- The Good Doctor is quickly becoming
one of my favorite medical dramas,
and you continually request it.
So, I figured let's just go ahead
and watch the second episode of the first season.
(high pitched noise)
(subtle music)
(car engine revs)
(police sirens blare)
- That does not look like a comfortable sleeping position.
I wish I was this happy when I woke up early in the morning.
(triumphal string music)
What is he measuring?
- Where to?
- San Jose Saint Bonaventure Hospital.
I'm a surgical resident, today's my first full day.
- I'm that floor.
(laughs)
- I like this show, I don't know, it gets me happy,
it just puts me in a good mood.
- This is Mitchell Brand, I reviewed his chart.
He's 55 years old, from Chicago,
divorced with two children,
you did a radical prostatectomy on him yesterday.
- This is actually very accurate.
In a post-op unit,
you will get visited by the attending physician,
the head physician, who's usually the main surgeon.
They will have their residents following them along.
Here, in this case, the patient has a radical prostatectomy,
which is a removal of the entire prostate gland.
I have a whole video on the prostate
and how things can go wrong with it,
so if you wanna check that out on my channel.
The thing about the radical prostatectomy,
why it's a difficult surgery,
is because there's a lot of nerves in
the region of the prostate,
amongst other structures that
are very anatomically important,
including your urinary system, your semen duct.
Going in to perform that surgery,
you wanna make sure that anatomically you're very careful
not to damage the surrounding structures,
but as we know, things can go wrong and things happen.
- You're late.
- Five minutes, we've all been there.
- Your first day, no less.
It is your responsibility to be here.
If you were not, you have failed in your responsibility,
which makes it your fault.
- Okay, how can it be my fault?
I did nothing wrong, the bus.
- This is gonna work out great,
the board clearly made the right choice in hiring you.
- Thank you.
(scoffs)
- I think the attending is being mean,
but on the other hand, I think he's right.
As a doctor, it's very important to be on time.
There should be no excuses, because ideally,
you should be there early.
Being a good resident, it's ideal to get places early,
so that you can review the charts beforehand,
get all of the information, so that when you are
rounding with your attending, you know all the information.
- [Female Doctor] It's definitely a budding the aorta,
and the left kidney.
Renal angiomyolipoma?
- [Male Doctor] You see an extensive blood supply?
- [Female Doctor] No.
- God, I wish I could do this.
- She has a sarcoma, a malignant tumor.
(intense music)
- Malignant?
That means it's killing me, right?
- Yes!
- I get that it may have features of a malignant sarcoma,
but to know instantly, without a proper biopsy,
it could be several things.
- So that's it?
You just accept my answer at face value?
Why?
- You're very arrogant.
(laughs)
Arrogant people don't think they need to lie.
- How long will this be?
- Seven minutes.
Without any complications,
it takes seven minutes to do a discharge
examination properly.
- Dr. Dunsmear has already cleared him to go,
and we need the bed.
- Okay, protocol requires that the surgical department
also clears him.
- Why is a patient that has an ear infection
admitted into the hospital?
And question number two, why is a patient that has
an ear infection being treated by a member
of the surgical team?
(laughs)
- What are you doing down here?
- I'm waiting for her to fart.
(whimsical music)
Flatulence, but I'm using the word fart
in front of the patient to be more casual.
(laughs)
You're the president of the hospital,
so I'll say flatulence to you.
- Well, I appreciate that.
(laughs)
Why are you doing that?
- She had her deviated septum repaired,
before we can release her, we have to make sure
she isn't suffering from postoperative ileus.
- Postoperative ileus is when the muscles of the intestines
don't move correctly,
and it basically, it's like a frozen intestine,
meaning that the gut is not moving the food,
and its remnants, and the stool further down,
and allowing it to pass.
This can happen sometimes,
one of the first things you wait is for the patient to
pass gas,
and then in some cases,
if you had something more complicated,
like an abdominal surgery,
you wait for them to have a stool before sending them home.
- I think that was it.
(machines beeping)
- You don't have to smell it.
- I don't think so.
(bouncy piano music)
I'll wait a little longer.
This is important.
- No it's not.
- The procedure is called a laparotomy.
Your heart sounds good.
- I don't know what she was listening to her heart for,
that was definitely just an add-on for the show,
but when we listen to the heart,
we listen in multiple areas.
