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I jumped into the comments section
and I hear you loud and clear.
Code Black is up next.
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(static)
An influx of patients so great,
At the different hospitals that I worked
there were different definitions of code
followed by a different color.
For example Code Blue generally meant
that someone's heart stopped or they weren't breathing.
Rapid response meant something.
Code Pink sometimes meant that a baby was abducted
from the newborn nursery.
Code Black generally referred to like a terrorist threat
or some kind of crime going on.
I've never heard this type of definition from this show
but, it does make sense.
Hospitals get overcrowded, especially in busy areas
like Los Angeles.
I'm excited to watch this.
- Your momma know when you're lying, crying, or dying
and it's not only my job to teach you right from wrong,
but to make sure you don't leave here in three years
thinking you can do no wrong.
- One of the biggest things you have to do as a doctor
is learn that there's a lot you can do wrong.
I'm talking about over treating, over diagnosing patients.
That's truly a health hazard that most people
don't even think about.
So, I love this nurse and frankly I love this actor,
so I'm super excited to see him in this show.
- The most famous strip of hospital real estate
in the nation, where emergency medicine was born,
where the secret service reserves a trauma bed
for the President of the United States
when he is in Los Angeles.
This is trauma one.
- Wow.
- Angels Memorial.
You are not under any circumstances allowed
to kill a guest in my house.
- I love this orientation, this is so good.
- What the hell is the homeboy drop off?
- Gang bangers leave the wounded on the sidewalk.
- I've worked in numerous hospitals uh where the ER was
in a part of town where there was a lot
of gang related activities
and literally people would walk into the hospital
or get thrown out of a car with a gunshot wound
and there was one time I literally got a patient
that crawled into the uh emergency room
bleeding from his femoral artery,
so I had to grab a glove, stick my finger
into his femoral artery and pull him to the bed and pull him
to the bed and get the whole process started
with the trauma team.
I remember that because my hands were so covered uh
in blood, at least up to my uh elbows, that I was like
oh man, I have to wash this off really quickly
cause that's the first step of infection control is
to wash your hands.
I left the trauma scene and the trauma bay and walked
to one of the nearest um sinks to wash my hands properly
because the situation was being taken care of
by a lot of doctors, and then I realized
I was tracking blood all across the hospital,
so the maintenance staff looked at me with these angry eyes
and I was like I'm so sorry, I didn't mean to make a mess,
but literally they had to clean up my bloody footsteps
that traveled halfway across the hospital
to go wash my hands.
It's part of life, it's scary but it's part of life.
- Gunshot wound to the neck, obliterated carotid.
He's lost half his volume here, Jess,
we got to get him out of here - Oh my god, that's dangerous
- Just get the gurney underneath him please.
- Alright, you get over there on the other side
and push with both legs.
One, two, three, go.
- So this is very realistic.
I know it looks like they're being rough
and they're kicking the patient out of the uh SUV,
but that's true because you literally have uh
seconds before the person completely bleeds out and dies,
especially from the carotid artery.
Plugging the wound obviously is the first step,
so they're doing a great job.
I'm assuming they still feel a pulse
cause they said that the artery was still wiggling.
So right now, the most important thing
is to fluid resuscitate this person,
meaning to give as much fluids as you can
with two large bore ivs.
Large bore meaning thick ivs so they can deliver a lot
of fluids very quickly
and then it's to obviously give them uh blood back,
donated blood that we have in the hospital
from the blood bank, and give them as much blood as we can
in the short period of time.
- Look at his pulse, doctor,
this man's heart need's assistance.
- Stop compressing til we can intubate.
- Got it?
- Yeah.
- Who can tell me why this patient can not be transfused
in type and crossmatched blood? Anyone?
- Because it takes time to type and cross someone's blood,
so therefore you want to give them blood
that's universally considered donor blood,
which is O negative blood.
- I need a hero, come on.
Come on, let's go find you an attending to annoy.
- Honestly, this is so accurate,
because at times the hospital's busy
you have to find a doctor to shadow or learn from
or follow around and it is sometimes unorganized like this,
especially when it gets busy.
- What's your name?
- Ariel.
- Ariel, I'm Dr. Rorish
and the truth is we don't know why your father's unconscious
and I can't learn anything out here in the dark.
So with your permission, I want to take him inside
and I promise you I will tell you everything I know
as soon as I know it, okay?
- Okay.
- Very good doctor-patient relationship.
I found myself very often in the emergency room
having very serious conversations like that
and I found that yields the best results,
so even in dire situations
when a family is hysterical like that,
the more honest I was with them,
and I was brutally honest at times,
saying that these treatments aren't going to help
your father, mother, whoever I was talking about
at the time, and I would apologize,
I would say I'm sorry I'm being brutally honest right now,
but I want you to make the best decision
with the limited amount of time we have
and people respected that, they appreciated that
because in reality nobody wants them to lie to them,
nobody wants false promises.
