Remind me not to watch soap operas

[Winged Scapula]

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So I am watching "All My Children" on this holiday.

A young physician is injured and apparently has a liver lac.

She is alert, conversant albeit pale.

The surgeon wants to "prep her for surgery" ostensibly to repair the lac, although he mentions packing.

She demurs, saying that the repair "will not hold and I will die anyway."

Her friend, hearing this, says "surely a transplant is an option."

The surgeon replies, "it takes weeks to get the tests back, we don't have time."

He agrees to "make her comfortable".

She dies a classic soap opera death a few moments later after reminding them her daughter likes creamy PB not the chunky kind...boopboop boop boop boop boop eyes close boop ............................

Is this the way we are managing liver lacs these days? She looked pretty good for someone with a hilar devascularization. Glad I don't have to tell some family about their loved one having a liver lac, its an instant death sentence without any treatment!

 

[beaverfetus]

I wouldn't worry too much, shell wake up next episode, alive but with a little known complication of liver lacs.... COMPLETE AMNESIA.

 

[Trekdoc]

And fall down an elevator shaft in a couple weeks.

 

[tussy]

a few months ago on general hospital - the hotshot young neurosurgeon said "i didn't do 3 years of medical school and 2 years of residency to be treated this way - i'm one of the top surgeons in this country". I nearly died laughing.

 

[Winged Scapula]

This is what I read.

Obviously you've got nothing else better to do today either, so quit your complaining.😛

Anyway, this thread has gotten more responses in a short period of time than any of the others here!

 

[cbass1350]

I would like to watch that case being presented at the M&M. Especially in one of those ultra-malignant programs.

 

[Winged Scapula]

I would like to watch that case being presented at the M&M. Especially in one of those ultra-malignant programs.

"So Dr., you allowed the patient to make an ill informed decision?"

"Yes. I thought her training in Neurology gave her adequate insight into the management of liver lacerations."

"And you did not feel the need to put her in the ICU after you diagnosed her with an apparently terminal injury. Why did you not place a central venous catheter and start transfusing her?"

"There was no time, no time."

"Tell us about the management of fulminant liver failure and what we do when we do not have 'weeks' to get liver tests back, Dr. Do we just let them die too?"

"Uhh...since I am normally an internist/Chief of Staff on this show, I must admit I was woefully underprepared to play the role of a Trauma Surgeon and really don't know anything about management of live injuries...."

"Sit down Dr."

 

[radslooking]

So I am watching "All My Children" on this holiday.

A young physician is injured and apparently has a liver lac.

She is alert, conversant albeit pale.

The surgeon wants to "prep her for surgery" ostensibly to repair the lac, although he mentions packing.

She demurs, saying that the repair "will not hold and I will die anyway."

Her friend, hearing this, says "surely a transplant is an option."

The surgeon replies, "it takes weeks to get the tests back, we don't have time."

He agrees to "make her comfortable".

She dies a classic soap opera death a few moments later after reminding them her daughter likes creamy PB not the chunky kind...boopboop boop boop boop boop eyes close boop ............................

Is this the way we are managing liver lacs these days? She looked pretty good for someone with a hilar devascularization. Glad I don't have to tell some family about their loved one having a liver lac, its an instant death sentence without any treatment!

lol. this just shows i could never write medical scripts for TV. i mean, i couldnt even write that no matter how hard i tried

 

[radslooking]

a few months ago on general hospital - the hotshot young neurosurgeon said "i didn't do 3 years of medical school and 2 years of residency to be treated this way - i'm one of the top surgeons in this country". I nearly died laughing.

two years! wow! dude must be smart!

 

[radslooking]

"So Dr., you allowed the patient to make an ill informed decision?"

"Yes. I thought her training in Neurology gave her adequate insight into the management of liver lacerations."

"And you did not feel the need to put her in the ICU after you diagnosed her with an apparently terminal injury. Why did you not place a central venous catheter and start transfusing her?"

"There was no time, no time."

"Tell us about the management of fulminant liver failure and what we do when we do not have 'weeks' to get liver tests back, Dr. Do we just let them die too?"

"Uhh...since I am normally an internist/Chief of Staff on this show, I must admit I was woefully underprepared to play the role of a Trauma Surgeon and really don't know anything about management of live injuries...."

"Sit down Dr."

Your'e right. Sometimes there just isn't time to put in a line. Best to move straight to comfort care and no dilly dallying around.

 

[bjolly]

oh god, don't get me started. A while back I saw a soap opera scene that hinged around an adopted baby who needed a blood transfusion. They had to make heroic efforts to locate the bio parents asap. Or the baby would die!!!! Because apparently you can only transfuse blood from an immediate relative?

