Dr. Mohan, do you have a minute?
Is there a problem over there?
No, her pain is well controlled.
You understand that's my polite way of asking why are you spending so much time with one patient? You're an R3. As an R3, you should be seeing at least two patients an hour.
I have two, Joyce and Mr. Wallace, our Good Samaritan.
Who's comatose and stable. You should have four by now.
I have the highest patient satisfaction of anyone.
I don't doubt it, but we just had this conversation a couple of hours ago.
I know people call me Slow-Mo. You don't have to confirm or deny. It used to hurt my feelings a lot, but I can't help it. I work at the speed I'm comfortable at.
Because you're afraid of making a mistake?
I'm always afraid of making a mistake. Aren't you?
Yeah, of course I am. But you know what I mean. You make a mistake once, and somebody dies, and you feel so badly about it, you'll never let it happen again
Because you waste time and money on unnecessary tests. You keep sick patients waiting too long. You miss out on cases you could be learning from. You shortchange your own education. I'm not saying this to be a hard-ass. I'm saying this because I know you could do this, but you need to do it at a level I also know you're capable of.
Then you should look into a specialty that better suits you. Have you thought about psychiatry?
I don't want to go into psychiatry. I want to be here.
Being here means no matter how good you are or how hard you try, you're gonna make another mistake, and someone else might even die. That's called being an emergency medicine doctor. And if you can't accept that, then maybe this isn't the place for you.
OK, good. Go save some lives. Clear some beds while you're at it.
Mr. Gellin, you're having a very big heart attack right now. Major artery that carries oxygen to your heart is almost totally blocked.
GMr. Gellin
That doesn't sound too good.
No, it's not very good. We're gonna send you up to the cath lab. A cardiologist is gonna unblock that with a balloon and leave it open with a stent.
GMr. Gellin
But I'm still having a heart attack?
If everything goes as planned, it'll be like you never had a heart attack. We're gonna put a catheter in this artery right here. We're gonna shave the hair with a clipper.
GMr. Gellin
Long as you stop short of a Brazilian.
It's an option we offer. Costs a little bit more. A lot of people's insurance won't cover it.
KAKiara Alfaro
She's worried sick about her son. What are you going to do?
I thought he would come back after mom called him. Hey, what are the ethics about me reaching out to him under the guise of a medical emergency with mom?
KAKiara Alfaro
If he's a danger to himself or others, I'd argue you have a professional responsibility to do whatever is necessary.
HSHelen Spencer
He keeps trying to pull away.
We're giving him some more sedation.
JJereme
Why is he so agitated?
He could have some awareness of the tube in his throat or that he's in a strange place, or it could be lack of oxygen to his brain.
HSHelen Spencer
Does he need more oxygen?
He's on 100%. That's as high as it goes. [vitals monitor beeps loudly] That is his blood pressure dropping.
JJereme
Oh, is that even fixable?
Normally, yes, with IV fluids, but we now know that that will just fill up his lungs, drop his oxygen even more.
HSHelen Spencer
Well, isn't there something else we can do?
We can place a long, large IV catheter in his jugular vein down into his heart and administer Levophed, which is a very powerful medicine to constrict his arteries, raise his blood pressure. But that could cause other organ damage, organ failure. I'm really sorry, but each new step is even more invasive, could cause more suffering with minimal benefit.
