins in the brain, it helps keep my pain
at a manageable level. - Not gonna lie, if that helps him over an opioid addiction, I'm with getting him a private room. - I am a firm believer in the what it takes school of medicine so whatever it takes to make the patient comfortable. - Okay, Pete Willoughby, 25 year old, GSW to the chest, immediate return of 860 cc's of blood from this-- - I can't handle it, this hurts! - He's put out more than
200 cc's over the past hour. - They never tell you in movies how much it hurts to get shot. - Push morphine, two milligrams. Alex, this is my case. - I don't understand in this show, when they say a person's
lost a liter of blood that they're hanging out, talking, casually just chilling.
- His hair looked good. His hair looked good.
- His hair looked good. - Looks like you'll be able to go home today, Ellis. - But I still have patients to see. - No, no more patients. I'll be back to check on you later. - You should know, I'm thinking of leaving Thatcher. I should never have married him. I leave him, you leave Adele. Then when residency's over we can both get jobs at the same hospital. - Why don't you get her meds ready for discharge nurse, thank you. - I mean, I was an old resident, but that's an old resident, if that guy's a resident. - I don't know if he's a resident. I don't understand the storyline. She may be suffering from dementia. - She may be, yeah. I mean, I was old but that guy makes me look like you.
- Yeah. - Well, maybe not quite, but. - That was a long time ago, remember? We had this discussion 21 years ago. - Oh Lou, it wasn't the rain. I just passed out. - Actually Mrs. Bradley.
- Verna. - Verna, you presented with lateral ST elevations and
recipricon failure changes is consistent with an MI. A heart attack. So, when a patient has a heart attack, as they described at a ST elevation MI, it's called a STEMI, you got to get a patient right away into the cath lab, which is where they put a catheter from your artery, either from down below or from your arm, into your heart and either open it up with a stent or just evaluate and see if you even need
a stent to begin with. - And there's a very strict protocol as to how much time it is from the door to the balloon. - 90 minutes!
- Yeah. So, you have to be there. - Door to balloon tops. - You have to be on the table and have a cath started. - I've had a twinge in
my back for a while, I thought it would go
away but then last night, my legs went numb and
this morning my back, the pain is just too much. - Miss Chue, we're gonna
push in a PCA pump. We'll give you some morphine which should help control the pain. - Thank you.
- But there's a greater. - That was quick, huh? - It's an awfully comfortable PCA pump. - That's a quick PCA pump. A PCA pump is a pump that's controlled by the patient in order
to give them anesthesia, usually there's an opioid in there. It's programmed so that they can give themself dosages,
but if they're using it too frequently it times out and doesn't allow them to do it. Now, this is good because when patients have that ability to
control their pain relief, they generally use less of it and are more aware of
how much they're using, as opposed to when a nurse comes in and doses it, they may overuse. - And, in and of itself,
being in that much pain can be just a humbling
situation so it returns some measure of control to the patient. - What's going on? - I was just about to explain that Anna's MRI has shown that that she has a paplar ependymoma. It's a tumor in her spinal canal, but the good news is that we can operate. You have a 95% chance of fully recovering if we get you into surgery
as soon as possible. - Do you know about that?
- No. - I don't know about that. And I don't know how he gets those stats right off the top of the dome. - Even waiting another day puts you at risk for permanent paralysis. - Father? - No. No surgery. - Mr. Chue, without surgery Anna will be paralyzed, probably within the next 24 hours. - I hate how they talk about medicine with such certainty, 'cause then it tricks our viewers here, from going into the hospital, where don't give them direct answers, they're gonna be like,
"But Derek Shepherd, "McDreamy, told me that my tumor, "if I don't operate, a 95." - I thought you were McDreamy. No, sorry.
- I know, but this guy. - Mr. Chue-- - We are taking our daughter home. - Anna, you're over 18. You don't need your father's consent. - This is true. - I'm Hmong and my father's the elder. If he says I go home, I go home. - Do I continue to process her discharge? - [Derek] Yeah, we have to. It's insane, but we have to. - Well actually, we wouldn't process this as a discharge, we would process this as an AMA, which is leaving against medical advice. 'Cause if we're telling a patient, "Hey, you may have a disability "if you don't get this
surgery immediately," and they choose to leave, we have to say that they left against medical advice,
otherwise they can say we told them to leave and then something tragic happens, right? - Right.
