Hey guys you requested House M.D. “I get the bonus points if I act like I care,” Let’s get started. This reminds me of where I grew up in Brooklyn. Wait, is this a jail? “Why are you late? You’re not gonna like the answer. I already know the answer. I missed the bus! I don’t doubt it No bus stops near Brad’s house.” Every medical show has to start off with some kind of sexual thing. Medicine is so exciting as it is, why does there have to be sex? Just calm down stop having sex for a second. “You should never keep anything from your parents” And I told mine Oh Are we having a stroke slurred speech classic sign of a stroke Problems with moving the arms Call nine one one Oh, call the nurse.
Oh Oh, that’s a seizure She is having a general tonic-clonic seizure. 29-year old female. First seizure one month ago, lost the ability to speak. Babbled like a baby. Progressive deterioration of mental status. See that? They all assume I’m a patient because of this cane. So put on a white coat like the rest of us. I don’t want him to think I’m a doctor. You see where the administration might have a problem with that attitude. People don’t want a sick doctor. Now wearing your white coat, I guess it’s not really a big deal. Because sometimes I go without my white coat and just wear my stethoscope It’s really for infectious purposes only. So that if you get any kind of germs on you, you don’t bring you back home to your family, or if obviously some blood splatters on you or some other bodily fluid I guess. Brain tumor. She’s gonna die. Boring. That’s a little cold. She’s 29. Whatever she’s got is highly unlikely. Protein markers for the three most prevalent brain cancers came up negative. Tumor markers for brain cancer That’s not how we diagnose brain tumors. We use imaging.
That’s the gold standard for brain tumors. Obviously in addition to biopsy, if needed. But tumor markers are not a way to rule out a cancer. And she’s not responding to radiation treatment. None of which is even close to dispositive. Medically I’m very confused. There’s a patient who had a seizure. They think that she has a tumor. They did some lab work. Doesn’t show she has a tumor. They’re giving her radiation even though that they don’t see a tumor.
I cannot be more confused right now Or this totally doesn’t make sense medical. Medically. Shouldn’t we be speaking to the patient before we start diagnosing? She a doctor? No, but everybody lies. Dr. House doesn’t like dealing with patients. Isn’t treating patients why we became doctors? No, treating illnesses is why we became doctors. Treating patients is what makes most doctors miserable. So you’re trying to eliminate the humanity from the practice of medicine. We don’t talk to them, they can’t lie to us. Excuse me Dr. House. You can have a good conversation with patients. You don’t need to believe every word they say. You can be honest, you can say you don’t know.
But give a plan of what you’re doing about not knowing, so basically how you’re getting to the answer. First year of medical school. If you hear hoofbeats, think horses not zebras. Very common phrase. Lab in Trenton could have screwed up the blood test. I assume it’s a corollary, if people lie that people screw up. Redraw the blood tests and get her scheduled for that contrast MRI ASAP. Let’s find out what kind of zebra we’re treating here. So a contrast MRI basically allows you to see what blood vessels are doing within the brain.
The fact that they’re going to a lab and questioning if the lab is accurate, we do do that occasionally. But that’s not the first thing we think about I guess cuz this case is more complex I was expecting you in my office 20 minutes ago really. That’s odd. There’s no intention of being in your office 20 minutes ago I think we have nothing to talk about No, we just can’t think of anything I’d be interested in I sign your paychecks.
I got tenure I Still fire you if you’re not doing your job I’m here from to if Billings are practically non-existent rough year you ignore requests for consult I call back so I guess it’s under snow years behind on your obligation. That’s class I was right this doesn’t interest me six years times three weeks. You only better than four months. It’s five o’clock I’m going home doctors don’t work to We have crazy schedules if someone that’s more senior to us obviously like our boss like she is in this case Tells you to get something done You’re getting it done, but also because we have a love for the job we want to treat patients I don’t know why he’s being the sarcastic guy, but I will say it’s really funny.
I’m angry you’re risking a patient’s life I assume those are two separate points You showed me disrespect you embarrass me and as long as I work here You haven’t no wedding designed to scare me because I’m not sure what it is. I’m supposed to be scared of more yelling That’s not scary That you’re gonna hurt me that’s scary, but I’m pretty sure I can outrun you Okay, that’s cool ladies popping pills on the job. Oh, this is in Jersey Plainsboro I Work in New Jersey all right Rebecca I know Feel a little claustrophobic in there But we need you to remain still it’s very true that people get claustrophobic And MRIs you have to have to lay there for an extended period of time the noise is very loud So there are times that I have to pre medicate my patients and give them a dose of a benzodiazepine like xanax most commonly that you’re probably familiar with Yeah, it’s really loud.
It’s even louder than this All right, just try to relax Was she having another seizure Rebecca She’s choking She having an anaphylactic attack to the contrast Get her out of there she probably fell asleep Zeus she was claustrophobic 30 seconds ago She’s not sleeping. We gotta get her out. Just the another she’s having allergic reaction the cattle in he should be dead to me. Oh No get her out EpiPen into the upper thigh quick This is not breathing at 2.5.
