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[ SIREN WAILS ]

SHOCK ADVISED.

THESE ARE THE REAL STORIES OF THE E.R.

THAT DOCTORS NEVER TALK ABOUT.

DOCTOR, SOMETHING'S WRONG. SHE'S NOT BREATHING RIGHT.

Dr. Kahn: SHE'S HAVING PROBLEMS SITTING UP.

HER STRENGTH IS DECLINING.

WHEN WERE YOU PLANNING ON TELLING ME?

WHAT ARE YOU TALKING ABOUT?

YOU THINK I'M AN IDIOT?

NO, WE DON'T.

SHUT UP, CARSON!

WATCH WHERE YOU'RE GOING, YOU STUPID LADY DRIVER.

WHY AREN'T YOU LADIES ALL AT HOME, WHERE YOU BELONG?

WHO'S LOOKING AFTER YOUR KIDS?

I'M LEAVING.

TAKE THESE TUBES OUT OF MY ARM.

MR. LEVCHAK.

I DON'T WANT TO HEAR ABOUT IT.

I WAS REALLY WORRIED ABOUT THIS PATIENT'S HEART.

I'VE HAD ENOUGH.

INCOMING MVA, FIVE MINUTES.

Dr. Michos: THIS IS NOT GONNA BE GOOD.

A COUPLE OF BLOOD TESTS AND A FULL CT SCAN.

I SAW SOMEBODY THAT WAS SWOLLEN BEYOND BELIEF.

DOCTOR.

THIS PERSON HAS TRANSFORMED INTO A GIANT MARSHMALLOW.

WHAT HAVE YOU DONE TO ME?

Narrator: THESE ARE THE UNTOLD STORIES OF THE E.R.

-- Captions by VITAC -- www.vitac.com

CAPTIONS PAID FOR BY DISCOVERY COMMUNICATIONS

E.R. PHYSICIAN DR. CHRIS MICHOS

MAKES A POINT OF PUTTING HIS PATIENTS' NEEDS FIRST.

HAVE YOU TAKEN A BREAK YET?

GONNA GRAB A SANDWICH AS SOON AS I WRITE THIS UP.

E.D.

YOU KNOW WHY E.R. DOCTORS TALK ABOUT FOOD ALL THE TIME?

'CAUSE WE NEVER GET ANY.

INCOMING MVA.

HOW FAR OUT?

FIVE MINUTES.

WHEN A MOTOR VEHICLE ACCIDENT COMES IN,

WE NEVER KNOW WHAT TO EXPECT.

BUT THIS TIME, WE GOT A PREVIEW.

YOU GAVE E.M.S. YOUR CELLPHONE NUMBER?

YEAH. HE'S GONNA TEXT ME A PHOTO OF THE WRECK.

WHOA.

THIS IS NOT GONNA BE GOOD.

I WANT A FULL TRAUMA ACTIVATION ON THIS ONE.

AND THAT INCLUDES EVERYBODY FROM THE SURGEON TO THE PRIEST.

I WANTED TO BE PREPARED FOR ANYTHING.

HEY, GUYS. WHAT DO WE GOT?

THIS IS THOMAS, AGE 42.

DRIVER, SINGLE-CAR MVA.

NO, I KNOW.

NO OBVIOUS INJURIES.

AUTO VERSUS LIGHT POLE.

WHEN I SAW THE PATIENT, HE DIDN'T LOOK SO BAD.

BP's 110 OVER 60.

PULSE 84. RESPIRATION 16.

OKAY. DID YOU TAKE THAT PHOTO?

YEAH. PRETTY GNARLY, HUH?

I WILL TAKE CARE OF IT AS SOON AS I GET BACK TO THE OFFICE.

ARE YOU KIDDING ME? WHO IS HE TALKING TO?

A BOSS. HE WAS ON THE PHONE THE WHOLE WAY IN.

OH, MY GOSH.

THOMAS, I'M DR. MICHOS. I'M GONNA BE YOUR DOCTOR.

OH, GREAT. YOU'RE HERE.

HEY, CAN I, UH, GET YOU TO GET SOME OF THIS STUFF OFF OF ME?

I HAVE GOT A DINNER THAT I NEED TO GET TO.

LET'S CHECK YOU OUT FIRST.

ARE YOU HAVING ANY NECK PAIN?

NO. NO, I'M FINE.

I GUESS I DIDN'T NEED THE PRIEST.

BUT CONSIDERING THE SEVERITY OF THE ACCIDENT, I NEVER KNOW

WHAT KIND OF INTERNAL INJURIES THIS GUY MIGHT HAVE.

DID YOU HAVE THIS BRUISE BEFORE THE ACCIDENT?

WHAT? NO.

BUT IT'S NOTHING, THOUGH. LOOK, IF I'VE GOT A PROBLEM,

I'LL COME BACK.

I UNDERSTAND YOU WANT TO LEAVE,

BUT YOU'RE IN A HIGH-RISK CATEGORY FOR SERIOUS INJURIES.

UH, THAT IS A RISK I'M WILLING TO TAKE

COMPARED TO THE INHERENT DANGER I'M GONNA BE IN

IF I MISS DINNER WITH MY WIFE, DOCTOR.

YOU NEED TO SEE SOMETHING BEFORE YOU GO ANYWHERE.

I'M JUST GONNA GO GET IT. SIT TIGHT.

WHERE ARE YOU GOING? DOCTOR.

JUST STAY PUT.

I HAD TO DO WHATEVER I COULD TO GET THIS GUY'S ATTENTION.

VICKY, DO YOU STILL HAVE THAT PHOTO ON YOUR PHONE?

YEAH.

APPARENTLY, THIS GUY'S GOT A VERY IMPORTANT DATE.

YEAH, WITH RADIOLOGY.

THEY'RE READY FOR HIM.

GREAT.

NOW, WE JUST HAVE TO CONVINCE HIM TO STAY.

I HAVE PATIENTS THAT ARE SO OBLIVIOUS TO PAIN

THAT I HAVE TO USE SHOCK TACTICS

TO GET THEM TO DO WHAT'S RIGHT FOR THEM.

THOMAS, I WANT YOU TO THINK CAREFULLY.

DO YOU REMEMBER ANYTHING ABOUT THE ACCIDENT?

Thomas: I WAS ON MY WAY TO THE RESTAURANT.

I KNOW I WAS RUNNING A LITTLE BIT LATE.

AND THEN THE FENDER BENDER.

THIS IS THE FENDER BENDER.

THIS IS WHAT YOU'VE JUST BEEN THROUGH.

OH, MY GOD.

YOU SEE?

MY CAR.

MY WIFE'S GONNA KILL ME.

WELL, THAT DIDN'T WORK.

Narrator: DR. CASSIUS DRAKE IS THE MEDICAL DIRECTOR

OF A SMALL HOSPITAL IN THE SUBURBS.

MORNING.

IT IS MORNING. YOU'RE RIGHT, DR. DRAKE.

THERE YOU GO. NOW, LET'S SEE IF I CAN BE RIGHT ALL DAY.

WE WORK IN A SMALL COMMUNITY HOSPITAL.

WE HAVE FULL EMERGENCY SERVICES,

BUT PEOPLE WHO REQUIRE MORE ADVANCED

OR HIGHER LEVELS OF CARE, WE TRANSFER.

SO I'D JUST GOTTEN TO WORK.

IT WAS ABOUT 8:00 IN THE MORNING.

THIS IS DR. DRAKE.

WE GOT A PHONE CALL

FROM ONE OF THE CARDIOLOGIST'S OFFICE IN THE BUILDING

THAT THEY HAD A PATIENT

WHO WAS COMING IN FOR A ROUTINE EVALUATION.

AND HE'D HAD SOME CHEST PAINS,

SO THEY SENT HIM OVER FOR FURTHER EVALUATION.

WATCH WHERE YOU'RE GOING, YOU STUPID LADY DRIVER.

THIS IS MR. LEVCHAK. DR. MITCHELL CALLED ABOUT HIM.

SO THE PATIENT SHOWS UP, ESCORTED BY A NURSE.

WHAT IS THIS, A SEWING CIRCLE?

WHY AREN'T YOU LADIES ALL AT HOME, WHERE YOU BELONG?

WHO'S LOOKING AFTER YOUR KIDS?

Dr. Drake: SHE'D APPARENTLY HAD A LOT OF THIS ALL THE WAY

DOWN THE HALLWAY FROM THE CARDIOLOGIST'S OFFICE.

CHEST PAINS ON THE WAY IN FROM HIS CAR.

HIS EKG SHOWED SOME CHANGES,

SO HE'S BEEN REFERRED HERE, TO DR. DRAKE.

DON'T TELL ME DR. DRAKE IS A GIRL, TOO.

NO, SIR. DR. DRAKE IS A MAN.

AND WE'RE WOMEN.