- It's illegal. - You'd be responsible. The problem that you have there is that you want to try to convince the patient and the family with logic and reason,
but also some empathy. Because if you just throw the AMA papers in their face and walk out the door, they're definitely gonna leave. So, sometimes it takes
a little bit of honey to catch the bees. - I was married for 11 years, Addison is my family. That is 11 Thanksgivings, 11 birthdays, and 11 Christmases and in one day I'm supposed to sign a piece of paper and end my family? A person doesn't do that, not without a little hesitation.. I'm entitled to a little uncertainty here, just a moment to understand the magnitude of what it means to cut
somebody out of my life. I'm entitled to at least one moment (door opening)
of painful doubt. - I know nothing about their relationship but that sounded very logical to me. Y tu? - You might want to
have thought about that before you jumped in bed with the intern. - Scratch my previous piece of advice, I'm going with Dr. Espina, my elder. - You might want to have a little doubt before you run off with
the attractive colleague. - Dr. Shepherd, still here I see. - I couldn't leave you. Have you seen the other Dr. Shepherd? - I'll tell him you're looking for him. - Ooh, that's his wife?
- I guess. - Oh. - Hey, I got Verna Bradley's test back, I don't think she had a heart attack. - Yeah, but look at
the changes in her EKG, she had something. - Yeah, but her serial enzymes and dobutamine stress
echo came back negative. I actually think she's. (laughing) - Her dobutamine stress
echo came back negative while she's having a STEMI. Let's explain what a
dobutamine stress echo is. So, an echocardiogram is an ultrasound of the heart. You can give a chemical which actually stresses the heart, makes
it beat more rapidly, which, therefore makes
more blood flow occur. Now, you can look at the echo and see how the heart responds, to see if the walls of the heart are moving appropriately, if blood flow is circulating appropriately within the heart. But now, why are they
doing a test like that on someone who's actively
having a heart attack based on the EKG, let's do this as a patient simulation. We have a late 40's female, syncopy, chest pain, negative cardiac enzyme
with ST elevations, with a negative stress echo. What's you're diagnosis of this lady? - She's having a MI, so that's my. - You would say she's having an MI? - Heck yeah. - You're gonna say she has a left anterior descending lesion. - I'm saying, until proven otherwise, there's something in the
left anterior descending, however, there's gonna be more drama and I'm gonna be wrong. - I have an idea.
- What's that? - She did something bad and she has takotsubo carditis. - No, she didn't do something bad, her husband did and he's stressing her out and she has takotsubo or
broken heart syndrome. - Well, that's not a
bad guess, though right? - You're really, no,
you'd see it on the echo. - No, if it's resolved,
it's a stress response. - It doesn't resolve that fast. (elevator squealing) - Ooh, you in trouble now. They're gonna crack his
chest in the elevator. - No they're not, no they're not. - They're gonna crack his
chest in the elevator. - No they're not, no they're not, no. - [Alex] Dude, we're not moving. - Really, you think? - You need a strong hand and a pair of sharp
trauma shears right now. - Oh. - That doesn't really happen. - We have generators. - [Preston] How's the patient? - He's not looking so good. - You're a doctor and
that's your explanation of what's happening? Give the rhythm, give the pulse. - Have you even even
heard of the Hmong people? Our religion has got
rules that are way old and way set in stone, and way spiritual and you don't mess with them. And you don't anger the ancestors. Even if you pierce your
tongue and play in a band. - What are the rules, exactly? - Good, when encountering a situation with a patient that culturally, it's something that you
are not familiar with, smartest question thus far in the show, what are the rules? By knowing that, you might be able to find a point of compromise to fix the situation. - Apparently Anna's father believes she's missing something that she needs for surgery. - Missing something? Missing what?
