Er 2/17

[NotWithoutRage]

This is disturbing. Fascinating, and wonderfully directed, but disturbing.

[Queen Tonya]

Woo, I loved this episode!! See, this is why I still watch, I was riveted, I laughed, I sighed, I got teary, ahhhhhhhh. :)

Grrr, I can't wait for the inevitable Morris meltdown, he bugs me. I had yet another argument with my ER buddies tonight that no, Morris is not a Romano replacement, Rocket Romano could be a dickhead because he had the superior skills. Morris is an incompetent jerk with no redeeming social qualities.

Next week's teaser with the Iraq tie-in, wow!

[Large Marge]

No, don't tell me! It hasn't showed here yet!!

*puts fingers in ears*

la la la la la la la la

[CrazyCatLady]

I love this show so much when they focus on the medicine and the patients and the hospital as a whole and who's boinking whom is barely even a side issue--you know, when it's ER and not General Hospital. Wonderful episode, just wonderful.

And finally I can stop wanting to bitchslap Carter every time I see him on my screen. Morris's constant bitchslap status remains unchanged, however, and at this point it would require a total personality transplant and several months of acting like the love child of Mark Green and Mother Theresa to get him down to intermittent bitchslap.

Oh, and based on the intro before the credits, I'm going to make the prediction that Sam gets knocked up in May sweeps and there's mucho drama between her and Luka about what to do. And we all know that Carter's going back to Africa to be with Kem at the end of the season. So could we just go on and send him now? Please? Before he has another little sanctimonious crusade?

[Queen Tonya]

Ya, I dunno....Noah Wylie was on Ellen saying he's signed on for another year of ER at least, so now I don't know what to think. :confused:

[eenerms]

I believe I read that Noah W. was perhaps coming back next year??

[Larry Mudd]

Just starting here.

I think it's going to be hard going, because in my opinion Cynthia Nixon is the most perfectly boinkable of the SitC ensemble, and it's going to be difficult to see her all uglied up. And, you know, concentrate on her acting and all. :D

[BobT]

You are aware that Cynthia Nixon has decided to switch teams as it were.

[Larry Mudd]

Hardly matters where it concerns me. :D She shore is purdy.

That was a pretty good show. (I think I've seen maybe half-a-dozen episodes of ER since it's been on, so the plotline about the running lovers was totally lost on me.)

Everything else was great. Loved the bit where it appeared as though she managed to communicate with her husband through that one terrified eye. I'll have to sit down with a stack of DVDs sometime.

[vivalostwages]

It was a great moment when she was thinking of all the things that mattered most to her: love, kids, noisy, messy, you, etc.

Nice to have the patient's perspective/thoughts.

[LavenderBlue]

I adored the Cynthia Nixon plotline. That was one of the best patient stories they've done in years. My local newscast had a feature about the procedure they used on her character. Apparently it really does work that well.

[AmericanMaid]

I watched last night's episode because I had a stroke. A lot of parts of the episode set off the B.S. meter and there were glimmers of accuracy.

B.S.
- Having a stroke with no mention of stabbing pain in the head
- Not numbing the site of the leg where the catheter is fed through
- Magical procedure that not only removes the clot but also reverses brain damage
- No defecits. Brain damage is permanent and irreverisble and Ellie should have had some lingering effects.

Accurate
- The panicked thinking "Stroke?!? Only old people have strokes!"
- Getting clothes cut off and not really understanding why
- the bilateral strength/motion check. Yup, been there with the arm falling like lead. Ouch.

[Telemark]

But why have the subplot with Abby and the surgeon who has a crush on her? It seems so junior high school.

Pratt is growing in his leadership role, it'll dawn on him (I hope) that he can become more than he currently is by stepping up. He's gonna be Chief Resident, one way or the other.

I'm looking forward to next week's show, that looked quite interesting in the previews.

[CrazyCatLady]

AmericanMaid, not all strokes are the same, so it seems a bit over the top to call the show BS because it doesn't match up with your particular experience.

When my father had his stroke, he didn't have a stabbing pain in the head. He just got weak and dizzy and couldn't talk right all of a sudden. That's apparently fairly common with the type of stroke he had.

The fact that they didn't explicitly show them numbing the site of the catheter doesn't mean they didn't do it. They can't show every single step onscreen--it's a longish procedure and the show's only 45 minutes long by the time you take out the commercials. IIRC, they talked about prepping the site, she thought "Oh, great" and then they cut to another plotline, cutting back when they were already in and ready to inject the dye. And actually, if they went in on her right side, I'm not entirely sure they would have needed to numb the site. She couldn't feel that leg anyway, though I suppose she might have regained sensation between the time the clot was removed and the time they pulled the cath and had some pain.

And yes, that procedure is real, and it really can work that well. They've been doing it at our local hospital for quite some time now. When Ellie popped all perfectly normal, I immediately turned to Dr.J and demanded, "Do they really just spring right back like that?" He said that it usually takes a few hours for someone to fully recover, but yes, it's remarkably fast. He also said that it's a procedure that you only do under a very, very specific set of circumstances regarding timeline, type of stroke, etc.

