- The Good Doctor is being recommended more than
Grey's Anatomy by you guys in my comment section.
And in fact, this episode has popped up
more times than any other.
So, let's get started.
Be-woop!
(upbeat music)
- I think you may need a new mentor.
(melancholy music)
I'm dying.
- Ooh.
That's a concern.
I know I only watched the first two episodes with you guys,
and now I'm on the 18th and it feels like
I'm skipping around like crazy,
but this was voted the number one episode by Episode Ninja,
so I feel like I had to check it out.
Don't judge me.
I'm excited.
- 12 to 18 months.
And I'd appreciate it if you didn't tell anyone.
- I wanna know the diagnosis. - Okay, I will in my own time.
- Okay, have you had a full workup?
- Yes, of course.
- It could be a secondary tumor metastasized
to your brain from somewhere else.
- It could be a primary tumor,
which means that it originated in the brain.
Or it could be a secondary tumor,
let's say a lung tumor that started in the lungs,
through the lymphatic system or the blood
went into the brain and then created a secondary tumor.
- You should get a second opinion.
- Shaun, I've been a neurosurgeon for 30 years.
I think that qualifies as a second opinion.
- (laughs) You know what's interesting about being a doctor
who's practiced 30-something years as a neurosurgeon?
You actually make really bad decisions
when it comes to your own health.
It's notorious that doctors are really bad patients,
and I totally agree with this.
I'm the worst.
And in fact, if I have a patient that
I'm treating that I know is a doctor,
I know I'm gonna have to take extra time.
I know I'm gonna have to do a little arguing
with them in order to get them
to take care of themselves properly.
- Well, given the degree of the rotation
and the fact that the break is almost compound,
I say we're dealing with a bimalleolar,
not a trimalleolar fracture.
- Very good.
What else? - Dr. Darr to radiology.
Darr to radiology.
- Color?
- Blood flow's restricted.
His foot's dying.
- Oh no.
- So, they're talking about this ankle fracture.
And when they say it's a compound fracture,
that means it's fractured in multiple places.
When there's lack of blood flow,
that means there's pressure being put
on the arteries or veins in that area,
which is very dangerous 'cause that's called
a vascular compromise, meaning not enough blood
is going to that area and that area is necrosing or dying.
- I'm gonna have to reset it now.
Hold his leg. - When they say resetting,
it's exactly what you think it is.
Gah!
- It's just gonna take a second.
I need you to count to three.
One.
- One, two.
(bone clicks) Ah! (grunts)
- I think that was kinda accurate.
I don't know, even my scream matched it.
(heart monitor beeping)
- Shouldn't I be asleep for this?
- [Neil] Well, your blood alcohol level
complicates anesthesia, and we think you have a concussion,
so we wanna keep you responsive.
We did give you a regional nerve block,
so you shouldn't feel anything.
- This is actually similar to what
we do when we do a C-section.
The mother is not asleep.
We do a regional block just like this.
We need the mother conscious in case
we need to make decisions so that she can help
facilitate the process if anything happens.
- I had a friend, a neurosurgeon at SF Muni.
She looked at the scan.
She came to the same diagnosis.
Shaun, I have an inoperable glioma.
- Glioma is a type of tumor.
When we say a tumor is inoperable,
usually that's because the area where it's found.
How encompassing is it?
If a tumor's spread throughout the
entire brain, how are you gonna operate?
You can't take out the entire brain.
Sometimes if we're very lucky and it's localized
to a specific region, we can just take that part out.
But even then, we're at risk at harming
the surrounding structures of the brain
and leaving someone with neurological defects.
And you can imagine how awful that could be.
Yeah, okay, take out my tumor, help me live,
but then I can no longer speak.
Horrible, horrible situations.
- Be reasonable.
- Beg your pardon?
- Be reasonable.
- I have no idea what you're talking about.
- Well, it'll be clear.
What the hell happened to Caden?
- I don't know, he twisted his ankle, I--
- You've lied to me before.
You're lying to me now, you spoiled little coward.
- Hey, hey.
Be reasonable.
His friend's hurt, he's scared, and you're freaking him out.
- Good cop, bad cop.
The reason good cop, bad cop works so well
is exactly based on the principle that I've told you before
in some of my Wednesday Checkup videos.
