Dr. Mike: Not even one year ago, I was a resident. Now there's a TV show called "The Resident". Let's get started!
[ Intro Music ]
[ music playing ]
Dr. Mike: It is true, surgeons play their favorite music... Male Surgeon 1: Well yank that sucker
...when there are operating. I need to poop bro
Female Surgeon 1: Did you guys know this is my first surgery with Dr. Bell?
Female Surgeon 2: No kidding. We have to get a photo.
Female Surgeon 3: Make it quick.
Female Surgeon 1: Get in, (inaudible).
Dr. Mike: Ok, no. No one's taking out their cell phone in the middle of an operation and taking selfies.
Male Surgeon: I wish we could get one without the mask. [ camera shutter ]
Dr. Mike: Uh oh, tremor.
[ Surgeons discussing photos ]
[ Medical machinery beeping aggressively ]
[ Surgeons gasp ]
Female Surgeon 1: Oh my god. He cut an artery?
Female Surgeon 2: On an appendectomy?
Male Surgeon: He's losing blood fast.
Male Surgeon: We need 2 litres of (inaudible) wide open. Call for 4 units of blood and 2 FFPs, stat. Give him (inaudible) number.
Dr. Bell: Packing, suction.
Dr. Mike: He's breathing very heavily, rightfully so.
Female Surgeon: Clamp something, he's lost at least 2 litres already.
Dr. Bell: Come on.
Dr. Mike: What's splattered on him, maybe a quarter of a litre...
Two litres is a LOT of blood and that's probably not two litres.
He has some shaky hands, may have hit an artery. When you hit an artery, it does splash like that.
The first step during a surgery is to get one of the tools called the hemostat and basically it clamps off the artery to get it to stop bleeding.
Female Surgeon: CPR isn't going to put all that blood back into his body.
Dr. Mike: Whoa.
Dr. Bell: Don't die on me.
Dr. Mike: Happy?
I'm assuming this is someone's bad dream because they're not following proper protocol. I have no idea why he's stopping CPR...
Nothing makes sense here.
Female Surgeon: He is so dead.
Male Surgeon: Time of death -
Dr. Mike: Okay. [ chuckles ] Whoa.
You guys told me The Resident is the most accurate medical show on television.
So far, this has been incredibly inaccurate. This gentleman's heart stopped in the middle of the procedure because he was losing blood.
They were supposed to get blood and start the blood flow through an IV.
They started chest compressions. They didn't follow, uh,
the cardiac life support algorithm of giving epinephrine, rechecking the rhythm after two minutes, and it looks like they called a time of death after... 30 seconds?
Dr. Bell: Well, I think we can all agree, it was the misdosed sevo...
Dr. Mike: What?
Dr. Bell: ...that led to this unfortunate situation.
Male Surgeon 1: You're kidding, right?
Dr. Bell: The patient woke up. His arm hit my hand.
Male Surgeon 2: You left the blade in the field.
Male Surgeon 1: You nicked the artery! You all saw it!
Dr. Bell, interrupting: You never should have OK'd him for for surgery in the first place as INR was abnormal.
Male Surgeon 1: The upper range of normal. That's never gonna fly.
Female Surgeon: We're all on the same team here. Right?
Dr. Mike: [ scoffs ] Oh my god! He's trying to blame it on the patient coming in with a high INR,
which is basically the ability of the patient (sic), the inability of a patient to to clot properly.
So if you have a very high INR, you're more likely to bleed out. If this happened, I hope that the people around me, uh,
have the courage to speak up and say something about it.
In fact, one of the biggest initiatives that have been going on in hospitals over the last 10 to 20 years is to give nurses
uh... the voice and the courage to speak up when they see doctors, especially senior doctors like this gentleman who's a Chief of Surgery
who's been practicing for 30 years, to speak up and say no you've made a mistake and we need to own up to it
and figure out what went wrong and how we can prevent this in the future. This is awful.
This is an awful situation. I have goosebumps. Honestly.
Man: We have 206 bones, and I can name each one.
Dr. Mike: ( laughing ) It's a very cheesy way to, uh, turn somebody on.
Doctor: Everything you thought you knew about medicine is wrong.
All the rules you followed will break.
I have only one rule, covers everything. I'm never wrong.
You do whatever the hell I tell you.
No questions asked.
Dr. Mike: I can't take this guy seriously. He sounds like he's from a western movie and he's like welcome to the wild wild west.
Yes, in reality, medical school is quite different from life as a resident.
There's a lot that you think you know about working in a hospital, when in reality you start working in a residency you realize that
you didn't know, or what you thought you knew was actually wrong and you practice it in a different way.
