- It's time for my third Grey's Anatomy review,
but for this one, I brought a friend.
(Soul music)
Please welcome my colleague Dr. Luis Espina,
who I actually did residency with
and he was my senior resident,
so he taught me everything I knew.
- Not everything, but yeah.
- You ready?
(squealing)
We have to do that, by the way.
- No. - No, no, no, come on.
- I'm not doin' it. - No, you have to do it.
- Bee whoop, bee whoop. - Yeah.
- [Meredith] You didn't sign the divorce papers.
Fine, I get it, end of discussion.
- [Derrek] Meredith.
- What!
- I actually don't know anything
about their romance
and I know people in the comments
are already getting their bows and arrows out
to hunt me down. - It's okay, it's okay.
- I don't think they're married,
I think he's about to divorce wifey.
- Ooh.
- And she's trying to get him to do that.
- Dr. Bailey, Henry Lamott, age 42,
is scheduled with Dr. Shepherd
for a spinal implant to control the pain
of his herniated disc,
is allergic to all pain medication.
Is that? - Porn.
- Porn?
As in porn?
- All right, what are we watching.
- Karev, go stand in the hall.
- You have to be sensitive
to the needs of the patient.
- Yeah, but that's overstating it.
Have you had a patient do that?
- No, I don't think,
I don't think the television can get CNN
much less pornography. (laughing)
- Look, we can't have porn in here,
this is a hospital.
- It's for my pain.
My doc says it releases endorphins in the brain,
it helps keep my pain at a manageable level.
- Not gonna lie, if that helps him
over an opioid addiction,
I'm with getting him a private room.
- I am a firm believer
in the what it takes school of medicine
so whatever it takes
to make the patient comfortable.
- Okay, Pete Willoughby, 25 year old,
GSW to the chest, immediate return
of 860 cc's of blood from this--
- I can't handle it, this hurts!
- He's put out more than 200 cc's over the past hour.
- They never tell you in movies
how much it hurts to get shot.
- Push morphine, two milligrams.
Alex, this is my case.
- I don't understand in this show,
when they say a person's lost a liter of blood
that they're hanging out, talking,
casually just chilling. - His hair looked good.
His hair looked good. - His hair looked good.
- Looks like you'll be able
to go home today, Ellis.
- But I still have patients to see.
- No, no more patients.
I'll be back to check on you later.
- You should know,
I'm thinking of leaving Thatcher.
I should never have married him.
I leave him, you leave Adele.
Then when residency's over
we can both get jobs at the same hospital.
- Why don't you get her meds ready
for discharge nurse, thank you.
- I mean, I was an old resident,
but that's an old resident,
if that guy's a resident.
- I don't know if he's a resident.
I don't understand the storyline.
She may be suffering from dementia.
- She may be, yeah.
I mean, I was old but that guy
makes me look like you. - Yeah.
- Well, maybe not quite, but.
- That was a long time ago, remember?
We had this discussion 21 years ago.
- Oh Lou, it wasn't the rain.
I just passed out.
- Actually Mrs. Bradley. - Verna.
- Verna, you presented with lateral
ST elevations and recipricon failure changes
is consistent with an MI.
A heart attack.
So, when a patient has a heart attack,
as they described at a ST elevation MI,
it's called a STEMI,
you got to get a patient right away
into the cath lab, which is where
they put a catheter from your artery,
either from down below or from your arm,
into your heart and either open it up
with a stent or just evaluate
and see if you even need a stent to begin with.
- And there's a very strict protocol
as to how much time it is
from the door to the balloon.
- 90 minutes! - Yeah.
So, you have to be there.
- Door to balloon tops.
- You have to be on the table
and have a cath started.
- I've had a twinge in my back for a while,
I thought it would go away but then last night,
my legs went numb and this morning my back,
the pain is just too much.
- Miss Chue, we're gonna push in a PCA pump.
We'll give you some morphine
which should help control the pain.
- Thank you. - But there's a greater.
- That was quick, huh?
- It's an awfully comfortable PCA pump.
- That's a quick PCA pump.
A PCA pump is a pump that's controlled
by the patient in order to give them anesthesia,
usually there's an opioid in there.
It's programmed so that they can
give themself dosages, but if they're using
it too frequently it times out
and doesn't allow them to do it.
Now, this is good because when patients
have that ability to control their pain relief,
they generally use less of it
and are more aware of how much they're using,
as opposed to when a nurse comes in
and doses it, they may overuse.
- And, in and of itself, being in that much pain
can be just a humbling situation so it returns
some measure of control to the patient.
- What's going on?
- I was just about to explain
that Anna's MRI has shown
that that she has a paplar ependymoma.
It's a tumor in her spinal canal,
but the good news is that we can operate.
You have a 95% chance of fully recovering
if we get you into surgery as soon as possible.