Also, brain damage is a very broad term. Not all brain injury is permanent and irreversible. If it were, no stroke patients would ever recover even the slightest bit. If they can get the clot out and restore circulation before the tissue reaches the point of no return, AFAIK there's no reason the patient shouldn't make a full recovery.

[Dewey Finn]

One question about the stroke victim storyline. How were the paramedics dispatched to her house? I thought she was home alone.

[Wile E]

I don't know. It was interesting enough. I wasn't all that impressed with Cynthian Nixon, since there wasn't a whole lot she could do physically she had to act through voice overs and her voice wasn't convincing me.

I think I missed some stuff. Is Morris actually in the running for Chief Resident? How can that be?

[BobT]

One question about the stroke victim storyline. How were the paramedics dispatched to her house? I thought she was home alone.
Her neighbor called the paramedics. She was the one who brought the children over. Before the woman passed out, she told her neighbor that she would call her back in about 5 minutes. When that wait became too long, she probably went over to check on her.

[AuntiePam]

I don't ordinarily find much in ER to chuckle about, but Nixon's comments about Dr. Kovac were hysterical. Yep, that's pretty much what the rest of us have been thinking too.

I wonder if that episode will prompt couples to talk about situations like this -- make their wishes known, clearly. Or write it down -- Living Will or whatever it's called.

[AmericanMaid]

AmericanMaid, not all strokes are the same, so it seems a bit over the top to call the show BS because it doesn't match up with your particular experience.

When my father had his stroke, he didn't have a stabbing pain in the head. He just got weak and dizzy and couldn't talk right all of a sudden. That's apparently fairly common with the type of stroke he had.
They said on the show that Ellie had a MCA territory stroke. I did too and it hurt. I am not trying to say that my experience is universal but I have had years of medical tests and research done to me so I'm pretty darn knowledgable.


The fact that they didn't explicitly show them numbing the site of the catheter doesn't mean they didn't do it.
When the surgeon announced, "Okay, I'm inserting the catheter." Ellie's mind said "Ouch."

I'm not entirely sure they would have needed to numb the site. She couldn't feel that leg anyway, though I suppose she might have regained sensation between the time the clot was removed and the time they pulled the cath and had some pain.
A person can be paralyzed from a stroke and still have feeling. I assumed Ellie had feeling because she could tell that she was drooling. I happened to have lost movement and feeling when I had my stroke so I couldn't move and couldn't tell I was drooling. Both losses don't have to occur .

brain damage is a very broad term. Not all brain injury is permanent and irreversible. If it were, no stroke patients would ever recover even the slightest bit. If they can get the clot out and restore circulation before the tissue reaches the point of no return, AFAIK there's no reason the patient shouldn't make a full recovery.
The injury to the brain is permanent. The effects aren't. I have permanent holes in my brain and I'm not paralyzed anymore. The brain is not like other parts of your body which can heal. If there's damage done, the dead cells are swept away/purged. I guess I take issue with this episode's timeline. It's too late for TPA and yet early enough to have healthy brain tissue.

[CrazyCatLady]

I think I missed some stuff. Is Morris actually in the running for Chief Resident? How can that be?

He has applied for the position, yes, but he has zero chance of actually getting the job if there are any other candidates at all (and Susan will find some other candidates, by hook or by crook). So I guess the answer to your question sort of depends on how you define "in the running."

[CrazyCatLady]

Sorry I didn't get back to you before, American Maid--I had stuff that needed doing.

Anyway, when you called the lack of pain BS, I took that to mean that you were saying that all stroke patients had a stabbing pain in the head. Since that clearly wasn't what you meant, I apologize for the misunderstanding.

The catheter placement must have happened while we were talking about the procedure, because I totally missed it. Still, I got the impression that Ellie had had loss of sensation as well as loss of movement, because I could have sworn at one point she was thinking "Where is my leg?" I suppose it could be a proprioceptive loss while still having pain, though. And I didn't think much of her realizing she was drooling because if you drool really badly it often goes down both sides of your face. Or at least mine did when I had one side of my face full of novacaine. The stuff from the middle hit the protrusion of my chin and some it ran down one side and some down the other.

I think we're talking past each other on the brain damage issue. When a nerve cell dies or is mangled, it almost never regrows, yes. (In some extremely rare cases, nerves can grow back, but nerves never regenerate is a good rule of thumb.) But I'm talking about cells that aren't quite dead yet. My understanding is that if the tissue isn't actually dead, once it becomes adequately perfused it should be fine. Of course, that understanding could be incorrect, but it fits in with all the stuff my biology profs ever told me and with the effects of this treatment. I'll nag Dr.J in here later so he can clarify the issue for us, both about the brain damage and the details of how this procedure works.

