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Welcome to Inside the Pit, where the drama of the pit meets the reality of emergency
medicine when your hosts, Heather Pierce and Dr.
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Adrian Koyce, go beyond the characters to explore the clinical decisions, healthcare
issues, and real-life outcomes behind what happens inside the pit.
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All right, welcome back to the next episode of Inside the Pit.
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Today we are on season one, episode 10.
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This is the 4 to 5 p.m.
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hour.
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Um, I don't know if this is like when the crazy starts happening, Dr.
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Christ, because it's the end of the workday or what.
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This is like the evening, we're gonna get to the evening hours, but um, there's there's
some stuff brewing here.
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So we just came off of episode nine.
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Yeah, what what are you feeling?
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How are you feeling about episode 10 right now?
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Yeah, you know, I thought uh typically typically this is the time in emergency
departments, they generally start to heat up from midday through to this time of day.
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And this is the time of day where you really start heating up and you get lots of patients
in and you end up seeing lots of waiting in your wait room.
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But my gosh, this hospital has had waiting room like that from the start of the day.
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So I can't imagine what's gonna happen for the rest of the season.
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But yeah, we we kinda ended on a bit of a uh talking about
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violence in the workplace for our previous episode.
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So I don't know.
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Seems like that's a pretty good place to start.
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Yes, our our very favorite Dana, the charge nurse, who got punched by who I discontinue
calling him the jerk off guy.
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he doesn't deserve a name.
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He's mean.
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He's so horrible.
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And I wanna like, yeah, I wanna punch him back.
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so she goes to CT, right?
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So she goes through that, she falls on the ground at the end of this the episode, and then
they bring her in.
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So ha i if if somebody gets hurt, and we were talking about this, right?
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Like somebody actually gets physically assaulted.
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There's certain protocols that they're dealt with.
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I mean, you could see that with how they were if Dr.
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Robbie was kind of assessing her.
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Yeah.
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Yeah, for sure.
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I mean, look, essentially there's there's the medical piece and he essentially did a a
trauma evaluation for her, specifically looking at her face, making sure she didn't have
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any facial fractures.
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So she ended up going down to the C T scan, which ruled out brain bleeds or facial
fractures.
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Um, you know, that sometimes needs surgery.
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so uh and I think that he was able to do that effectively.
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you know, and then I think
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And it I think it turned out that she was totally fine from a uh injury perspective,
right?
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She didn't have any any issues um or or traumatic injuries that needed surgery or
something like that.
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Um, but I I think you could tell and I hope the the viewers would would be able to pick
out that she was very much like, no, let's I just gotta get back to work, I've got to get
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back to work.
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And that's part of the problem, right?
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We sort of alluded to it before is that a lot of healthcare workers just think that, it's
part of the job, you know.
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It comes with the territory.
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and the reality is is that it's not.
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It shouldn't happen.
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And it should and it should be something that we should feel like we can go and do our
jobs effectively.
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Um, because we are where we are expected to perform to a high standard, providing the best
quality of care.
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and then you think that you're trying to do that while you're also trying to, you know,
protect your own body.
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Um, that that just makes it very hard to do that.
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Um, so yeah.
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I mean there's I I I pulled up some stats in preparation for this one, um, just looking at
at the types of violence, particularly towards nurses, um, and a report out of the
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National Nurses United, which I don't actually know the organization, but this is very
similar to a lot of the the the data that I've seen previously.
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Um and maybe I can ask you some questions, Heather.
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You can do the guessing you can do the guessing game.
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What's uh what do you think is the percentage of nurses that would report they've been
verbally threatened?
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Verbally threatened, I wanna say that's probably pretty high.
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I'm gonna say like 85%.
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Not quite that high, seventy percent in this report of twelve hundred.
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What about what about people that have been slapped, punched, or kicked?
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Mm, that's gonna be lower, right?
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So I'm gonna but I say like at least half, right?
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Like fifty, fifty five percent.
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In this report, thirty-three percent.
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You are, you are.
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I think we tea I teed you up.
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I teed you up.
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but then also just you know, sexually harassed or made comments about their their
appearance, um, about their bodies, that that's around forty percent.
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wow.
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you know, so just what bottom line is this, it's very prevalent.
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Um and and it's you're you're then expecting them to do a lot of like very challenging
jobs.
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you know, simple things like giving medications.
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Um I always say that I always say that doctors are I I always say that the nurses are the
ones who actually heal patients, um, because they're the ones that are in with the
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patients when they're sick, they're talking to them, they're the ones that are doing
spending the time with them.
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giving a medication, seeing how it works, reevaluating them, you know, then coming back to
the physician and saying, hey, this medication didn't really work, or it's working, but
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they still need, you know, a little bit more.
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Um, so, you know, they're they're the ones that are really doing the hard work and the the
heavy lifting of actually helping the patients get better.
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Um, you know, the physicians really are just doing the like assessing and figuring out
what's wrong and then
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making the orders and the the nurses are the ones that are doing the hard work of actually
healing the patient.
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So um when you're trying to heal someone who is also sexualising you or hitting you or
verbally abusing you, that's a that's a really hard job.
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Um and it shouldn't be something that we say is just part of the territory.
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we should be we should be it demanding more um and better safety for our for our co
workers.
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Yeah, I agree.
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I've fortunately never been witness to anything like that.
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Um, thankfully, but clearly think I it happens more than it does, but it's still high
numbers.
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Um, one of the things too that I thought was and I want to ask you about this is kind of
like the, you know, you just go back to work where Dana and Dr.
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Collins, who which we haven't really talked about, and she she had an she had a
miscarriage while working, like on her own.
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Totally alone, dealing with it by herself.
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Um, and this has come up, right?
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And like every single episode, something with her having this miscarriage for the last
three episodes.
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And the two of them got in that bed in one of the um the trauma rooms or whatever, um, the
triage rooms.
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And the two of them just kind of sat there, laid there next to one another and had that
like really special kind of emotional moment because Dana, Dana knows that Dr.
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Collins had um a miscarriage.
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during the shift.
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And yet she's still working and dealing with, you know, Dana.
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She's like, nope, I'm going back to work.
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Right.
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And then she walks back in there.
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Like I was just like, How?
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How are they doing this?
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Yeah.
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I just want to go home.
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For sure.
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And that's that's those are the those are the the the themes that keep coming up is that,
you know, patients or the physicians and the nurses and and the the custodian staff, they
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will have, you know, have dealt with some horrible trauma and then have to walk into
someone who's like yelling at them about wearing a mask or yelling at them not to give
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them a vaccination or or whatever it is.
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Um, you know, and that sort of like switching and kind of like not dealing with something
that
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you know, a very emotional thing that you've just gone through and then continuing to, you
know, press on.
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That happens across healthcare and across the show.
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more specifically with Collins and her miscarriage, when in my notes I was looking back at
at the f when that actually happened, the thing that I wrote after Collins miscarriage I
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said Collins miscarriage, and then I wrote how lonely that is.
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Um and I think that's something I think that's underappreciated is that how alone women
are.
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when they have a miscarriage.
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Um and and it's actually a pretty good metaphor for just women's healthcare in general,
with the lack of, you know, research dollars that have gone towards it and, you know,
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understanding of of how, you know, disease affects women uniquely.
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And then beyond that, just policies that are currently being made that are taking away
healthcare access for women, you know, access to abortion as as the most prominent
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example.
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And then even just contraceptive medications.
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those those things I think are are incredibly massive issues that make peop women less
healthy.
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and we need we it's something we need to change.
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Um and that only comes by making some pretty bold policy decisions and and investing in in
those in those research avenues and and public health initiatives.
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Yeah.
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Um so yeah but mean agreed and and miscarriage for example, like just back on the
miscarriage piece, it's so common.
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Um, you know, I think that if you were to talk to, you know, if you so it's one in four to
one in five.
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Um, you know, sometimes people you can see stats that say one in six of all pregnancies
end in a miscarriage.
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Um, so it it's and maybe some peop some women don't know that they actually had a
miscarriage, maybe they had, you know, a heavier period than they normally would have had
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or it was a little bit late or something like that.
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Um, you know, other women definitely know.
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Um
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You know, and and this like this intuitive sense that women have about about being
pregnant, um, and then and then the loss that they have when they do have a miscarriage.
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And I think that there's been this cultural like norm where that's th that's women's
business, you don't talk about it.
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Um and I fortunately I I I think I see that changing just from a cultural perspective.
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but just how lonely it is.
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Um, and then to think that you don't
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have a space for some women, particularly in the US, you don't have a safe space to come
and seek care.
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It's a horrible position to be in.
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Yeah, it really is.
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Yeah, I d I I wanted to touch on that.
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I didn't realize it hadn't come up.
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And then just that moment with with Dana and and Dr.
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Collins just um I don't know.
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It just you know, we we ask a lot of of our healthcare providers.
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and I think that the the show, I think the pit did a really nice job of portraying exactly
what kind of pressure we do put on them um in order to then show up for us when we show up
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sick and
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pissed off or whatever it is into the ER and sent, you know, and expecting to be to be
supported all the ways.
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So anyway, with that, let's move on.
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What what I you have a couple of other there's a couple of other situations in this
episode that we want to talk about.
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Um the stroke patient, the burn patient.
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do you wanna start with the stroke patient first?
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Yeah, yeah, let's talk about the stroke patient.
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So that was, I think it was an online gamer or an online poker player or something.
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Very young, had come in with a stroke to the middle cerebral artery.
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So that's basically the art, there's three main arteries in the brain.
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Um, and this is my very you can tell I'm an emergency doctor, that's simplifying neurology
here.
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You have the anterior, the middle, and the posterior.
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Um, and based on where you get a blockage of one of those arteries, you get very specific.
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patterned symptoms.
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So the MCA typically will take out this sort of this side of the brain, which is
responsible for the upper and lower body on the other side.
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ah So if you have a stroke on the on your left side, you will get symptoms on your right
side and it typically will result in a motor deficit.
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So that like weakness and strooping of face on one side.
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ah Now this person had had a vertebral artery dissection.
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So the two arteries that run through the vertebra um in the neck.
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um the basically the wall of that kind of sheared away and it it threw off a clot that
goes up into the brain um and causes the causes the stroke.
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ah I wanted to talk about this case because I think it's it's a really important public
health initiative to talk about recognizing the signs of stroke and coming in to be seen
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very quickly.
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There's this four and a half hour window of time to to get identified as having had a
stroke and a large vessel occlusion like that.
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Um, because we can give the thrombolytic, which is what this patient received.
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So it's a medication that breaks up a clot.
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Ah, okay.
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And I've I've only given it once in my career.
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and I've dealt with many, many strokes.
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And part of that is because patients um either don't come in quick enough, so they're
outside of that four and a half hour window from onset of symptoms, so we're not able to
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give that medication, or they are having um only a very small stroke um that doesn't rise
to the level of needing that thrombolytic medication, or they're not having a stroke and
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we activate like they are.