- Do you know about that? - No.
- I don't know about that.
And I don't know how he gets those stats
right off the top of the dome.
- Even waiting another day
puts you at risk for permanent paralysis.
- Father?
- No.
No surgery.
- Mr. Chue, without surgery
Anna will be paralyzed,
probably within the next 24 hours.
- I hate how they talk about medicine
with such certainty,
'cause then it tricks our viewers here,
from going into the hospital,
where don't give them direct answers,
they're gonna be like, "But Derek Shepherd,
"McDreamy, told me that my tumor,
"if I don't operate, a 95."
- I thought you were McDreamy.
No, sorry. - I know, but this guy.
- Mr. Chue--
- We are taking our daughter home.
- Anna, you're over 18.
You don't need your father's consent.
- This is true.
- I'm Hmong and my father's the elder.
If he says I go home, I go home.
- Do I continue to process her discharge?
- [Derek] Yeah, we have to.
It's insane, but we have to.
- Well actually, we wouldn't process
this as a discharge,
we would process this as an AMA,
which is leaving against medical advice.
'Cause if we're telling a patient,
"Hey, you may have a disability
"if you don't get this surgery immediately,"
and they choose to leave,
we have to say that they left
against medical advice, otherwise they can say
we told them to leave
and then something tragic happens, right?
- Right. - It's illegal.
- You'd be responsible.
The problem that you have there
is that you want to try
to convince the patient and the family
with logic and reason, but also some empathy.
Because if you just throw the AMA papers
in their face and walk out the door,
they're definitely gonna leave.
So, sometimes it takes a little bit of honey
to catch the bees.
- I was married for 11 years,
Addison is my family.
That is 11 Thanksgivings, 11 birthdays,
and 11 Christmases and in one day
I'm supposed to sign a piece of paper
and end my family?
A person doesn't do that,
not without a little hesitation..
I'm entitled to a little uncertainty here,
just a moment to understand the magnitude
of what it means to cut somebody out of my life.
I'm entitled to at least one moment
(door opening) of painful doubt.
- I know nothing about their relationship
but that sounded very logical to me.
Y tu?
- You might want to have thought about that
before you jumped in bed with the intern.
- Scratch my previous piece of advice,
I'm going with Dr. Espina, my elder.
- You might want to have a little doubt
before you run off with the attractive colleague.
- Dr. Shepherd, still here I see.
- I couldn't leave you.
Have you seen the other Dr. Shepherd?
- I'll tell him you're looking for him.
- Ooh, that's his wife? - I guess.
- Oh.
- Hey, I got Verna Bradley's test back,
I don't think she had a heart attack.
- Yeah, but look at the changes in her EKG,
she had something.
- Yeah, but her serial enzymes
and dobutamine stress echo came back negative.
I actually think she's.
(laughing)
- Her dobutamine stress echo came back negative
while she's having a STEMI.
Let's explain what a dobutamine stress echo is.
So, an echocardiogram
is an ultrasound of the heart.
You can give a chemical which actually
stresses the heart, makes it beat more rapidly,
which, therefore makes more blood flow occur.
Now, you can look at the echo
and see how the heart responds,
to see if the walls of the heart
are moving appropriately,
if blood flow is circulating
appropriately within the heart.
But now, why are they doing a test like that
on someone who's actively having a heart attack
based on the EKG, let's do this
as a patient simulation.
We have a late 40's female,
syncopy, chest pain,
negative cardiac enzyme with ST elevations,
with a negative stress echo.
What's you're diagnosis of this lady?
- She's having a MI, so that's my.
- You would say she's having an MI?
- Heck yeah.
- You're gonna say she has
a left anterior descending lesion.
- I'm saying, until proven otherwise,
there's something in the left anterior descending,
however, there's gonna be more drama
and I'm gonna be wrong.
- I have an idea. - What's that?
- She did something bad
and she has takotsubo carditis.
- No, she didn't do something bad,
her husband did and he's stressing her out
and she has takotsubo or broken heart syndrome.
- Well, that's not a bad guess, though right?
- You're really, no, you'd see it on the echo.
- No, if it's resolved, it's a stress response.
- It doesn't resolve that fast.
(elevator squealing)
- Ooh, you in trouble now.
They're gonna crack his chest in the elevator.
- No they're not, no they're not.
- They're gonna crack his chest in the elevator.
- No they're not, no they're not, no.
- [Alex] Dude, we're not moving.
- Really, you think?
- You need a strong hand
and a pair of sharp trauma shears right now.
- Oh.
- That doesn't really happen.
- We have generators.
- [Preston] How's the patient?
- He's not looking so good.
- You're a doctor and that's your explanation
of what's happening?
Give the rhythm, give the pulse.
- Have you even even heard of the Hmong people?
Our religion has got rules that are way old
and way set in stone, and way spiritual
and you don't mess with them.