YEAH, WELL,

GET HIM OVER HERE BEFORE I DIE OF ESTROGEN EXPOSURE.

YOU HAVE TO GET THROUGH THE INITIAL RESISTANCE

OF, "THIS PERSON'S JUST A JERK," AND, "I DON'T HAVE TO PUT UP

WITH THIS," AND, "THEY SHOULDN'T BE TREATING ME THAT WAY,"

AND REMEMBER THAT WE ARE HERE TO BE OF SERVICE.

GOOD MORNING.

ARE YOU THE DOCTOR?

I AM.

WELL, YOU'VE GOT SOME PRETTY UPPITY GIRLS RUNNING THIS PLACE.

PRETTY PATHETIC, IF YOU ASK ME.

WELL, I DIDN'T ASK YOU. AND THIS IS MY STAFF.

SO, PLEASE, STOP BEING RUDE TO THEM, STARTING RIGHT NOW.

YOU ALSO HAVE TO SOMETIMES JUST

SET A BOUNDARY ON WHAT YOU WILL TOLERATE.

CAN I GET AN I.V., CHEST X-RAY,

EKG, FULL SET OF LABS, AND AN ASPIRIN

FOR MR. LEVCHAK HERE?

YEAH.

DO YOU HAVE THE RIGHT TO HOLD ME AGAINST MY WILL,

LEGALLY SPEAKING?

IF YOU DON'T WANT TO STAY,

WE'RE NOT GONNA HOLD YOU AGAINST YOUR WILL.

BUT I HIGHLY SUGGEST, AS THE DOCTOR TREATING YOU,

THAT YOU AT LEAST WAIT UNTIL WE GET THE BLOOD RESULTS

BACK BEFORE YOU LEAVE.

OH, GOOD RECOMMENDATION.

SEE YOU LATER.

Narrator: SUMMERTIME TEMPERATURES ARE THROUGH THE ROOF,

AND THE E.R. IS PACKED WITH PEOPLE SUFFERING FROM THE HEAT,

INCLUDING ATTENDING PHYSICIAN SAJID KAHN.

HEY, DOC.

HEY.

HOW ARE YOU HOLDING UP?

PRETTY GOOD,

AS LONG AS THE AIR-CONDITIONING HOLDS UP.

ANYONE CAN DEVELOP HEAT EXHAUSTION,

BUT WE SEE A LOT OF YOUNG ADULTS BECAUSE THOSE ARE THE ONES

THAT SPEND SO MUCH TIME OUTSIDE IN THE SUN.

OUR GIRLFRIEND COLLAPSED AT THE BEACH.

WE DON'T KNOW WHAT'S WRONG WITH HER.

I'LL GO GET THEM A ROOM.

[ WOMAN SPEAKING INDISTINCTLY OVER P.A. ]

LADIES, FOLLOW ME, PLEASE.

Dr. Kahn: A GROUP OF FOUR GIRLS COME IN, KIND OF COLLEGE AGE.

ONE OF THEM LOOKS REALLY WEAK, KIND OF COVERED IN SWEAT,

LIKE SHE'S DEHYDRATED.

NO WAY, BROOKE. I'M MUCH DARKER THAN YOU.

HEY, LADIES. I'M DR. KAHN.

WHAT'S GOING ON?

WE WERE AT THE BEACH ALL DAY.

IT WAS REALLY HOT.

AND THEN SHE FAINTED. WE DIDN'T KNOW WHAT TO DO.

102.

OKAY.

Dr. Kahn: HER INITIAL VITAL SIGNS

SHOW A HEART RATE OF 120 AND A TEMPERATURE OF 102.

SO SHE HAS A FEVER.

HER HEART RATE'S A LITTLE BIT UP.

BOTH OF THOSE VITAL SIGNS,

WHILE ABNORMAL, ARE CONSISTENT WITH HEAT EXHAUSTION.

UM, ALICIA, CAN YOU TELL ME ABOUT YOUR MEDICAL HISTORY?

DO YOU HAVE ANY CONDITIONS OR PROBLEMS

THAT I SHOULD KNOW ABOUT?

NO, I'M HEALTHY.

I'VE NEVER EVEN BEEN IN A HOSPITAL BEFORE.

OKAY. NEVER HAD ANY SURGERIES?

DO YOU TAKE ANY MEDICATIONS?

NO.

IS THERE ANY CHANCE YOU COULD BE PREGNANT?

NO CHANCE OF THAT.

CAN YOU SIT UP FOR A SECOND

SO I CAN LISTEN TO YOUR HEART AND LUNGS?

THE NEXT STEP IS TO DO A BRIEF EXAM.

TAKE A FEW DEEP BREATHS FOR ME.

HER HEART AND LUNGS SOUND FINE.

SHE'S ANSWERING QUESTIONS APPROPRIATELY.

SHE JUST SEEMS A LITTLE FATIGUED.

WELL, ALICIA, YOUR SYMPTOMS ARE CONSISTENT WITH HEAT EXHAUSTION.

SO WE'RE GONNA GIVE YOU SOME I.V. FLUIDS,

CHECK SOME BLOOD WORK, AND JUST MAKE SURE YOU FEEL BETTER, OKAY?

I ORDER THE NORMAL HEAT EXHAUSTION WORKUP.

WE GET AN EKG BECAUSE HER HEART RATE'S 120,

AND WE CHECK SOME ELECTROLYTES.

WE ALSO CHECK A URINE AND A PREGNANCY TEST, JUST AS ROUTINE.

SHOULDN'T WE CALL YOUR BROTHER?

NO. THIS ISN'T SERIOUS.

NOW, TO BE FAIR, WE DON'T KNOW THAT YET.

SO, IF THERE IS SOMEONE YOU WANT US TO CALL,

JUST LET US KNOW, OKAY?

SO I GO TO THE DESK TO START TYPING UP HER ORDERS,

AND THE NEXT THING YOU KNOW...

DOCTOR, SOMETHING'S WRONG.

SHE'S NOT BREATHING RIGHT.

I GO BACK INTO THE ROOM, AND SHE'S DEFINITELY BREATHING HARDER.

[ PANTING ]

SHE'S SEEMING A LITTLE DISTRESSED AND VERY CONFUSED.

SHE'S FEELING WARMER.

CAN WE REPEAT A TEMPERATURE?

NORMAL HEAT EXHAUSTION REALLY DOESN'T DO THAT TO YOU.

OPEN YOUR MOUTH, LIFT YOUR TONGUE.

JUST RELAX. TAKE SOME DEEP BREATHS.

103.

103?

HER TEMPERATURE'S GOING THE WRONG WAY, DESPITE OUR FLUIDS.

I THINK THIS IS MORE THAN JUST A STRAIGHTFORWARD CASE

OF HEAT EXPOSURE.

SO WE REALLY NEED TO GET TO THE BOTTOM OF THIS.

THE SOONER WE GET YOU THE CAT SCAN,

THE SOONER WE CAN RELEASE YOU.

WHEN I WALKED INTO THAT TRAUMA BAY...

DOCTOR.

...THIS PERSON HAS TRANSFORMED

INTO A GIANT MARSHMALLOW.

WATCH WHERE YOU'RE GOING, YOU STUPID LADY DRIVER.

Narrator: DR. DRAKE IS TRYING TO TREAT A BELLIGERENT PATIENT

WHO MAY HAVE A DANGEROUS HEART CONDITION.

SEE YOU LATER.

SIR, IT'LL ONLY TAKE A FEW MINUTES TO GET AN EKG.

AT LEAST WE CAN MAKE SURE YOU'RE NOT HAVING A HEART ATTACK.

[ MAN SPEAKING INDISTINCTLY OVER P.A. ]

DO YOU HAVE ANY HEART TROUBLE THAT YOU KNOW OF

FOR YOURSELF OR YOUR FAMILY?

NOPE.

ANY MEDICAL PROBLEMS OR ALLERGIES?

TAKING A HISTORY REALLY WASN'T GETTING ME ANYWHERE.

AND THE EKG I HAD, WHILE ABNORMAL,

WASN'T GIVING ME A CLEAR DIAGNOSIS, EITHER.

SO THIS WAS JUST A ROUTINE VISIT TO THE CARDIOLOGIST,

THEN?

YEP.

MY DOCTOR SENT ME JUST 'CAUSE I'M OLD.

HMM. JUST RELAX AND BREATH NORMAL, MR. LEVCHAK.

SHE MAKES ME NERVOUS. I -- I DON'T TRUST YOUNG NURSES.

WELL, I HAPPEN TO KNOW THAT TARA GRADUATED TOP OF HER CLASS,

SO SHE'S SMARTER THAN ME.

UH, WELL, OVEREDUCATED DOESN'T MAKE YOU SMART.

WHAT IS IT WITH YOU AND WOMEN?