- What's your evaluation, doctor?
- Patient unconscious, low bp, warm extremities
and he's in spinal shock.
- No additional examination.
- Uh, it's pretty textbook.
- Pretty textbook, huh?
- Yeah.
- Okay, what about you doctor, textbook?
- The way that this attending is teaching,
while trying to actively save the patient's life
is very accurate.
Like I feel like I'm in the hospital as a resident learning.
It's very accurate, this is exactly how it happens.
She's not giving the patient worse care,
which is also educating with pressure
in a time sensitive situation to the residents.
Excellent, excellent recreation.
- 654 is normal, brain function 111 is the lowest.
- He's brain dead.
- That poor kid.
- He was confused that I didn't understand him.
- Yes, called expressive aphasia.
It's word salad, sounds right to him but the words
come out all tossed around.
- Yeah, expressive aphasia is really interesting,
it's also known as Broca's aphasia
and that happens if you have damage to the left front uh
frontal area of your brain,
so that can happen in car accidents,
it can happen in traumatic illnesses,
also strokes, basically what happens is,
in your mind you know what you want to say
and it's you think you're saying the right words
but when it comes out
you're saying completely different words
and the way that I memorized this when I was studying
and learning about it was boca means mouth in Spanish
so it was like what's coming out of your mouth is wrong.
- TPA is a kind of miracle drug that has the potential
to bust the clot up and reverse the stroke,
but only if there's no actual bleeding yet in the brain.
We're going to need a scan to know for sure.
- So this is the one part about this
that's pretty inaccurate.
So, most hospitals have stroke protocols
when a patient even comes in with remotely similar symptoms
to a stroke they instantly go to a CAT scan,
they instantly get blood work drawn,
you instantly page the internal medicine
or family medicine residents to follow stroke protocol,
we instantly call the neurologist and get the robot out
and all of this happens right away because again
you have a small time of window
that you could actually give the TPA.
So it's about the fastest fastest way
you can get things done.
Never is it standing at bedside having conversations
of oh, let's get the CT scan
and see if there's any bleeding going on. No.
- He's brain dead.
- Oh, god.
- And she's all alone til tomorrow.
- Has someone called child and family services
to come get her?
- Yeah, but you know how that goes it could be hours.
- It gets worse, he's an organ donor.
Transplant team's on the way.
- Then we can't wait for CFS, I have to tell her.
- This is definitely the most medically accurate show
I've seen in such a long time.
I don't know why I'm getting excited about it
but it's just it's very accurate.
These conversations happen in this matter.
- Your father died, Ariel.
- Well, technically, technically it's uh a brain death.
- So he's not dead?
- No, no. That's, what I mean is
machines are keeping his body at a state of
- What are you saying?
- I'm trying to explain to you
- No you're not.
What happened to just giving it to me straight?
- I'm giving it to you straight.
- So he's dead, but technically not really, right?
Oh, I want to go see him, I want to see him
- I've had conversations like this,
again the more brutally honest you can be,
at least in the beginning, that's usually the best policy.
My general strategy is to get as much of the information
out there, console them as much as I can,
but if they become hysterical, get upset,
tell you to shut up, tell you to leave, never get offended
because what they say in those moments
that's not who they are as people,
they're going through a moment of shock, emotional shock.
I'll leave them alone in the room
with maybe someone watching them a nurse or someone else
but me because I'm the one who gave the bad news,
give them some time,
and then come see them once some time has gone by
and pretty much every time that I've done this conversation
they apologize, we hug,
I understand that they've just lost a family member,
I've gone through that in my life with my mom.
I've actually had to ask residents to stop doing CPR
on my mom, so I know what this feels like
and sometimes people just need a moment to themselves,
they need to not see the person
who just gave them the bad news,
so it's okay to be the bad person, leave, come back.
- Transplant team's in route.
I want to tell you how fabulous you look right now.
- I do?
- No, I want to tell you that but then it'd be a lie.
(laughter)
- You look like you've been strapped to the bow of a ship.
- So true, um, this is so true - [Dr. Rorish] Is that so?
- Interesting about the transplant team.
They are a skilled set of surgeons that come in
and basically take the organs
as soon as the time of death is called.
Actually, um while I was doing my training uh
when I was on the surgical unit I was one of the people
that was put in a room with the transplant team
to call the time of death.
You can not start to operate on the patient
taking out the organs, harvesting the organs, what have you,
until the person is completely dead,
so we had to stand there until I didn't feel a pulse
and my exam was negative.