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and it turns out to be something else, like a urinary tract infection or an electrode
abnormality or a migraine or something like that.
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Um so I think the take-home here is understanding the signs of um of what a stroke could
be.
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And the AHA and the American Stroke Association have a a mnemonic called BFAST that they
look at, um, where they look at, you know, how's their balance?
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Are their eyes, you know, do they have dizziness or blurry vision?
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What's their face look like?
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Are they able to move their arms?
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So that the and and we can we can put a link to that, I think, because I think it's a
really important one, just the American Heart Association and and stroke, what to do in
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terms of recognizing a stroke.
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Um, you know, and and I and in fact I have a I have a I just recently did a a an episode
on it that'll come out on my YouTube channel as well.
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So um that that would be a really good one for people to look at to know a little bit more
about that.
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That's a good idea.
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But I think it's really important that that folks understand what the signs of a potential
stroke are and just have a very low threshold for coming in.
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That's what we're set up for and that's what we're designed to to do.
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And I always say time is tissue.
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So um getting that under control and getting it identified early is super important.
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And you could see that as she got that medication, the patient started to talk again and
move her arm.
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And it and it is the one the one case that I've given.
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You know, and I've been an emergency physician for
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what is it, six years now and then a a doctor on top of that for for since for a further
five years, you know, that's uh seeing the patient essentially come back to normal on the
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end of your needle is is an incredible thing to witness.
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So yeah especially for such a young person.
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Yeah, and I I loved it when the um the two dots they were so excited they were like, yay,
like jumping up and down when she started coming back.
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Now having a stroke in your twenties though, right?
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Like that's pretty unusual.
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You know, and unfortunately, as I've gotten older, right, I'm 49.
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Most of my friends are turning 50 or in their fifties.
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I know now two people my age who have had strokes.
205
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Right.
206
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One really bad.
207
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The other one was like after a hernia surgery recently.
208
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Um
209
00:15:38,016 --> 00:15:40,159
Nothing like my friend who had the stroke two years ago.
210
00:15:40,159 --> 00:15:44,012
Like it's, you know, it it's like forever she'll have issues.
211
00:15:44,274 --> 00:15:45,706
It's scary, right?
212
00:15:45,706 --> 00:15:46,221
For sure.
213
00:15:46,221 --> 00:15:52,022
Uh that that feels more normal, but somebody in their twenties, like that's that's
unusual, right?
214
00:15:52,428 --> 00:15:53,118
Yeah, for sure.
215
00:15:53,118 --> 00:15:56,479
I mean, so you you use the word normal.
216
00:15:56,590 --> 00:15:58,951
I don't think we should ever normalize these things, right?
217
00:15:58,951 --> 00:16:04,743
Because it isn't normal to have to have a stroke and lose function, but it's very common.
218
00:16:04,743 --> 00:16:14,788
Um and it's very common because we have poorly controlled blood pressure, elevated
cholesterol, and we have a large percentage of our population uh have diabetes.
219
00:16:14,788 --> 00:16:21,190
These are all risk factors for developing cardiovascular disease, which includes heart
attacks or myocardial functions and strokes.
220
00:16:21,490 --> 00:16:29,947
Um, so so it's just this is a this is a good opportunity to say, hey, if you're in your
20s and 30s, it's important that you do things that that prevent your risk of getting
221
00:16:29,947 --> 00:16:33,000
those things, elevated blood pressure, diabetes, cholesterol.
222
00:16:33,000 --> 00:16:38,304
And part of that is having a primary doctor who can screen you periodically to make sure
that you're not developing those diseases.
223
00:16:38,304 --> 00:16:49,474
Um, and then two, if you're later in your life and you're in your late 40s, 50s, 60s, even
more reason to get those things under control if you have those.
224
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Because
225
00:16:50,136 --> 00:16:54,408
Fortunately, we have improved our mortality from cardiovascular disease.
226
00:16:54,408 --> 00:17:06,171
So people still have these things, diabetes, hypertension, cholesterol, strokes, heart
attacks, but they're not dying as frequently from those diseases because we have better
227
00:17:06,171 --> 00:17:06,803
interventions.
228
00:17:06,803 --> 00:17:14,986
And part of that is that we see people earlier and we have better treatment in the acute
stage, but then we also have better medicines to help keep them controlled so that they
229
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have lower risk of having events.
230
00:17:17,760 --> 00:17:26,755
So yeah, I think it's really important that folks if you haven't done it or you don't have
one, get yourself a primary doctor and try to get an appointment in to get an annual and
231
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do it today, even if it's six months down the track.
232
00:17:29,186 --> 00:17:33,788
Just it's important that you do that because they they're your best partner in good
health.
233
00:17:34,058 --> 00:17:34,708
Absolutely.
234
00:17:34,708 --> 00:17:36,169
Preventive care is important.
235
00:17:36,169 --> 00:17:37,690
I feel like we t we say that a lot.
236
00:17:37,690 --> 00:17:46,386
So um yeah, get in front of things before they get too big and you end up in the ER and
you're in the pit and you know, things are spiraling.
237
00:17:46,386 --> 00:17:48,448
So um cool.
238
00:17:48,448 --> 00:17:48,988
All right, good.
239
00:17:48,988 --> 00:17:50,879
I'm glad we we w I wanted to talk about that.
240
00:17:50,879 --> 00:17:52,450
That was an interesting one.
241
00:17:52,450 --> 00:17:56,093
Um, so what about the burn patient?
242
00:17:56,093 --> 00:18:04,108
And because I've already watched season one and season two, this is going to be a story,
obviously, that's gonna continue on.
243
00:18:04,322 --> 00:18:07,005
so the but this is brand new, brand new case.
244
00:18:07,005 --> 00:18:09,527
That's horrifying, by the way.
245
00:18:10,288 --> 00:18:13,351
and I I don't know, I'm just gonna let you talk about this.
246
00:18:13,351 --> 00:18:14,422
Have you ever dealt with that before?
247
00:18:14,422 --> 00:18:17,184
Have you ever had a burn patient in in your yard?
248
00:18:17,366 --> 00:18:18,827
Yeah, not not to that degree.
249
00:18:18,827 --> 00:18:20,799
That was a that was a crazy burn.
250
00:18:20,799 --> 00:18:28,535
I think they were talking about they said ninety percent BSA, you know, which obviously is
body surface area is is significant.
251
00:18:29,437 --> 00:18:38,885
you know, and they they started to talk about the the prognosis there and that's like
prognosis is kind of a dirty word in the emergency department because you know, we are
252
00:18:38,885 --> 00:18:45,208
we're the folks that that deal with the stabilization and get them to to the people who do
the prognostication.
253
00:18:45,208 --> 00:18:55,071
So I d I I actually don't have a sophisticated answer in terms of this particular
gentleman's, you know, prognostic likelihood or outcomes um in terms of how he'll do with
254
00:18:55,071 --> 00:18:56,411
s such significant burns.
255
00:18:56,411 --> 00:19:00,462
But I think the bottom line is he's got a long, long, long road ahead of him.
256
00:19:00,462 --> 00:19:08,164
Um, you know, and then the the downstream disability that will happen to him as a result
is is going to be significant.
257
00:19:08,164 --> 00:19:14,166
But there are a couple of things that stuck out in my mind was one Whitaker talking about
the Parkland formula.
258
00:19:14,230 --> 00:19:24,379
Um, which is essentially a a formula to determine how much fluid that patient needs to
have um over the next, you know, couple of days.
259
00:19:24,379 --> 00:19:27,731
And I don't know if you f you saw the numbers or or recognized the numbers.
260
00:19:27,731 --> 00:19:31,054
They were talking about 18 liters within 16 hours.
261
00:19:31,054 --> 00:19:37,169
So, you know, you think about those fluid bags that we have, he's gonna have eighteen of
those in sixteen hours or twelve hours.
262
00:19:37,169 --> 00:19:38,360
I can't remember exactly what he said.
263
00:19:38,360 --> 00:19:39,681
Wow.
264
00:19:40,012 --> 00:19:43,150
so it's a ton of fluid and it it
265
00:19:43,150 --> 00:19:46,633
Points out how important our skin is as an organ system.
266
00:19:46,633 --> 00:19:58,483
Um, and the reason for that is this gentleman had his his skin burned off, so he's just
losing fluid constantly, um, just out of out of the the subcutaneous layer.
267
00:19:58,483 --> 00:20:09,733
Um so so that was one thing that I thought was was really interesting, and it's a it's a
formula that has been um, you know, clever people researchers have developed that, and
268
00:20:09,733 --> 00:20:10,974
it's something that that.
269
00:20:10,974 --> 00:20:15,497
we always almost always have to look up before we we instituted it for patients.
270
00:20:15,748 --> 00:20:18,730
but then there was the escherotomy that had to happen for him.
271
00:20:18,730 --> 00:20:22,383
So because of the Yeah.
272
00:20:23,404 --> 00:20:28,538
Yeah, because the the the skin was so tight that he's he wasn't able to expand his chest.
273
00:20:28,538 --> 00:20:33,973
So they essentially had to create space that he could expand his chest because of the
burns.
274
00:20:33,973 --> 00:20:38,036
Um and how the burn was affecting the tissue and causing restriction.
275
00:20:38,036 --> 00:20:39,837
So I've never done that.
276
00:20:39,837 --> 00:20:40,778
Um
277
00:20:40,778 --> 00:20:51,482
and but I've have have read about it and you know obviously it's the type of thing that
you you I think that if of most physicians if they had to do it they'd probably have to do
278
00:20:51,482 --> 00:21:00,346
a quick bit of research on on exactly how to do it and where to do it um you know before
they before they go ahead and and actually do the procedure, particularly outside of a
279
00:21:00,346 --> 00:21:03,337
trauma center, you know, if you don't have a trauma surgeon on hand.
280
00:21:03,337 --> 00:21:08,629
So um yeah, that that gentleman's got a long, long road ahead of him for sure.
281
00:21:08,629 --> 00:21:10,580
Um very, very soon.
282
00:21:10,774 --> 00:21:21,338
Well, even, you know, in the end, right, Whitaker and Langdon are talking as they roll him
out and and Langdon says, Listen, hope, we're giving her hope, that's it.
283
00:21:21,338 --> 00:21:28,862
But the chances of him surviving after, I don't know, it was like so many days were were
pretty low.
284
00:21:28,862 --> 00:21:34,384
Um like I guess you know when you see those things, right?
285
00:21:34,384 --> 00:21:39,254
Um, have you have you had to like have you ever been in that kind of situation?
286
00:21:39,254 --> 00:21:41,695
Not even necessarily being like a burn situation.
287
00:21:41,695 --> 00:21:45,639
Uh well, I mean, I think it was even that was even a thing that happened with Dr.
