- The Good Doctor is being
recommended more than Grey's Anatomy by you guys
in my comment section. And in fact, this episode has popped up more times than any other. So, let's get started. Be-woop! (upbeat music) - I think you may need a new mentor. (melancholy music) I'm dying. - Ooh. That's a concern. I know I only watched the first
two episodes with you guys, and 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 wanna know the diagnosis.
- Okay, 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. - Shaun, I've been a
neurosurgeon for 30 years. I think that qualifies
as a second opinion. - (laughs) 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 that 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 bimalleolar, not a trimalleolar fracture. - Very good. What else?
- Dr. Darr to radiology. Darr to radiology. - Color? - Blood flow's restricted. His foot's dying. - Oh no. - So, they're talking
about this ankle fracture. And when they say it's
a compound fracture, that means it's fractured
in multiple places. 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
'cause 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. Gah! - It's just gonna take a second. I need you to count to three. One. - One, two. (bone clicks)
Ah! (grunts) - I think that was kinda accurate. I don't know, even my scream matched it. (heart monitor beeping) - Shouldn't I be asleep for this? - [Neil] Well, your blood alcohol level complicates anesthesia, and we
think you have a concussion, so we wanna 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. 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. Shaun, 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. How encompassing is it? If a tumor's spread throughout the entire brain, how are you gonna 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 defects. And you can imagine how
awful that could be. Yeah, okay, take out
my tumor, help me live, but then I can no longer speak. Horrible, horrible situations. - Be reasonable. - Beg your pardon? - Be reasonable. - I have no idea what
you're talking about. - Well, it'll be clear. What the hell happened to Caden? - I don't know, he twisted his ankle, I-- - You've lied to me before. You're lying to me now,
you spoiled little coward. - Hey, hey. Be reasonable. His friend's hurt, he's scared,
and you're freaking him out. - Good cop, bad cop. The reason good cop, bad cop works so well is exactly 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 wanna influence
someone in a positive way, it's not ideal to put
a stone in between you. It's not ideal to just
state your argument, then be confrontational about it 'cause that person won't
wanna 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 see eye to eye with you, you're more likely to
convince them of something. And good cop, bad cop is a fast track to achieving that goal. - We were pledging, and there's this wheel of torture thing you
gotta do for initiation. - Torture.
- But it's mostly stupid stuff, dude. It's like they drink a cup of olive oil or eat a tablespoon of cinnamon. - Or jump off a roof. - And what did Caden land on? - Laundry. - He had to do laundry? - No, like he had to eat
those laundry things. - Oh my god, Tide POD-- - As many as he could--
- Challenge? - In 30 seconds. - Detergent. Eat detergent. 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 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's asking
for you in OR number two. We got an emergency thoracotomy. - [Neil] Who can give me the
remaining steps for closing? - [Morgan] Cut anchoring sutures, clear laps, and reposition the bowel. 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. It'll fester, bacterial
infection, all this stuff. So yes, we count every tool. We make sure everything
is in, everything is out. We even have 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. - [Shaun] While you run the bowel for me. (stirring music) - When we say run the
bowel, what we're doing is we're looking for any
injuries to the bowel. Most commonly this happens
in a gunshot wound. 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. 'Cause if there's a lot of
blood pooling in the abdomen, the patient could die very quickly, and you have the run the
bowel quickly but effectively to make sure that you find
the area that's bleeding. (dramatic music) - [Claire] Shaun? - [Morgan] Shaun, is everything all right? - [Neil] What happened this time? - He's got a bleed somewhere. - I want a capsule endoscopy to check the entire length of the
bowel for bleeding and leaks. And give me a complete
coagulation and metabolic profile. - A capsule endoscopy
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
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, 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.
- Ooh. - [Neil] 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 in 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, 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. - He could have a crush
injury from his ankle. - Or a bacterial infection he picked up before or during surgery. - It might've been set off by drug use. - Or we did this to him. (stirring music) And by we, I mean Shaun. He spaced out in 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. - Shaun was distracted
by a personal issue? What, did Lea come back? Does she have a new boyfriend? His 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 multiforme located--
- Which is worse. - In your pons. - Oh! - [Oncologist] I'm sure I
don't need to tell you this, but it's the most aggressive
form of brain cancer. - Ugh! - [Oncologist] We estimate
three, maybe four months. (phone dings and vibrates) - Uh oh, someone's in trouble. (cheerful merry-go-round music) - Do you need me to listen to you anymore? - No, Shaun, it's okay.
(Mike laughs) - Do you need me to listen! - Hope is irrelevant for me. Hope is painful. (somber music) I don't wanna 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 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. (stirring music) An 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 cribriform 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 and M review,
which means no one will be asking questions and no one
will have to give answers. - M and M 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 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 backfire, see doctors get into near fistfights. - Is that from an IV? (hopeful music) You did the biopsy. - I did. I have a low-grade glioma. - Not a GBM? I told you. - Cancer, Shaun, it's still cancer. I have to undergo brain surgery, which is really scary because
I'm not the one performing it. (Mike laughs)
Five days a week for six weeks of radiation,
10 more weeks of chemotherapy. - And then? - And then with a little luck, you and I can go to the
Super Bowl next season. - Yay! I almost became a concierge doctor. If you wanna know what that is, check out my medical drama
review of Royal Pains. Click here. Click it, click it, click it, click it! Stay happy and healthy. (upbeat music)
