- What's up guys, we've done three reviews of "The Good Doctor" already, but we haven't even seen season two yet. So let's start it up. Season two, episode one. Dr. Shaun, I'm coming for you, bew! - 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. Often times once medication fails, the last approach becomes
surgical intervention which is what I expect to happen here. When I say surgical
intervention, means a transplant. - What about a fix isn't
it just a transplant? (Mike chuckles)
- 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. (tense music) - Well it's still a transplant! You tricked us 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 extra support? You probably would have to be
on blood thinning medication, immunosuppressive medication because you have more
turbulent blood flow, you have another organ inside of you that your body will probably
react to unless you have immunosuppressive medication onboard. I could see a huge
challenge coming up here. - Do you live in a tent? (Mike laughs)
- Yeah. - I lived in a tent too. It wasn't very good so I moved to a bus. You should move to a bus, you will be much less likely to develop ulcerative tinea pedis. - Tinea pedis, or pedis, 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 antifungal medication because topical would not have
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, so-- - 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 two 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 patients to
take in the information without feeling like all eyes on them. Good job, Shaun. - 'Scuse me, please. 'Scuse 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. Blaize, I am
like any other patient, entitled to have say 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. Blaize, slash, Dr. Cuddy. - What's your name? - I'm Harry, these are my meds. - Those pills are for people
with chlamydia, Harry. - No, you're all the same. See, I know better! That's why I had to
hide out in the streets. I had to move next door
to Mr. Googly Eyes. I trust him! He's my friend! - Why are doctors involved in
this and not security staff? 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, ah, ah, ah! - I trust him! - I'm okay, I'm 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. Shaun. As a surgeon, perhaps,
he can look at someone and figure out the problem right away, 'cause 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 that schizophrenia? No, it's not. So, Dr. Shaun, pump those brakes and let a non-surgical
doctor take over here. That's an abscess. - That smells very bad. So the reason why abscess 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 it essentially
creates a bubble of pus. And pus never smells good
because of the dead bacteria. The only treatment, I and
D, 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, but-- - 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. Andrews? - And they both already
spent half the morning raving to the press. - Ooh.
- Well that's very kind. You spoke to the press? You spoke to the patient, my patient? - As I explained to 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 wanna
get a better surgical center so we can help more people. We wanna create funding for our hospital, notoriety for a hospital. The question needs to be
asked is, at what cost? Do we discuss this with our patient? Are they onboard 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,
- Are you having trouble with your neck too?
- is he having meningitis? - It's stiff. - A stiff neck could be an early indicator of bacterial meningitis? (Mike laughs)
- There many possible explanations for a stiff neck, most of which are much more likely than bacterial meningitis-- - If has invaded the meninges of his brain it could be exacerbating his paranoia. - So bacterial meningitis is
inflammation of the meninges, the soft layer 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 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 gotta 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. - [Claire] Melanie has a aortic aneurysm? - Two hearts beating into that. - Yeah, not so good. - So I've talked about aortic aneurysms on the 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 doctors
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 he not brought him
in he would have passed. Let's see if my prediction is right. - Harry has kaleidoscopic disintegration. - (laughs) What?
- We thought he had schizophrenia but he does not. He has a brain tumor. - This is why you said 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, it's
not how medicine is practiced. Kind of a shame to see this, 'cause 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 I
need to be ruled out Shaun. - Have you seen Harry he lives in-- (metal clattering) We need to find Harry, you don't-- (metal clattering) - So those who are diagnosed with autism sometimes have a condition where if there's over stimulation, whether it's light, sounds, even stress, they can sometimes be
overwhelmed like this. I totally sympathize with
Shaun, what's happening here, 'cause he's tryna do the
best for his patient. But clearly to 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. (laughs) Some surgery. (Mike laughs)
- Knife. - 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. (gentle 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 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 wanna just do as best as you can in the given moment. But in this scenario, this is not urgent, this patient has lived for
a while with this tumor and 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. - [Claire] 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 do they find out they had this tumor the whole time. (tense music) It's just like playing
"Surgeon Simulator". Just drop it in, it's all good. Heart. (text pings)
(audience applauds) Check out this playlist of
me running around the streets answering people's
questions, curbside consult. Click it and I'll see you on this one, being happy and healthy. (gentle music) ♪ We could finally be ♪
Hey doctor Mike.
I have 2 questions.
1.what is the equivalent action to chest compressions for a person who has chest damage?
in this thread: the good doctor reacts to the good doctor