288
00:21:45,639 --> 00:21:49,192
Robbie and the parents whose son overdosed on fentanyl.
289
00:21:49,192 --> 00:21:50,163
It's like you give them hope.
290
00:21:50,163 --> 00:21:51,984
You keep doing the tests.
291
00:21:52,745 --> 00:21:54,356
have you ever been faced with that?
292
00:21:54,678 --> 00:21:55,188
for sure.
293
00:21:55,188 --> 00:21:55,528
Yeah.
294
00:21:55,528 --> 00:22:04,201
I mean that's that's I mean the end of life is the is the most obvious example, you know,
where where perhaps people aren't r willing or ready to accept.
295
00:22:04,201 --> 00:22:13,724
Um, you know, that the you know you can see the writing on the wall that this person is
dying and you know there's there's nothing that you can do about it, um, unfortunately,
296
00:22:13,724 --> 00:22:21,666
and then, you know, trying to negotiate with them about well, what's what's in their best
interest, what are they actually what do they want, you know, do they want
297
00:22:21,666 --> 00:22:23,957
To get all of this care, because we can do all of these things.
298
00:22:23,957 --> 00:22:31,949
We can put true we can put breathing tubes in and put them on ventilators and we can we
already talked about we can replace the heart and lungs with an echo machine, you know.
299
00:22:32,689 --> 00:22:37,650
you know, so we can do all of these things, but doesn't just because we can do them
doesn't mean we should do them.
300
00:22:37,650 --> 00:22:49,674
Um so so you know, but but at the same time, you know, we we also have to we do have a lot
of things that we can do and you have to try to tow the line in terms of well, what's
301
00:22:49,674 --> 00:22:50,764
reasonable.
302
00:22:50,950 --> 00:23:00,424
Um, you know, and and at the same time it's important to not give people false hope about
what we are able to achieve because that doesn't help anyone either.
303
00:23:00,424 --> 00:23:01,244
So
304
00:23:01,568 --> 00:23:02,418
Right.
305
00:23:02,659 --> 00:23:03,029
Yeah.
306
00:23:03,029 --> 00:23:05,262
I I had a note here too.
307
00:23:05,262 --> 00:23:09,625
The um the social worker, Kiara, she's down in the ER quite a bit.
308
00:23:09,625 --> 00:23:13,690
Um, and they even said at the end, he's Yeah, you need to call her in.
309
00:23:13,690 --> 00:23:20,236
And I thought, Well, it you know, the show the pit, obviously, it's one day, it's fifteen
hours.
310
00:23:20,236 --> 00:23:22,248
They're like cramming everything in, right?
311
00:23:22,248 --> 00:23:27,022
Because it is it is a dramatic television show in the end of the at the end of the day.
312
00:23:27,182 --> 00:23:29,664
Um, but they gotta show kind of all of the things, right?
313
00:23:29,664 --> 00:23:31,646
All the possibilities that can happen.
314
00:23:31,646 --> 00:23:35,148
Um, but the I I had a question about this.
315
00:23:35,148 --> 00:23:37,391
So, like every hospital has a social worker.
316
00:23:37,391 --> 00:23:40,793
Um, and this one care is down there often.
317
00:23:40,793 --> 00:23:45,397
Um, do you engage with social workers on a pretty regular basis?
318
00:23:45,397 --> 00:23:51,104
Is that a I mean, maybe not quite as common as she shows up because of this is a TV show,
but I was curious.
319
00:23:51,104 --> 00:23:52,215
All the time.
320
00:23:52,215 --> 00:23:52,784
All the time.
321
00:23:52,784 --> 00:23:53,044
Okay.
322
00:23:53,044 --> 00:23:53,495
Yeah.
323
00:23:53,495 --> 00:23:53,936
Yeah.
324
00:23:53,936 --> 00:24:00,659
Th a big hospital system like that, they will have they will have a team of social workers
in the department that that are in the emergency room.
325
00:24:00,759 --> 00:24:01,460
Okay.
326
00:24:01,460 --> 00:24:06,843
because, you know, the you're you're dealing with so many varied things.
327
00:24:06,843 --> 00:24:15,797
You know, we at our hospital, we're a small community hospital, we only have coverage
during office hours um for our social workers, but they cover the whole hospital and we
328
00:24:15,797 --> 00:24:21,260
have a team of of social workers, typically three or so social workers that help, you know
329
00:24:21,260 --> 00:24:36,594
Get people into homes, get people into skilled nursing facilities, help with housing,
temporary housing, phones, clothing, um, food vouchers, transport vouchers, um, linking
330
00:24:36,594 --> 00:24:47,607
them up with with outpatient mental health resources, getting them into you know, into a
transferred to a mental health hospital, um, you know, helping coordinate with caseworkers
331
00:24:47,607 --> 00:24:49,408
that are already working with these patients.
332
00:24:49,408 --> 00:24:50,530
So like
333
00:24:50,530 --> 00:24:58,853
These these folks are incredibly valuable resources um that that actually do a ri a lot of
great work for patients.
334
00:24:59,894 --> 00:25:02,185
and provide them with with some of that support.
335
00:25:02,185 --> 00:25:10,178
We we even have fortunately we have an addiction medicine team as well that has a social
worker specifically looking at addiction medicine and people who have alcohol use
336
00:25:10,178 --> 00:25:19,432
disorder, opiate use disorder, and they have specific ways and places that they can refer
patients for outpatient help for their their substance use disorders.
337
00:25:19,432 --> 00:25:20,172
So
338
00:25:20,987 --> 00:25:27,751
yeah, I mean the ideal ideally you would have a social worker in every single department
that and probably a couple of them.
339
00:25:27,751 --> 00:25:35,716
Um because they're the ones that are really uh they're the ones that that do the work of
essentially helping patients navigate the system.
340
00:25:35,716 --> 00:25:38,568
Um which we've talked about since I burnout.
341
00:25:38,594 --> 00:25:39,407
High burnout, right?
342
00:25:39,407 --> 00:25:39,996
With social work.
343
00:25:39,996 --> 00:25:43,591
Like go hug a social worker people because those are like angels on earth.
344
00:25:43,591 --> 00:25:44,712
Just saying.
345
00:25:44,942 --> 00:25:45,702
For sure.
346
00:25:45,702 --> 00:25:51,247
Well it's it's just like imagine doing a job where you feel like you're never ever, you
know, making improvements.
347
00:25:51,247 --> 00:25:53,608
You know, how how dissatisfying that would be.
348
00:25:53,608 --> 00:26:02,644
Um, you know, and part of that is because they're fighting against a system that is not
set up to to be able to help people in a way that's optimal.
349
00:26:03,170 --> 00:26:04,431
Yeah, it's a tough job.
350
00:26:04,431 --> 00:26:07,374
Um, yeah, Kiara shows up a lot.
351
00:26:07,374 --> 00:26:13,729
So, um, and I'm like, wow, man, you gotta be a certain special kind of person, just like
Dana's a charge nurse, Dr.
352
00:26:13,729 --> 00:26:15,210
Robbie runs the ER.
353
00:26:15,210 --> 00:26:26,371
I mean, like, it it just they do such a great job of like showing um where people belong
in certain roles, you know, and I feel like that's kind of applicable across like
354
00:26:26,371 --> 00:26:27,131
anywhere, right?
355
00:26:27,131 --> 00:26:27,762
Like any job.
356
00:26:27,762 --> 00:26:29,934
Like we're all made for certain things, right?
357
00:26:29,934 --> 00:26:30,754
And
358
00:26:30,860 --> 00:26:36,932
They do a really the the pit does a really wonderful job of showing those people in those
right roles.
359
00:26:36,932 --> 00:26:39,182
Um just being amazing.
360
00:26:39,182 --> 00:26:44,664
So um yeah, I've been I've been wanting to t I've been wanted to plug Kira in here at some
point.
361
00:26:44,664 --> 00:26:46,654
So that was my that was my opportunity.
362
00:26:46,654 --> 00:26:56,467
Um but before before we we run out of time today, let's talk about that lateral can I'm
looking at this because I'm gonna mess up this word here.
363
00:26:56,467 --> 00:26:59,318
Can can't can't autonomy?
364
00:26:59,534 --> 00:26:59,815
Yeah.
365
00:26:59,815 --> 00:27:01,666
oh
366
00:27:01,666 --> 00:27:04,753
The the baseball to the eye, the line drive to the eye.
367
00:27:04,753 --> 00:27:05,813
Yeah.
368
00:27:05,915 --> 00:27:06,957
Cringey.
369
00:27:06,957 --> 00:27:07,696
Not gonna
370
00:27:07,696 --> 00:27:08,396
much so.
371
00:27:08,396 --> 00:27:09,167
Very much so.
372
00:27:09,167 --> 00:27:09,417
Yeah.
373
00:27:09,417 --> 00:27:17,812
Well, I mean, so so just talking about uh anything that has otomy on the back means that
you're you're cutting into it, basically.
374
00:27:17,812 --> 00:27:27,689
Um so the the lateral canthus is a specific portion of the anatomy of the eye where you
have these little tendon things on the outside of the eye.
375
00:27:27,689 --> 00:27:34,894
And what happened for that guy is he got the line line drive to the face and he had
basically blood building up behind the eye, which is a
376
00:27:34,894 --> 00:27:35,775
closed space.
377
00:27:35,775 --> 00:27:41,129
ah And that as that blood is building up, it's pushing on the eye and it's pushing it
forward.
378
00:27:41,129 --> 00:27:46,163
So it's increasing the pressure, which then it squeezes the optic nerve and it can cause
blindness.
379
00:27:46,163 --> 00:27:49,986
So he wasn't able to see on that side because he had high high pressure.
380
00:27:49,986 --> 00:27:59,925
So they did the lateral cantholomy where they basically make an incision into the skin on
the sides where the eyelids connect, you basically put local anesthetic in there and then
381
00:27:59,925 --> 00:28:04,524
you get some forceps and you crush that ah that space.
382
00:28:04,524 --> 00:28:07,606
And then you cut down into, and that kind of blocks off all the blood vessels.
383
00:28:07,606 --> 00:28:14,439
You cut into that, and then you take the two lateral canthus uh anatomy portions there and
you cut those.
384
00:28:14,440 --> 00:28:18,162
And it basically releases the pressure that's on the eye.
385
00:28:18,162 --> 00:28:23,245
And it looks very scary and looks like it's going to be incredibly deforming.
386
00:28:23,245 --> 00:28:30,709
uh But I've we had we had an opth, I remember having an ophthalmologist come in and give
us a lecture about this and how to do the procedure properly.
387
00:28:30,709 --> 00:28:33,154
And they showed a bunch of before and after.
388
00:28:33,154 --> 00:28:40,580
photos of people who had had lateral canthotomies and then what they look like months down
the road in clinic and their eyes look completely normal.