That's why those who get overly confident by
regurgitating facts and figures
really have their minds blown when they enter the hospital and they see the way medicine is practiced. Because humans are very complex,
they don't present like the way the textbooks says they will present. They don't always
give you a clear indication of what's wrong with them.
It's a lot more of a puzzle and figuring out what's going on. The heart of what he's saying is true. The way he's presenting it is way overblown and dramatic.
Doctor: My last resident had an attitude, too,
and you know where he is now? He's teaching eighth grade biology. I cut him. Do you know what that means?
It means I can end your career!
Just like that, remove you from this residency at any time for any reason, and if I do that, no other residency will take you.
Dr. Mike: Completely untrue. Senior residents don't have the ability to get you kicked out unless you do something just
horribly wrong, and if you lose your spot in a residency because you disagree with a senior resident, doesn't mean that no other
residencies will touch you. Again, a completely overblown statement and untrue, I guess for the dramatic factor of the show.
Attending: This is Dobroslav. He's Croatian, speaks no English. He has severe cauda equina syndrome. What are we worried about?
Resident: Early paralysis.
Attending: Hey, man, what's the first sign of paralysis?
Resident: Anal tone.
Attending: Stick your finger up his ass.
Dr. Mike: ( laughs )
Resident: Normal procedure is to get an MRI.
Attending: Thank you so much for telling me about normal procedure.
Dr. Mike: Cauda equina syndrome is where you have
severe narrowing of the area of the spinal cord where your nerves travel through.
So, you lose the sensation of your lower limbs, you lose the ability to have proper anal tone. Some people have
incontinence, where they just pass their their bowels,
they lose urinary control and just have urinary incontinence meaning that they pee themselves and if any of those things happen you have to call 911
because cauda equina, this procedure (sic) this condition they're talking about is a medical emergency.
Obviously, one of the ways to test that is to do a rectal exam and check the sphincter tone,
but he's being really rude about it.
Attending: Good afternoon, we need to explore your rectum.
[ Phone plays translation audio ]
Dr. Mike: Back in the day, we used to have translators that lived in the hospital
I mean, worked in the hospital.
Now we have really good intercom systems. Some hospitals even have iPads that connect you to another person who can be the
functioning translator. The correct way to do this is to not talk to the translator and have them translate it, but talk to the patient
normally and have the translator somewhere behind you or on the phone talking to them, translating.
So you're still having a conversation with the patient, not a conversation with the translator. That's a very important distinction to make.
Dr. Mike: I was hoping this show wouldn't involve sex, but I'm striking out week by week because apparently
everyone's in love in the hospital. Maybe I've just worked in the wrong hospitals.
Paramedic: Acute leukemic on chemo. Fiance called because she was shaking uncontrollably.
Fiance: Uh, she spiked the fever this morning, a hundred point eight. Also there-
Dr. Mike: So commonly, someone who has
chemotherapy performed on them they can develop something known as neutropenic fever.
It's what a specific type of white blood cell's very low and you have a fever. It's a very dangerous situation.
Broad-spectrum antibiotics, meaning antibiotics that cover a whole host of different bacteria,
need to be given right away in order to prevent the person from dying
because their immune system is incapable in dealing with the bacteria on its own.
So I think this is a pretty interesting case already and I've just seen like five seconds of it.
Fiance: -there was some vomiting, there was no blood in it. Last chemo was a week ago.
Patient: You're here!
Dr. Mike: Very accurate presentation so far. Knowing when the last chemo treatment's very important when
judging what the next step of the treatment plan is.
Patient: I'm scared.
Attending: Ah, you're running a fever.
Just another infection. Chemo's still pushing your immune system. I'll get you started on broad-spectrum antibiotics again.
Acetaminophen to get your fever down.
Get cultures from both arms here and she'll need a head CT.
Attending: Don't worry. We'll get this under control get your both back home soon.
Dr. Mike: Having a good rapport with patients like that is very important. Nurses and some doctors and even
people that are just spending time in the hospital for a short period of time are very somber when they're around sick people.
Especially chronically sick people who've been sick for a long period of time.
But in reality, they would love for someone to come in with a little
more lighthearted approach, can laugh with them, make them smile. I'll always try and have a laugh with them,
tell some jokes, especially if I know the family well and I think that makes a very
unpleasant experience a little bit more bearable. That's just my take on it.
Resident: How did you get that cheeseburger, Chet?
Chet: Delivery app.
Resident: Looks like you haven't been following your diet.
Chet: Diets don't work.
Doctor: Have you been taking your insulin?
Chet: I don't want to let your (inaudible) here cuz...
Chet: ...my toe's killing me.
Resident: Severe gangrene.
Dr. Mike: So a gangrenous - just, really gross. A gangrenous toe could be so infected and dead, it's basically necrotic,
(that means dead tissue), that it can fall off like that. Obviously, that's a little exaggerated.