And you don't anger the ancestors.
Even if you pierce your tongue and play in a band.
- What are the rules, exactly?
- Good, when encountering a situation
with a patient that culturally,
it's something that you are not familiar with,
smartest question thus far in the show,
what are the rules?
By knowing that, you might be able
to find a point of compromise
to fix the situation.
- Apparently Anna's father believes
she's missing something
that she needs for surgery.
- Missing something?
Missing what? - One of her souls.
We don't need a social worker,
we need a shaman.
- Get a shaman.
- You definitely did not have a heart attack.
- So I can go home?
- Not yet, your EKG shows significant changes
and I'm gonna find out why
before you leave the hospital.
- Got to get home.
- Pete, you're in a hospital.
- [Pete] Need to get home.
- So when you lose a lot of blood
you become hypoxic.
You're brain's not getting enough blood flow.
When your brain doesn't get enough blood flow
it doesn't get enough oxygen.
When your brain doesn't get enough oxygen,
it starts saying crazy things like,
you're in the middle of an elevator that's stuck,
bleeding out from your chest
from a gun shot wound
and you say you want to go home.
- O'Malley, blood pressure.
- I've taken it three times. - And?
- I can't hear a systolic over 50.
(whistling)
- So that's quite dangerous,
that means he's not getting profusion
to his vital organs,
including his liver, brain, and kidneys,
which means that those organs
are currently dying.
- I'll be right back.
- Wait, where are you going?
- To get an instrument tray.
You guys are going to have to open up his chest.
- Hot damn.
- I'm just gonna have to get a shaman,
today, in the hospital.
- Shaman's aren't listed in the yellow pages.
Our shaman is 500 miles from here.
You are an arrogant man.
- No, I'm just a guy with access to a helicopter.
- Cool, let's see how this is gonna happen.
- Hey, where are you two going so fast?
- Burke is talking George and Alex
through heart surgery in the elevator.
- Shepherd's setting up a shaman healing ritual.
- [Izzie] Rock on!
- I have porn guy.
- This show is really medically inaccurate
but it's hilarious. - It is, it's funny.
- She has the porn guy. - That's funny.
- Wouldn't have residency been much more fun
if it was like this?
We didn't have to operate in the elevators,
we didn't have shaman,
we just had patients who had no insurance
that we had to battle to get them treatment.
- You never shaved your legs. - What?
- [Preston] But be sure you don't
cut in to the lung or heart.
- How can I be sure of that?
- You just have to be sure.
(laughing)
- On this date, for the past seven years,
you have what looks like a heart attack.
- No, no, I know I've had some scares but I don't--
- Every year on this date?
- Is there some significance to this date
for you personally?
- No.
Nothing.
- What were you doing the first year,
the first time you had a cardiac episode?
- Oh, I couldn't remember back that far.
- We were in the yard.
I remember because our neighbor,
what was his name?
- Ted.
- That's right, he died of an aneurism I think,
and we watched as the funeral home people
took him away and you had your first attack.
- And you were close to Ted?
- No, we barely knew Ted.
- She shaved her legs.
If this is takotsubo's I'm gonna smack you,
I'm telling you right now.
- Come on, that's impressive.
- [George] It's beating a little stronger.
- [Preston] Excellent, keep your finger there.
- Okay, now what?
- That's it. - That's it?
- What's wrong with that picture?
- There's open flame in a hospital.
- And why is open flame in a hospital,
especially in that bed, really dangerous?
- You've got oxygen around there.
- Oxygen's a little flammable.
- Oh, it potentiates the fire, yeah.
- Poof.
- You have stress cardiomyopathy.
- Cardiomyopathy.
- Bravo Dr. Mike.
- I have an offer from Boston General.
- You took it to get away.
We swore we'd never talk again
about what we had together.
- This reminds me of The Notebook.
You guys ever watch The Notebook?
Romantic movie. - I didn't see it.
- You didn't see it? - No.
- We should watch it, like a bro night.
- Yeah, no. (laughing)
- It takes away his pain.
You see, the thing is, Henry?
Henry takes away my pain.
- Humans are weird.
All of us, myself included.
- Well, we're all unique and again, whatever.
- Did you just use a synonym for weird?
In a more positive tone?
- Yeah. - Usually you're the dark one.
- I am, I am.
I don't know, I'm in a good mood today, but yeah.
- It's probably 'cause of the porn.
- It must be the porn.
- Choose me.
Love me.
I'll be at Joe's tonight so if you do
decide to sign the papers, meet me there.
- Oh, no, you didn't like it?
Too narcissistic for your taste?
Pick me.
I hope you enjoyed our little collab here.
If you want to see a playlist of all my collabs
with Ricky, Ava, Gabby, Molly, click here.
Do it, say click here.
- Click here.
- And stay happy and healthy.
(soft music)