389
00:28:40,580 --> 00:28:55,313
Um so it's a it's a sight saving procedure that seems really barbaric and brutal, but it's
an incredibly important procedure that that helps save people's vision with no downstream
390
00:28:55,313 --> 00:28:56,674
negative effects.
391
00:28:56,718 --> 00:28:58,055
Have you ever done one?
392
00:28:58,378 --> 00:28:58,888
I have.
393
00:28:58,888 --> 00:28:59,659
I have done one.
394
00:28:59,659 --> 00:28:59,989
Yeah.
395
00:28:59,989 --> 00:29:04,141
They were um it was I wasn't good at it, put it that way.
396
00:29:04,141 --> 00:29:12,106
Uh we fortunately had the ophthalmologist there and and and the the she was she was
fantastic, fantastic teacher.
397
00:29:12,106 --> 00:29:15,047
Um and essentially sort of talked me through it.
398
00:29:15,047 --> 00:29:20,380
And I was the the bottom line is I think she said something like, You're far too timid
with it.
399
00:29:20,380 --> 00:29:23,652
You need to go go deeper, cut cut more aggressively.
400
00:29:23,652 --> 00:29:27,658
Um and I was just I couldn't get to the canthus because I just was
401
00:29:27,658 --> 00:29:29,390
This is this is this person's eye.
402
00:29:29,390 --> 00:29:30,181
I don't want to cut it.
403
00:29:30,181 --> 00:29:39,762
Um so so she she ended up taking the scissors and she saw what I was doing and and could
feel what I was doing and she just she did the exact same thing that I was doing, but just
404
00:29:39,762 --> 00:29:43,116
went deeper and more aggressive and she was able to release the pressure.
405
00:29:43,116 --> 00:29:48,242
So yeah, uh I will remember that next time I I have to do that.
406
00:29:48,642 --> 00:29:49,833
Yeah, hopefully you don't have to.
407
00:29:49,833 --> 00:29:51,023
But yeah, that one was a doozy.
408
00:29:51,023 --> 00:29:54,505
That one and and also that's the other thing with this show.
409
00:29:54,666 --> 00:30:06,332
The pit has these moments that are so realistic that like even, you know, people with the
s the strongest stomachs are gonna be like, Ugh, my mom, when she watches it with me, she
410
00:30:06,332 --> 00:30:08,854
does not have a strong stomach, hates horror movies.
411
00:30:08,854 --> 00:30:11,675
She like I get to see like she covers her face.
412
00:30:11,675 --> 00:30:17,088
And I'm like, I'll keep watching, but I'm just like, damn, they do a great job of like
413
00:30:17,442 --> 00:30:21,072
that realistic, like it just, you know what I mean?
414
00:30:21,072 --> 00:30:24,824
Like stop that just there's so many things I'm thinking about right now.
415
00:30:24,824 --> 00:30:26,104
Like even beyond that one.
416
00:30:26,104 --> 00:30:28,685
But um yeah.
417
00:30:28,685 --> 00:30:34,146
So last thing, let's tease this one up before we run out time.
418
00:30:34,146 --> 00:30:37,307
Um physician drug use.
419
00:30:37,307 --> 00:30:46,636
So Langdon and his benzo popping addiction starts to be revealed here.
420
00:30:46,636 --> 00:30:47,586
So
421
00:30:47,586 --> 00:30:52,230
Would in the last few minutes that we have, would love to hear kind of your take on this.
422
00:30:52,230 --> 00:30:58,324
And then we're gonna definitely explore that more in the future episodes coming up because
this story does not go away.
423
00:30:58,710 --> 00:31:09,258
Yeah, I uh I to be honest, I this not this this particular um storyline is one that I've I
I have lost some sleep about thinking about this.
424
00:31:11,401 --> 00:31:18,607
one because I I think Langdon is a is a is a really good physician, um and like an
excellent teacher.
425
00:31:18,607 --> 00:31:22,990
And I think there's been a number of times where he's been recommended for
426
00:31:23,028 --> 00:31:23,748
I think Dr.
427
00:31:23,748 --> 00:31:27,059
Robbie recommended him for the position as the the teaching fellow.
428
00:31:27,059 --> 00:31:30,980
you know, he's he's had a number of great cases that have been good saves.
429
00:31:30,980 --> 00:31:33,871
Um, you know, and he is a good teacher.
430
00:31:33,871 --> 00:31:43,761
But I think that the way that he in this episode, I think it was in this episode, maybe
the one before, but the last two episodes he he had that episode that that period where he
431
00:31:43,761 --> 00:31:51,386
he started to go off on Santos and then Robbie had to tell him to stop when he was yelling
at her.
432
00:31:51,386 --> 00:31:51,656
Yeah.
433
00:31:51,656 --> 00:31:52,056
Yeah.
434
00:31:52,056 --> 00:31:52,866
So
435
00:31:53,362 --> 00:31:58,266
and then obviously it ended with with him finding the patient medication in the locker.
436
00:31:58,266 --> 00:32:09,896
Um, and it it just it feels I just had this like heart sink moment where I said, My gosh,
this guy's got so much potential and he's just kind of throwing it all away.
437
00:32:11,238 --> 00:32:19,274
you know, and I I I personally don't know any physicians who've been in that situation
where they've had, you know, drug problems, you know, diverting drugs.
438
00:32:19,274 --> 00:32:21,186
I've heard about it a lot, you know.
439
00:32:21,186 --> 00:32:30,509
different healthcare workers of different varieties, you know, diverting patient drugs for
their own use, even selling those drugs to other people as recreational drugs.
440
00:32:30,509 --> 00:32:35,790
Um, there's certainly lots of stories going around about that kind of thing happening and
it's real.
441
00:32:36,951 --> 00:32:44,653
you know, uh I'm I'm curious to see where this storyline goes because it it felt like the
way that Dr.
442
00:32:44,653 --> 00:32:48,674
Rob I'm I'm curious to see what they do because part of it is um
443
00:32:48,674 --> 00:32:52,357
Like there's an instinct or an knee jerk reaction to just say, All right, you're done.
444
00:32:52,357 --> 00:32:54,919
You're that's it, your medical career's over.
445
00:32:54,919 --> 00:32:56,394
Go find a different job.
446
00:32:56,394 --> 00:33:04,136
Um, but then there's the other the other side of that to say, well, you know what, they're
they they have a they have an issue, um, and they need help.
447
00:33:04,136 --> 00:33:12,282
How can we support them so that we you know we don't lose that talent and all the good
things that they can do, but doing it in a in a safe way.
448
00:33:12,282 --> 00:33:14,423
And then how do you build that trust back up again?
449
00:33:14,423 --> 00:33:15,784
Cause that's like
450
00:33:15,784 --> 00:33:20,209
how how do you tr how can you trust that that's not gonna happen, you know, again in the
future.
451
00:33:20,209 --> 00:33:26,606
So I'm curious to see where that storyline goes, 'cause that's a that's a really important
one to address.
452
00:33:26,934 --> 00:33:31,085
Yeah, and I I can't stop thinking about another show that I've watched is called Nurse
Jackie.
453
00:33:31,085 --> 00:33:38,713
I don't know if you've ever seen it, um, where basically the entire premise of that show
is about Nurse Jackie's uh addiction problems, right?
454
00:33:38,713 --> 00:33:46,168
And kind of how she gets moved through that system, how she's able to come back and, you
know, practice and cause she was amazing, right?
455
00:33:46,168 --> 00:33:47,910
Like kind of similar situation.
456
00:33:47,910 --> 00:33:53,986
So anyone listening to this, if you like that storyline um and you like medical shows,
457
00:33:53,986 --> 00:33:54,877
Go watch Nurse Jackie.
458
00:33:54,877 --> 00:33:56,268
That one's kind of funny too, right?
459
00:33:56,268 --> 00:33:57,629
Like there's this drama.
460
00:33:57,629 --> 00:33:58,589
It's kind of older.
461
00:33:58,589 --> 00:33:59,220
It's older.
462
00:33:59,220 --> 00:34:03,452
But my husband and I watched it like the whole like multiple seasons.
463
00:34:03,673 --> 00:34:06,375
I feel like it was like last year and it was fantastic.
464
00:34:06,375 --> 00:34:09,357
But that's kind of like the main storyline with that show.
465
00:34:09,357 --> 00:34:18,923
But um, yeah, Langdon's Benzo Use is definitely gonna keep um showing up, um, coming over
future episodes.
466
00:34:18,923 --> 00:34:21,045
And that's all I'm going to say.
467
00:34:21,045 --> 00:34:23,306
Um, but
468
00:34:23,564 --> 00:34:24,074
I don't know.
469
00:34:24,074 --> 00:34:33,218
We again here we are at the end of episode ten and it's just like woo stuff is just up and
down and all over the place.
470
00:34:33,218 --> 00:34:34,978
So um
471
00:34:34,978 --> 00:34:40,706
I always wanna finish saying that it the show's really heating up, but it's I don't know
how it could get any hotter, you know.
472
00:34:40,706 --> 00:34:44,180
It's it's we're we're being thrown lots of stuff every episode.
473
00:34:44,418 --> 00:34:45,478
Guess what?
474
00:34:45,658 --> 00:34:47,359
It can and it will.
475
00:34:47,359 --> 00:34:55,371
So come back for next week's show, season one, episode 11, that is the 5 to 6 p.m.
476
00:34:55,371 --> 00:34:56,181
hour.
477
00:34:56,181 --> 00:35:02,803
There is a couple of Easter eggs in this episode, I know now, because I have now watched
the entire season.
478
00:35:02,803 --> 00:35:04,403
But I'm gonna leave you in suspense.
479
00:35:04,403 --> 00:35:11,665
And the rest of you, if you haven't seen it, make sure you watch, come back and talk with
us next week, and we will unpack all of the things.
480
00:35:11,665 --> 00:35:14,246
So until then, em
481
00:35:14,830 --> 00:35:15,542
Well, I don't know.
482
00:35:15,542 --> 00:35:19,742
Until then just just try to chill out and breathe.
483
00:35:19,742 --> 00:35:22,074
Totally, stay happy and healthy.
484
00:35:34,870 --> 00:35:36,274
not give medical advice.
485
00:35:36,274 --> 00:35:40,382
If you're seeking medical advice, consult a physician or healthcare professional.
486
00:35:42,446 --> 00:35:44,071
This has been a shut up production.
487
00:35:45,176 --> 00:35:45,947
What?
00:00:04,238 --> 00:00:14,638
Welcome to Inside the Pit, where the drama of the pit meets the reality of emergency
medicine when your hosts, Heather Pierce and Dr.
2
00:00:14,638 --> 00:00:26,388
Adrian Koyce, go beyond the characters to explore the clinical decisions, healthcare
issues, and real-life outcomes behind what happens inside the pit.
3
00:00:27,358 --> 00:00:31,542
All right, welcome back to the next episode of Inside the Pit.