- One of her souls. We don't need a social worker, we need a shaman. - Get a shaman. - You definitely did
not have a heart attack. - So I can go home? - Not yet, your EKG
shows significant changes and I'm gonna find out why before you leave the hospital. - Got to get home. - Pete, you're in a hospital. - [Pete] Need to get home. - So when you lose a lot of blood you become hypoxic. You're brain's not
getting enough blood flow. When your brain doesn't
get enough blood flow it doesn't get enough oxygen. When your brain doesn't get enough oxygen, it starts saying crazy things like, you're in the middle of
an elevator that's stuck, bleeding out from your chest from a gun shot wound and you say you want to go home. - O'Malley, blood pressure. - I've taken it three times.
- And? - I can't hear a systolic over 50. (whistling) - So that's quite dangerous, that means he's not getting profusion to his vital organs, including his liver, brain, and kidneys, which means that those organs are currently dying. - I'll be right back. - Wait, where are you going? - To get an instrument tray. You guys are going to
have to open up his chest. - Hot damn. - I'm just gonna have to get a shaman, today, in the hospital. - Shaman's aren't listed
in the yellow pages. Our shaman is 500 miles from here. You are an arrogant man. - No, I'm just a guy with
access to a helicopter. - Cool, let's see how
this is gonna happen. - Hey, where are you two going so fast? - Burke is talking George and Alex through heart surgery in the elevator. - Shepherd's setting up
a shaman healing ritual. - [Izzie] Rock on! - I have porn guy. - This show is really medically inaccurate but it's hilarious.
- It is, it's funny. - She has the porn guy.
- That's funny. - Wouldn't have residency
been much more fun if it was like this? We didn't have to
operate in the elevators, we didn't have shaman, we just had patients who had no insurance that we had to battle
to get them treatment. - You never shaved your legs.
- What? - [Preston] But be sure you don't cut in to the lung or heart. - How can I be sure of that? - You just have to be sure. (laughing) - On this date, for the past seven years, you have what looks like a heart attack. - No, no, I know I've had
some scares but I don't-- - Every year on this date? - Is there some significance to this date for you personally? - No. Nothing. - What were you doing the first year, the first time you had a cardiac episode? - Oh, I couldn't remember back that far. - We were in the yard. I remember because our neighbor, what was his name? - Ted. - That's right, he died
of an aneurism I think, and we watched as the funeral home people took him away and you
had your first attack. - And you were close to Ted? - No, we barely knew Ted. - She shaved her legs. If this is takotsubo's
I'm gonna smack you, I'm telling you right now. - Come on, that's impressive. - [George] It's beating a little stronger. - [Preston] Excellent,
keep your finger there. - Okay, now what? - That's it.
- That's it? - What's wrong with that picture? - There's open flame in a hospital. - And why is open flame in a hospital, especially in that bed, really dangerous? - You've got oxygen around there. - Oxygen's a little flammable. - Oh, it potentiates the fire, yeah. - Poof. - You have stress cardiomyopathy. - Cardiomyopathy. - Bravo Dr. Mike. - I have an offer from Boston General. - You took it to get away. We swore we'd never talk again about what we had together. - This reminds me of The Notebook. You guys ever watch The Notebook? Romantic movie.
- I didn't see it. - You didn't see it?
- No. - We should watch it, like a bro night. - Yeah, no.
(laughing) - It takes away his pain. You see, the thing is, Henry? Henry takes away my pain. - Humans are weird. All of us, myself included. - Well, we're all unique
and again, whatever. - Did you just use a synonym for weird? In a more positive tone? - Yeah.
- Usually you're the dark one. - I am, I am. I don't know, I'm in a
good mood today, but yeah. - It's probably 'cause of the porn. - It must be the porn. - Choose me. Love me. I'll be at Joe's tonight so if you do decide to sign the papers, meet me there. - Oh, no, you didn't like it? Too narcissistic for your taste? Pick me. I hope you enjoyed our little collab here. If you want to see a
playlist of all my collabs with Ricky, Ava, Gabby, Molly, click here. Do it, say click here. - Click here. - And stay happy and healthy. (soft music)