AT A CERTAIN POINT, I COULD SEE IT WASN'T GONNA GET ANY BETTER.

FRED, CAN YOU COME IN HERE AND TAKE OVER?

TARA, PLEASE GET THE BLOOD TO THE LAB.

WE SENT HIS BLOOD OFF FOR A TEST CALLED A TROPONIN TEST,

WHICH MEASURES A MUSCLE PROTEIN FOUND IN THE HEART

THAT CAN SHOW UP WHEN THERE'S HEART DAMAGE.

OKAY! I'M LEAVING.

ARE YOU OKAY?

FINE.

PRINCE CHARMING'S X-RAY WILL BE UP IN ABOUT 5 MINUTES,

IF YOU WANT TO SEE IT.

UNBELIEVABLE.

TAKE THESE TUBES OUT OF MY ARM. I -- I'VE HAD ENOUGH.

MR. LEVCHAK.

I DON'T WANT TO HEAR ABOUT IT.

I'M OUTTA HERE.

SO I WAS REALLY WORRIED ABOUT THIS PATIENT'S HEART.

BUT, AT SOME POINT, IF THE PATIENT REFUSES TO COOPERATE,

THERE'S ONLY SO MUCH I CAN DO.

HAVE A NICE DAY.

HMM.

WELL, HIS HEART LOOKS OKAY ON THE CHEST X-RAY.

YOU'RE KIDDING ME. THERE'S A HEART IN THERE?

DR. DRAKE, YOU BETTER LOOK AT THIS.

HIS LABS. LOOK AT THE TROPONIN.

WHAT I SAW ON THAT SCREEN WAS A WORST-CASE SCENARIO.

HOLY...

THE TROPONIN WAS VERY ELEVATED,

WHICH INDICATED ONE THING --

A SERIOUS HEART ATTACK.

BRAD, YOU HAVE TO CATCH HIM.

THIS IS WHAT YOU'VE JUST BEEN THROUGH.

Thomas: OH, MY GOD.

YOU SEE?

MY CAR.

Narrator: DR. MICHOS' PATIENT

IS MORE CONCERNED ABOUT THE DAMAGE TO HIS CAR

THAN THE DANGER OF HIS INJURIES.

MY WIFE'S GONNA KILL ME.

OH!

CAREFUL, CAREFUL.

ARE YOU FEELING PAIN ANYWHERE?

I THINK I JUST TRIED TO GET UP TOO FAST.

HOW ABOUT THIS?

YOU STICK AROUND FOR A COUPLE OF BLOOD TESTS AND A FULL CT SCAN,

AND IF EVERYTHING LOOKS GOOD, YOU GO TO YOUR DINNER.

IT'S MY ANNIVERSARY.

THE SOONER WE GET YOU TO THE CAT SCAN,

THE SOONER WE CAN RELEASE YOU.

SPEAK OF THE DEVIL.

OKAY, GUYS. HE'S ALL YOURS.

THOMAS, WE'LL SEE YOU WHEN YOU GET BACK.

FINALLY, I GET A LITTLE BREAK WHILE THOMAS IS IN CAT SCAN,

SO I TRY TO GET A LITTLE SNACK.

CHOCOLATE.

HOW OLD ARE YOU?

MING DYNASTY?

"GOOD THINGS COME TO THOSE WHO WAIT."

WELL, GUESS WHAT. I'M NOT WAITING.

YOU'VE GOT TO COME TO THE TRAUMA BAY.

WHY?

JUST --

PLEASE, JUST COME NOW.

UGH!

WHEN I WALKED INTO THAT TRAUMA BAY...

DOCTOR.

...I SAW SOMEBODY

THAT WAS SWOLLEN BEYOND BELIEF,

EVEN BEYOND SOME OF MY WORST ALLERGY PATIENTS.

WE NEED TO ACT FAST.

THIS PERSON HAS TRANSFORMED INTO A GIANT MARSHMALLOW.

Narrator: DR. KAHN'S SUNBURNED PATIENT

SEEMS TO BE SUFFERING FROM MORE THAN JUST HEAT EXHAUSTION.

Dr. Kahn: DESPITE THE COOL FLUIDS WE'VE GIVEN HER, HER TEMPERATURE

HAS ACTUALLY GONE UP TO 103 DEGREES.

LET'S GET SOME ICE PACKS UNDER HER ARMS AND IN HER GROIN AREA.

AND PLEASE ORDER US A COOLING BLANKET.

Girl #1: IS SHE GONNA BE OKAY?

Girl #2: WHAT'S HAPPENING?

I PUT HER ON SUPPLEMENTAL OXYGEN,

AND I REASSESS HER BETWEEN LABORED BREATHS.

SO NOW, I'M STARTING TO THINK, "WHAT ELSE COULD BE CAUSING

HER TEMPERATURE TO GO UP?"

THERE ARE CERTAIN DRUGS THAT ARE KNOWN FOR CAUSING A HIGH FEVER

AND A FAST HEART RATE.

COCAINE, METHAMPHETAMINE,

AND CERTAIN ANTIPSYCHOTICS CAN DO IT.

SO I ASK FOR A DRUG SCREEN, AN ARTERIAL BLOOD GAS,

AND A CHEST X-RAY.

ARE YOU SURE THERE ISN'T A FAMILY MEMBER

THAT YOU WANT US TO CALL?

MY FAMILY DOESN'T LIVE HERE.

I THINK WE SHOULD CALL CARSON.

NO!

DON'T YOU DARE!

WHO'S CARSON?

HER OLDER BROTHER. HE GOES TO OUR COLLEGE.

WHY DON'T YOU WANT US TO CALL HIM?

BECAUSE WE DON'T NEED HIM.

WE PERFORM A PORTABLE CHEST X-RAY.

THE X-RAY SHOWS HER LUNGS ARE CLEAR,

BUT WE'RE STILL WAITING FOR THE LABS TO COME BACK.

WHY?

WHY? I DON'T...

AT THIS POINT, I NOTICE A DISTINCT CHANGE IN HER DEMEANOR.

SHE'S HAVING PROBLEMS SITTING UP,

HER STRENGTH IS DECLINING,

AND SHE'S STARTING TO SAY SOME INCOHERENT THINGS.

GIRLS, I NEED TO ASK YOU SOMETHING,

AND I NEED YOU TO BE COMPLETELY HONEST WITH ME.

DOES ALICIA USE ANY MEDICATIONS?

NO.

NO.

IS THERE ANY REASON TO THINK SHE MIGHT BE USING DRUGS?

NEVER. SHE DOESN'T EVEN SMOKE WEED.

COULD IT BE SOMETHING YOU GAVE HER?

WE HAVEN'T GIVEN HER ANYTHING YET,

JUST THE FLUIDS TO HYDRATE HER.

[ Chuckling ] YOU CAN'T FOOL ME.

THIS THING JUST KEEPS SNOWBALLING.

SHE'S STABLE ENOUGH TO LEAVE THE DEPARTMENT FOR A CT SCAN,

SO I GO AHEAD AND ORDER THAT.

WE'LL BE RIGHT HERE WAITING FOR YOU, ALICIA.

AT THIS POINT, THE DIFFERENTIAL

IS EXPANDED TO INCLUDE THINGS LIKE MENINGITIS, ENCEPHALITIS,

EVEN A HEAD BLEED.

DOCTOR, LOOK AT THIS.

HER FRIEND RUSHES UP TO ME WITH HER CELLPHONE,

AND IT HAS A TEXT MESSAGE ON THERE THAT SAYS,

"TELL THE DOCTOR TO GIVE HER DANTROLENE."

IT'S PROBABLY THE STRANGEST TEXT MESSAGE

I COULD IMAGINE RECEIVING.

THIS IS A VERY SPECIFIC MESSAGE ABOUT A VERY UNCOMMON DRUG.

IN FACT, I'VE NEVER GIVEN IT TO ANYONE IN MY ENTIRE CAREER.

SOMEBODY CALLED. MY HUSBAND'S HERE.

HE'S BEEN IN ANOTHER ACCIDENT.

WHERE IS HE?

EVEN HIS OWN WIFE DOESN'T RECOGNIZE HIM.

HEY, BABE.

Narrator: DR. KAHN IS TRYING TO GET TO THE BOTTOM

OF HIS OVERHEATED PATIENT'S PUZZLING SYMPTOMS.

HE RECEIVES A MYSTERIOUS TEXT,

INSTRUCTING HIM TO ADMINISTER A DRUG HE'S NEVER USED.

DANTROLENE IS A VERY OBSCURE MEDICATION,

AND IT'S ONLY ADMINISTERED FOR A COUPLE OF THINGS

THAT HAVE NO RELATION TO WHAT WE'RE SEEING WITH THIS PATIENT.

WHO IS THIS FROM?

IT'S ALREADY APPARENT

THAT SHE HAS MORE THAN JUST HEAT EXHAUSTION.