4
00:00:31,542 --> 00:00:34,114
Today we are on season one, episode 10.
5
00:00:34,114 --> 00:00:35,365
This is the 4 to 5 p.m.
6
00:00:35,365 --> 00:00:36,378
hour.
7
00:00:36,378 --> 00:00:40,099
Um, I don't know if this is like when the crazy starts happening, Dr.
8
00:00:40,099 --> 00:00:42,511
Christ, because it's the end of the workday or what.
9
00:00:42,511 --> 00:00:48,226
This is like the evening, we're gonna get to the evening hours, but um, there's there's
some stuff brewing here.
10
00:00:48,226 --> 00:00:51,549
So we just came off of episode nine.
11
00:00:51,549 --> 00:00:52,970
Yeah, what what are you feeling?
12
00:00:52,970 --> 00:00:55,222
How are you feeling about episode 10 right now?
13
00:00:55,330 --> 00:01:03,876
Yeah, you know, I thought uh typically typically this is the time in emergency
departments, they generally start to heat up from midday through to this time of day.
14
00:01:03,876 --> 00:01:11,001
And this is the time of day where you really start heating up and you get lots of patients
in and you end up seeing lots of waiting in your wait room.
15
00:01:11,001 --> 00:01:15,013
But my gosh, this hospital has had waiting room like that from the start of the day.
16
00:01:15,013 --> 00:01:18,565
So I can't imagine what's gonna happen for the rest of the season.
17
00:01:19,747 --> 00:01:24,962
But yeah, we we kinda ended on a bit of a uh talking about
18
00:01:24,962 --> 00:01:27,846
violence in the workplace for our previous episode.
19
00:01:27,846 --> 00:01:29,248
So I don't know.
20
00:01:29,248 --> 00:01:31,380
Seems like that's a pretty good place to start.
21
00:01:31,490 --> 00:01:39,453
Yes, our our very favorite Dana, the charge nurse, who got punched by who I discontinue
calling him the jerk off guy.
22
00:01:40,584 --> 00:01:41,734
he doesn't deserve a name.
23
00:01:41,734 --> 00:01:42,335
He's mean.
24
00:01:42,335 --> 00:01:43,195
He's so horrible.
25
00:01:43,195 --> 00:01:46,076
And I wanna like, yeah, I wanna punch him back.
26
00:01:46,266 --> 00:01:47,867
so she goes to CT, right?
27
00:01:47,867 --> 00:01:52,699
So she goes through that, she falls on the ground at the end of this the episode, and then
they bring her in.
28
00:01:52,699 --> 00:01:56,511
So ha i if if somebody gets hurt, and we were talking about this, right?
29
00:01:56,511 --> 00:01:59,202
Like somebody actually gets physically assaulted.
30
00:01:59,416 --> 00:02:01,792
There's certain protocols that they're dealt with.
31
00:02:01,792 --> 00:02:04,939
I mean, you could see that with how they were if Dr.
32
00:02:04,939 --> 00:02:06,752
Robbie was kind of assessing her.
33
00:02:07,768 --> 00:02:08,478
Yeah.
34
00:02:08,478 --> 00:02:09,298
Yeah, for sure.
35
00:02:09,298 --> 00:02:18,264
I mean, look, essentially there's there's the medical piece and he essentially did a a
trauma evaluation for her, specifically looking at her face, making sure she didn't have
36
00:02:18,264 --> 00:02:19,265
any facial fractures.
37
00:02:19,265 --> 00:02:25,018
So she ended up going down to the C T scan, which ruled out brain bleeds or facial
fractures.
38
00:02:25,018 --> 00:02:27,790
Um, you know, that sometimes needs surgery.
39
00:02:28,631 --> 00:02:32,452
so uh and I think that he was able to do that effectively.
40
00:02:33,273 --> 00:02:34,742
you know, and then I think
41
00:02:34,742 --> 00:02:38,815
And it I think it turned out that she was totally fine from a uh injury perspective,
right?
42
00:02:38,815 --> 00:02:44,690
She didn't have any any issues um or or traumatic injuries that needed surgery or
something like that.
43
00:02:44,690 --> 00:02:54,518
Um, but I I think you could tell and I hope the the viewers would would be able to pick
out that she was very much like, no, let's I just gotta get back to work, I've got to get
44
00:02:54,518 --> 00:02:55,159
back to work.
45
00:02:55,159 --> 00:02:57,331
And that's part of the problem, right?
46
00:02:57,331 --> 00:03:04,150
We sort of alluded to it before is that a lot of healthcare workers just think that, it's
part of the job, you know.
47
00:03:04,150 --> 00:03:05,891
It comes with the territory.
48
00:03:07,072 --> 00:03:08,963
and the reality is is that it's not.
49
00:03:08,963 --> 00:03:10,014
It shouldn't happen.
50
00:03:10,014 --> 00:03:14,757
And it should and it should be something that we should feel like we can go and do our
jobs effectively.
51
00:03:14,757 --> 00:03:23,043
Um, because we are where we are expected to perform to a high standard, providing the best
quality of care.
52
00:03:23,644 --> 00:03:27,947
and then you think that you're trying to do that while you're also trying to, you know,
protect your own body.
53
00:03:27,947 --> 00:03:31,009
Um, that that just makes it very hard to do that.
54
00:03:31,009 --> 00:03:32,800
Um, so yeah.
55
00:03:32,800 --> 00:03:43,938
I mean there's I I I pulled up some stats in preparation for this one, um, just looking at
at the types of violence, particularly towards nurses, um, and a report out of the
56
00:03:43,938 --> 00:03:53,725
National Nurses United, which I don't actually know the organization, but this is very
similar to a lot of the the the data that I've seen previously.
57
00:03:53,770 --> 00:03:57,268
Um and maybe I can ask you some questions, Heather.
58
00:03:57,268 --> 00:04:00,072
You can do the guessing you can do the guessing game.
59
00:04:00,072 --> 00:04:05,062
What's uh what do you think is the percentage of nurses that would report they've been
verbally threatened?
60
00:04:05,548 --> 00:04:09,478
Verbally threatened, I wanna say that's probably pretty high.
61
00:04:09,478 --> 00:04:12,916
I'm gonna say like 85%.
62
00:04:13,590 --> 00:04:16,906
Not quite that high, seventy percent in this report of twelve hundred.
63
00:04:16,906 --> 00:04:21,002
What about what about people that have been slapped, punched, or kicked?
64
00:04:21,634 --> 00:04:23,836
Mm, that's gonna be lower, right?
65
00:04:23,836 --> 00:04:27,060
So I'm gonna but I say like at least half, right?
66
00:04:27,060 --> 00:04:28,902
Like fifty, fifty five percent.
67
00:04:28,928 --> 00:04:31,299
In this report, thirty-three percent.
68
00:04:32,699 --> 00:04:33,860
You are, you are.
69
00:04:33,860 --> 00:04:35,260
I think we tea I teed you up.
70
00:04:35,260 --> 00:04:36,560
I teed you up.
71
00:04:37,101 --> 00:04:49,204
but then also just you know, sexually harassed or made comments about their their
appearance, um, about their bodies, that that's around forty percent.
72
00:04:49,334 --> 00:04:50,144
wow.
73
00:04:50,144 --> 00:04:55,836
you know, so just what bottom line is this, it's very prevalent.
74
00:04:55,838 --> 00:05:03,645
Um and and it's you're you're then expecting them to do a lot of like very challenging
jobs.
75
00:05:03,735 --> 00:05:07,409
you know, simple things like giving medications.
76
00:05:07,409 --> 00:05:17,237
Um I always say that I always say that doctors are I I always say that the nurses are the
ones who actually heal patients, um, because they're the ones that are in with the
77
00:05:17,237 --> 00:05:22,752
patients when they're sick, they're talking to them, they're the ones that are doing
spending the time with them.
78
00:05:22,786 --> 00:05:32,469
giving a medication, seeing how it works, reevaluating them, you know, then coming back to
the physician and saying, hey, this medication didn't really work, or it's working, but
79
00:05:32,469 --> 00:05:34,350
they still need, you know, a little bit more.
80
00:05:34,350 --> 00:05:41,482
Um, so, you know, they're they're the ones that are really doing the hard work and the the
heavy lifting of actually helping the patients get better.
81
00:05:41,482 --> 00:05:47,894
Um, you know, the physicians really are just doing the like assessing and figuring out
what's wrong and then
82
00:05:47,894 --> 00:05:52,415
making the orders and the the nurses are the ones that are doing the hard work of actually
healing the patient.
83
00:05:52,415 --> 00:06:03,519
So um when you're trying to heal someone who is also sexualising you or hitting you or
verbally abusing you, that's a that's a really hard job.
84
00:06:03,519 --> 00:06:07,840
Um and it shouldn't be something that we say is just part of the territory.
85
00:06:08,070 --> 00:06:14,742
we should be we should be it demanding more um and better safety for our for our co
workers.
86
00:06:15,042 --> 00:06:16,622
Yeah, I agree.
87
00:06:17,904 --> 00:06:21,206
I've fortunately never been witness to anything like that.
88
00:06:21,206 --> 00:06:26,929
Um, thankfully, but clearly think I it happens more than it does, but it's still high
numbers.
89
00:06:26,929 --> 00:06:34,953
Um, one of the things too that I thought was and I want to ask you about this is kind of
like the, you know, you just go back to work where Dana and Dr.
90
00:06:34,953 --> 00:06:44,038
Collins, who which we haven't really talked about, and she she had an she had a
miscarriage while working, like on her own.
91
00:06:44,578 --> 00:06:47,119
Totally alone, dealing with it by herself.
92
00:06:47,119 --> 00:06:49,580
Um, and this has come up, right?
93
00:06:49,580 --> 00:06:54,482
And like every single episode, something with her having this miscarriage for the last
three episodes.
94
00:06:54,542 --> 00:07:01,345
And the two of them got in that bed in one of the um the trauma rooms or whatever, um, the
triage rooms.
95
00:07:01,345 --> 00:07:10,769
And the two of them just kind of sat there, laid there next to one another and had that
like really special kind of emotional moment because Dana, Dana knows that Dr.
96
00:07:10,769 --> 00:07:13,560
Collins had um a miscarriage.
97
00:07:13,560 --> 00:07:14,281
during the shift.
98
00:07:14,281 --> 00:07:18,356
And yet she's still working and dealing with, you know, Dana.
99
00:07:18,356 --> 00:07:20,068
She's like, nope, I'm going back to work.
100
00:07:20,068 --> 00:07:20,338
Right.
101
00:07:20,338 --> 00:07:22,140
And then she walks back in there.
102
00:07:22,140 --> 00:07:25,363
Like I was just like, How?
103
00:07:25,504 --> 00:07:26,915
How are they doing this?
104
00:07:26,915 --> 00:07:27,778
Yeah.