This smell is probably the worst part of all of it. Because the bacteria, once they eat your tissue,
they release a very foul smell. It will light up the entire room.
I'm not talking about you have to sniff the wound. As soon as you walk into the room, and there's gangrene present,
you're gonna smell it. That is very true.
[ Patient screams while doctors try to calm her down ]
Attending: New admission. 21 year old girl, history of IV drug use. Likely endo.
Doctor: She was trying to steal dilaudid, now she wants to leave AMA.
Woman: She's been spiking fever, vomiting.
Young Woman: She's using again. She took all my money (inaudible)
Dr. Mike: Those who use drugs, especially injection drugs, they're predisposed to a whole host of illnesses.
So this is a common presentation, unfortunately
especially in light of the opioid epidemic that's going on right now. When you inject into your body anything -
especially in a non sterile technique, meaning the needle isn't clean, your skin isn't clean -
you're more predisposed to things like meningitis, endocarditis.
Meningitis is an infection of the pads surrounding the brain. Endocarditis is infection of the heart valves.
These are life-threatening illnesses that can make you act this way because bacteria is festering in your body.
And unless it's treated quickly and correctly, you can die.
And that's just talking about infection. Think about all the other things that could be going on when you're under the influence of drugs.
It's very possible
that you're acting this way as a result of an overdose from simply the drug. When a patient comes into the emergency room
and they're presenting with this kind of outcry,
screaming, what we call altered mental status, AMS.
We have to figure out is it related to the drugs? Is it because of infection?
Is it something more sinister? Has this patient had a seizure? There's a lot of things that are happening simultaneously in a doctor's mind
so it's not an easy situation to deal with but ER doctors are the frontline in dealing with this and then once the patient is
stabilized and ready to be admitted into the hospital
it then goes to internal medicine doctors like this gentleman or family medicine doctors like myself.
Attending: If you walk out of here without any antibiotics, this will kill you.
Give us a chance, we can save your life
Patient: I'll stay if you give me three milligrams of dilaudid.
If you calm down.
Dr. Mike: (sighs) I can't say what he's doing is wrong
because she's likely withdrawing from dilaudid or opioids or heroin
whatever it may be. In order to help her condition,
it's possible that you need to taper her off meaning give her smaller and smaller doses more spaced apart of
the same chemical that she normally gets high on. Plus if it's gonna make her reconsider
and stay and get treated with antibiotics for her endocarditis. You're saving her life.
Some people may disagree with his approach and say absolutely not she's not getting dilaudid. Some will say that there is a medical benefit.
So that's why practicing medicine is an art.
It's not a science because two doctors can look at the same situation and have different approaches for solving it.
I understand what he's doing and I sort of respect it.
Doctor: Get a crash cart.
Attending: I'm not getting a pulse.
Doctor: Code blue (inaudible).
Attending: Keep them out of here.
Dr. Mike: Someone falls and they have no pulse. You call for help and without even thinking about it
you're pumping on the chest. Chest compressions. Chest compressions save lives. I've said it before, chest compressions.
I'm gonna say one more time, chest compressions is the first thing you do.
Even if you have no training in it, start pumping on the chest.
Attending: You're running the code.
Resident: I've never run a code.
Doctor: Do you want an amp of bicarb?
Attending: He's in charge.
Doctor: Page anesthesia.
Dr. Mike: When you're running a code blue, you're following the advanced cardiac life support algorithm.
It's literally written out for you. You give each person role: You do chest compressions,
you monitor the medications, you monitor the time, you monitor the rhythm, and everybody has roles.
After that, there is a specific algorithm.
You literally follow steps on little cards that you can carry in your pocket of: When to recheck the rhythm,
what medications to give, what options of medications do you have, what dosage?
Attending: What is the first question you ask in code?
Resident: Rhythm. What's rhythm?
Dr. Mike: PEA is pulseless electrical activity.
It basically means the heart has a rhythm, but you do not feel a pulse.
There's some electricity going through the heart
But it's useless because it's not creating enough
of a muscular motion and within the heart to create a pulse to make the heartbeat.
PEA is not a shockable rhythm, meaning you do not use the paddles for that.
You use epinephrine, you use drugs, use chest compressions, and you hope to get the patient back, and you wait for the rhythm to change
into one of the two shockable rhythms.
Attending: Should we shock?
Resident: No, we can't.
Her rhythm's not shockable. Get me one of epi.
Make those compressions harder and faster.
Prepare to intubate.
Dr. Mike: So when you're doing chest compressions, you want to make sure you're doing quality chest compressions.
You want to push at least 2 inches deep into the chest, which sometimes can break ribs.