IT'S ALICIA'S BROTHER. I TEXTED HIM WHAT'S HAPPENING.

DOES HE WORK IN THE MEDICAL FIELD?

NO. HE'S A THEATER MAJOR.

AND WITH THIS STRANGE TEXT MESSAGE,

THERE'S CLEARLY SOMETHING ELSE GOING ON.

DOES HE KNOW SOMETHING ABOUT ALICIA THAT WE DON'T KNOW?

I DON'T KNOW. THAT'S ALL HE SAID.

IS THERE ANY WAY I COULD TALK TO HIM?

HE'S DRIVING.

OKAY.

WELL, TRY YOUR BEST. I REALLY NEED TO TALK TO HIM.

OKAY.

IT'S VERY STRANGE TO RECEIVE MEDICAL INSTRUCTION

BY TEXT MESSAGE.

BUT WHEN SOMEONE IS SUGGESTING USING A MEDICATION THAT'S

ALMOST NEVER GIVEN IN THE E.R., MAYBE THEY KNOW SOMETHING

THAT I DON'T.

THE PATIENT COMES BACK FROM HER HEAD CT,

SO I GO TO CHECK ON HER.

LIKE EVERYTHING ELSE WE'VE ORDERED, HER SCAN IS NORMAL.

SO WE'RE BACK TO SQUARE ONE.

DID YOU HEAR BACK FROM HER BROTHER?

NO, NOT YET.

YOU CALLED CARSON?

I SAID NOT TO.

SHE'S STARTING TO HAVE MORE TROUBLE BREATHING.

HER O2 LEVELS ARE DROPPING.

CALL R.T., AND LET'S GET THEM TO PUT A BIPAP, STAT.

IS SHE GONNA BE OKAY?

WHAT'S THAT EVEN MEAN?

HANG ON, ALISH.

WE REALLY NEED TO GET TO THE BOTTOM OF THIS.

BUT EVEN WITH THE BIPAP MASK,

SHE'S REALLY NOT GETTING A WHOLE LOT BETTER.

IF SHE DOESN'T START TO TURN THE CORNER SOON,

WE MAY HAVE TO PUT A BREATHING TUBE IN.

LOOK, THERE'S HER DOCTOR.

HI.

I THINK I KNOW WHAT'S WRONG WITH HER.

SO NOW, AFTER ALL OF OUR EXAMS AND TESTS,

WE'RE FINALLY GONNA GET THE WHOLE STORY...MAYBE.

Narrator: DR. MICHOS' PATIENT HAS COME BACK FROM HIS CT SCAN...

DOCTOR.

...SWOLLEN UP BEYOND RECOGNITION.

WHERE HAVE YOU BEEN? I DID ALL THE TESTS YOU ASKED FOR.

I'M TOTALLY FINE. I HAVE GOT TO GO, SIR.

THIS PERSON HAS TRANSFORMED INTO A GIANT MARSHMALLOW.

THOMAS, YOUR CONDITION HAS WORSENED.

I'M FINE.

IT WAS AMAZING HE COULDN'T FEEL WHAT WAS HAPPENING TO HIS BODY.

BUT DENIAL IS A VERY POWERFUL MECHANISM.

[ SCOFFS ] I CAN BREATHE.

THOMAS, THE CAT SCAN'S GONNA CONFIRM THIS,

BUT I BELIEVE YOU HAVE A COLLAPSED LUNG.

I'M GONNA HAVE A QUICK LOOK AT YOUR CAT SCANS.

I'LL BE RIGHT BACK.

IT ALL MAKES SENSE NOW,

THE BRUISE ON HIS CHEST, THE DIMINISHED BREATH SOUNDS,

AND NOW THIS CRAZY SWELLING.

I DON'T EVEN NEED TO LOOK AT THE CAT SCAN

TO KNOW THIS GUY NEEDS A CHEST TUBE RIGHT AWAY.

GET SET UP FOR A CHEST TUBE, PLEASE.

UH, ARE HIS SCANS UP?

NOT YET.

SO, UH, IS HE STILL FIGHTING DARWIN,

OR IS HE GONNA STICK AROUND FOR THE PROCEDURE?

I'M KEEPING HIM HERE IF I HAVE TO SIT ON HIM TO MAKE HIM STAY.

UH, DR. MICHANOS?

[ CHUCKLES ] MICHOS.

AND YOU ARE?

MY NAME IS OLIVIA.

UM, SOMEBODY CALLED. MY HUSBAND'S HERE.

THOMAS?

YEAH.

HE'S BEEN IN ANOTHER ACCIDENT.

I'M AFRAID SO.

OKAY.

WELL, WHERE IS HE?

YOU DON'T SEE HIM?

THOMAS?

Dr. Michos: HE'S SO SWOLLEN

THAT EVEN HIS OWN WIFE DOESN'T RECOGNIZE HIM.

HEY, BABE. SORRY. I WAS ON MY WAY HOME.

THIS BIG OLD HONKIN' POLE JUMPED RIGHT IN FRONT OF ME.

UM...

I'M READY. I'M READY TO GO.

Dr. Michos: AND YET HE STILL WANTS TO GO OUT

AND CELEBRATE.

LET'S GO. LET'S GO.

THOMAS.

AT THIS POINT, I'M REALLY HOPING THE WIFE

CAN HELP HIM SEE HOW SERIOUS THIS SITUATION REALLY IS.

THOMAS, DO YOU HAVE ANY IDEA WHAT YOU LOOK LIKE?

YOU LOOK NICE.

THANK YOU.

THAT'S MY WIFE.

I KNOW.

FOR ONCE IN YOUR LIFE,

PAY ATTENTION TO WHAT'S GOING ON AROUND YOU.

WHAT HAVE YOU DONE TO ME, DOCTOR?

HAVE A NICE DAY.

HMM.

Narrator: THE TEST RESULT'S FOR DR. DRAKE'S ORNERY PATIENT

INDICATE A SERIOUS HEART ATTACK.

BUT THE MAN HAS JUST FLED THE E.R.

YOU HAVE TO CATCH HIM.

Dr. Drake: THIS MAN WAS IN HIS 70s.

AND I'M VERY CONCERNED THAT, IN HIS CONDITION,

HE COULD GO INTO CARDIAC ARREST AT ANY TIME.

SO WE HOPED THAT WE COULD CATCH HIM BEFORE HE LEFT THE BUILDING.

LUCKY FOR US, HE WAS ELDERLY, SO THE ODDS WERE IN OUR FAVOR.

MR. LEVCHAK, I'M SO GLAD WE CAUGHT UP WITH YOU.

I'M NOT.

I SHOULD'VE PUSHED THE "STOP" BUTTON

AND STAYED IN THE ELEVATOR.

SIR, I GOT SOME OF YOUR BLOOD RESULTS BACK.

I HAVE NEWS FOR YOU. YOU'VE HAD A HEART ATTACK.

I FEEL FINE.

I KNOW YOU FEEL FINE.

BUT SOME OF YOUR HEART MUSCLE IS DYING.

THE LONGER WE WAIT TO START YOUR TREATMENT,

THE WORSE THIS COULD BE.

THE WORD "HEART ATTACK" CAUGHT HIS ATTENTION,

AND HE AGREED TO COME BACK WITH US TO THE E.R.

WE IMMEDIATELY STEPPED UP HIS MEDICAL TREATMENT.

BRAD, LET'S START AN I.V. INFUSION OF HEPARIN,

AND START AN I.V. NITROGLYCERIN DRIP AT LOW DOSE.

HOW ARE YOU FEELING?

ANY CHEST PAIN?

NO, I FEEL FINE.

GOOD.

SO I'M GONNA MAKE ARRANGEMENTS FOR YOU

TO BE TRANSFERRED BY AMBULANCE TO OUR CARDIAC CARE FACILITY

SO YOU CAN CONTINUE TO GET THE CARE THAT YOU NEED.

I'LL CALL YOUR DOCTOR AND LET HIM KNOW.

HE NEEDED A PROCEDURE CALLED A CARDIAC CATHETERIZATION,

WHERE THEY WOULD ACTUALLY LOOK AT THE ARTERIES IN HIS HEART

AND SEE IF THERE WAS ONE THAT WAS BLOCKED THAT THEY CAN OPEN.

EXCUSE ME. I'LL NEED YOUR ARM.

DON'T TOUCH ME!

WHAT IS SHE DOING HERE?

TARA IS ASSISTING ME, MR. LEVCHAK.

AND I'M GONNA ASK YOU AGAIN -- THIS IS MY STAFF.

PLEASE STOP DISRESPECTING THEM.

WE MADE ARRANGEMENTS FOR THE AMBULANCE TO PICK HIM UP

AND TRANSFER HIM TO THE INPATIENT FACILITY.

HI. WE'RE HERE TO SEE A PATIENT -- MR. LEVCHAK.

