- 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.
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(gentle music)
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