It's a horrible sound to hear but you're doing this to help resuscitate the patient, basically bring them back to life.
So, if on the off chance you break a rib, that's okay.
It does happen in elderly folks much more than in young folks.
You also want to do it to at least a hundred beats per minute.
So if you think there's 60 seconds in a minute,
you're pushing a little bit faster than once per second.
A good way to sort of monitor if you're doing it right is to sing the song, in your head please,
Stayin' Alive because that does go to about a hundred beats per minute. It's the classic way that we're taught.
(Singing) Ah, ah, ah, stayin' alive.
Funny that it's called Stayin' Alive and we try to bring someone back to life.
But that's some of that raw medical edgy humor.
Attending: It's been 24 minutes is time to come home.
This is my code. You gave me this code.
[ Flatline tone starts to pick up ]
Resident: We got a pulse.
Female Resident: You saved her life.
Dr. Mike: Doing a code on a young person for 20 minutes is not unrealistic.
Also not unrealistic to recommend stopping the code because the brain without oxygen for 24 minutes is obviously very
dangerous and even again, even if you bring the pulse back will the brain work again?
You won't even know until the person wakes up.
The first line that one of the other residents tells them as you saved her life. In reality, that could be a great thing.
But also on the other hand,
it could also be an awful thing, because she may just need to be on a ventilator for the rest of her life,
functionally brain-dead. Just her heart beating and her lungs working because she's on a machine.
So, very difficult situation to find yourself in.
Attending: You came in here all bright-eyed and bushy-tailed, ready to save lives, but today you didn't save a life,
you saved a brainstem.
You didn't listen to me.
Dr. Mike: Did he do the wrong thing?
Not necessarily. In this situation, especially because her family looked like they were there.
This is the time to have a conversation with the family very quickly and explain to them what's going on and explain the consequences of
Hey, if we bring her back at this point 20 minutes in she could could come back with a pulse
but also be brain dead and help them decide what to do in the situation allow them to make the decision because you know
next living kin. Some hospitals have a cooling procedure that when someone undergoes either a heart attack or
A sudden stoppage of the heart like she did that they cool the body down which slows them metabolic rate
Which can help the brain survive a little bit longer. So this doesn't always hold true
Don't use this as an application for your own life or making decisions for your family's life treat each situation on its own
Talk to the doctors in front of you and make the best decision that you can with the information
Given to you at the time.
Attending: What was rule 1 then?
Resident: Do whatever you tell me to do. No questions asked.
Attending: All we want to do is help our patients, but what they don't teach us in medical school is
there are so many ways to do harm.
Dr. Mike: The first job of a doctor is not to heal, it's to first do no harm.
Because if you look at the history of doctors in the past, we've made a lot of mistakes
Over treating patients, under treating patients, deciding what's right for our patients and going against their own wishes.
I think we've done a lot better in recent years,
but there's still plenty of room to go to improve.
Attending: If it were easy, everyone would be a doctor, because
this is the best job in the world despite everything.
Because of everything.
Dr. Mike: There you have it, The Resident season 1 episode 1 in the books.
Initial impression, umm, this show's absolutely ridiculous
This resident (sic), while he's, you know, smart and has some experiences,
he just does some crazy things. He's a cowboy in my eyes.
Deciding who lives and who dies. I'll say the way that they're talking about medicine is accurate some of the medical
terms that they use, or use accurately. The procedures... ehh...
Somewhere in the middle 50/50 of their accuracy. I think it's gonna make for a fun show.
I definitely relate more to this show because it's more internal medicine and I'm family medicine
So I practice a lot of internal medicine on my own as compared to Grey's Anatomy
Which is a surgical show and I'm less of a surgeon. I like watching all medical shows
So if you have a show you want me to watch or an episode of this show or any other show?
Drop it down below in the comments
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We are back with another installment of the "Doctor Reacts" series and this time I'm covering Fox's new show The Resident. I have not watched this show before but in reading your comments on the last few videos it seemed like this should be next up for the medical drama review series.
Considering I was a resident doctor myself this time last year, I was really excited to react to this new tv drama. In your comments, many of you made it seem as this show would be more accurate than the last few I've done so I had my hopes set very very high on this hospital tv drama.
Matt Czuchry does a great job of acting the part of an internal medicine resident but the writing leaves a little something to be desired (from the medical point of view at least). The main plotline of the show might have to develop a little more for me to fall in love with it. The medical accuracy is pretty good but again very very dramatic, which is not new to this type of series.
I hope you enjoy this episode of Real Doctor Watches The Resident / Real Doctor Reacts to The Resident. If you want me to continue making this series please like the video and leave me a comment on which show or episode you'd like for me to review next. Love you all!
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