So, if you want someone to see your point of view,
you wanna influence someone in a positive way,
it's not ideal to put a stone in between you.
It's not ideal to just state your argument,
then be confrontational about it
'cause that person won't wanna change their beliefs.
But now on the other hand, if you can get that person
to see that you're on their side,
that you have the same intentions,
you're also a human, and they can see eye to eye with you,
you're more likely to convince them of something.
And good cop, bad cop is a fast
track to achieving that goal.
- We were pledging, and there's this
wheel of torture thing you gotta do for initiation.
- Torture. - But it's mostly
stupid stuff, dude.
It's like they drink a cup of olive oil
or eat a tablespoon of cinnamon.
- Or jump off a roof.
- And what did Caden land on?
- Laundry.
- He had to do laundry?
- No, like he had to eat those laundry things.
- Oh my god, Tide POD--
- As many as he could-- - Challenge?
- In 30 seconds.
- Detergent.
Eat detergent.
And how many did he have?
- I don't know, like six, maybe seven.
- I feel like I shouldn't be here,
even on a medical channel, explaining to you why that's bad.
I mean, it's like, don't eat knives,
don't eat forks, and don't eat Tide PODS.
The only time that I'll say that
someone may accidentally ingest a Tide POD is
if you have a child, very young,
who's not aware, and they see a colorful pod
and they think it's candy and they swallow it.
But if you're an adult or an adolescent
and you're eating Tide PODS, come on.
You can do better, I know you can.
That's my spiel.
- The trauma SOD's asking for you in OR number two.
We got an emergency thoracotomy.
- [Neil] Who can give me the remaining steps for closing?
- [Morgan] Cut anchoring sutures,
clear laps, and reposition the bowel.
Remove clamps from the duodenal resection site,
keeping clear of the underlying aorta.
- When he says clearing laps, what he's talking about
are those pads that we use to control the bleeding
or to put pressure or to clean the site
so that we can actually see what we're doing
when a patient has some blood in place.
The nurses that are there with us,
the assistants that are there with us
are counting each one of those laps.
Because if we leave one of those in, horrible situation.
It'll fester, bacterial infection, all this stuff.
So yes, we count every tool.
We make sure everything is in, everything is out.
We even have a little wall of pockets,
almost like a shoe organizer where we put each one
of the things, and then we count them out afterwards.
- [Shaun] While you run the bowel for me.
(stirring music)
- When we say run the bowel, what we're doing is
we're looking for any injuries to the bowel.
Most commonly this happens in a gunshot wound.
If someone gets shot in the abdomen,
right away the first step in the trauma situation
is to open the patient, do an explorative laparotomy,
which means that you cut the stomach open,
you run the bowel, you see if there's any injury anywhere.
'Cause if there's a lot of blood pooling in the abdomen,
the patient could die very quickly,
and you have the run the bowel quickly but effectively
to make sure that you find the area that's bleeding.
(dramatic music)
- [Claire] Shaun?
- [Morgan] Shaun, is everything all right?
- [Neil] What happened this time?
- He's got a bleed somewhere.
- I want a capsule endoscopy to check
the entire length of the bowel for bleeding and leaks.
And give me a complete coagulation and metabolic profile.
- A capsule endoscopy is when you take a pill
that actually has a camera in it,
and it takes about 24 hours to go through the system,
and you get quality photos consistently, photos and video.
It records its way through the GI system,
which allows you to see if there's any bleeding anywhere.
In my past experience, what I've seen is that
if someone is bleeding and we suspect
it's from an upper GI source, meaning from the stomach,
the esophagus, what we do is we do an endoscopy
where you put the camera in the mouth
and you try and find where that bleed is coming from,
and you can control that bleed in a number of ways.
If you think it's from a lower GI bleed,
you could do a colonoscopy, which is just another form
of endoscopy where you put a camera up the butt.
Not sure if they're doing a capsule endoscopy here
just to look cool for TV or because they don't feel
comfortable taking him for an endoscopy
because he's in a critical state.
Now, he's getting lab work.
That is legitimate because when you take detergent,
it can mess up the acid base balance in your blood.
It can mess with the electrolytes of your blood.
And if it messes with them too much, it can kill you.