Woman: OKAY.

YOU MUST BE MR. LEVCHAK'S NEIGHBOR.

YEAH.

I'M DR. DRAKE.

HI, I'M AARON. THIS IS MY DAUGHTER, MAYA.

HELLO.

HOW'S HE DOING?

PLEASURE TO MEET YOU.

WELL, WE'RE WAITING FOR AN AMBULANCE TO COME

AND TRANSPORT HIM TO THE HOSPITAL.

LOOKS LIKE HE'S HAD A SLIGHT HEART ATTACK,

BUT HE'S DOING FINE.

WOULD YOU LIKE TO SEE HIM?

YES, PLEASE.

OKAY.

COME THIS WAY.

Dr. Drake: SO THIS WAS STRANGE.

YOU KNOW, THIS WAS ONE OF THE RUDEST,

MOST BELLIGERENT PATIENTS WE'VE SEEN IN A LONG TIME.

SO HOW DO YOU KNOW MR. LEVCHAK?

UH, WE MOVED IN NEXT DOOR A COUPLE MONTHS AGO.

I'M A SINGLE DAD, SO I KIND OF FELT BAD FOR HIM,

AN OLD MAN LIVING ALL BY HIMSELF.

KNOCK, KNOCK.

WHEN THE PATIENT AND THE LITTLE GIRL SET EYES ON EACH OTHER,

WHAT HAPPENED WAS UNBELIEVABLE.

WELL, WELL, WELL. LOOK WHO'S HERE.

MAYA.

OKAY, SO AT LEAST THERE'S ONE FEMALE HE ISN'T MEAN TO.

DID YOU BRING ME SOMETHING?

I HAVE A JUICE BOX.

OOH, A JUICE BOX.

HOLD ON, MAYA.

I THINK WE SHOULD ASK THE DOCTOR.

I'M NOT SURE IF MR. LEVCHAK'S ALLOWED TO DRINK THAT.

WELL, HE CAN HAVE IT, IF YOU WANT TO GIVE IT TO HIM.

THEY SEEM TO LIKE EACH OTHER.

OH, YEAH. THEY'RE BEST FRIENDS.

THEY PLAY HIDE-AND-SEEK ALMOST EVERY DAY.

REALLY? HIDE-AND-SEEK.

HUH.

WELL, YOU'LL BE IN GOOD HANDS AT THE HOSPITAL.

THANK YOU.

Dr. Drake: AT THIS POINT,

MY WORK WAS PRETTY MUCH DONE.

I WENT ON TO SEE OTHER PATIENTS.

ABOUT HALF AN HOUR LATER, THE FATHER AND HIS DAUGHTER

HEADED OFF TO THE OTHER HOSPITAL TO MEET HIM THERE.

SO I'M WAITING FOR THE AMBULANCE TO COME AND PICK UP THE PATIENT,

AND THEY FINALLY SHOW UP.

EXCUSE ME FOR A MOMENT.

SO I WENT OVER TO SPEAK

TO THE EMTs THAT WERE GOING TO TRANSPORT HIM.

HI. I'M DR. DRAKE.

EXCUSE ME, DR. DRAKE.

YEAH?

WE HAVE A PROBLEM.

MR. LEVCHAK IS GONE.

THEY CAN'T FIND HIM ANYWHERE. HE'S GONE.

WHAT?

IT'S GETTING REALLY HARD -- REALLY HARD TO BREATHE, OLIVIA.

THE PATIENT NEEDS TO BE INTUBATED.

AND THAT COULD KILL OUR PATIENT.

IF YOU LOSE THIS PATIENT, OH, IT'S ON YOU.

DOCTOR, WHAT HAVE YOU DONE TO ME?

WHAT HAVE YOU DONE TO ME?

Dr. Michos: CALM DOWN, THOMAS.

Narrator: DR. MICHOS' SWOLLEN PATIENT

IS JUST DISCOVERING WHAT HE LOOKS LIKE.

Dr. Michos: WHAT SEEMS TO HAVE HAPPENED IS YOU FRACTURED YOUR RIBS,

PUNCTURED AND COLLAPSED YOUR LUNGS.

AND THAT'S TRAPPING ALL OF THIS AIR UNDERNEATH YOUR SKIN.

WHAT WE NEED TO DO IS INSERT A TUBE IN THE THE SIDE

OF YOUR CHEST,

RELEASE THE AIR, AND EXPAND YOUR LUNG

BEFORE IT CAUSES YOU MORE SERIOUS PROBLEMS.

WHAT I'M NOT TELLING THEM

IS HOW TRICKY THIS PROCEDURE REALLY IS GONNA BE.

THIS GUY IS TWICE HIS NORMAL SIZE.

I DON'T HAVE ANY OF MY USUAL LANDMARKS

SO I KNOW EXACTLY WHERE TO PUT THIS TUBE.

IT'S GONNA BE OKAY, RIGHT?

IT'LL BE FINE, BUT WE NEED TO DO THE PROCEDURE.

HEY, OUT OF SURGERY.

I GOT HERE AS SOON AS I COULD.

Dr. Michos: AT THIS POINT, THE TRAUMA SURGEON SHOWS UP.

I'M GLAD TO SEE HER,

BUT WE DON'T ALWAYS SEE EYE TO EYE.

THIS IS, UH, DR. GLENS, OUR, UH, TRAUMA SURGEON.

HI.

IT'S -- IT'S -- IT'S OKAY.

I THINK WE'VE GOT IT SOLVED.

HE APPEARS TO HAVE A PNEUMOTHORAX.

I MEAN, I WOULDN'T BE SO SURE.

DID YOU HAVE A CT SCAN WITH CONTRAST DYE?

YEAH.

WE'RE WAITING FOR THE RESULTS.

SIR, I THINK YOU MIGHT BE HAVING AN ALLERGIC REACTION

TO THE CONTRAST DYE IN THE CT SCAN.

AN ALLERGIC REACTION?

MM-HMM.

PERHAPS, UH, WE CAN HAVE A WORD IN THE HALLWAY?

PLEASE?

I'VE LEARNED NOT TO ENGAGE IN CONTROVERSY

IN FRONT OF A PATIENT.

I THINK HE'S GOT SUBCUTANEOUS EMPHYSEMA FROM A PNEUMOTHORAX.

I CAN FEEL THE CREPITUS AND HEAR DIMINISHED BREATH SOUNDS.

OKAY. FROM YOUR OWN ACCOUNT,

THE PATIENT CAME IN PRESENTING NO SYMPTOMS.

HE WENT FOR A CAT SCAN, AND HE COMES BACK,

AND HIS FACE IS SWOLLEN BEYOND RECOGNITION.

IF...

HEY.

CLEARLY, HE'S ALLERGIC TO THE I.V. CONTRAST.

WHILE YOU'RE OUT HERE ARGUING WITH ME,

HE COULD BE LOSING HIS AIRWAY.

THE PATIENT NEEDS TO BE INTUBATED.

INTUBATE, OR I WILL.

IF WE INTUBATE THIS PATIENT,

WE'RE GONNA CONVERT A PNEUMOTHORAX

TO A TENSION PNEUMOTHORAX.

AND THAT COULD KILL OUR PATIENT.

YOU KNOW WHAT?

YOU DO WHATEVER YOU WANT.

BUT LET'S BE CLEAR, OKAY?

YOU LOSE THIS PATIENT, OH, IT'S ON YOU.

YEAH.

Narrator: DR. KAHN CAN'T UNDERSTAND WHY THE CONDITION

OF HIS OVERHEATED PATIENT CONTINUES TO WORSEN.

BUT THE PATIENT'S BROTHER SAYS HE KNOWS.

MY SISTER'S BEEN TAKING THESE DIET PILLS CALLED DNP.

YOU KNOW ABOUT 'EM?

DNP? NO.

THEY'RE VERY POTENT. BODYBUILDERS USE THEM.

UP TO NOW, WE WERE SORT OF IN THE DARK,

SO THIS NEW INFORMATION DEFINITELY SHEDS SOME LIGHT.

ALICIA'S USING BODYBUILDER DRUGS?

I SAW A BOTTLE IN HER DORM ROOM.

SHE TOLD ME TO MIND MY OWN BUSINESS.

SO I DID SOME RESEARCH ON IT.

IT'S BANNED BY THE FDA, BUT YOU CAN STILL BUY IT ONLINE.

AND YOU THINK DANTROLENE WILL HELP HER?

YES. THERE'S A CASE

WHERE DANTROLENE WAS USED TO TREAT A DNP OVERDOSE

AND SAVED THE PERSON'S LIFE.

HEY, SANDY. LET'S CALL POISON CONTROL

AND SEE WHAT THEY CAN FIND OUT ABOUT TREATING DNP, OKAY?

IN THE MEANTIME, LET'S GO TALK TO YOUR SISTER.