105
00:07:27,778 --> 00:07:29,319
I just want to go home.
106
00:07:29,319 --> 00:07:30,079
For sure.
107
00:07:30,079 --> 00:07:40,763
And that's that's those are the those are the the the themes that keep coming up is that,
you know, patients or the physicians and the nurses and and the the custodian staff, they
108
00:07:40,763 --> 00:07:49,217
will have, you know, have dealt with some horrible trauma and then have to walk into
someone who's like yelling at them about wearing a mask or yelling at them not to give
109
00:07:49,217 --> 00:07:51,388
them a vaccination or or whatever it is.
110
00:07:51,388 --> 00:07:56,738
Um, you know, and that sort of like switching and kind of like not dealing with something
that
111
00:07:56,738 --> 00:08:01,760
you know, a very emotional thing that you've just gone through and then continuing to, you
know, press on.
112
00:08:01,760 --> 00:08:04,861
That happens across healthcare and across the show.
113
00:08:05,722 --> 00:08:14,985
more specifically with Collins and her miscarriage, when in my notes I was looking back at
at the f when that actually happened, the thing that I wrote after Collins miscarriage I
114
00:08:14,985 --> 00:08:18,327
said Collins miscarriage, and then I wrote how lonely that is.
115
00:08:18,327 --> 00:08:26,560
Um and I think that's something I think that's underappreciated is that how alone women
are.
116
00:08:26,636 --> 00:08:27,947
when they have a miscarriage.
117
00:08:27,947 --> 00:08:37,562
Um and and it's actually a pretty good metaphor for just women's healthcare in general,
with the lack of, you know, research dollars that have gone towards it and, you know,
118
00:08:37,562 --> 00:08:41,894
understanding of of how, you know, disease affects women uniquely.
119
00:08:41,894 --> 00:08:51,520
And then beyond that, just policies that are currently being made that are taking away
healthcare access for women, you know, access to abortion as as the most prominent
120
00:08:51,520 --> 00:08:52,070
example.
121
00:08:52,070 --> 00:08:54,761
And then even just contraceptive medications.
122
00:08:55,596 --> 00:09:02,709
those those things I think are are incredibly massive issues that make peop women less
healthy.
123
00:09:03,769 --> 00:09:06,230
and we need we it's something we need to change.
124
00:09:06,230 --> 00:09:17,015
Um and that only comes by making some pretty bold policy decisions and and investing in in
those in those research avenues and and public health initiatives.
125
00:09:17,015 --> 00:09:17,375
Yeah.
126
00:09:17,375 --> 00:09:25,128
Um so yeah but mean agreed and and miscarriage for example, like just back on the
miscarriage piece, it's so common.
127
00:09:25,162 --> 00:09:32,207
Um, you know, I think that if you were to talk to, you know, if you so it's one in four to
one in five.
128
00:09:32,207 --> 00:09:37,591
Um, you know, sometimes people you can see stats that say one in six of all pregnancies
end in a miscarriage.
129
00:09:37,591 --> 00:09:47,518
Um, so it it's and maybe some peop some women don't know that they actually had a
miscarriage, maybe they had, you know, a heavier period than they normally would have had
130
00:09:47,518 --> 00:09:49,559
or it was a little bit late or something like that.
131
00:09:49,559 --> 00:09:52,681
Um, you know, other women definitely know.
132
00:09:52,681 --> 00:09:54,060
Um
133
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You know, and and this like this intuitive sense that women have about about being
pregnant, um, and then and then the loss that they have when they do have a miscarriage.
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And I think that there's been this cultural like norm where that's th that's women's
business, you don't talk about it.
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Um and I fortunately I I I think I see that changing just from a cultural perspective.
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but just how lonely it is.
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Um, and then to think that you don't
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have a space for some women, particularly in the US, you don't have a safe space to come
and seek care.
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It's a horrible position to be in.
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Yeah, it really is.
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Yeah, I d I I wanted to touch on that.
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I didn't realize it hadn't come up.
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And then just that moment with with Dana and and Dr.
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Collins just um I don't know.
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It just you know, we we ask a lot of of our healthcare providers.
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and I think that the the show, I think the pit did a really nice job of portraying exactly
what kind of pressure we do put on them um in order to then show up for us when we show up
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sick and
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pissed off or whatever it is into the ER and sent, you know, and expecting to be to be
supported all the ways.
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So anyway, with that, let's move on.
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What what I you have a couple of other there's a couple of other situations in this
episode that we want to talk about.
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Um the stroke patient, the burn patient.
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do you wanna start with the stroke patient first?
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Yeah, yeah, let's talk about the stroke patient.
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So that was, I think it was an online gamer or an online poker player or something.
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Very young, had come in with a stroke to the middle cerebral artery.
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So that's basically the art, there's three main arteries in the brain.
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Um, and this is my very you can tell I'm an emergency doctor, that's simplifying neurology
here.
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You have the anterior, the middle, and the posterior.
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Um, and based on where you get a blockage of one of those arteries, you get very specific.
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patterned symptoms.
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So the MCA typically will take out this sort of this side of the brain, which is
responsible for the upper and lower body on the other side.
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ah So if you have a stroke on the on your left side, you will get symptoms on your right
side and it typically will result in a motor deficit.
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So that like weakness and strooping of face on one side.
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ah Now this person had had a vertebral artery dissection.
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So the two arteries that run through the vertebra um in the neck.
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um the basically the wall of that kind of sheared away and it it threw off a clot that
goes up into the brain um and causes the causes the stroke.
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ah I wanted to talk about this case because I think it's it's a really important public
health initiative to talk about recognizing the signs of stroke and coming in to be seen
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very quickly.
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There's this four and a half hour window of time to to get identified as having had a
stroke and a large vessel occlusion like that.
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Um, because we can give the thrombolytic, which is what this patient received.
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So it's a medication that breaks up a clot.
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Ah, okay.
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And I've I've only given it once in my career.
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and I've dealt with many, many strokes.
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And part of that is because patients um either don't come in quick enough, so they're
outside of that four and a half hour window from onset of symptoms, so we're not able to
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give that medication, or they are having um only a very small stroke um that doesn't rise
to the level of needing that thrombolytic medication, or they're not having a stroke and
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we activate like they are.
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and it turns out to be something else, like a urinary tract infection or an electrode
abnormality or a migraine or something like that.
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Um so I think the take-home here is understanding the signs of um of what a stroke could
be.
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And the AHA and the American Stroke Association have a a mnemonic called BFAST that they
look at, um, where they look at, you know, how's their balance?
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Are their eyes, you know, do they have dizziness or blurry vision?
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What's their face look like?
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Are they able to move their arms?
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So that the and and we can we can put a link to that, I think, because I think it's a
really important one, just the American Heart Association and and stroke, what to do in
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terms of recognizing a stroke.
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Um, you know, and and I and in fact I have a I have a I just recently did a a an episode
on it that'll come out on my YouTube channel as well.
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So um that that would be a really good one for people to look at to know a little bit more
about that.
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That's a good idea.
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But I think it's really important that that folks understand what the signs of a potential
stroke are and just have a very low threshold for coming in.
190
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That's what we're set up for and that's what we're designed to to do.
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And I always say time is tissue.
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So um getting that under control and getting it identified early is super important.
193
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And you could see that as she got that medication, the patient started to talk again and
move her arm.
194
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And it and it is the one the one case that I've given.
195
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You know, and I've been an emergency physician for
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what is it, six years now and then a a doctor on top of that for for since for a further
five years, you know, that's uh seeing the patient essentially come back to normal on the
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end of your needle is is an incredible thing to witness.
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So yeah especially for such a young person.
199
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Yeah, and I I loved it when the um the two dots they were so excited they were like, yay,
like jumping up and down when she started coming back.
200
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Now having a stroke in your twenties though, right?
201
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Like that's pretty unusual.
202
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You know, and unfortunately, as I've gotten older, right, I'm 49.
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Most of my friends are turning 50 or in their fifties.
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I know now two people my age who have had strokes.
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Right.
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One really bad.
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The other one was like after a hernia surgery recently.
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Um
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Nothing like my friend who had the stroke two years ago.
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Like it's, you know, it it's like forever she'll have issues.
211
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It's scary, right?
212
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For sure.
213
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Uh that that feels more normal, but somebody in their twenties, like that's that's
unusual, right?
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Yeah, for sure.
215
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I mean, so you you use the word normal.
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I don't think we should ever normalize these things, right?
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Because it isn't normal to have to have a stroke and lose function, but it's very common.
218
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Um and it's very common because we have poorly controlled blood pressure, elevated
cholesterol, and we have a large percentage of our population uh have diabetes.
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These are all risk factors for developing cardiovascular disease, which includes heart
attacks or myocardial functions and strokes.
220
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Um, so so it's just this is a this is a good opportunity to say, hey, if you're in your
20s and 30s, it's important that you do things that that prevent your risk of getting
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those things, elevated blood pressure, diabetes, cholesterol.
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And part of that is having a primary doctor who can screen you periodically to make sure
that you're not developing those diseases.
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Um, and then two, if you're later in your life and you're in your late 40s, 50s, 60s, even
more reason to get those things under control if you have those.
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Because
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Fortunately, we have improved our mortality from cardiovascular disease.
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So people still have these things, diabetes, hypertension, cholesterol, strokes, heart
attacks, but they're not dying as frequently from those diseases because we have better
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interventions.
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And part of that is that we see people earlier and we have better treatment in the acute
stage, but then we also have better medicines to help keep them controlled so that they
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have lower risk of having events.
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So yeah, I think it's really important that folks if you haven't done it or you don't have
one, get yourself a primary doctor and try to get an appointment in to get an annual and
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do it today, even if it's six months down the track.
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Just it's important that you do that because they they're your best partner in good
health.
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Absolutely.
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Preventive care is important.
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I feel like we t we say that a lot.
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So um yeah, get in front of things before they get too big and you end up in the ER and
you're in the pit and you know, things are spiraling.
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So um cool.
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All right, good.
239
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I'm glad we we w I wanted to talk about that.
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That was an interesting one.
241
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Um, so what about the burn patient?
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And because I've already watched season one and season two, this is going to be a story,
obviously, that's gonna continue on.
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so the but this is brand new, brand new case.
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That's horrifying, by the way.
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and I I don't know, I'm just gonna let you talk about this.
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Have you ever dealt with that before?
247
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Have you ever had a burn patient in in your yard?
248
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Yeah, not not to that degree.
249
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That was a that was a crazy burn.
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I think they were talking about they said ninety percent BSA, you know, which obviously is
body surface area is is significant.
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you know, and they they started to talk about the the prognosis there and that's like
prognosis is kind of a dirty word in the emergency department because you know, we are
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we're the folks that that deal with the stabilization and get them to to the people who do
the prognostication.