- Our patient has disseminated intravascular
coagulation. - Ooh.
- [Neil] Can anyone tell me why that is very bad?
- Blood clots form throughout the blood vessels
and rapidly deplete the body's clotting factors,
thereby causing a systematic bleed.
- It's also a catch-22.
If we treat the clotting,
he might end up with a terminal bleed.
- So, DIC is actually a very rare condition.
It's life-threatening.
The last time I saw it was probably in my residency
when I was at the intensive care unit.
And it's a condition where you have excessive clotting
going on within the blood vessels.
So it's intravascular.
And when that happens, you can have organs die,
think stroke, pulmonary embolism in the lungs.
Just think of it simply put as a clotting condition
where your body's clotting a lot,
and because it's clotting a lot,
it's using up all of its clotting factors and platelets,
which then makes you more susceptible to bleed.
- He could have a crush injury from his ankle.
- Or a bacterial infection he
picked up before or during surgery.
- It might've been set off by drug use.
- Or we did this to him.
(stirring music)
And by we, I mean Shaun.
He spaced out in the OR when
he was closing, kind of like he is now.
- I'm listening.
- Comforting.
He wasn't focused.
- He got some bad news.
- About what?
- It's a personal matter.
- Shaun was distracted by a personal issue?
What, did Lea come back?
Does she have a new boyfriend?
His cable get cut off?
- I have an inoperable glioma.
18 months.
- There were some surprises on your images.
The previous diagnosis was incorrect.
You have a glioblastoma
multiforme located-- - Which is worse.
- In your pons.
- Oh!
- [Oncologist] I'm sure I don't need to tell you this,
but it's the most aggressive form of brain cancer.
- Ugh!
- [Oncologist] We estimate three, maybe four months.
(phone dings and vibrates)
- Uh oh, someone's in trouble.
(cheerful merry-go-round music)
- Do you need me to listen to you anymore?
- No, Shaun, it's okay. (Mike laughs)
- Do you need me to listen!
- Hope is irrelevant for me.
Hope is painful.
(somber music)
I don't wanna spend what's left
of my life chasing my tail around in a circle.
- See, I disagree with him a little bit on the hope aspect.
I understand what he's feeling,
and it's part of the process.
But hope is really important in the medical community.
Hope is very important when you have a disease.
Because when you have hope, you can have a more
positive mental state, and a more positive mental state
will give you the best chances,
irrespective of what illness you have.
If you have a cold, you'll feel better sooner
if your mental state is better.
If you have pain, you'll feel less of it
if your mental state is better.
So I think maintaining hope is one of those ways nature
allows us to have a natural relief
of whatever suffering we're going through.
So I like to hold out hope.
- Your tumor is located at the base of your skull.
(stirring music)
An open cranial biopsy would tell us what's wrong.
But there are blood vessels in the way.
The biopsy would cause an aneurysm or a bleed.
But if we go through your nasal cribriform plate,
we can cross the tentorium on the contralateral side
and avoid all those blood vessels.
We can do a biopsy through your nose.
- Caden is still alive, and if we can keep it that way,
there won't be an M and M review, which means no one will be
asking questions and no one will have to give answers.
- M and M is a morbidity and mortality conference.
That happens if someone gets really sick or dies.
We take some of the most complex cases
during these meetings, and you have all the residents there,
all the doctors that participated in the case,
some specialists are required to attend this.
And basically we dissect the case from the beginning to end
trying to figure out what we can do better,
learn from our mistakes, use it as a learning opportunity.
And I've seen these be incredibly educational,
but I've also seen them backfire,
see doctors get into near fistfights.
- Is that from an IV?
(hopeful music)
You did the biopsy.
- I did.
I have a low-grade glioma.
- Not a GBM?
I told you.
- Cancer, Shaun, it's still cancer.
I have to undergo brain surgery,
which is really scary because I'm not the one performing it.
(Mike laughs) Five days a week
for six weeks of radiation, 10 more weeks of chemotherapy.
- And then?
- And then with a little luck,
you and I can go to the Super Bowl next season.
- Yay!
I almost became a concierge doctor.
If you wanna know what that is,
check out my medical drama review of Royal Pains.
Click here.
Click it, click it, click it, click it!
Stay happy and healthy.
(upbeat music)