NOW, I NEED MY PATIENT TO BE 100% HONEST WITH ME.

ALICIA.

ALICIA,

ARE YOU FEELING ANY BETTER?

THE PATIENT'S REALLY MAD

AT HER BROTHER AND THE GIRL THAT CALLED HIM.

WHEN WERE YOU PLANNING ON TELLING ME?

WHAT ARE YOU TALKING ABOUT?

YOUR LITTLE LOVE AFFAIR.

YOU THINK I'M AN IDIOT?

NO, WE DON'T.

SHUT UP, CARSON!

Dr. Kahn: HEY, GUYS, MAYBE GIVE --

GIVE US A FEW MINUTES, GO GET SOME COFFEE FROM DOWNSTAIRS.

ALICIA, DO YOU MIND IF WE TAKE OFF THIS MASK

FOR JUST A MINUTE?

ARE YOU DOING OKAY?

MY BEST FRIEND [Indistinct]

AND MY BIG BROTHER...

I CAN'T BELIEVE THEY DIDN'T TELL ME.

IT MUST BE A LOT TO DEAL WITH,

YOU KNOW, HAVING TO DEAL WITH ALL THIS AT ONCE.

WELL, YOU KNOW, AS YOUR DOCTOR,

IT'S MY JOB TO MAKE SURE YOU GET BETTER, RIGHT?

IN ORDER TO DO THAT, I NEED TO MAKE SURE I KNOW EVERYTHING.

HAVE YOU BEEN TAKING ANY KIND OF PILLS?

IS IT DNP?

WHAT TOLD YOU? MY BROTHER?

YEAH.

BUT THE GOOD THING IS, NOW THAT WE KNOW WHAT WE'RE DEALING WITH,

WE CAN MAKE SURE WE GET YOU THE RIGHT TREATMENT.

OKAY. LET'S GET THIS BACK ON HER.

THE PATIENT'S ADMISSION

THAT SHE'S BEEN USING THIS BANNED DIET DRUG

COMPLETELY CHANGES THE EQUATION.

IT EXPLAINS WHY NOTHING

WE'VE BEEN DOING SO FAR HAS BEEN VERY EFFECTIVE.

DNP HAS A VERY NARROW THERAPEUTIC INDEX.

SO, IF YOU TAKE EVEN JUST A LITTLE BIT TOO MUCH,

IT CAN LITERALLY BURN YOU UP FROM THE INSIDE.

OKAY, THANK YOU.

POISON CONTROL SAYS THERE'S NO ANTIDOTE OR TREATMENT

FOR A DNP OVERDOSE.

THEY DON'T ADVISE GIVING DANTROLENE.

THEY ONLY ADVISE PROVIDING SUPPORTIVE CARE.

THAT'S NOT VERY HELPFUL.

POISON CONTROL REALLY HAS NOTHING TO OFFER.

OUR SUPPORTIVE CARE HASN'T BEEN VERY EFFECTIVE,

AND THE PATIENT'S JUST CONTINUING TO DECLINE.

LET'S SEE WHAT WE CAN FIND OUT.

I BEGAN TO LOOK INTO HOW DNP AFFECTS THE BODY.

DNP STANDS FOR 2,4-DINITROPHENOL.

IT HAS CAUSED ROUGHLY 60 DEATHS WORLDWIDE.

IT WAS BANNED BY THE FDA IN 1938.

THIS STUFF SOUNDS ABSOLUTELY TOXIC.

CAN INDUCE RAPID WEIGHT LOSS BY INCREASING METABOLIC RATE

BUT CAN, AT THE SAME TIME,

CAUSE POTENTIAL LIFE-THREATENING HYPOTHERMIA.

YOUR BODY TEMPERATURE GETS SO HIGH

THAT TRADITIONAL METHODS OF LOWERING YOUR BODY TEMPERATURE,

LIKE THE COOL I.V. FLUIDS, THE ICE PACKS,

THE MIST, AND THE FAN OFTENTIMES DON'T WORK.

DR. KAHN, NEED YOU IN HERE.

O2 LEVELS HAVE DROPPED INTO THE LOW 80s.

Narrator: DR. DRAKE IS ABOUT TO SEND HIS HEART ATTACK PATIENT

TO AN OUTSIDE HOSPITAL FOR TREATMENT.

HE'S GONE.

WHAT?

Dr. Drake: THIS IS VERY TROUBLING BECAUSE,

EVEN THOUGH THE PATIENT WAS STABLE,

HIS TREATMENT WAS INCOMPLETE,

AND HE COULD HAVE A CARDIAC ARREST AT ANY MOMENT.

I SWEAR I DIDN'T LET HIM OUT OF MY SIGHT

FOR MORE THAN THREE MINUTES.

ANY LUCK?

NO.

I CHECKED THE TRAUMA BAY AND EVERY BATHROOM IN THE E.R.

CALL HIS FRIEND, AARON, THE NEIGHBOR.

WE HAVE HIS CELLPHONE NUMBER, RIGHT?

YES.

ASK HIM TO CHECK LEVCHAK'S HOUSE.

MAYBE HE WENT HOME.

SO, IN THE MEANTIME, YOU KNOW, WE CHECKED EVERYWHERE.

WE LOOKED IN THE CAFETERIA. WE LOOKED AT THE COFFEE SHOP.

WE WENT BACK TO HIS CARDIOLOGIST'S OFFICE.

WE COULDN'T FIND HIM ANYWHERE.

DR. DRAKE.

ANY LUCK?

WE WERE STILL CLOSE BY,

SO WE CHECKED THE PARKING GARAGE FOR HIS CAR.

IT'S HERE. HE HASN'T DRIVEN HOME.

SO HE'S STILL HERE SOMEWHERE.

WHERE'S MR. LEVCHAK?

I DON'T KNOW, MAYA.

I THINK HE'S PLAYING HIDE- AND-GO-SEEK WITH US TODAY.

I CAN FIND HIM.

I FIGURED IT WAS A LONG SHOT,

BUT, AT THIS POINT, I'M WILLING TO TRY ANYTHING.

I THINK HE'S IN THERE.

IN THERE? IN THE ELEVATOR?

MR. LEVCHAK, ARE YOU IN THERE?

Mr. Levchak: GO AWAY.

GUESS WHAT? SHE FOUND HIM.

I'M TAKING THE STAIRS.

WANT ME TO CALL SECURITY?

YEAH.

Dr. Drake: AT THIS POINT, THE LITTLE GIRL IS BATTING 1,000,

SO MY MONEY'S ON HER.

YOU THINK YOU CAN GET HIM OUT OF THERE?

WHY DON'T YOU GIVE IT A SHOT?

MR. LEVCHAK, COME OUT.

IT'S MY TURN TO HIDE.

Mr. Levchak: ALL RIGHT.

AND, SURE ENOUGH, SHE DID IT AGAIN.

AND THAT'S WHEN OUR LUCK CHANGED.

MR. LEVCHAK?

[ GROANING ]

MR. LEVCHAK!

MR. LEVCHAK!

IT WAS EXACTLY WHAT I FEARED WOULD HAPPEN.

HE WAS IN FULL CARDIAC ARREST.

HE'S CODING. WE NEED A CRASH CART RIGHT AWAY.

CODE BLUE, LEVEL FIVE. CODE BLUE.

HER TEMPERATURE IS STILL DANGEROUSLY HIGH.

WHAT ELSE CAN WE DO?

Dr. Kahn: YOU DON'T READ ABOUT SOMEONE

OVERDOSING ON DNP AND SURVIVING

BECAUSE THERE IS NO ANTIDOTE.

O2 LEVELS HAVE DROPPED INTO THE LOW 80s.

Narrator: DR. KAHN'S PATIENT'S HEALTH IS RAPIDLY DETERIORATING.

SHE'S ADMITTED TAKING A BANNED DIET DRUG

KNOWN FOR ITS LETHAL SIDE EFFECTS.

ALICIA, THIS MASK JUST ISN'T CUTTING IT,

SO WE'RE GONNA GIVE YOU SOME MEDICINE THROUGH YOUR I.V.

TO PUT YOU TO SLEEP.

ONCE YOU'RE ASLEEP, WE'LL GO AHEAD

AND PUT A BREATHING TUBE IN.

THAT'LL HELP YOUR BREATHING A LOT.

ONCE WE HAVE YOU ASLEEP, WE CAN DO EVERYTHING WE CAN

TO LOWER YOUR BODY TEMPERATURE, AS WELL, OKAY?

Dr. Kahn: I CAN TELL SHE'S SCARED.

THE PATIENT'S CARBON DIOXIDE LEVELS ARE HIGH,

WHICH MAKES HER SLEEPY AND WHICH SUPPRESSES HER DRIVE

TO TAKE BREATHS ON HER OWN.