I can’t ventilate Too much edema Wiz the surgical airway you’re gonna need to go in the neck and do a tracheostomy Did they give her the EPI I didn’t see it Okay, that’s way too big of an incision Okay, not exactly how that goes if you’re allergic to the contrast that they gave for the MRI It’s possible that you can get this anaphylactic attack Which means that your airway starts closing down basically your throat swells up to the point where you can no longer? Oxygenate some people also vomit some people get very nauseous blood pressure drops her airway closes up to the point where she couldn’t breathe but Because it’s her throat closing up and swelling if you make an incision In the trachea right here where there’s a soft little spot for an opening you can continue helping the patient breathe I’m gonna call some inaccuracies here if a patient turns blue like that.
You’re hitting a code blue there’s an emergency team coming nurses doctors respiratory therapists you also got to get IV set you got to figure out why the Patient’s heart stopped or stopped breathing. There’s a lot more that has to happen You don’t just automatically assume it has something to do with the contrast that you gave, and he’s still popping pills What is he popping? Hope those are advil actually want me to talk to the patient get a history? We need to know if there’s some genetic or environmental causes Planetary response I thought everybody lied truth begins it lies Okay, so why did you tell them to not talk to the patient initially dr. House? truth begins and lies Just means that in order to find out the truth you have the person lie to you and from there You can then start making a deduction on what part.
They’re lying about so you need to hear the lie That’s why it definitely makes sense to always talk to patients first Regardless if you believe that they’re telling the truth or not were you doing painkillers, Oh Feel free like no because they’re yummy you want one back feel better Now don’t do it. That’s how the opioid crisis started House. Why are you so afraid of making a mistake because I’m a doctor Because when we make mistakes people die come on Didn’t used have more respect for cripples. You know They didn’t really I can’t see I can’t Having a seizure again Returning a patient on their side is the smartest move because you want them to If they’re gonna vomit they don’t aspirate and you arrange these to tell a story This is a type of neurological testing to see if the person can follow a series of events a couple headaches last month mild fever Sometimes I can’t sleep and I have trouble concentrating Apparently not while I was searching this stuff on the internet.
I was thinking it also might be fibromyalgia Excellent diagnosis is there anything before that? Do you know I think that person might be 36 vicodin change for a dollar 36 vicodin and change for a dollar Oh Lissie bow Is gonna give sugar pills? Oh, and he’s stealing the vicodin for himself again? Obviously doctors don’t swap out Medications if we prescribe something to the patient we send an order to pharmacy and the pharmacist fill the order And we don’t replace them with sugar pills for placebo effect, so you didn’t find anything everything. I found was in my found ham oh So whether is ham there’s pork with there’s pork? There’s neurocysticercosis That’s the creation bom bom bom tapeworm See it fits. It’s perfect it explains everything, but it proves nothing I can prove it by treating.
No you can’t I Was just with her she doesn’t want any more treatments she doesn’t want any more experiments She wants to go home and die that’s called the principal autonomy Basically that a patient has the right to refuse treatment any point as long as they’re competent and by competent I means that they’re able to understand the consequences of their actions so if They say they want to go home, and you tell them you can possibly die if you go home They can say that back to you and understand what that means they’re free to go home for being an idiot You have a tapeworm in your brain It’s not pleasant, but if we don’t do anything you’ll be dead by the weekend he’s right You should x-ray her, but we don’t x-ray her brain. We x-ray her leg Worms love thigh muscle. She’s got one in her head. I guarantee you. There’s one in her leg oh I did not know this this is Beyond my expertise and probably most doctors expertise This here There’s a worm larva well serve it’s in my leg it’s in my brain.
Are you looking for a guarantee? It’s there probably been there six to ten years. How did she know that I’ve been zone? He’s giving her a dewormer anyone asks him eleven daughters and five sons Wait that’s 16 students they said her class has 20. What are the other five did they show up? Oh a 11:05? Sorry the other for me. We’re happy Don’t give the kids the worms, I’m just kidding dr. House you have a patient He says he needs a refill Change the dollar That’s patient got hooked on them Tic tacs there we have it House episode 1 season 1 is in the books Medical accuracy it’s somewhere in the middle range These are very rare cases Almost never seen in the United States like pork tapeworm most of our pork is well cooked so we don’t see that the way that They go about Practicing medicine is probably the most unrealistic part of it house is just a maniac Treating patients without telling them what he’s treating them for breaking into their homes crazy But also crazy entertaining, so I think there’s gonna be some very interesting episodes to review from dr. house if you know any of these specific episodes that carry a good mystery and a good balance of Medical stuff and drama stuff leave it down below in the comments if you want me to do a different show Definitely leave it in the comments the more subscribers.
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