When you're listening to one area,
you're listening to one part of the heart,
then you move the stethoscope around,
and you're getting the other part of the heart,
which gives you more information.
Then, you move it to the other side of the chest,
where you're listening to separate arteries,
so you can hear what the aorta's doing,
you can hear what the pulmonary valve is doing.
- My husband died in a car accident a couple of years ago.
Mark is our only child.
I can't die right before his wedding.
I can't.
- You're not gonna die.
- Making promises like that, I've said it before,
it's not wise.
We have only so much control over certain things,
especially if they don't know the grade of this tumor,
they don't know the spread of the tumor.
- My little girl has a tummy ache
because mommy and daddy won't stop fighting.
This isn't a medical issue, send them home.
- It could be intestinal malrotation,
which could quickly become fatal.
- And every patient in this hospital could have malaria.
That doesn't mean we're gonna go around testing
for every condition we think they could have.
- Ordering random tests just to make sure that
a patient doesn't have that condition
is certainly not smart,
and I agree with the senior attending here.
What you learn from experience is,
when you go on a hunt and start ordering a bunch of tests,
certain tests will come up positive
mostly because a lot of those tests
have the high possibility of coming back as false positive.
Which then encourages you to order more tests,
which has several effects.
The patient gets anxiety.
Second, some tests carry risks.
For example,
if you start ordering CAT scans on every patient,
you're exposing the patient to unnecessary radiation.
On top of that,
you may find on a CAT scan some kind of nodule,
some kind of node,
which will need further testing,
sometimes a biopsy, and biopsies carry risk.
You see where I'm going with this?
- From now on,
you don't run any tests you don't have to run.
- How do I know if a test is needed until after I run it?
- She'll tell you.
- Nurses actually have a lot of experience
in knowing what test to run, which tests are excessive,
which tests are very important.
In fact, when residents in my hospital ran rapid responses,
the nurses from the ICU were so experienced,
they already knew what medications to pull up
at what dosages even more so than
some of the young residents.
(heart monitor beeps)
- I'm Dr. Claire Brown, I'm first assist today,
and I'll be leading the time out.
Patient's name?
- Stephanie Willis.
- Scheduled surgery?
- Excision of indeterminate retroperitoneale tumor.
- Oh, now it's indeterminate.
- We don't anticipate any complications with the surgery.
- Thank you, Dr. Brown.
- That time out actually happens,
it's basically, we confirm all of the information.
Generally, we do it while the patient's awake,
so they can confirm all of this information,
and then we do it one more time before we start,
including, this may surprise you,
discussing the site of the operation.
Because it has happened, unfortunately,
horribly,
that we've operated on the wrong side of a patient's body.
There's been a lot of things procedures put in place
that prevent us from making that horrible mistake,
with the time out being one of the most important ones.
- It might be infected.
- It's not.
- There is some discoloration.
- He's 82 years old, everything is discolored.
(laughs)
- Blood pressure 120 over 70,
heart rate 60, she's holding steady.
- I have opened the fascia.
- You know what you guys should do?
You should screenshot this little scene
where she says, "I opened the fascia,"
and send it to Gabbie Hannah,
because she tweeted me not so long ago
saying that she can't believe that
after we operate on organs, and we put them back,
are they just like floating around in our bodies?
And I told her that everything is interconnected with
fascia, and she had no idea what fascia looked like,
so send her this picture on her twitter,
she's gonna love it.
- I thought you'd wanna see it.
- It looks like puke.
- No no no.
It's not the regular color.
- Puke has a regular color?
- Yeah.
- It is a bit of an unusual color.
We could order some-
I'm sending you home!
- Are you sure?
(laughs)
- This is so good!
Part of medicine, and a big part of medicine,
and something that I learned and teach my students
is that a big part of what we do is reassure,
because people worry, and there's a lot of anxiety that
comes with people's bodies.
Fluids start coming out of random places,
fluids change color,
we bleed, body aches, our heads hurt,
our vision changes, a cough occurs,
upset stomach.
As soon as you go on the internet and look at any one
of these websites,
you could fall down into a wormhole
thinking that your headache is caused by a tumor
like this.
(snaps)
- Claire, tell me you got something.
- I've got nothing.
This tumor is way bigger than it looked on the scans.
- Hence, why we don't diagnose people just by
looking at scans.
