- Not even one year ago, I was a resident.
Now there's a TV show called The Resident.
Let's get started.
(upbeat music)
(classical music)
- It is true, surgeons play their favorite music.
- Oh yank that sucker.
- When they're operating.
- Did you guys know that this is my first surgery
with doctor Bell?
- No kidding, we have to get a photo.
- Make it quick.
- Get in, Chu.
- Okay, no, no one's taking out their cellphone
in the middle of an operation and taking selfies.
- I wish we could get one without the mask.
- Quit clowning, Chu.
- Uh oh, tremor?
- Just one more, I think we got it.
- I'm going to send this to my mother.
- You'll get us all fired, cameras aren't allowed in the OR.
- He's waking up, I need to up the C-roll.
- Oh, oh.
- Oh my god.
- Did you hit an artery?
- On an appendectomy?
- You're losing blood fast.
- I need two liters of normal saline
wide open
Call for four units of blood
and do FFP STAT.
- I can suction.
- He's breathing very heavily, rightfully so.
- You've got to clamp something,
he's lost at least two liters already.
- Come on! Come on!
- What splattered on him may be a quarter of a liter,
two liters is a lot of blood,
and that's probably not two liters.
He has some shaky hands,
may have hit an artery.
When you hit an artery,
it does splash like that.
The first step during a surgery
is to get one of the tools called the Hemostat.
And basically, it clamps off the artery
to get it to stop bleeding.
- CPR isn't going to put all that blood back into his body.
- Whoa.
- Don't die on me!
- Happy?
I'm assuming this is someone's bad dream,
because they're not following proper protocol.
I have no idea why he's stopping CPR.
Nothing makes sense here.
- He's so... dead.
(flatline noise from machine)
- Time of death
- Okay, okay.
Whoa.
You guys told me The Resident is the most accurate
medical show on television.
So far,
this has been incredibly inaccurate.
This gentleman's heart stops in the middle of the procedure,
because he was losing blood.
They were supposed to get blood
and start the blood flow through an IV.
They started chest compressions.
They didn't follow the cardiac life support algorithm
of getting epinephrine,
rechecking the rhythm after two minutes.
And it looks like that called the time of death
after 30 seconds.
- Well, I think we can all agree missed dose-
- What?
- Let this unfortunate situation-
- What? You're kidding, right?
- The patient woke up, his arm hit my hand.
- You left the blade in the field.
You nicked the artery.
- Well, you never should have OK'ed him
for surgery in the first place.
His INR was abnormal.
- The upper range of normal.
That's never going to fly.
- You know what, I'm-
- We're all on the same team, here.
Right?
- Oh my God.
He's trying to blame it on the patient
coming in with a high INR,
which is basically the ability of the patient...
The inability of a patient to clot properly.
So, if you have a very high INR,
you're more likely to bleed out.
If this happened, I hope that the people around me
have the courage to speak up
and say something about it.
In fact,
one of the biggest initiatives
that have been going on in hospitals
over the last ten to 20 years,
is give nurses the voice and the courage
to speak up when they see doctors,
especially senior doctors like this gentleman,
who's a Chief of Surgery,
who has been practicing for 30 years,
to speak up and say
"No, you've made a mistake and you need to own up to it,
and figure out what went wrong,
and how we can prevent this in the future."
This is awful.
This is an awful situation.
I have goosebumps, honestly.
- You have 206 bones, and I can name each one.
(laughs)
- It's a very cheesy way to turn somebody on.
- Everything you thought you knew about medicine is wrong.
All the rules you followed, we'll break.
I have only one rule,
covers everything,
I'm never wrong.
You do whatever the hell I tell you,
no questions asked.
- I can't take this guy seriously.
He sounds like he's from a Western movie,
and he's like, "Welcome to the wild, wild, West."
Yes, in reality,
medical school is quite different
from life as a resident.
There's a lot you think you know
about working in a hospital.
When in reality,
you start working in a residency,
you realize that you didn't know,
or what you thought you knew
was actually wrong,
and you practice it in a different way.
That's why those who get overly confident,
by regurgitating facts and figures,
really have their minds blown
when they enter the hospital,
and they see the way medicine is practiced.
Because humans are very complex,
they don't present like the way the textbook
says they will present.
They don't always give you a clear indication
of what's wrong with them.
It's a lot more of a puzzle
and figuring out what's going on.
The heart of what he's saying is true,
the way he's presenting it
is way overblown and dramatic.
