- We've only watched one episode of "Chicago Med"
in the past,
but there's some extreme episodes we're about to watch.
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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)
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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)
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As always, stay happy and healthy.
(energetic music)