SINCE SHE'S NOT BREATHING ON HER OWN,

HER CARBON DIOXIDE LEVELS ARE GONNA GET EVEN HIGHER.

IT'S A SELF-PERPETUATING CYCLE THAT, IF LEFT UNTURNED,

CAN EVEN LEAD TO DEATH.

I PERFORM THE INTUBATION AND GET HER ON THE VENTILATOR,

WHICH SHOULD HELP WITH THE CARBON DIOXIDE LEVELS.

BUT HER TEMPERATURE IS STILL DANGEROUSLY HIGH.

WHAT ELSE CAN WE DO?

THE BROTHER IS CONVINCED THAT DANTROLENE WILL HELP CURE

HIS SISTER'S OVERDOSE.

BUT I NEED TO FIND SOME EVIDENCE

BEFORE I CAN ADMINISTER SUCH A RARELY-USED DRUG,

ESPECIALLY SINCE POISON CONTROL

DIDN'T SPECIFICALLY RECOMMEND IT.

YOU DON'T READ ABOUT SOMEONE OVERDOSING ON DNP AND SURVIVING

BECAUSE THERE IS NO ANTIDOTE.

BUT THERE WAS ONE CASE REPORT OF SOMEONE WHO RECEIVED DANTROLENE

AND ACTUALLY SURVIVED.

SANDY, CAN YOU GET THE PHARMACY ON THE LINE, PLEASE?

WHETHER IT WAS FROM THE DANTROLENE

OR IT WAS COINCIDENTAL, THERE'S NO WAY TO KNOW.

HI, PLEASE HOLD FOR DR. KAHN IN THE E.R.

BUT IT SEEMED LIKE IT WAS WORTH A SHOT.

YEAH, HI. WE NEED TO GET 700 MILLIGRAMS

OF DANTROLENE SENT UP TO THE E.R. IMMEDIATELY.

I -- I KNOW WE DON'T USUALLY USE IT HERE, BUT WE HAVE A PATIENT

WITH LIFE-THREATENING MALIGNANT HYPOTHERMIA,

AND WE NEED IT.

OKAY.

OKAY, GREAT. THANKS.

WHILE THE DANTROLENE COULD WORK TO LOWER HER BODY TEMPERATURE,

IT'S NOT A DE FACTO ANTIDOTE TO DNP.

NONE EXISTS.

OKAY, GUYS.

WE GOT AHOLD OF THE DANTROLENE, SO WE'RE GONNA TRY THAT.

WILL IT REALLY HELP HER?

WE'VE DONE EVERYTHING ELSE WE CAN DOWN HERE.

UH, THERE IS A SINGLE CASE REPORT OF AN INSTANCE

WHERE IT MADE A DIFFERENCE,

SO IT'S WORTH A SHOT. OKAY.

LET'S GO AHEAD AND GIVE 150 MILLIGRAMS RAPID I.V. PUSH.

AT THIS POINT, WE REALLY DON'T HAVE ANY OTHER OPTIONS.

SO I'M JUST HOPING AGAINST HOPE THAT THIS WILL WORK.

MR. LEVCHAK?

Narrator: DR. DRAKE HAS FINALLY FOUND HIS MISSING PATIENT...

CODE BLUE, LEVEL FIVE. CODE BLUE.

...BUT HE MIGHT BE TOO LATE.

Dr. Drake: I DID A COUPLE OF ROUNDS OF CPR,

AND THERE WAS STILL NO PULSE.

HE'S IN FULL CARDIAC ARREST,

AND OUR ONLY OPTION IS THAT HE HAS A SHOCKABLE RHYTHM.

SO WE NEED A CRASH CART IMMEDIATELY.

GET THE PADS ON!

WHAT DO WE HAVE?

ETHAN, CHARGE 200.

CLEAR!

SHOCK!

WE'RE GOOD.

SINUS RHYTHM. [ SIGHS ] GOOD.

CHECK FOR PULSE.

WE WERE LUCKY.

HE WAS LUCKY.

HE WENT BACK INTO A SINUS RHYTHM,

AND AFTER A COUPLE OF MINUTES OF CPR,

HE RETURNED TO FULL CONSCIOUSNESS.

MR. LEVCHAK.

UH...

DO YOU KNOW WHERE YOU ARE?

YOUR HEART STOPPED, BUT YOU'RE OKAY NOW.

SHARON?

NO. MY NAME'S TARA.

TARA'S ONE OF THE NURSES THAT HELPED SAVE YOUR LIFE.

WHO'S SHARON?

SHARON WAS MY WIFE.

I -- I LOST HER THREE YEARS AGO.

YOU MUST MISS HER TERRIBLY.

SHE WAS MY HIGH-SCHOOL SWEETHEART.

I LOVED HER VERY MUCH.

DOCTOR, I SAW HER. I JUST SAW HER.

I DID.

I WAS WANTING TO GO TO HER, AND SHE SAID, "NO, STAY,

FOR OUR DAUGHTER."

WHO'S YOUR DAUGHTER?

SHE WENT TO COLORADO.

SHE DISOWNED ME.

AND I DESERVED IT.

AFTER SHARON DIED, I --

I WASN'T VERY NICE.

OFTENTIMES, ANGER IS COVERING SADNESS OR TEARS.

AND IF I CAN GET A PATIENT TO CONNECT WITH THAT,

IT CAN SHIFT THEIR RELATIONSHIP WITH IT,

AS IT DID IN THIS CASE, WHERE IT SHIFTED --

IMMEDIATELY SHIFTED HIS RELATIONSHIP WITH THE NURSES IN THE ROOM.

IT'S OKAY. HE'S OKAY.

MAYA?

WE'RE FINALLY GETTING HIM PACKED UP AND ON THE GURNEY

AND ON HIS WAY TO THE OTHER HOSPITAL

SO HIS HEART CAN BE TAKEN CARE OF.

TAKE CARE OF THAT HEART OF YOURS, MR. LEVCHAK.

I WILL. AND THANK YOU.

YOU'RE WELCOME. TAKE CARE.

WAIT.

TARA, I'M SORRY FOR EVERYTHING I SAID.

IT'S OKAY.

AND THANK YOU.

YOU'RE WELCOME.

WHY DON'T YOU CALL YOUR DAUGHTER?

I KNOW, IF I WERE HER, I'D WANT TO HEAR FROM YOU.

I WILL.

THANK YOU.

SOMETIMES, YOU JUST HAVE TO SPEAK TO THE PAIN

BENEATH THE ANGER.

AND THEN THERE IS AN OPPORTUNITY TO BRING COMPASSION AND EMPATHY

TO THAT PATIENT'S PAIN.

AND THAT COMPASSION AND EMPATHY CAN BE THE WATER THAT PUTS OUT

THE FIRE OF THEIR ANGER AND SHIFTS EVERYTHING.

AND, WHEN THAT HAPPENS, IT'S MAGIC.

THE PATIENT NEEDS TO BE INTUBATED.

INTUBATE, OR I WILL.

Narrator: DR. MICHOS IS TORN BETWEEN A TRAUMA SURGEON

WHO DISAGREES WITH HIS DIAGNOSIS

AND HIS BADLY BLOATED PATIENT,

WHO NEEDS HIS IMMEDIATE ATTENTION.

YOU LOSE THIS PATIENT, OH, IT'S ON YOU.

YEAH.

WHAT DID SHE MEAN, "IF WE LOSE THIS PATIENT"?

IT'S -- IT'S OKAY. OKAY.

WE WERE JUST TALKING ABOUT TREATMENT.

SHE'S TRANSFERRING RESPONSIBILITY BACK TO ME.

WE HAVE A CLEAR PLAN OF ACTION NOW.

WE'RE GONNA DO EVERYTHING POSSIBLE FOR YOUR HUSBAND.

I NEED TO RELEASE ALL THE PRESSURE IN THOMAS' CHEST,

OR IT COULD STOP HIS HEART.

I KNOW THAT THIS GUY

IS NOT GONNA BE ABLE TO BREATHE MUCH LONGER.

BUT I NEED TO STAY CALM.

HOW THE SWELLING OCCURS IS THAT THE AIR THAT YOU BREATHE

DOESN'T GO INTO THE LUNG BECAUSE THE LUNG IS COLLAPSED.

THE LUNG IS INJURED.

SO IT HAS TO GO SOMEWHERE.

SO IT LITERALLY GOES IN THE SKIN.

I'VE GOT TO FIND LANDMARKS TO INSERT THE CHEST TUBE.

I'VE GOT TO MAKE SURE THAT I GO ABOVE THE RIB

SO I DON'T DAMAGE THE BLOOD VESSELS AND THE NERVE

UNDER THE RIB.

AND, IF I GO TOO LOW,

I RISK ENTERING THE ABDOMEN AND PUNCTURING HIS LIVER.

BP's DROPPING -- 70 OVER 50.

AT THIS POINT, I'M TRYING TO FEEL MY WAY,

AND I'M SWEATING BULLETS.

I CAN'T GET AN O2 SAT READING.

GET A NON-REBREATHER ON HIM STAT.

I CAN'T FIND THE LANDMARKS, AND I'M RUNNING OUT OF TIME.

[ Gasping ] I CAN'T BREATHE!

Dr. Kahn: WE WATCHED THE PATIENT'S VITAL SIGNS FOR A MINUTE.

HER TEMPERATURE IS STILL REMAINING THE SAME.

HER HEART RATE, HER BLOOD PRESSURE ARE UNCHANGED.

YOU CAN'T GIVE UP NOW.

Narrator: DR. KAHN'S PATIENT OVERDOSED ON A BANNED DIET DRUG

THAT ELEVATES BODY TEMPERATURE TO FATAL LEVELS.

HIS LAST RECOURSE IS A MEDICATION HE HAS NEVER USED.

DANTROLENE WORKS SORT OF THE OPPOSITE OF DNP.

IT PREVENTS THE RELEASE OF CALCIUM,

CAUSING MUSCLE RELAXATION AND LESS RELEASE OF HEAT.

WE WATCHED THE PATIENT'S VITAL SIGNS FOR A MINUTE.

HER TEMPERATURE IS STILL REMAINING THE SAME.

HER HEART RATE, HER BLOOD PRESSURE ARE UNCHANGED.

SO IT SEEMS TO HAVE HAD NO EFFECT NO HER.

LET'S TRY ANOTHER DOSE.

AT THIS POINT, WE'VE KIND OF DONE EVERYTHING ELSE WE CAN.

UM, I THINK SHE NEEDS TO BE ADMITTED TO THE INTENSIVE CARE

UNIT SO WE CAN WATCH HER A LITTLE BIT CLOSER.

NO WAY. YOU CAN'T GIVE UP NOW.

IT'S ONLY BEEN 10 MINUTES.

LOOK! HER TEMPERATURE WENT DOWN.

IT'S WORKING.

FINALLY, HER TEMPERATURE COMES DOWN A LITTLE BIT.

HER VITAL SIGNS ARE STILL A LITTLE BIT IFFY,

BUT SHE'S DEFINITELY STABLE ENOUGH TO LEAVE THE E.R.

AND GO TO THE ICU.

OKAY, BEST OF LUCK, GUYS.

SHE'LL BE MONITORED IN THE ICU,

AND HOPEFULLY, HER TEMPERATURE WILL CONTINUE TO COME DOWN

AND HER VITAL SIGNS WILL STABILIZE.

THREE DAYS LATER, I RAN INTO MY PATIENT IN THE HALL.

DR. KAHN.

HEY, ALICIA.

HOW ARE YOU DOING?

I'M GOOD.

READY TO GO HOME.

SHE'S EATING REAL FOOD NOW.

NO MORE DIET SUPPLEMENTS FOR ME.

I FEEL SO STUPID, TAKING THOSE PILLS.

SO WHY DO YOU THINK YOU DID IT?

I DON'T KNOW.

I...

ALL MY FRIENDS ARE SO PRETTY.

AND I JUST FELT FAT, ESPECIALLY AFTER MY BIG BROTHER

TOLD ME HE THOUGHT MILEY WAS HOT.

HEY, THAT WAS FLATTERING,

BUT THAT'S ALL IT WAS.

YOU KNOW NOTHING HAPPENED.

AND YOU'RE NOT FAT, ALICIA. YOU LOOK FANTASTIC.

YEAH, RIGHT.

ALICIA, I THINK YOU SHOULD LISTEN TO YOUR FRIEND.

YOU'RE GONNA BE JUST FINE.

JUST TAKE CARE OF YOURSELF, OKAY?

OKAY.

THANKS, DR. KAHN.

I WILL.

Dr. Kahn: THIS CASE STICKS WITH ME BECAUSE IT INVOLVED A DRUG

THAT I HAD NEVER HEARD OF BEFORE,

USING A TREATMENT THAT I'D NEVER USED BEFORE,

AND I COULDN'T HAVE DONE IT WITHOUT INFORMATION

FROM THE PATIENT'S FAMILY AND FRIENDS.

SO IT WAS A TOTAL TEAM EFFORT.

I CAN'T GET AN O2 SAT READING.

GET A NON-REBREATHER ON HIM STAT.

Narrator: DR. MICHOS' PATIENT IS SO SWOLLEN

THAT INSERTING THE CHEST TUBE THAT WILL SAVE HIS LIFE

IS NEARLY IMPOSSIBLE.

Dr. Michos: I'M LITERALLY CUTTING THROUGH FLESH

TO TRY TO GET DOWN TO THE RIB AND INSERT THE TUBE.

AND I KNOW, IF I CAN'T REACH THAT CHEST CAVITY,

THIS GUY'S GONNA CRASH.

THOMAS, I'M GONNA PUT THE CHEST TUBE IN.

THIS WILL HELP YOUR BREATHING,

AND THE SWELLING WILL GET BETTER.

AAH!

I HEARD THE WHOOSH!

FINALLY,

I HEAR THAT TELLTALE WHOOSH THAT THE AIR HAS BEEN RELEASED.

HOOK HIM UP TO THE PLEUR-EVAC.

I SWEATED SO MUCH DURING THIS PROCEDURE

THAT I THINK I LOST ANOTHER 5 POUNDS RIGHT THERE.

AH!

IS THE PLEUR-EVAC WORKING?

YES, IT IS.

GOOD, GOOD.

THOMAS, HOW ARE YOU HOLDING UP?

BETTER.

OKAY.

NOW THAT HE WAS NO LONGER FEARING HIS WIFE'S WRATH,

NOW HE WAS FEELING THE APPROPRIATE AMOUNT OF PAIN.

IT MADE SENSE THAT HIS CHEST HURT.

I GOT A CALL FROM THE RADIOLOGIST

THAT HE HAD SO MANY RIB FRACTURES,

HE COULDN'T EVEN COUNT 'EM ALL.

IS HE GONNA BE OKAY?

WE'VE PUT THE CHEST TUBE IN.

THIS WILL KEEP HIS LUNG EXPANDED WHILE IT HEALS.

IT'LL TAKE A WHILE FOR THE SWELLING TO GO DOWN

AND HIS BROKEN RIBS TO HEAL,

BUT HE SHOULD PULL THROUGH JUST FINE.

HE HAD A LIFE-THREATENING PNEUMOTHORAX ON THE RIGHT SIDE.

SO WE GOT IT RIGHT.

SO THIS MEANS THAT THE RESTAURANT'S GONNA

BE ON HOLD FOR A WHILE, OKAY?

I GET IT.

GOOD TO HEAR.

OUR CAPACITY TO DENY PAIN IS PRETTY AMAZING.

THIS PATIENT WAS SO CONSUMED WITH ALL THIS ANXIETY,

HE WAS MISSING THE CUES HIS BODY WAS GIVING HIM.

THIS PATIENT WAS SO MEMORABLE

THAT WE KEPT TABS ON HIM FOR A COUPLE OF DAYS

WHILE HE WAS IN THE HOSPITAL.

DID YOU CALL UPSTAIRS?

MM-HMM.

HOW'S HE DOING?

OH, HE'S WORKING LIKE A DOG.

TALKING TO THE OFFICE AGAIN?

NOT EXACTLY.

APPARENTLY, HE'S BEEN WORKING ON SOMETHING ELSE.

HMM.

ARE YOU GONNA GO SEE FOR YOURSELF?

YEP.

GET SOMETHING TO EAT.

I WILL SOON.

I WENT TO SEE HOW MY PATIENT WAS DOING.

[ INDISTINCT TALKING ]

WOW.

WHAT'S ALL THIS?

THIS IS OUR ANNIVERSARY DINNER.

I TOLD YOU, NOTHING'S GONNA STAND IN THE WAY OF, WELL,

US CELEBRATING OUR MARRIAGE.

GLAD TO SEE YOU'RE DOING WELL.

BUT, UH, I DON'T WANT TO INTERRUPT.

WHEN WAS THE LAST TIME YOU ATE?

NOT SURE.

BUT DON'T WORRY ABOUT ME. I'LL BE FINE.

YOU'VE GOT TO LEARN TO LISTEN TO YOUR BODY, DOC.

I LEARNED THAT.

AT LEAST HAVE A COOKIE.

OKAY. THANKS.

THANK YOU.

Woman: THANK YOU, DOC.

TAKE CARE.

HAPPY ANNIVERSARY, SWEETIE.

HAPPY ANNIVERSARY.

"DON'T PUT OFF TILL TOMORROW WHAT YOU CAN DO TODAY."

I GUESS I'D BETTER GO GET LUNCH.

The Description of Beyond Recognition