- My last resident had an attitude, too
and do you know where he is now?
He's teaching eighth grade biology.
- (laughs)
- I cut him.
You know what that means?
It means I can end your career,
just like that,
remove you from this residency,
at any time for any reason,
and if I do that,
no other residency will take you.
- Completely untrue.
Senior residents don't have the ability
to get you kicked out,
unless you do something, just horribly wrong.
And, if you lost your spot in a residency,
because you disagree with the senior resident,
it doesn't mean that no other residencies will touch you.
Again, a completely overblown statement.
Untrue.
I guess for the dramatic factor of the show.
- This is Dobroslav.
He's Croatian, speaks no English.
He has severe cauda equina syndrome.
What are we worried about?
- Early paralysis.
- Hey, man.
- What's the first sign of paralysis?
- Anal tone.
- Stick your finger up his ass.
- (laughs)
- Normal procedure is to get an MRI.
- Thank you so much
for telling me about normal procedure.
- Cauda Equina Syndrome is where you have
severe narrowing of the area of the spinal cord,
where your nerves travel through.
So, you lose sensation of your lower limbs,
you lose the ability to have proper anal tone.
Some people have incontinence,
where they just pass their bowels,
they lose urinary control,
and just have urinary incontinence,
meaning that they pee themselves.
And, if any of those things happen,
you have to call 911
because Cauda Equina...
This procedure... this condition that they're talking about,
is a medical emergency.
Obviously one of the ways to test that,
is to do a rectal exam,
and check the sphincter tone,
but he's being really rude about it. (laughs)
- Good afternoon, we need to explore your rectum.
(translates to Croatian)
- Back in the day, we used to have translators
that lived in the hospital...
I mean, worked in the hospital.
Now, we have really good intercom systems,
some hospitals even have iPads
that connect you to another person,
who can be the functioning translator.
The correct way to do this,
is to not talk to the translator and have them translate it,
but talk to the patient, normally,
and have the translator
somewhere behind you, or on the phone,
talking to them, translating.
So, you're still having a conversation with the patient,
not a conversation with the translator.
That's a very important distinction to make.
I was hoping this show wouldn't involve sex,
but I'm striking out week by week.
Because apparently,
everyone's in love in the hospital.
Maybe I've just worked in the wrong hospitals.
- Acute Leukemic on chemo,
fiancee called because she was shaking uncontrollably.
- She spiked a fever of 100.8
- So, commonly someone who has chemotherapy performed
on them, they can develop something known as
neutropenic fever, it's when a specific type
of white blood cells is very low,
and you have a fever.
It's a very dangerous situation.
Broad spectrum antibiotics,
meaning antibiotics that cover a whole host
of different bacteria,
need to be given right away
in order to prevent the person from dying,
because their immune system
is incapable in dealing with bacteria on its own.
So, I think this is a pretty interesting case, already.
And I've just seen like five seconds of it.
- There was some vomiting,
there was no blood in it,
last chemo was a week ago.
- Hey.
- You're here.
- Very accurate presentation so far,
knowing when the last chemo treatment's
very important, when judging
what the next step of the treatment plan is.
- I'm scared.
- You're running a fever, it's just another infection.
Chemo's still crushing your immune system,
we'll get you started on broad spectrum antibiotics,
again, and acetaminophen to get your fever down.
Get cultures from both arms,
urine,
she'll need a head CT.
- Okay.
- Don't worry, we'll get this under control.
Get you both back home soon.
- Having a good rapport with patients like that,
is very important.
Nurses, and some doctors, even people that are just
spending time in the hospital,
for short periods of time,
are very somber when they're around sick people.
Especially chronic sick people,
who have been sick for a long period of time.
But in reality,
they would love for someone to come in
with a little more lighthearted approach,
can laugh with them,
make them smile.
I'll always try and have a laugh with them,
and tell some jokes,
especially if I know the family well.
And, I think that makes a very unpleasant experience
a little bit more bearable.
That's just my take on it.
- How'd you get that cheeseburger, Chet?
- Delivery app.
- (laughs)
- Looks like you haven't been following your diet.
- Diets don't work.
- Have you been taking your insulin?
- I don't want a lecture, Nic.
- What?
- I'm here 'cause my toe is killing me.
- (gagging noise)
Severe gangrene.
- (laughs)
So, a gangrene... this is really gross.
A gangrene in his toe,
could be so infected and dead,
that it's basically necrotic,
that means dead tissue.
Then it can fall off like that.