There's a lot of pressure and there there was a time
where there wasn't a pulse then he came back
so I had to say well you know, wait,
and it was a lot of pressure on me being a young doctor,
but I wanted to do what was right by the patient
and waited until the heart completely stopped,
the patient had no pain response,
and only then did we begin uh taking out the organs
so they could save someone else's life.
- Oh no, don't do that.
You don't need anymore laugh lines, believe me.
- Me, have you looked at yourself in the mirror lately?
- Uh huh.
- I love their relationship, it's so real
- I love you so much, I want to break you in half.
- I love you so much, I want to punch your face in.
(laughter)
- There was a recent article whether or not it's okay
for doctors to hug patients and other coworkers
and I thought it was insane because if we're going to get
to the state of where we're not allowed
to make physical contact with people,
humans crave physical contact.
I'm not talking about inappropriate physical contact,
I'm talking about moments like that
where you need encouragement, where you need a hug.
Even most recently I had like
an eighty-four year old patient
that was going through a difficult moment in her life
and I spent an hour with her in a visit,
we talked about all the things going on,
we treated her medical conditions,
she became very emotional and cried and asked for a hug.
Of course I'm going to hug her.
- Worst part is the headache.
I live above the boiler room in my building
and the noise just keeps cracking my head open.
Is there anything you can give me for that?
- You're nine months pregnant,
there's not a whole lot we can do
other than give you Tylenol.
- I've tried that, it doesn't work.
- Using again?
- Excuse me?
- Mario.
- Scars on the inside of your arm are all track marks,
right?
- None of your damn business.
- Bad bedside manor obviously.
I've never seen a more aggressive resident
in in questioning a patient.
You're going to get the patient angry,
whether not you're right or wrong,
it could bring up old feelings or old habits
that the patient had that can make them very emotional,
they're going to disconnect,
they're not going to follow what you're saying.
No one's winning here by you doing that.
Shame on you, sir.
- Uh, where are you from?
- Norway.
- Uh, center stage.
Your son has a collapsed lung we're going to help him.
- How could you know that?
- That the Norwegian kid can't breathe,
it's pneumothorax it's a genetic disposition.
- I've never heard of that.
(coughing)
I'm about to have spontaneous pneumothorax.
- A Norwegian child having pneumothorax?
I'm learning something from this show.
I'm going to look this up afterwards.
Actually, let's look this up right now together.
I'm curious what what pops up here.
A significant fraction of families
with familial spontaneous pneumothorax
have mutations in the gene.
The fact that she's just guessing
that this child has pneumothorax without a physical exam
is a little crazy for me.
- Diesel fumes. Oh my god.
- What?
- What if it's causing carbon monoxide
- She lives on top of a boiler room
- Carbon monoxide poisoning can mimic flu symptoms.
She said she lived above a boiler room, right?
Oh my god, Mario I could kiss you.
But not really.
- Common symptoms of carbon monoxide poisoning
is feeling sleepy, having a headache, fatigue,
and the treatment is breathing in oxygen.
- You're not going to like this Neal, but uh
- She has to perform a C-section on a rig.
Sometimes you have to be a cowboy, right?
- Oh god.
(water bursting)
Oh. Okay.
- Now, this is going to happen very quickly.
I want you to reach your hand inside as fast as you can,
carefully feel for the baby.
- When?
- Have you made the cut yet?
- Yes.
- Now. - Now.
- These are very crude instructions,
but I guess in an emergence setting
this is what they need to do.
It feels like they're making a rash decision here uh
in doing a C-section like this
with someone who's not a trained operator.
There's so many mistakes that can happen.
I don't know.
I don't know what the right answer is.
- Her, her.
(baby crying)
I got her.
(baby crying)
- How about suturing the patient back up
so she doesn't bleed to death.
- Hi, I'm Vanessa.
- I'm Ariel.
- Oh, the organs were used to save her.
- Can you hear it?
- Yeah, I can hear it.
- Powerful moment, when you know uh
you had to lose your father but it saved uh
another person's life.
Code Black, in the books.
This show pleasantly surprised me.
I feel like all the other shows I've watched so far
were written by a Hollywood person
and then a doctor contributed some medical knowledge to it
as opposed to this one, it felt like it was written
by a doctor and then a Hollywood person
injected some drama into it.
It was a good show. I mean it was feel good,
it was medically accurate where it needed to be,
the interpersonal relationships were accurate.
I'm excited for this show, I think it has a lot of potential
and if you guys like this show please let me know,
give me some episodes to watch because I'm so down
to watch more of Code Black.
Go ahead and smash that subscribe
and like button down below.
As always, stay happy and healthy.
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