- (mumbles) to see her aorta.
- That's a problem.
(machine beeps)
- The tumor is encasing her aorta,
meaning that it's fully surrounding it and engulfing
the aorta, which serves to be the main blood supply
to the bottom of the body.
- Dr. Melinda sent you a biopsy,
when will the results be ready?
- When I get to it.
- It's very important.
- They're all very important.
- Let me see the other test orders.
I'll tell you which one's the most important,
and you can do them in that order.
I'll be honest and fair.
(laughs)
- In complex surgeries like this,
we not only have the pathology lab on standby,
but you could also even have a pathologist in the room
with a microscope, ready to make the call immediately,
especially when a patient is under sedation.
You don't want to extend the patient's time under sedation
just because the pathologist is busy with other cases.
- There is one possibility.
If we remove the left kidney, we might be able to
get a good enough view to successfully remove the mass.
- Take out a healthy kidney to get a better view.
That's insane.
- The tricky part with this is that
if they're not successful, she could die.
If they're somewhat successful,
she could be incredibly disabled
and have horrible disability from the surgery,
and her last six weeks to live with this horrible tumor
are gonna be awful,
as opposed to if they just suture her up now,
and she could just enjoy her last few weeks of life.
Even if the surgery's a major success,
does that mean they were able to get the entire tumor out,
and now she's completely cured?
It could be spread all across the peritoneum,
which is the inside of the abdominal cavity.
To me, this sounds too risky
and too much like a cowboy move,
but, then again, I'm not a surgeon,
nor a surgical oncologist.
That's why I would ask someone who's more of a
sub-specialist, which I don't think any of these people are.
- Am I healthy?
- Probably.
- You're a doctor, you're supposed to know.
- No we're not, nobody knows anything for sure.
Anybody could drop dead of a heart attack any time.
- Who is this guy?
Am I gonna have a heart attack?
- First of all, don't do this in an open space like this,
because if he starts yelling, it's not gonna look good
for anybody.
I have these conversations all the time,
patients come in and demand to know that they're healthy,
there's nothing wrong with them.
You can't promise that,
but what I can do is answer specific questions that
they have about their health.
Doctor, my ear hurts, why do you think that is?
And I can say, well, I looked in your ear,
and I found that you have an ear infection.
Let's treat it, and see what the outcome is.
You give them reassurance that it's likely to pass,
but you tell them if the symptoms continue,
if the symptoms are to worsen,
if new symptoms appear,
please return so we can do a further evaluation.
That's it.
- The small bowel is twisted around the superior
mesenteric artery.
Martine needs surgery, immediately.
- We need to confirm with Dr. Melendez.
- No, Dr. Melendez is in surgery,
part of Martine's bowel is dying, and killing her with it.
- No, you can not make these calls on your own.
Dr. Melendez was very clear.
- He was very clear.
It's past midnight, which means it's tomorrow,
which means you're no longer my boss.
(heart monitor beeps)
- Is this the OR scheduler?
Yes, this is Dr. Murphy.
Prepare an OR for surgery.
- As feelgood as this is, an intern cannot just book an OR,
can't schedule their own surgery,
no one would ever allow this to happen.
Actually, this could be grounds for expulsion
from a surgical program.
- Why do all surgeons all look so frail in these shows?
Him, McDreamy.
Man, I get you're operating all the time, but come on.
A little deadlift and bench press never hurt nobody.
- Thank you.
(upbeat music)
I like the minimalist look for an apartment.
Oh, he got a mattress, look at that upgrade.
When I say this show has good writing,
I'm not talking about the actual speech
and the words that the characters say,
that's good, but when I say they have great writing,
it means they think ahead for each situation,
to make it not only lighthearted, comical, fun,
and interesting, but they show a way to highlight a person
who has autism in such a unique light
that it's very positive for people who
are born or develop this condition.
This is probably one of my favorite shows right now
as far as medical dramas go.
I'm certainly a fan.
The reason I watched episode two is because
I want to learn more about the first season
before jumping into the second season.
Now, if there are some good episodes within the first season
you want me to watch, please let me know down below
in the comments.
Hit that subscribe button and the notification bell
so you get all my videos,
and check out my other content
if you enjoyed my medical drama reviews.
You'll love it, or your money back.
As always, stay happy and healthy.
(upbeat music)