Obviously it's a little exaggerated.
The smell is probably the worst part of all of it,
because the bacteria,
once they eat your tissue,
they release a very foul smell.
It will light up the entire room.
I'm not talking about,
you have to sniff the wound.
As soon as you walk into the room,
and there's gangrene present,
you're going to smell it.
That is very true.
- (screaming)
- Settle down!
- Calm down!
- I need you to look at me.
- New admission. 21 year old girl,
history of IV drug use.
Likely endo.
- She was trying to steal Dilaudid,
now she wants to leave AMA.
- She's been spiking fever, vommitting.
- She's using again, isn't she?
She took all my money-
- Those who use drugs,
especially injection drugs,
they're predisposed to a whole host of illnesses.
So, this is a common presentation, unfortunately.
Especially in light of the opioid epidemic
that's going on right now.
When you inject into your body, anything,
especially in a non-sterile technique,
meaning the needle isn't clean,
your skin isn't clean,
you're more presidposed to things like
meningitis, endocarditis.
Meningitis is an infection of the pads
surrounding the brain.
Endocarditis is an infection of the heart valves.
These are life-threatening illnesses
that can make you act this way,
because bacteria is festering in your body.
And unless it's treated quickly and correctly,
you can die.
And that's just talking about an infection.
Think about all the other things that could be going on.
When you're under the influence of drugs,
it's very possible that you're acting this way,
as a result of an overdose,
from simply the drug.
But when a patient comes into the emergency room,
and they're presenting with this kind of outcry,
screaming,
what we call altered mental status, AMS.
We have to figure out,
is it related to the drugs?
Is it because of an infection?
It is something more sinister?
Has this patient had a seizure?
There's a lot of things that are happening
simulatenously in a doctor's mind.
So, it's not an easy situation to deal with.
But, ER doctors are the frontline of dealing with it.
And once the patient is stabilized
and ready to be admitted into the hospital,
it then goes to internal medicine doctors,
like this gentlemen,
or family medicine doctors, like myself.
- If you walk out of here without any antibiotics,
this will kill you.
If you give us a chance,
we can save your life.
- I'll stay, if you give me three milligrams of Dilaudid.
- (laughs) Two. If you calm down.
- I can't say what he's doing is wrong,
because she's likely withdrawing from Dilaudid,
or opioids, or heroin,
whatever it may be.
In order to help her condition,
it's possible that you need to taper her off,
meaning give her smaller and smaller doses,
more spaced apart,
of the same chemical that she normally gets high on.
Plus, if it's going to make her reconsider,
and stay and get treated with antibiotics,
for her endocarditis,
you're saving her life.
Some people may disagree with this approach,
and say, "Absolutely not, she's not getting Dilaudid."
Some will say that there is a medical benefit.
So, that's why practicing medicine is an art,
it's not a science,
because two doctors can look at at the same situation
and have different approaches for salving it.
I understand what he's doing,
and I sort of respect it.
Oh.
- Chloe, baby!
- Get a crash cart!
- I'm not getting a pulse
- Code blue-
- Get them out of here!
- Someone falls, and they have no pulse?
You call for help,
and without even thinking about it,
you're pumping on the chest, chest compressions.
Chest compressions save lives.
I've said it before, chest compressions.
I'm going to say it one more time, chest compressions
is the first thing you do,
even if you have no training in it,
start pumping on the chest.
- You're running the code.
- I've never done a code.
- Do you want to amp up the Bicarb?
- He's in charge.
- Page anesthesia.
- When you're running a code blue,
you're following the
Advanced Cardiac Life Support Algorithm.
It's literally written out for you.
You give each person a role.
You do chest compressions,
you monitor the medications,
you monitor the time,
you monitor the rhythm,
and everybody has roles.
After that, there is a specific algorithm,
you literally follow steps on little cards
that you can carry in your pocket,
of when to recheck the rhythm,
what medications to give,
what options of medications do you have,
what dosage.
- What is the first question you ask in code?
- Rhythm.
What's the rhythm?
PEA.
- PEA is Pulseless Electrical Activity.
It basically means,
the heart has a rhythm,
but you do not feel a pulse.
There's some electricity going through the heart,
but it's useless,
because it's not creating enough of a muscular motion,
within the heart,
to create a pulse,
to make the heart beat.
PEA is not a shockable rhythm.
Meaning, you do not use the paddles for that.
You use epinephrine,
you use drugs,
you use chest compressions,
and you hope to get the patient back.