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So I d I I actually don't have a sophisticated answer in terms of this particular
gentleman's, you know, prognostic likelihood or outcomes um in terms of how he'll do with
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s such significant burns.
255
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But I think the bottom line is he's got a long, long, long road ahead of him.
256
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Um, you know, and then the the downstream disability that will happen to him as a result
is is going to be significant.
257
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But there are a couple of things that stuck out in my mind was one Whitaker talking about
the Parkland formula.
258
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Um, which is essentially a a formula to determine how much fluid that patient needs to
have um over the next, you know, couple of days.
259
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And I don't know if you f you saw the numbers or or recognized the numbers.
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They were talking about 18 liters within 16 hours.
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So, you know, you think about those fluid bags that we have, he's gonna have eighteen of
those in sixteen hours or twelve hours.
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I can't remember exactly what he said.
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Wow.
264
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so it's a ton of fluid and it it
265
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Points out how important our skin is as an organ system.
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Um, and the reason for that is this gentleman had his his skin burned off, so he's just
losing fluid constantly, um, just out of out of the the subcutaneous layer.
267
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Um so so that was one thing that I thought was was really interesting, and it's a it's a
formula that has been um, you know, clever people researchers have developed that, and
268
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it's something that that.
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we always almost always have to look up before we we instituted it for patients.
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but then there was the escherotomy that had to happen for him.
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So because of the Yeah.
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Yeah, because the the the skin was so tight that he's he wasn't able to expand his chest.
273
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So they essentially had to create space that he could expand his chest because of the
burns.
274
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Um and how the burn was affecting the tissue and causing restriction.
275
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So I've never done that.
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Um
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and but I've have have read about it and you know obviously it's the type of thing that
you you I think that if of most physicians if they had to do it they'd probably have to do
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a quick bit of research on on exactly how to do it and where to do it um you know before
they before they go ahead and and actually do the procedure, particularly outside of a
279
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trauma center, you know, if you don't have a trauma surgeon on hand.
280
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So um yeah, that that gentleman's got a long, long road ahead of him for sure.
281
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Um very, very soon.
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Well, even, you know, in the end, right, Whitaker and Langdon are talking as they roll him
out and and Langdon says, Listen, hope, we're giving her hope, that's it.
283
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But the chances of him surviving after, I don't know, it was like so many days were were
pretty low.
284
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Um like I guess you know when you see those things, right?
285
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Um, have you have you had to like have you ever been in that kind of situation?
286
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Not even necessarily being like a burn situation.
287
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Uh well, I mean, I think it was even that was even a thing that happened with Dr.
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Robbie and the parents whose son overdosed on fentanyl.
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It's like you give them hope.
290
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You keep doing the tests.
291
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have you ever been faced with that?
292
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for sure.
293
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Yeah.
294
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I mean that's that's I mean the end of life is the is the most obvious example, you know,
where where perhaps people aren't r willing or ready to accept.
295
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Um, you know, that the you know you can see the writing on the wall that this person is
dying and you know there's there's nothing that you can do about it, um, unfortunately,
296
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and then, you know, trying to negotiate with them about well, what's what's in their best
interest, what are they actually what do they want, you know, do they want
297
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To get all of this care, because we can do all of these things.
298
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We can put true we can put breathing tubes in and put them on ventilators and we can we
already talked about we can replace the heart and lungs with an echo machine, you know.
299
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you know, so we can do all of these things, but doesn't just because we can do them
doesn't mean we should do them.
300
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Um so so you know, but but at the same time, you know, we we also have to we do have a lot
of things that we can do and you have to try to tow the line in terms of well, what's
301
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reasonable.
302
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Um, you know, and and at the same time it's important to not give people false hope about
what we are able to achieve because that doesn't help anyone either.
303
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So
304
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Right.
305
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Yeah.
306
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I I had a note here too.
307
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The um the social worker, Kiara, she's down in the ER quite a bit.
308
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Um, and they even said at the end, he's Yeah, you need to call her in.
309
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And I thought, Well, it you know, the show the pit, obviously, it's one day, it's fifteen
hours.
310
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They're like cramming everything in, right?
311
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Because it is it is a dramatic television show in the end of the at the end of the day.
312
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Um, but they gotta show kind of all of the things, right?
313
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All the possibilities that can happen.
314
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Um, but the I I had a question about this.
315
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So, like every hospital has a social worker.
316
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Um, and this one care is down there often.
317
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Um, do you engage with social workers on a pretty regular basis?
318
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Is that a I mean, maybe not quite as common as she shows up because of this is a TV show,
but I was curious.
319
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All the time.
320
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All the time.
321
00:23:52,784 --> 00:23:53,044
Okay.
322
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Yeah.
323
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Yeah.
324
00:23:53,936 --> 00:24:00,659
Th a big hospital system like that, they will have they will have a team of social workers
in the department that that are in the emergency room.
325
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Okay.
326
00:24:01,460 --> 00:24:06,843
because, you know, the you're you're dealing with so many varied things.
327
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You know, we at our hospital, we're a small community hospital, we only have coverage
during office hours um for our social workers, but they cover the whole hospital and we
328
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have a team of of social workers, typically three or so social workers that help, you know
329
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Get people into homes, get people into skilled nursing facilities, help with housing,
temporary housing, phones, clothing, um, food vouchers, transport vouchers, um, linking
330
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them up with with outpatient mental health resources, getting them into you know, into a
transferred to a mental health hospital, um, you know, helping coordinate with caseworkers
331
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that are already working with these patients.
332
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So like
333
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These these folks are incredibly valuable resources um that that actually do a ri a lot of
great work for patients.
334
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and provide them with with some of that support.
335
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We we even have fortunately we have an addiction medicine team as well that has a social
worker specifically looking at addiction medicine and people who have alcohol use
336
00:25:10,178 --> 00:25:19,432
disorder, opiate use disorder, and they have specific ways and places that they can refer
patients for outpatient help for their their substance use disorders.
337
00:25:19,432 --> 00:25:20,172
So
338
00:25:20,987 --> 00:25:27,751
yeah, I mean the ideal ideally you would have a social worker in every single department
that and probably a couple of them.
339
00:25:27,751 --> 00:25:35,716
Um because they're the ones that are really uh they're the ones that that do the work of
essentially helping patients navigate the system.
340
00:25:35,716 --> 00:25:38,568
Um which we've talked about since I burnout.
341
00:25:38,594 --> 00:25:39,407
High burnout, right?
342
00:25:39,407 --> 00:25:39,996
With social work.
343
00:25:39,996 --> 00:25:43,591
Like go hug a social worker people because those are like angels on earth.
344
00:25:43,591 --> 00:25:44,712
Just saying.
345
00:25:44,942 --> 00:25:45,702
For sure.
346
00:25:45,702 --> 00:25:51,247
Well it's it's just like imagine doing a job where you feel like you're never ever, you
know, making improvements.
347
00:25:51,247 --> 00:25:53,608
You know, how how dissatisfying that would be.
348
00:25:53,608 --> 00:26:02,644
Um, you know, and part of that is because they're fighting against a system that is not
set up to to be able to help people in a way that's optimal.
349
00:26:03,170 --> 00:26:04,431
Yeah, it's a tough job.
350
00:26:04,431 --> 00:26:07,374
Um, yeah, Kiara shows up a lot.
351
00:26:07,374 --> 00:26:13,729
So, um, and I'm like, wow, man, you gotta be a certain special kind of person, just like
Dana's a charge nurse, Dr.
352
00:26:13,729 --> 00:26:15,210
Robbie runs the ER.
353
00:26:15,210 --> 00:26:26,371
I mean, like, it it just they do such a great job of like showing um where people belong
in certain roles, you know, and I feel like that's kind of applicable across like
354
00:26:26,371 --> 00:26:27,131
anywhere, right?
355
00:26:27,131 --> 00:26:27,762
Like any job.
356
00:26:27,762 --> 00:26:29,934
Like we're all made for certain things, right?
357
00:26:29,934 --> 00:26:30,754
And
358
00:26:30,860 --> 00:26:36,932
They do a really the the pit does a really wonderful job of showing those people in those
right roles.
359
00:26:36,932 --> 00:26:39,182
Um just being amazing.
360
00:26:39,182 --> 00:26:44,664
So um yeah, I've been I've been wanting to t I've been wanted to plug Kira in here at some
point.
361
00:26:44,664 --> 00:26:46,654
So that was my that was my opportunity.
362
00:26:46,654 --> 00:26:56,467
Um but before before we we run out of time today, let's talk about that lateral can I'm
looking at this because I'm gonna mess up this word here.
363
00:26:56,467 --> 00:26:59,318
Can can't can't autonomy?
364
00:26:59,534 --> 00:26:59,815
Yeah.
365
00:26:59,815 --> 00:27:01,666
oh
366
00:27:01,666 --> 00:27:04,753
The the baseball to the eye, the line drive to the eye.
367
00:27:04,753 --> 00:27:05,813
Yeah.
368
00:27:05,915 --> 00:27:06,957
Cringey.
369
00:27:06,957 --> 00:27:07,696
Not gonna
370
00:27:07,696 --> 00:27:08,396
much so.
371
00:27:08,396 --> 00:27:09,167
Very much so.
372
00:27:09,167 --> 00:27:09,417
Yeah.
373
00:27:09,417 --> 00:27:17,812
Well, I mean, so so just talking about uh anything that has otomy on the back means that
you're you're cutting into it, basically.
374
00:27:17,812 --> 00:27:27,689
Um so the the lateral canthus is a specific portion of the anatomy of the eye where you
have these little tendon things on the outside of the eye.
375
00:27:27,689 --> 00:27:34,894
And what happened for that guy is he got the line line drive to the face and he had
basically blood building up behind the eye, which is a
376
00:27:34,894 --> 00:27:35,775
closed space.
377
00:27:35,775 --> 00:27:41,129
ah And that as that blood is building up, it's pushing on the eye and it's pushing it
forward.
378
00:27:41,129 --> 00:27:46,163
So it's increasing the pressure, which then it squeezes the optic nerve and it can cause
blindness.
379
00:27:46,163 --> 00:27:49,986
So he wasn't able to see on that side because he had high high pressure.
380
00:27:49,986 --> 00:27:59,925
So they did the lateral cantholomy where they basically make an incision into the skin on
the sides where the eyelids connect, you basically put local anesthetic in there and then
381
00:27:59,925 --> 00:28:04,524
you get some forceps and you crush that ah that space.
382
00:28:04,524 --> 00:28:07,606
And then you cut down into, and that kind of blocks off all the blood vessels.
383
00:28:07,606 --> 00:28:14,439
You cut into that, and then you take the two lateral canthus uh anatomy portions there and
you cut those.
384
00:28:14,440 --> 00:28:18,162
And it basically releases the pressure that's on the eye.
385
00:28:18,162 --> 00:28:23,245
And it looks very scary and looks like it's going to be incredibly deforming.
