I thought it was going to be a scripted show, but it’s a documentary, filmed in several Boston hospitals.
I didn’t catch the whole hour, but I liked what I saw. It doesn’t look like a puff piece.
A resident (or maybe an intern) got chewed out for not taking control of a situation. A dialysis patient had gone into cardiac arrest. The resident was trying to intubate the patient and give orders for meds at the same time. And while she was trying to intubate, someone was doing CPR (chest compressions). Wouldn’t it be difficult to intubate while someone’s getting CPR?
Anyway, it didn’t look like it looked on ER and other medical shows. Except for the resident asking for meds and the guy doing CPR, it was just a bunch of people standing around, getting in the way, not doing anything. The patient died.
We also saw bits of two lung transplants, and surgery on a policeman who’d been shot.
It was interesting, and I think I’ll keep watching. It’d be great if one of the Dope medicos was watching too, for expert commentary.
If you missed part of it those whole episode is available on the ABC website.
I hope that a lot of people watch it and see things like the code that was depicted. In fictional medical shows the majority of patients who code get better. In real life once a patient codes there is a miniscule chance they’re going to make it out of the hospital alive. So when doctors are talking with patients and patient families we often have to deal with totally unrealistic expectations based on years of watching ER or whatever. And yeah there are often a lot of people just standing around getting in the way. The criticism the resident got was valid. There primary responsibility of the person running the code is to run the code and make sure that there is someone assigned to each task. And if the team leader is someone who’s good at taking charge they can get the spectators out of the way. I was surprised that ER staff were code team for the rest of the hospital. The places I’ve been the on-call medicine team is in charge of codes that happen outside the ED.
The first anesthesiologist they showed annoyed me. The one who stepped in and did the intubation when the ED resident missed it. “My job is to take care of the patient, not to teach the resident.” Bullshit, your job is to do both. If you’re a physician at a teaching hospital teaching is part of your job description. If you’re an attending you teach residents and students. If you’re a resident you teach students and residents who are junior to you.
Do you know what that surgeon meant when he was handling the lungs and said it “feels like Rice Krispies”? He said they were good lungs – “beautiful” – but why would they feel crackly? Air pockets?
I agree about the doctor who said it’s not his job to teach. I wanted to see him ask her what she should have done and how she’d do it. But the looky-loos share some blame too. If I know to get out of the way when someone’s doing an emergency procedure, you’d think they’d know.
“Brigham and Women’s Medical Center” – odd name. Why not just Brigham Women’s Medical Center". Sounds like it’s for people named Brigham, and women.
Still is. All my kids (and one nephew) were born there. My wife used to work there, and it was a Very Big Deal to management when they dropped off the list of the top 10 hospitals in the USA - IIRC, they dropped to #12.
Rice crispies was about the old lungs. They were operating on the woman with severe emphysema. When they removed her lung there was a shot of it and then they cut to looking at the face of the resident who was handling it and who described it as feeling like rice crispies.
There’s a physical finding called crepitus that you sometimes encounter when someone has gas that has escaped into tissues where it shouldn’t be (among other causes) which feels like you’re crunching rice crispies under the skin. It’s kind of creepy the first time you feel it. Apparently her lungs were so destroyed by emphysema that they also felt like that. Healthy lungs feel smooth and not crackly.
Well according to this site lung transplants are a lot less common than kidney and liver transplants but still more common than pancreas or intestine transplants. I was going to say that’s probably because you can use living donors for kidney and liver but while looking for statistics I ran across the fact that apparently you can do living donors for lung as well. Huh, who knew? Clearly it’s not common enough that I know much about it.
Actually the only time I’ve had anything to do with lung transplant was on my the first shift of an ED clerkship at a major medical center when I picked up a chart with the complaint of shortness of breath thinking that was something I could handle. When I walked into the room the patient was on supplemental oxygen and still gasping wildly for breath. Speaking about 2 words at a time he was finally able to tell me that he’d had a double lung transplant and had some complications. :eek: Hello, transplant? I have a consult for you!
The producer of the show, Terrance Wrong, also made a similar series “Hopkins 24/7” a few years ago with the same kind of theme (obviously set in Baltimore).
It is offensive to present Patel as the typical resident. Independent of her skill level (which shows one flail after another), she comes across as completely self-absorbed and not able to put her patient first. This is not how residents are and should be trained. At the very least, by the end of residency it should be clear whose life is the priority (the patient’s).
And I am sorry, but let me clarify one thing that I hope everyone can agree to: The patient always comes first. Recognizing an impending disaster is more important than anyone’s ego, and the resident must ask for help. Teaching physicians-in-training is never at the expense of a patient’s life.
Anesthesia residents usually don’t complain when their attendings push them aside, probably because they are better trained to recognize when they need help.
I thought that this ED resident was presented as incompetent and frankly dangerous.
In full disclosure I am an academic physician in a teaching hospital…
Showed this to Mrs. FtG as this is sort of her thing. She really liked it. Me, not so much. The fast cutting, moving camera, handheld shakiness, etc. just made it maddening to watch. Slow it down, frame the shots and hold them a while. (Which makes it really weird that she liked it. She is so easily nauseated by that sort of thing.)
I was also hoping for more shots of surgery and you know, actual medicine. Too much jabbering with families, etc. The proportion is way off.
Learned a few things. E.g., I thought the calling out of time of death was a TV trope. But Mrs. FtG assures me it does happen (having seen it herself). I know that the time needs to be entered on a form, but why can’t the doctor just write it down? Apparently that’s one of those “just not done” things.
Yup. She watched the first ep, and said she saw some people she recognized, and that it was pretty accurate, but either some doctors cleaned up their behavior a bit for the cameras or there was some creative editing going on.