 

[Winged Scapula]

Another injury on the show today was a 40s male whom (I think) fell out of a helicopter onto the roof of the hospital. He was cyanotic, dyspneic, with shallow breathing. The young physician diagnosed him with a PTx. Pulled out his Swiss Army Knife (don't we all carry one of those around) and stabbed him with it in the mid axillary line but didn't insert anything in the hole (I was sure he was going to MacGyver a pen and put it in). Instant relief!!

 

[SocialistMD]

The young physician diagnosed him with a PTx. Pulled out his Swiss Army Knife (don't we all carry one of those around) and stabbed him with it in the mid axillary line but didn't insert anything in the hole (I was sure he was going to MacGyver a pen and put it in). Instant relief!!

They better give me my royalty check on that one because it is my story, except it was the neighbor's roof and i shoved a piece of garden hose into the hole.

 

[Winged Scapula]

They better give me my royalty check on that one because it is my story, except it was the neighbor's roof and i shoved a piece of garden hose into the hole.

What would that be a 50 French tube?

And what was the garden hose doing on the roof? Did you then suck on the end to provide the vacuum?

Write to ABC, I'm sure they'll send you a big fat check!!

 

[SocialistMD]

No, he fell from the roof to the ground, not from a helicopter to the roof. That was the change they made. And I constructed a three-chamber suction device using more of the garden hose, two paint buckets and a shop-vac. I'm like MacGyver, but for saving lives...

 

[roja]

Winged-

your poor training is showing. Of course the way they do it on tv is the way modern surgeons are caring for these patients. Seriously. You aren't even 5 years out and you are so far behind the curve. Sheesh.


You need to get a DVR or TiVo

 

[radslooking]

Winged-

your poor training is showing. Of course the way they do it on tv is the way modern surgeons are caring for these patients. Seriously. You aren't even 5 years out and you are so far behind the curve. Sheesh.


You need to get a DVR or TiVo

No, I'm not a doctor. But I did watch "All my Children" on DVR last night.

 

[Winged Scapula]

I would imagine that, if you insert the knife parallel to the rib, then twist 90 degrees, it would hold the hole open long enough to allow the pressure to re-equilibrate, at least temporarily.

Sure, you might damage the NV bundle, and sure, you might lacerate the lung, but hey, you do what you gotta do.

I'll try this with the K-bar in Iraq (on a local, of course) and let you know how it goes.

Makes sense in a remote war zone.

But on the ROOF of a hospital? Why not just take him inside and do it right?

Guess that wouldn't be as much of a ratings winner.

 

[Apollyon]

Is this the way we are managing liver lacs these days? She looked pretty good for someone with a hilar devascularization. Glad I don't have to tell some family about their loved one having a liver lac, its an instant death sentence without any treatment!

Well, not "instant" if it can be treated...and it reminds me of a case my program director said she saw in SF - a woman having sex rather vigorously, utilizing a "rear entry" position. So vigorous, that she suffered a liver lac.

 

[Winged Scapula]

Well, not "instant" if it can be treated...and it reminds me of a case my program director said she saw in SF - a woman having sex rather vigorously, utilizing a "rear entry" position. So vigorous, that she suffered a liver lac.

I think you missed my point.

While a hilar devascularization is a morbid injury, this show acted like a simple liver laceration had:

a) no good treatment
b) even treatment resulted in death, which after the decision to withhold treatment was made, became "instant"

The vast majority of liver lacerations in which the patient is stable (which it appears she was on the show) are managed non-operatively. Even those that fail non-operative management, get better with repair or resection.

 

[Apollyon]

I think you missed my point.

While a hilar devascularization is a morbid injury, this show acted like a simple liver laceration had:

a) no good treatment
b) even treatment resulted in death, which after the decision to withhold treatment was made, became "instant"

The vast majority of liver lacerations in which the patient is stable (which it appears she was on the show) are managed non-operatively. Even those that fail non-operative management, get better with repair or resection.

That's what I thought. Me trainin' in me job served me well!

 

[ddmo]

This script for this show was probably written by the same guy who was on here a couple of months asking for scenarios in which a medical mistake could kill a patient.

 

[Winged Scapula]

Style points, obviously.

Your failure to recognize this is exactly why Ortho will always be cooler than General Surgery.

Good point.

I will have to reconsider because I am generally all about style.

 

[JackADeli]

...i shoved a piece of garden hose into the hole.

Just to add a little historical perspective, a genthoracic attending (he's dead now) said 15 or more yrs ago they used to use gassed garden hose sections for "empyema tubes". Apparently this shocked the oral exam/CE examiners for a couple of years. But they then started to recognize what Jersey community program these candidates came from... because they always talked about using garden hose for empyemas.

I still have to turn away everytime I see someone on a TV show make a fist around a big syringe and pound it down on the dying dudes chest!

Anybody see the "Hopkins" reality show? That one can be shocking too.... like the pediatric critical care attending telling everyone to let the kid die who had some sort of heart failure... before the biopsy results were back. Then the kid he thought, "we should let go", got a heart transplant and walked out the building!

JAD