Come to think of it, did they ever say that she had no brain damage? I know they showed that she had no deficits (or at least not any major ones). But I wonder if it was a situation where she didn't lose any neurons, or if she lost some but not enough for them to particularly bother about.

[av8rmike]

Hmm... a Special Guest Star and a Very Special Episode, to boot.

Too much about this episode just screamed to me, "give us an (another?) Emmy!"

The stroke discussion here is interesting, though.

[Cyros]

Hubby and I talked about our wishes after this episode. We would both want the risky procedure with chance of recovery. Neither of us is interested in being kept alive indefinitely by machines.

/Ms Cyros

[Stainz]

av8rmike - that's exactly what I was thinking!

For some reason, the idea of having a stroke terrifies me, so I almost didn't watch this episode. Then I decided to give it a shot, with a promise to myself to turn it off if it started to get to me.

I watched the whole thing without any emotion whatsoever about that storyline. It really seemed like the writers were trying too hard, and I just didn't find it convincing. (Maybe I just like it better when the patients die). :(

I know I am in the minority, but I was much more affected by the Ray Liotta episode.

S.

[Ellis Dee]

I know I am in the minority, but I was much more affected by the Ray Liotta episode.Agreed completely. I was greatly disappointed by this episode, only because my hopes were very high based on the Ray Liotta episode. (Not to mention Sally Field's first episode, where we meet Abby's mom for the first time. They usually do pretty well with guest stars.)

I found Cynthia Nixon's voiceover work atrocious. I only sensed fear/suffering in maybe one or two of her line readings.

Still, it wasn't the worst episode I ever saw, I just couldn't buy into the stroke victim's thoughts.

One thought I had while watching, which was strongly reinforced by this week's TNT reruns, (I'm finally caught up, woohoo!), was: "How many scenes, exactly, have we seen with Carter lounging around in bed?" It's so frequent that it's starting to feel like a running gag by the writers; some kind of inside joke that I don't quite get.

Next week's episode looks solid, but could the promo at the end of last night's episode be any more pompous? Good lord, people, throttle back on the sanctimony already.

[TeaElle]

You are aware that Cynthia Nixon has decided to switch teams as it were.
She hasn't "switched teams" she plays for both. At the moment she's on the all-girls team.
This message brought to you by the Coalition to Advance Understanding of Bisexuality.
B.S.
- Having a stroke with no mention of stabbing pain in the head
It was pretty clear that she didn't remember that. That's not necessarily unusual.
- Not numbing the site of the leg where the catheter is fed through[quote]
They did. They mentioned that she'd feel the sting of the lidocaine. If she didn't have any, she wouldn't have thought "ouch" she would've thought "freakinghellwhatisthatgetitoutgetitoutgetitout!!!!!" Besides, I'm pretty sure that the "ouch" in response to a catheter wasn't during the clot-removal procedure but when Sam gave her a Foley catheter (to collect urine) in the ER.
[quote]- Magical procedure that not only removes the clot but also reverses brain damage
As I understood it, the physical symptoms Ellie experienced were mainly the result of the pressure being placed upon a neural center due to the blood clot. When the clot was removed, the pressure was relieved and the symptoms (paralysis, facial tic, ataxia) were reversed.
- No defecits. Brain damage is permanent and irreverisble and Ellie should have had some lingering effects.
That presumes that she had brain damage in a quantifiable amount to begin with, which we don't know that she did.

As CrazyCatLady mentioned, recovery to the point that we saw at the end of the program takes a while, but then, several hours had elapsed anyway. In the time that spanned between Ellie's treatment and when we saw her family coming in to see her in the recovery room upstairs, Kovac was off-shift (that's why he was able to come up and stay with her to begin with) and the residents and interns had finished their shifts and gone to the bar and Carter and Wendell had time for dinner, sex and some sleeping. The episode wasn't in real time.

[AmericanMaid]

TeaElle and CrazyCatLady, my reactions to the episode are based upon my experiences and are solely my opinion. I have shared them because I thought people might be interested in hearing from someone who actually had a stroke. I am not a doctor nor a nurse. I am simply a victim of bad luck who has tried to learn from the worst year of my life.
What I have learned might not be universally applicable. I sat in a neurologist's office after my stroke while she went through recent scans of my brain. She pointed out the black areas on my brain scan and commented "Well, that's gone." After I dealt with the emotional impact of that statement, I had her explain to me what she meant. I am missing chunks of my brain in my right frontal, parietal, and temporal lobe not neurons or synapses, chunks of tissue. These areas were starved of blood and oxygen and were swept away by what I call "janitor" cells.
I have been told what I didn't recover within the first year, is permanently gone and I have seen the black holes left in my brain. So, I guess this E.R. episode made me really sad and angry that I had my stroke before TPA was used and the corkscrew procedure was discovered.
I am sick of debating nuances of this episode since I didn't tape it and my memory is crap.

~ Ol' Swiss Cheese Brain