And you wait for the rhythm to change,
into one of the two shockable rhythms.
- Should we shock?
- No, we can't.
Her rhythm's not shockable.
Give me one of epi.
Make those compressions harder and faster.
Prepare to intubate.
- So, when you're doing chest compressions,
you want to make sure
you're doing quality chest compressions.
You want to push at least two inches deep into the chest,
which sometimes can break ribs.
It's a horrible sound to hear,
but you're doing this to help resuscitate the patient,
basically bring them back to life.
So, if on the off chance you break a rib,
that's okay.
It does happen in elderly folks,
much more than in young folks.
You also want to do it to at least
100 beats per minute.
So, if you think,
there's 60 seconds in a minute,
you're pushing a little bit faster,
than once per second.
A good way to sort of monitor if you're doing it right,
is to sing the song,
in your head, please,
Stayin' Alive,
because that does go to about
100 beats per minute.
It's the classic way that we're taught.
(singing) Ah, Ah, Ah, Ah, Stayin' Alive!
(laughs) Funny that it's called Stayin' Alive,
and we're trying to bring someone back to life.
But, that's some of that raw, medical edgy humor (laughs)
- It's been 24 minutes,
it's time to call the code.
- No! This is my code, you gave me this code.
- We've got a pulse.
- You saved her life.
- Doing a code on a young person for 20 minutes
is not unrealistic.
Also not unrealistic to recommend stopping the code,
because the brain,
without oxygen for 24 minutes,
is obviously very dangerous,
and again,
even if you bring the pulse back,
will the brain work again?
You won't even know until the person wakes up.
The first line that one of the other residents
tell him, is "You saved her life."
In reality,
that could be a great thing.
But also, on the other hand,
it could also be an awful thing,
because she may just need to be on a ventilator
for the rest of her life.
Functionally brain dead.
Just her heart beating, and her lungs working,
because she's on a machine.
So... very difficult situation to find yourself in.
- You came in here,
all bright and bushy-tailed,
ready to save lives.
But today you didn't save a life,
you saved a brainstem.
You didn't listen to me.
- Did he do the wrong thing? Not necessarily.
In this situation, especially because
it looked like their family was there,
this is a time to have a conversation
with the family, very quickly,
and explain to them what's going on.
Explain the consequences of,
"Hey, if we bring her back,"
"at this point,"
"20 minutes in,"
"she could come back with a pulse,"
"but also be brain dead."
And help them decide what to do in this situation.
Allow them to make the decision.
Because you know,
they're her next of living kin.
Some hospitals have a cooling procedure,
that when someone undergoes either a heart attack,
or a sudden stoppage of the heart,
like she did,
that they cool the body down,
which slows the metabolic rate,
which can help the brain survive a little bit longer.
So, this doesn't always hold true.
Don't use this as an application for your own life,
or making decisions for your family's life.
Treat each situation on its own.
Talk to the doctors in front of you,
and make the best decision that you can,
with the information given to you at the time.
- What was rule one, Devon?
- Do whatever you tell me to do.
No questions asked.
- All we want to do is help our patients.
But what they don't teach us in medical school,
is there are so many ways to do harm.
- The first job of the doctor is not to heal,
it's to first do no harm.
Because if you look at the history of doctors in the past,
we've made a lot of mistakes,
over treating patients, under treating patients,
deciding what's right for our patients,
and going against their own wishes.
I think we've done a lot better in recent years,
but there's still plenty of room to go to improve.
- If it were easy, everyone would be a doctor,
because this is the best job in the world,
despite everything.
Because of everything.
- There you have it.
The Resident, season one, episode one in the books.
Initial impression...
The show is absolutely ridiculous.
This resident,
while he's, you know, smart,
and has some experiences,
he just does some crazy things.
He's a cowboy in my eyes.
Deciding who lives and who dies.
I'll say that they way they're talking about the
medicine is accurate.
Some of the medical terms that they use
are used accurately.
The procedures,
somewhere in the middle... 50/50 of their accuracy.
I think it's going to make for a fun show.
I definitely relate more to this show,
because it's more internal medicine,
and I'm family medicine,
so I practice a lot of internal medicine on my own.
As compared to Grey's Anatomy,
which is a surgical show,
and I'm less of a surgeon.
I like watching all medical shows.
So, if you have a show you want me to watch,
or an episode of this show,
or any other show,
drop it down below in the comments.
And again,
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As always, stay happy, and healthy.