A day in the life of a public hospital's ER waiting room captures what…
In his vivid and thought-provoking filmmaking debut, physician Ryan McGarry gives us unprecedented access to America's busiest Emergency Department. Amidst real life-and-death situations, McGarry follows a dedicated team of charismatic, young doctors-in-training as they wrestle openly with both their ideals and with the realities of saving lives in a complex and overburdened system. Their training ground and source of inspiration is 'C-Booth,' Los Angeles County Hospital's legendary trauma bay, the birthplace of Emergency Medicine, where 'more people have died and more people have been saved than in any other square footage in the United States.'
CODE BLACK offers a tense, doctor's-eye view, right into the heart of the healthcare debate - bringing us face to face with America's only 24/7 safety net.
'Code Black chronicles the challenges of providing care in one of the nation's busiest emergency departments. It deftly captures the adrenaline of resuscitating critically ill patients and explores the role of the emergency department as the healthcare safety net.' Dr. Benjamin Sun, Associate Professor of Emergency Medicine, Oregon Health and Science University
'Electrifying is one way of describing Code Black, a remarkably candid and kinetic documentary about emergency medicine that could probably only have been made by an ER doctor.' John Anderson, Wall Street Journal
'A remarkably intimate portrait of a small group of young doctors swimming upstream against a nearly overwhelming tide of challenges. Viewers are treated to unfiltered glimpses of the expertise, emotion and chaos of emergency medicine and must discover an overarching message in the film themselves from its extensive and at times unrelenting glimpses of largely uncompensated patient care. One message is clear, however. Healthcare is broken. This film will be excellent for teaching purposes: for use in curricula in management, health care management, medicine, social work, and more.' Amy C. Edmondson, Professor of Leadership and Management, Harvard Business School, Author, Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy
'Dramatic...Code Black is an effective and well-done presentation of the trials and tribulations of an ER and all who serve within its walls.' George Allen Wistreich, Science Books and Films
'Code Black is highly recommended for every academic library that supports health sciences programs, particularly medical and nursing schools. It should probably be required viewing for anyone thinking about going into emergency medicine.' Lori Widzinski, SUNY at Buffalo, Educational Media Reviews Online
'What comes across loud and clear is the incredible idealism of doctors who are struggling to be effective in a healthcare system hobbled by political and economic constraints...insightful and genuinely moving...Highly recommended.' F. Swietek, Video Librarian
'Harrowing and unforgettable...Highly recommended.' Midwest Book Review
'What makes the film so powerful is its insider's perspective. Viewers are privy to scenes they could not possibly witness elsewhere...A highly ambitious and spellbinding film...Vitally important, urgent and sometimes heartbreaking, Code Black is consistently absorbing.' Claudia Puig, USA Today
'Code Black provides a compelling insider's view of what it is like to be a doctor in training in our struggling safety-net health care system. The documentary follows the transition of one of the nation's first emergency departments to a state-of-the art facility that comes with stifling paperwork requirements. The efforts of compassionate young doctors who outsmart the system should be inspiration for us to look critically at how health care is delivered in the United States, and to explore creative solutions.' Dr. Karoline Mortensen, Assistant Professor of Health Services Administration, University of Maryland
'Code Black provides a unique window into the struggles of some of our country's biggest unsung heroes. These passionate young doctors are trying to make an increasingly challenging health care system more humane for the patients they serve. As an emergency physician myself, living with many of the similar challenges day to day, I was inspired by the ideals of the next generation of physicians.' Azita G. Hamedani MD, MPH, MBA , Chair, Department of Emergency Medicine, University of Wisconsin
'A vigorous companion piece to Peter Nicks's revealing 2012 documentary, The Waiting Room , Code Black (the title describes the emergency room's saturation point) is a keening cri de coeur. Warriors for the neediest among us - the unauthorized, uninsured and just plain unlucky - Dr. McGarry and his cohort save plenty of lives. What they're most in danger of losing is hope.' Jeannette Catsoulis, New York Times
'Provides a fascinating and dramatic look into the ER. It also sheds light on health care reform as seen by those in the trenches.' Film Pulse
'Excellent...Shows what is really at stake as we debate how to make our system better, stronger and more equitable. Code Black shows the hospital emergency department as the great equalizer, where the minimum wage worker meets the corporate executive facing the life and death circumstances of a traumatic accident or illness, and the health professionals who work to keep them alive. In spite of its complexity, we are all part of a single health care system tied together by the dedication of those who spend their time and intellect to keep us alive and ready for another day.' Dr. Michael R. Cousineau, Professor of Family Medicine and Preventive Medicine, Director of the Center for Community Health Studies, University of Southern California
'Riveting! McGarry has created something that feels personal, vital and revelatory.' Los Angeles Times
'Code Black is a provocative, realistic depiction of a group of dedicated physicians providing care on the front lines of one of the busiest emergency rooms in the country...This film is a unique education in the art of healing broken lives, with valuable lessons in compassion, perseverance, and true grit within the increasingly complex world of healthcare delivery.' Dr. