We’re using our medical background to focus on the strange, baffling, and downright unsettling world of medical mysteries. We’re gonna dig into unusual cases, diagnostic puzzles, unexplained symptoms, and medical misadventures.
Our first three seasons covered a little bit of everything, including crime, conspiracy, mystery, and the occasional rabbit hole we probably shouldn’t have gone down.
Those episodes aren’t going anywhere, so the archives remain open for anyone who likes their mysteries, a little more broad spectrum.
But from season four on, the prescription is different. More medicine, more mysteries, more questions. So grab a drink, hit the follow, and tune in every Tuesday for a new episode.
How’s the weather? Happy fall, y’all. It is fall weather. We got a couple new Patreon subscribers. Thank you. Thank you to Blake and Caitlin. If you guys want a shout out on the pod, if you want more three schemes of Queen’s Chaos, if you want some bonus episodes, Colleen’s gonna make her solo episodes a regular thing. Yeah. And if you like today’s episodes, we’re gonna do some similar episodes that are bonus on the Patreon. So go check out our Patreon and follow us there. And otherwise, keep following us on Instagram and keep supporting the pod. Thank you. Hit us up with those five-star reviews and uh share in the episodes. Live, laugh, love. Um we have been looking forward to this episode, Megan. Yeah, when we did the rebrand, Kate specifically told me which week we should launch this new segment called Consult Queens. And despite the fact that she picked this week as our first week, for the last five weeks, she’s been asking me when is consult queens? When is consult queens? Well, I’m just so excited about it. And also, in my defense, I don’t know what day it is. Yeah, yeah. I had no idea it was the third week of October. Um, before we get into this fun new episode, though, is it time for our Drink Drink Chat? We have a sponsored drink deck today. Oh, sponsored by our gal, Hannah. Hannah. Thanks, Han. Thanks. Any day now, Hannah’s gonna pop and have her baby girl. Yep. And so we’ve got something to pop. We’ve got some little champagne, little prosecco. We’re popping champagne. Wishes. Heavy uh drink. We’re mixing our prosecco with some homemade apple cider. It’s delicious. It’s my favorite fall drink. And this was a Kate request. Uh, because remember, we did the bourbon and apple cider several weeks ago, but it still feels very fall now. It’s October. We’re approaching Halloween. So we’re doing some uh apple cider and sparkling, which is probably the only way Kate would choose to drink some sparkling. Well, yeah, the sparkling, it’s not that I it’s never that I don’t like it in the moment. It’s that immediately it gives me a headache. Oh yeah, yeah. It’s so yummy though. And we’re so excited for baby girl, Hannah. Congratulations, Hannah. Hope you binge our episodes while you’re resting with little baby and paternity leave. We don’t know. We don’t know the name yet. I’m voting for Colleen. Well, all right. Cheers. And let’s get into it. Welcome to Consult Queens, our brand new monthly series where we put Hollywood medicine under the microscope. For our inaugural consult, we’re scrubbing in with everyone’s favorite sarcastic, like it and popping diagnostician, Dr. Gregory House. My favorite. He could get it. We’re breaking down the Emmy winning episode three stories, which is season one, episode 21, where three patients present with leg pain, but their cases take some widely different turns. And if you are interested in watching this episode, it is available at the time of this recording, because you know these streaming services always bop around.
Yeah.
But as of this recording, you can stream season one, episode 21 of House MD on Hulu and Disney. And Prime. And Prime. That’s where I watched mine on Prime. Okay. Well, House MD, in case you weren’t obsessed like we were. Back in the day of House and Gray’s Anatomy were on at the same time. House was on Thursdays at 9 p.m. And so we’re so was Grey’s Anatomy. And I always watched House. I have not watched one single episode of Grey’s Anatomy ever. I have never watched House live. Like when I started watching it, it was already off the air. Yeah. Oh, I used to watch it over my there was these boys that I hung out with, and they all liked House, and I liked House, so we would like watch it together on Thursdays at 9 p.m. We were watching Gray’s Anatomy in college on Thursdays. Uh a lot of the girls I knew did that too. I mean they would they would like get together and I was like, I don’t understand the point of the show. The first, I mean like to season like six or so, six or eight, and then I watched Carrie still watches, but Carrie’s also watched every episode of ER. We’re gonna cover a Gray’s Anatomy episode and an ER episode at some point in this segment. Fact that you’ve never watched Gray’s Anatomy, Kate, I think is gonna make for a good consult cleans. Yeah, I watched Gray’s Anatomy up until like COVID season, and then I had to stop. I yeah, I stopped well before that, but I will say that that I turned it on one time during COVID and I was like, we’re living this, and who wants to watch a bunch of doctors fight COVID? Okay, so House MD, in case you were not like Kate watching all the time, it follows Dr. Gregory House, a brilliant but unconventional diagnostic specialist who leads a team at the fictional teaching hospital, Princeton, Plainsborough, and specializes in solving baffling medical cases. He is known for his abrasive personality, unconventional methods, and his willingness to challenge medical assumptions. He often pursues rare diagnoses that other doctors overlook, and alongside the medical mysteries, the series explores his complicated relationships with his colleagues, struggles with chronic pain and addiction, and the personal costs of his relentless pursuit of the truth. Yeah. I think you and I both like being right, but I think House likes being right even more than you and I. Oh, yeah. Sure. Yeah. Yeah. And the thing that House always says is everybody lies. Mm-hmm. I said something to Katie the day. I go, I feel like a lot of people in our social circle are like a little delayed in like recognizing toxic people. And I’m like, am I just a student? And she goes, No, Megan, you just start every interaction with I don’t trust you, and yeah, you’re and you’re not a good person. And then they have to prove themselves otherwise, which I think is not a good way to think. Skeptical. But guilty. But I think House is like that too. But yeah, but he doesn’t come around quite as easily as I do. And speaking of people that start every interaction skeptically, you know the person who gave us our drink channel, Hannah? Oh yeah, the opposite. Yeah. Hannah likes everyone immediately. Yes. To a fault. And I tell her that to her face. I love you, Hannah but girl. So the episode starts. The episode starts, Cuddy is like, you have to do clinic duty. And he’s like, no. And she’s like, you have to do clinic duty and teach this class. And he’s like, I don’t want to do clinic duty. I’ll teach the class. And she’s like, no, you have to do both. And he’s like, ugh. On his way to the lecture, he runs into Stacy Warner, his former girlfriend, whom he hasn’t seen in five years. Stacy is now married to a man named Mark, and she asks House to evaluate him because he’s been having unexplained symptoms. House initially refuses, partly because of his complicated history with Stacy. Uh. But I gotta say, already I’m thinking this hospital looks cleaner and nicer than any hospital I have ever seen. And the jackets are starched white. Yeah, and I also thought, yeah, and I also thought every time I watched the show, I was like, is this really what Princeton Hospital looks like? Like the campus. And then I never Googled it, but I was like, wow, this is a really it’s fictional. This isn’t Princeton. It’s Princeton Plainsborough. Oh, excuse me. Apologies. Yeah. Oh. Yeah. You know who used to work at Princeton? Who is Dr. Andrew? Oh, and his wife, Rachel. So anyway, that was my first. I’m like, look at how clean and bright and sterile this hospital is. And look at these starched white coats. Which feels very like 1990, I feel like. Yeah, people were very into their white coats. Nowadays we don’t I yeah, I would say there are still people who wear white coats, but I think it’s not as common. And the people who do wear white coats are generally not super starched to where they can like stand on their own.
Yeah. But I also think that like we have to give them credit.
Like it is a very big deal to get your white coat in medical school. And even like for NP school, it was a big deal to get our white coat. And it does like it is like you are a provider. There’s a ceremony. Yeah. Yes. Um, so I I appreciate that like they’re you know, it’s I think it helps distinguish characters because this this character wearing a white coat is a doctor or a provider, but not house. House isn’t wearing a white coat, right? House never wears his white coat. So House arrives at the lecture, and let me tell you, we have some star-studded med students. Doesn’t he? We do. I don’t know if Colleen could appreciate this. Yeah, I don’t think I I recognize one of them, like the handsome kid. Yeah, he’s a lot. But what else is he in? Ten Things I Hate About You. He was like the douchebag. He was a big 90s star. Yeah. Okay. He’s like a he was like a the heartthrob of our one of the heartthrobs of our era. And then Josh Zuckerman, who I had to look up, he’s from School Spirits. Does anyone watch School Spirits? That’s a newer one. Okay. One of the girls from Bring It On. Oh, I love Bring It On. There was like the um Which one? The OG Bring It On. First one. Yes. Who was like at the uh Oh, I know at the audition. Yeah. Yep. House begins talking to the students about the diagnostic dilemma of leg pain. And then we get another cameo by Carmen Electra, another 90s. Yeah, but it made me laugh because he’s like, okay, three three people walk in with leg pain. What’s the first thing you do? And they all start like raising their hands and they’re like talking about scans and they’re talking about like, you know, laugh, whatever. And he’s like, I don’t know, maybe we should look at the leg. Yeah, look at the leg. Yeah. And I I did, I like took note to that. I was like, yeah, that’s true. Like, but that’s like something that you do, like it’s what you have to learn in restarting. We harp so much on that with new Yeah, like you lift up the blanket and look at the patient. Right. Look at your patient. Yeah. It’s very easy to sit here, like, the symptoms and everything and get in your head, but like use your yeah, use your physical assessment to help guide your diet. Yeah. And your diagnosis, and along with the the diagnostics that you are going to order. Yeah. Yeah. Because a lot of things can happen with leg pain. It could be like, if okay, is this like purple? Because then that’s gonna change my whole indifferential. Don’t just hear leg pain and be like, consult the orta without actually looking at it. Because maybe you need to consult wound care, you know. And for the love of God, don’t consult, don’t consult me for intact cellulitis. Don’t consult vascular surgery for an interventional radiology thing. So the first case is a middle-aged farmer who developed severe pain in his leg while working outside and fixing a fence. House asks about the pain location, but did not finish the rest of his old carts. I noted. No. No. He did not ask about how long is this pain started? When did it start? Did you do anything for it? Makes it better. Worse. What makes it better? Yeah. The students want a D-dimer and CBC. So obviously they’re thinking blood clot. Blood clot. Blood clot. Okay. Get don’t get Megan on her soap butt about D dimers. It’s non-specific people, to be clear. But then he jumps to MRI versus pet. First of all, MRI and PET would not be first line workup for this, but those are not also not probably happening stat. So you know, pet’s gonna be like they need that outpatient. They need to not eat, they need to CT scan. They could scan his leg. Yeah, but they didn’t, I don’t think they mentioned CT scan. They could have even done an ultrasound. It just felt very aggressive to me that we are jumping to MRI or PET scan. Yeah, well, MRI is not happening. Because we’re gonna start with an ultrasound. Yeah. Right? We’re gonna start with an X-ray. But really the answer was look at the leg. Yes. Then they note a puncture wound and decide it was likely a snake bite. They were in tall grass and he felt a sudden shooting pain. So how sunsforeman and chase to investigate the farm? Because of course there’s a team of doctors who just go to people’s houses. That’s so unrealistic. Yeah, yeah. It’s very unrealistic. It is more like tell me about the environment that you in, and then you were in, and then let’s pontificate on the things that we think could happen. Also, you’re not going on site. Also, they’re looking for a snake, and I’m like, this they could just like run a lab test to see if the venom is in the system. Like, we don’t need to go do this whole like environmental. Yeah. Also, they’re at risk for getting snake bites. Like this caught wouldn’t cover them from going on site. No, but also like, are they gonna find what are the chances they’re gonna find that snake there? Yeah. Snake is not gonna be there. That’s crazy. Also, as though any medical provider has just two hours to kill, right, to leave the hospital and go search someone’s grass. I do, I I do question like what is House’s actual job. Epidemiology. No, it says he’s a diagnostician. Yeah. Which I’m like, what does that even mean? Epidemiologist. I don’t think that’s an actual job in hospitals, like a diagnostic-specific provider. No. Yeah, like no. He’s it’s definitely a made up position. Yeah, yeah. In the meantime, he talks, starts talking about the second case, which is a 16-year-old teenage girl who collapses during volleyball practice and complains of lect pain. Cameron takes an extremely thorough history and begins investigating all sorts of possibilities going back generations. And I thought Cameron’s saying, I went back three generations and this boy at the school is on the boys’ volleyball team and he kissed her at a party and now he won’t call her back. I actually thought was very real because we do like all the tea. We do. But also, but him being like, Why would you get all this information is like fair? No, like that is good information to gather. How is this critique for Cameron? Was why are you getting asking about these things? You’re you’re being you’re hyper-focusing. Yeah. Well, that’s because of critique. Well, that’s because part of Cameron’s character is she gets too involved. Yeah, she gets to yeah, she’s way too empathetic for him. But the point is that we do like the T. Yeah. She finds a thyroid nodule and they think depression, thyroid. I was like, I wrote also it’s always the thyroid. That’s also what I tell students all the time is like, what in doubt? It’s probably the check a TFD, right? Then there was a side story of an incidental incidentaloma where you find something, you look too hard, you find something that’s unrelated, you work it up. The complications of that workup, you know, cause more complications. And that’s why we don’t just, even though people are into this now full body MRI and stuff, that’s why we don’t just routinely scan people. And this is another soapbox I always have. And so when he starts talking about it, I was like, House, we are on the same wavelength. I you know somebody who did a full body scan and they found uh liver cancer. Okay, the studies they’ve done though about lives saved versus lives lost for unnecessary workup, there’s more lives lost. Okay. So while you might an individuals might have stories about something being discovered, it’s more likely that you’re gonna get like more problems. Yeah. Anyway, so the girl, the the young girl is there. She’s depression must be your thyroid. So you know what? We need to do a thyroid biopsy. And I thought, this is silly. No one is just jumping to thyroid biopsy. Well, yeah. And when they were doing that, I was like, but what about her leg? Well, she the thyroid doesn’t explain the leg. Well, they’re saying she’s depressed. Yeah. So her legs are her. It’s the co-manifestation of her mental illness. Yeah. And then House goes in and does the biopsy himself, which felt kind of this patient does a lot of things where like he’ll like be like, give me he goes into the car, and he’s like, Give me the scalpel.
Like, yeah, he does a lot of these like crazy things that are not happening in IRL.
Interventional radiology, please. Yeah, that’s where this patient would go. And I also think And it would take like days. It’d be like, that’s not urgent, so we’ll get to it when we can get to it. And then I again, why don’t we just check some thyroid function? Why did we just like jump to a TSA to why did we just chalk this? Okay. Thyroid biopsy reveals a low T4. So I wrote, okay, I roll, she gets synthroid. And then House introduces a third case, which we know at the end, the big reveal is that this is supposed to be House. He introduces the case by showing the class a woman who appears to be carmonelectric complaining about severe leg pain after playing miniature golf. But again, the actual patient is a middle-aged man experiencing excruciating leg pain. Andrew Keegan prescribes 50 milligrams of Demerol. I wrote, okay. Well, yeah, demerol is like a really old school pain medication. We literally only use Demerol for Rigers, and even that is not actually like recommendation. Demerol is a very old drug, but Demerol would not be my first pain pain. They use it a lot in labor, right? Demerol. The patient is yelling while doctors are trying to figure out an allergy history, which I wrote accurate. I wrote that too. That’s so funny. I was like, that is so accurate. People yelling, and then he’s just like, give me the pain medication. And then he like took the needle and like stabbed his own leg. Oh my god. I was like, that’s accurate. ER. I’m sure people have done that. Doctors initially dismiss him as a potential drug seeker because of the way he’s behaving and because his pain seems disproportionate to what they can immediately see. And then I wrote back to the golfer, house is straight, cathing him to assess for protein in his urine. Seems unnecessary. He could have just gotten a clean catch. Like, A, why is house there’s a reason he says he does it at first as like a um Oh, he says if he’s willing to tolerate this, then he must really be in pain. Right. Yes. Which is it’s like a test. Not real. I don’t think that this whole let’s give him a cath to see if he actually is in pain is nonsense. Secondly, the doctor is not doing a straight cath. And frankly, I don’t like I get called when when the nurse can’t get a catheter in, and the next step is urology. I just feel that I have to try, but it’s really just this it’s very performative when I do it. Okay, because I’m like, I’m sorry, if this nurse who does this every day can’t get it, I’m not about to get it, but I like to be able to tell urology that you try to I tried. Yeah. So my point is though that house is not put in anyone’s catheter in. That’s absurd. No, that is absurd. And I don’t think you really need to straight cathetician to find out if there’s protein in their urine because you can just have them pissing a cup for you. Yeah. Back to the case of the farmer. They find a timber rattlesnake, which seems to confirm the diagnosis. The farmer is treated with anti-venom, but then has a severe allergic reaction to it. This was the worst example of strider I have ever seen. Oh my gosh, I said allergic reaction. This is so inaccurate. He starts, he’s like, he’s like, and they’re like, you have strider, you have anaphylaxis. I don’t think I realized that that man was supposed to have strider. That’s how bad it was. It was such a bad allergic reaction. Yeah. He, first of all, if you are striderous and your airway is that edematist, you can’t bag a person. Second of all, I looked at the blood pressure. It was way too high to be that intense of an allergic reaction. No phasodilation was happening. Zero. It was like 150s. And then they get the paddles on. I’m like, I said, paddles? Question mark? Ma’am. He had a heart rate and was not in a shockable rhythm. Take the shirt off, head of bed flat, and where’s the Benadryl? I’m pretty sure though that all these TV shows do when they put these patients into asystole is unhook the monitor. Because to be clear, a unhooked monitor does not look the same as a true asystole flat line on the lead. So I’m pretty sure anyway, I was I was um poo-pooing the way they gave the anti-venom. It wasn’t appropriately diluted as it should have been. Um she’s like carrying around a 10-militer syringe, but regardless, she gets the BVM and starts ventilating. Is she even hooked up to O2? I wrote. I couldn’t tell, but definitely poor ventilation form. She wasn’t doing the he was sitting up, he had a poor seal. She didn’t have the good C, right? She’s giving very rapid, shallow breaths, and she calls for Epi’s and paddlestat. Patient has a heart rate of 120. So why are we calling for Epi and Paddle stat? Or why are we calling for paddles stat? Okay, Epi’s gonna treat the alleged. Oh, I really literally wrote this. I wrote heart rate of 120, blood pressure 146 over 72, and SAT is 90%.
That’s crazy.
Uh I said interesting monitor drops to 94 for 48, heart rate down to 80, and she yells paddles. Uh anaphylaxis usually causes hypoxia, which causes PEA, which he didn’t have based on his A-line, but that’s not a shock-level rhythm. So we never really got to see what he had. Oh, I see, I always think I I guess when you have a PEA, it’s always your H’s and T’s. So I I was thinking anaphylaxis causes massive vasodilation, which would cause your PEA, like a hypotension. Okay. So I guess if we have either an obstructed airway from strider, yeah, causing causing an oxygen issue, right? Ischemia, yeah, decreased oxygenation. And it’s like the whole cascade. Yeah. Um V fibber, V VTAC would be the shockable rhythm, but we’ve never, we never saw anything on the monitor that what indicated we had a shockable or even unshockable ACLS rhythm. Yes. Right? Okay. She’s holding the paddles over the fully clothed patient who is gasping for air, and then the scene cuts. That’s what I said. He recovers his shirt off, head of bed flat. He recovers with some epi. Great. I mean, yeah, epi is the right move. But also, like, let’s do the whole cascade. The whole thing felt wrong. Yeah. He recovers for uh with some epi, great, but the snake pathology is back, and the snake has 200 cc’s of venom. The patient was bit four hours, and house knew how much venom that snake should have available. So they have to give him anti-venom for the other possible snake. Um, so again, please, someone brought a snake into this hospital. They actually checked the venom. House actually knew what the numbers should be. This is all ridiculous. Well, to be clear, his whole House’s whole for sure character is that he is like super smart, like a textbook.
So, like it I find it accurate and within his character that he would like that they know that. Okay.
Is it realistic for a I don’t want any patient thinking their doctor should know these things? And then the patient says, My wife’s on his way, can this wait? Again, so accurate. So accurate. It’s like, sir, you’re you just tried to die, apparently, allegedly. So for something to be necrotizing fasciitis, you don’t just look at it and be like, that’s necrotizing fasciitis. You have to do aggression, right? It’s about excruciating severe pain, and they do like a probe test. And so if it’s not completely like fluctuant all the way through, if they quite literally will poke it, and if it’s not completely rotten all the way through, it doesn’t technically classify as necrotizing fasciitis. And the timing of it spreading is also a huge part of necrotizing fasciis. Yeah, I thought the key, I mean, you are the expert, you are a skin expert. I thought you you mark it and then you watch how it they call it a rapidly progressive soft tissue infection, which is duh which does not necessarily mean it’s necrotizing fasciitis. I have had patients who’ve had legs present the same way and they never actually had necrotizing fasciitis. A lot of it is about the timing of it, how much tissue is dead after they they’ll do like essentially like a punch biopsy where they just kind of punch through and they have to see it reach a certain depth into the tissue and the timing of it spreading. So, based on how this patient presented and how they actually described it in the show, I would I don’t think you can we have enough to call it neck fashion, it could just be a severely rapidly spreading soft tissue infection. It doesn’t necessarily mean neck fashion and they never call it neck fash in the show. Okay. Colleen wants to be noted because we kept texting about neck fashion and Colleen was like, I just watched it for the third time, and this patient, they did not say neck fashion. But when you have severe infection, there’s severe inflammation in the skin, there’s severe edema, but and sometimes abscess formation, so a pocket of pus forming around the wound and around the portal of entry. So for him, the portal of entry is this quote, snake bite, which we find out it’s not a snake bite, but we’ll I won’t spoil that just yet. So you when you have severe sepsis, severe infections of the area, you get ischemic changes, so loss of blood flow. And so that’s when you start seeing the tissue loss. And I don’t think, in my opinion, they didn’t show us his wounds enough for me to be able to give a full opinion. Well, I mean, they really cut away from all the good stuff here, I gotta say. Yeah, that’s I wanted to see like really like the rotting leg. I don’t think it spread fast enough because what was the timing of the whole episode? It was more than a day. Uh I don’t know about that. That’s I think it was within a day.
Yeah, this is all like within hours.
Yeah. I don’t know. Okay. But I don’t think they showed us the leg enough to be able to call it anything. Like okay. So like he would have had black tissue forming up the whole leg. He would have had skin pulling off, he would have had like visible up the thigh and we didn’t see that. Maybe they implied that he had necrotizing fasciitis, but in our wound care experts’ opinion, it did not match real world. That’s what you’re saying. Yes. Okay. So now we jump back. House catheterizes the golfer and examines his urine. And I said an anesthetic for a foley, dead. Ridiculous. What kind of anesthesia? Did they do like a Eurojet or did they do like real anesthetic?
They did like a real anesthetic.
Oh, uh for the love. I know these men. Men that is ridiculous. Okay. I I understand the Eurojet, but like an anesthetic. Give me a break. Yeah. It’s I guess it was actually house. That’s so funny. Because house is the one who has the rat. That’s right. Right. It’s dark tea colored, suggesting blood and muscle breakdown products. So at this point, the differential moves towards muscle injury or necrosis. And Cameron recognizes this is not a jump. Okay. Usually when we see dark tea colored urine, you’re always thinking rhto. Rabdo. Coca-Cola urine. Rabdo. But Cameron recognized that dying muscle can release myoglobin, which can damage the kidneys. I’m yelling fluids at the TV screen. The volleyballer develops extreme sensitivity to touch, and the team’s thinking has to shift again. Cameron is drawing her own labs. Again, what physician wouldn’t be drying their own labs? Right. The calcium is greater than 16. So the concern is a parathyroid adeno, uh, vitamin D intoxication, hyperthyroidism, kidney problems. When you’re when your calcium is that high, it’s like always cancer. It’s like a bone cancer, typically. Or it’s like Yeah. Yeah, it’s a primary. Farmer, the farmer is dying and he’s worried about his dog. And that’s when House realizes this was a dog bite and he’s covering for the dog. And then apparently Chase and Foreman are swabbing the mouth of the dog. Yes. For um blood cult for cultures to culture the dog’s mouth. And I’m sitting here thinking how gross that mouth must be.
Well, gross, but also like we couldn’t culture this wound.
We couldn’t culture the blood of this man, but we’re culturing the mouth of the dog. I was thinking the same exact thing. Even if it was a snake bite, you would have swabbed it. Like it’s a wound regardless. It would have had a full blood culture, wound care. It would have had the full workup regardless. So, like, why didn’t why did they assume it was a snake bite? But also, we then we wouldn’t have gotten, you know, Foreman and Chase wrestling with the dog and panicked about getting bit and spending two hours, two more hours of the day away from the hospital at this home. It’s less dramatic. Correct. You know? Yeah. Annoying. The infection has progressed so severely that the farmer’s leg has to be amputated to save his life. This is so dramatic and dumb. Also, this man would be so septic. He’s looking a little too healthy to have a leg that needs to be cut off. You know what I mean? Yeah. I don’t know if they would have cut the leg off. Like I think they would have cut out as much tissue. I I want to know the extent of the wound because it they always push for limb salvage first. So if it wasn’t infected down to the bone, I think they would have just taken out as much of the infected tissue as possible and done serial debrisments and then caught and involved plastic surgery for a complex closure. Like I it wouldn’t, I don’t think it would have jumped to an amputation right away unless it was infected down to the bone in the real world. I love this. And you know what else would have been happening?
Ortho and vascular surgery would be arguing about whose job it was to take off the leg.
Yeah. Yeah. And podiatry, ortho and vascular. Yeah. Podiatry doesn’t do anything above the knee. Or and half the time they’re fighting you on the calf. They normally don’t like to do the calf, but then ankle down. Then that’s why they want vascular surgery to tell them the level of amputation. Yeah. It’s normally had zero imaging on their blood vessels or anything. Yeah. But they want a level of amputation. God. And I’m going back to why didn’t they ultrasound this? Or C T still? Like this is ridiculous. So then the golfer who’s having the hematuria and we’re thinking about rhto rhabdo, and their blood test shows elevated creatinine, uh, creatinine kinase, dying muscle leaks, myoglobin. So anyway, we’re on this. This looks like rhabdo. So the patient gets an MRI of the leg. Right. So what not quite sure why, like, are we looking at the tissues, but I also think like we need we need a CTA with rhinoff, you know? First. Yeah. Yeah. Yeah. Can I the there is one thing that I would think of that that an MRI would tell you that the other things wouldn’t is that if it’s infected in the bone or not. MRI is the only way to usually jump. You can you would have done an ultrasound, you would have done a CT scan, you would have done a tremendous amount of other scanning. But if they’re concerned for amputation, they needed an MRI. Yes, but I but that wouldn’t have been fair. I feel like the MRI usually happens when it’s like they don’t have you if you can make the diagnosis diagnosis of the CT, then you’re then you make the diagnosis of the CT, right? Okay. The volleyballer also gets an MRI and it’s osteosarcoma. The doctors are concerned that the tumor may require amputation, however, they’re ultimately able to remove the tumor without amputating the leg and the girl recovers. Um, and again, we find out it was osteosarcoma. Can I ask a follow-up question? Why did they end up MRIing the young girl’s leg? Well, what pushed them for the leg MRI, the calcium levels? Oh, because they had yes, they had the LVD calcium, so they thought it must be cancer. Okay. Got leg pains, they scanned her leg. We go back to Carmen Electra slash house, the golf player, and we discovered that the actual problem was a clotted aneurysm in house’s leg, which had cut off blood flow and caused infarction of the thigh muscle. And again, did we not do did we not do a pulse check? Yeah. I have a lot of questions about all of this because why did we not first of all have we yes, have we not looked at have we not looked at the leg? If there was no flow, this leg would be black, it would be purple, it would be mottled, we would be seeing it with our own eyes. And you know what? Maybe if House had a good nurse who said, you know what, maybe my doctors aren’t looking at this, but I’m gonna do a full physical assessment on this patient and then raise a question to my provider. Hey, FYI, I can’t get uh DPs and PTs or a poppeteal pulse. Maybe we should talk about that. Also, you know he’s unable to move his leg at now at this point. Yeah, you know what that means?
Critical limb ischemia.
Yeah, he has critic limb ischemia, and I think he is pushing towards that irreversible phase. Yeah. And it’s really too bad that someone didn’t just can check a pulse. Just look at the leg. Yeah. Of all the things. And again, and again, MRI being your first line, your first study feels again. I don’t people MRI takes like over an hour to get done, and it’s there’s always a long line, and it never happens stat unless you’re like having a stroke. Right. So the fact that these patients are all just like getting labs and then MRI is driving me crazy. Yes, I agree. They want an amputation, he wants a bypass, they go in and do a thrombectomy and he wakes up in pain. Uh, the fact that they would withhold pain meds from him, I think is absurd. Even if you are an addict, we still have to treat your pain. So I think this is so inaccurate about how it how it happens. I wrote, why is he yellow? Is he in liver failure? Oh, he had a I think it’s like the I think the that the monitor was like low, it wasn’t up, and that was confusing me. It was like next to his head, and I was like, What? Why is this not wall-mounted? Yeah. Never never been an ICU where it’s next to your head. Right. It’s like it was like on the bedside table. Yeah. It was weird. I did I wrote vascular revascularization pain is real. Yeah. Because he was in a lot of pain. Like reperfusion. Well, and he his A-line splint was on backwards. I wrote. He prints his own telemetry strip at the bedside and his QR is is widening. And he tells a nurse to get him calcium gluconate. I said, Well, calcium gluconate would have staved off a cardiac arrest, but let’s get this man some Lasix insulin D50. You know what I mean? Let’s get him something that’s going to bring bring his cade on pretty quick. Calcium is going to be a cardiac stabilizer, but it’s not going to treat your hyperkalemia. Do we know its house now at this point in the episode? Okay. This is sort of the reveal, I think. Yeah. Because we’re because he’s they want to take his leg and his he doesn’t want him to take it. Well, and he’s also like, you’ve mismanaged me. Like you should have discovered this. When you do have tissue death, you do have a risk of high K. So I’ll give I’ll give the uh the TV producers this. They did some research about it. Yeah. This would be something that you would be worried about in a patient. Mm-hmm. Uh the telemetry is reading SVT. I wrote, don’t not usually a normal finding for hypercholemia. Where are those peaked T waves? It’s calcium for cardic stability, but how about some insulin glucose bicarb? He says, I’m going to go into a wide complex tachycardia. He’s not wrong. They won’t give him anything because they think he’s a this is all the same stuff. Okay. I wrote wide complex tachycardia shocked, accurate, not an accurate asympty appearance. Again, I’m pretty sure on all these TV shows, they think if you just unplug the monitor and have a f have a perfectly flat line that that is asystole. And that’s not what it really looks like. He sees the osteo girl with her leg playing volleyball and the farmer with the prosthetic and a new dog. Cutty is listening to his heart and says, He’s back. I was like, how about a good old-fashioned pulse check? Yeah. No one in a code is like, let me just put the studscopat and listen, right? We’re checking a pulse. Maybe you got a Doppler at the groin or something. The only reason you’re listening is to pronounce someone does. Yes. Then he says, put me in coma for pain. I said, I said, that’s crazy. I said, chemically induced coma for pain.
Exclamation point, exclamation point, exclamation point.
Like that’s crazy. My thought process was why couldn’t they have given him a nerve? I know that. How about a nerve block? Yeah. I will say getting nerve blocks are really difficult because anesthesia only wants to do it for certain patient populations. It’s like we’ve had so many patients with like chronic leg pain, that leg pain from chronic wounds, and like they can’t tolerate a dressing change in patient. And like when I ask for a nerve block, they look at me like I’m crazy. They’ll only do it for like orthopatients. So it’s not a common thing to get. But I’d seem safer than we’re going to put this patient into a coma. But he’s not intubated, right? No, no, he’s just got the nasal cannula on and he just drifts off to sleep. Yeah. And then the plan is to anesthetize him and then go against his wishes. Also, please. He’s he’s anesthetized, and there’s like nobody at the bedside. Like there’s no nurse, primary nurse just sitting there. Like you have a constantly sedated patient who’s not intubated and you don’t have anybody like round the clock monitoring him. Is crazy. How about some CO2 monitoring it? One of my biggest complaints with house is that you don’t there’s not I know the whole point is house with his diagnosing, but you don’t see like the nurses in the hospital very much. Well, that’s almost every show. Well, yes, I agree. But it’s like particularly at least in Grays, you see the nurse every once in a while. It’s crazy to me. Well, usually you see the nurse in Grays when she’s like in a closet with a doctor, but yeah. Well the thing is is that House agrees to be put into the coma because he wants his pain control, he wants his pain. Yes, he wants to sleep through the pain and and he knows it’s only going to be a certain amount of time for this, like, you know, reperfusion pain. Yes. So he agrees, but the girlfriend who is the girlfriend from the beginning of the show is has an ulterior motive. Yeah. And the ulterior motive is or he when he gets his coma and basically is not able to make decisions for himself. I am the POA and I can make the decisions. And she wants to, what does she want to do? She wants them to do the middle ground, I think. Yeah. Which is, I think, remove a bunch of the muscle. Yeah. I would say Cuddy being like, okay. Yeah, that’s a major. Let me just explain the healthcare private attorney to people. Okay. It’s not really the legal document that people believe it is. Okay. How if I have someone with a healthcare private attorney, the your point is to is to speak on behalf of the patient, what would the patient want? And if there’s theories that what you were that what you were telling me is in direct violation of what the patient would want, uh, then I’m calling in ethics. Yeah. You know? Yeah, there would be a whole meeting about it. Yeah. You we can’t just proceed forward with what this POA says she wants to do without somebody checking the POA. Yeah. Yeah. Checks and balances. Yeah. So I think this is, and I think the fact that Cuddy has had her friend tell him what he wants and then has had the girlfriend say, We’re gonna nepheze him, and then I’m gonna sign your consent. That it’s crazy that Cuddy would say, This is a great plan. Let’s do this. It’s just yeah, ethics immediately. It’s that feels so illegal. Uh-huh. And like, no wonder when House wakes up, he’s pissed off. Yeah. And then it cuts to the very end of the show in current time where House has finished the class. He’s diagnosed the previous professor with uh lead poisoning, I believe. He diagnosed lead poisoning because the professor that he was substituting for left his coffee cup in the lecture hall and House had been sipping from it. And like earlier in the episode, you see him sip and make a face, and then now is the reveal that he made a face because it tasted like lead. Which I’m like, what does the way I want to lick lead paint? What does lead taste like? That made me think, what does lead taste like? How do you know? In the end, current time though, House calls his ex, he offers to help her husband, and that’s the end. I think we’ve kind of dissected a lot of things that wouldn’t wouldn’t really happen. What do we think about what the writers got right? I mean, I think I’d the wide complex tachycardia that they shocked isn’t appropriate, right? If we if we’re calling that V-TAC, right? I think calcium gluke, like we said, is a treatment for hyperkalemia. And it’s right. He he’s not wrong, like it will stave off, it will stabilize the heart, like so that the patient won’t go into cardiac arrest. But I think we need it a little bit more there. And I think someone as smart as house would know that. Yeah. The anti-venom dosing was correct. I just didn’t like when I looked it up, it was not diluted appropriately. Um, it was like given in a 10cc syringe and it should have been diluted in a bag and yeah, given a little slower. But they would immediately for this girl she came in with leg pain. We would have immediately just be doing labs, right?
We would have done a CBC, a BMP, or even a CMP, and on the on the complete metabolic panel, immediately we would have seen the high calcium. The high calcium.
So I think we could have stopped like you know, skipped this whole thyroid business that we went down to get to the high calcium, which helped immediately, you know, like if patient again, if patient has a high calcium, like cancers on on the on the differential. But I do still want to give House credit the it the accuracy of the incidental and how that is such a hot button for me. And I was like, this was a this was a his description of it was perfect. I also just think it’s crazy to be like you have depression. That was the problem. Your leg hurts because of depression. Like you didn’t actually rule out, you have to rule out physical before you can start like concluding with mental.
But in that same thread, women do have a lot of things that are pushed off as yeah, present differently, but also are pushed off as like you’re crazy, this is an emotional response.
So like the men’s leg pain was real, but the woman’s leg pain was just depression because a woman broke up with a men’s was right. The other man was just drug seeking. So two out of three of them didn’t have a real physical reason. No, it was they called House a drug seeker because he shot himself with a demo on the leg and he was like better. And they were like, He’s a drug seeker. Oh, at first until the foley with the rhabdo, yeah. Right, yeah, yeah. And they accused her of they thought she was depressed from her thyroid. Oh, yeah. And the only person they believed was a snake who was lying. So yeah, everybody lies. Yep. Okay, so in overall, I think we should rank this how medically ac how do we want to rank it accuracy-wise? I feel like first code with the anaphylactic shock is bad. Second code, better. Okay, okay. So that’s one for the negative, one for the positive. That’s a zero. Uh looking at the leg, that’s a positive, right? In the beginning, like all these med students. I think that’s I think that is actually medically accurate for an institution because med students want to immediately jump to diagnostics instead of using their eyes to visit. So I’ll say that’s a point. And it was a diagnostics course. Yeah. Which again, you always I had I’ve taught a diagnostics course, and you were just like beating into them, like, you’re right, but you’re on step three. Let’s rewind to step one. Yeah. So that’s a that’s a positive. Um, I would say medically accurate. I say more than a five. I say so. We’re gonna do this on a scale to ten. I’d say more than five. I would say maybe a six. I give it a six. I was gonna say maybe it’s between a six and a six point five. Yeah. I think six. Yeah. I would give them six. Okay. They did some research, and they weren’t wrong with what they did. It’s just the order of things and the prioritization of things was really wrong. And I mean, I’m sure, you know, it’s TV, they gotta, they gotta make it more dramatic. I would say as house always has with like, you know, Foreman and Chase in that in the homes investigating, inaccurate. I would say, yes. Uh no, people not getting labs and all getting MRIs, inaccurate. Yes. Yeah. So I think maybe a six. I would say six. I also think it like again, we know this man has an active infection, but I don’t think they started actually treating him with antibiotics until like they were like, you have a flesh-eating bacteria. Like gosh, his leg died. They didn’t freaking treat the infection. It’s like, what is that’s I guess that’s like if the bay if the patient comes in with a puncture wound that looks clearly infected, you are immediately gonna start the patient on broad spectrum. Also you’re gonna get cultures and then you’re gonna start them on antibiotics. Well, you’ll get cultures, but you’ll broad spectrum antibiotic them first. And then once the cultures come back, you are I mean, also the patient was dying, was on the verge of death before they figured out this was a dog. And yeah, I’m with you that no one dies without antibiotics, okay? So, like, even though we’re trying to be really conscientious about our use of antibiotics, when you have a patient that critically ill, it’s always like throw, yeah, throw some big guns at them because they’re gonna die anyway. And we can continue to try to work this up and always stop them if we realize that it was something else. Right. But yeah, to be there and be like, you’re you’re gonna die. And it’s not until we found out that maybe this was a bacteria that suddenly we turned things around. Right. It’s crazy. Yes. Sounds good. Um we’ll be back in four weeks with another one of these for a different episode. Yeah. Let us know what you think. Let us know if you have any suggestions. Uh, that was fun. I love a consult queens episode. It’s gonna be my favorite. I think it’s gonna be my favorite thing that we do moving forward. We’ve had requests for this. Kate was like, this is what we should do. And then I had other people text me and say, you guys should really do a breakdown of medical shows. Yeah. So I’m excited about it. And um we’re gonna see you next week for a little Halloween special. We’re gonna dive deep into the Salem Witch trials. That’s right. Which is a common um well, there’s a lot that went wrong with that, with the Salem Witch trials, but we want to know what was the pure cause. Were they witches? Were they psychotic? Was it the bread? Was it the bread? Yeah. Anything else to say or should we just see them next Tuesday? See you next Tuesday, guys. We’ll see you next Tuesday. See ya next Tuesday.