386
00:28:23,245 --> 00:28:30,709
uh But I've we had we had an opth, I remember having an ophthalmologist come in and give
us a lecture about this and how to do the procedure properly.
387
00:28:30,709 --> 00:28:33,154
And they showed a bunch of before and after.
388
00:28:33,154 --> 00:28:40,580
photos of people who had had lateral canthotomies and then what they look like months down
the road in clinic and their eyes look completely normal.
389
00:28:40,580 --> 00:28:55,313
Um so it's a it's a sight saving procedure that seems really barbaric and brutal, but it's
an incredibly important procedure that that helps save people's vision with no downstream
390
00:28:55,313 --> 00:28:56,674
negative effects.
391
00:28:56,718 --> 00:28:58,055
Have you ever done one?
392
00:28:58,378 --> 00:28:58,888
I have.
393
00:28:58,888 --> 00:28:59,659
I have done one.
394
00:28:59,659 --> 00:28:59,989
Yeah.
395
00:28:59,989 --> 00:29:04,141
They were um it was I wasn't good at it, put it that way.
396
00:29:04,141 --> 00:29:12,106
Uh we fortunately had the ophthalmologist there and and and the the she was she was
fantastic, fantastic teacher.
397
00:29:12,106 --> 00:29:15,047
Um and essentially sort of talked me through it.
398
00:29:15,047 --> 00:29:20,380
And I was the the bottom line is I think she said something like, You're far too timid
with it.
399
00:29:20,380 --> 00:29:23,652
You need to go go deeper, cut cut more aggressively.
400
00:29:23,652 --> 00:29:27,658
Um and I was just I couldn't get to the canthus because I just was
401
00:29:27,658 --> 00:29:29,390
This is this is this person's eye.
402
00:29:29,390 --> 00:29:30,181
I don't want to cut it.
403
00:29:30,181 --> 00:29:39,762
Um so so she she ended up taking the scissors and she saw what I was doing and and could
feel what I was doing and she just she did the exact same thing that I was doing, but just
404
00:29:39,762 --> 00:29:43,116
went deeper and more aggressive and she was able to release the pressure.
405
00:29:43,116 --> 00:29:48,242
So yeah, uh I will remember that next time I I have to do that.
406
00:29:48,642 --> 00:29:49,833
Yeah, hopefully you don't have to.
407
00:29:49,833 --> 00:29:51,023
But yeah, that one was a doozy.
408
00:29:51,023 --> 00:29:54,505
That one and and also that's the other thing with this show.
409
00:29:54,666 --> 00:30:06,332
The pit has these moments that are so realistic that like even, you know, people with the
s the strongest stomachs are gonna be like, Ugh, my mom, when she watches it with me, she
410
00:30:06,332 --> 00:30:08,854
does not have a strong stomach, hates horror movies.
411
00:30:08,854 --> 00:30:11,675
She like I get to see like she covers her face.
412
00:30:11,675 --> 00:30:17,088
And I'm like, I'll keep watching, but I'm just like, damn, they do a great job of like
413
00:30:17,442 --> 00:30:21,072
that realistic, like it just, you know what I mean?
414
00:30:21,072 --> 00:30:24,824
Like stop that just there's so many things I'm thinking about right now.
415
00:30:24,824 --> 00:30:26,104
Like even beyond that one.
416
00:30:26,104 --> 00:30:28,685
But um yeah.
417
00:30:28,685 --> 00:30:34,146
So last thing, let's tease this one up before we run out time.
418
00:30:34,146 --> 00:30:37,307
Um physician drug use.
419
00:30:37,307 --> 00:30:46,636
So Langdon and his benzo popping addiction starts to be revealed here.
420
00:30:46,636 --> 00:30:47,586
So
421
00:30:47,586 --> 00:30:52,230
Would in the last few minutes that we have, would love to hear kind of your take on this.
422
00:30:52,230 --> 00:30:58,324
And then we're gonna definitely explore that more in the future episodes coming up because
this story does not go away.
423
00:30:58,710 --> 00:31:09,258
Yeah, I uh I to be honest, I this not this this particular um storyline is one that I've I
I have lost some sleep about thinking about this.
424
00:31:11,401 --> 00:31:18,607
one because I I think Langdon is a is a is a really good physician, um and like an
excellent teacher.
425
00:31:18,607 --> 00:31:22,990
And I think there's been a number of times where he's been recommended for
426
00:31:23,028 --> 00:31:23,748
I think Dr.
427
00:31:23,748 --> 00:31:27,059
Robbie recommended him for the position as the the teaching fellow.
428
00:31:27,059 --> 00:31:30,980
you know, he's he's had a number of great cases that have been good saves.
429
00:31:30,980 --> 00:31:33,871
Um, you know, and he is a good teacher.
430
00:31:33,871 --> 00:31:43,761
But I think that the way that he in this episode, I think it was in this episode, maybe
the one before, but the last two episodes he he had that episode that that period where he
431
00:31:43,761 --> 00:31:51,386
he started to go off on Santos and then Robbie had to tell him to stop when he was yelling
at her.
432
00:31:51,386 --> 00:31:51,656
Yeah.
433
00:31:51,656 --> 00:31:52,056
Yeah.
434
00:31:52,056 --> 00:31:52,866
So
435
00:31:53,362 --> 00:31:58,266
and then obviously it ended with with him finding the patient medication in the locker.
436
00:31:58,266 --> 00:32:09,896
Um, and it it just it feels I just had this like heart sink moment where I said, My gosh,
this guy's got so much potential and he's just kind of throwing it all away.
437
00:32:11,238 --> 00:32:19,274
you know, and I I I personally don't know any physicians who've been in that situation
where they've had, you know, drug problems, you know, diverting drugs.
438
00:32:19,274 --> 00:32:21,186
I've heard about it a lot, you know.
439
00:32:21,186 --> 00:32:30,509
different healthcare workers of different varieties, you know, diverting patient drugs for
their own use, even selling those drugs to other people as recreational drugs.
440
00:32:30,509 --> 00:32:35,790
Um, there's certainly lots of stories going around about that kind of thing happening and
it's real.
441
00:32:36,951 --> 00:32:44,653
you know, uh I'm I'm curious to see where this storyline goes because it it felt like the
way that Dr.
442
00:32:44,653 --> 00:32:48,674
Rob I'm I'm curious to see what they do because part of it is um
443
00:32:48,674 --> 00:32:52,357
Like there's an instinct or an knee jerk reaction to just say, All right, you're done.
444
00:32:52,357 --> 00:32:54,919
You're that's it, your medical career's over.
445
00:32:54,919 --> 00:32:56,394
Go find a different job.
446
00:32:56,394 --> 00:33:04,136
Um, but then there's the other the other side of that to say, well, you know what, they're
they they have a they have an issue, um, and they need help.
447
00:33:04,136 --> 00:33:12,282
How can we support them so that we you know we don't lose that talent and all the good
things that they can do, but doing it in a in a safe way.
448
00:33:12,282 --> 00:33:14,423
And then how do you build that trust back up again?
449
00:33:14,423 --> 00:33:15,784
Cause that's like
450
00:33:15,784 --> 00:33:20,209
how how do you tr how can you trust that that's not gonna happen, you know, again in the
future.
451
00:33:20,209 --> 00:33:26,606
So I'm curious to see where that storyline goes, 'cause that's a that's a really important
one to address.
452
00:33:26,934 --> 00:33:31,085
Yeah, and I I can't stop thinking about another show that I've watched is called Nurse
Jackie.
453
00:33:31,085 --> 00:33:38,713
I don't know if you've ever seen it, um, where basically the entire premise of that show
is about Nurse Jackie's uh addiction problems, right?
454
00:33:38,713 --> 00:33:46,168
And kind of how she gets moved through that system, how she's able to come back and, you
know, practice and cause she was amazing, right?
455
00:33:46,168 --> 00:33:47,910
Like kind of similar situation.
456
00:33:47,910 --> 00:33:53,986
So anyone listening to this, if you like that storyline um and you like medical shows,
457
00:33:53,986 --> 00:33:54,877
Go watch Nurse Jackie.
458
00:33:54,877 --> 00:33:56,268
That one's kind of funny too, right?
459
00:33:56,268 --> 00:33:57,629
Like there's this drama.
460
00:33:57,629 --> 00:33:58,589
It's kind of older.
461
00:33:58,589 --> 00:33:59,220
It's older.
462
00:33:59,220 --> 00:34:03,452
But my husband and I watched it like the whole like multiple seasons.
463
00:34:03,673 --> 00:34:06,375
I feel like it was like last year and it was fantastic.
464
00:34:06,375 --> 00:34:09,357
But that's kind of like the main storyline with that show.
465
00:34:09,357 --> 00:34:18,923
But um, yeah, Langdon's Benzo Use is definitely gonna keep um showing up, um, coming over
future episodes.
466
00:34:18,923 --> 00:34:21,045
And that's all I'm going to say.
467
00:34:21,045 --> 00:34:23,306
Um, but
468
00:34:23,564 --> 00:34:24,074
I don't know.
469
00:34:24,074 --> 00:34:33,218
We again here we are at the end of episode ten and it's just like woo stuff is just up and
down and all over the place.
470
00:34:33,218 --> 00:34:34,978
So um
471
00:34:34,978 --> 00:34:40,706
I always wanna finish saying that it the show's really heating up, but it's I don't know
how it could get any hotter, you know.
472
00:34:40,706 --> 00:34:44,180
It's it's we're we're being thrown lots of stuff every episode.
473
00:34:44,418 --> 00:34:45,478
Guess what?
474
00:34:45,658 --> 00:34:47,359
It can and it will.
475
00:34:47,359 --> 00:34:55,371
So come back for next week's show, season one, episode 11, that is the 5 to 6 p.m.
476
00:34:55,371 --> 00:34:56,181
hour.
477
00:34:56,181 --> 00:35:02,803
There is a couple of Easter eggs in this episode, I know now, because I have now watched
the entire season.
478
00:35:02,803 --> 00:35:04,403
But I'm gonna leave you in suspense.
479
00:35:04,403 --> 00:35:11,665
And the rest of you, if you haven't seen it, make sure you watch, come back and talk with
us next week, and we will unpack all of the things.
480
00:35:11,665 --> 00:35:14,246
So until then, em
481
00:35:14,830 --> 00:35:15,542
Well, I don't know.
482
00:35:15,542 --> 00:35:19,742
Until then just just try to chill out and breathe.
483
00:35:19,742 --> 00:35:22,074
Totally, stay happy and healthy.
484
00:35:34,870 --> 00:35:36,274
not give medical advice.
485
00:35:36,274 --> 00:35:40,382
If you're seeking medical advice, consult a physician or healthcare professional.
486
00:35:42,446 --> 00:35:44,071
This has been a shut up production.
487
00:35:45,176 --> 00:35:45,947
What?
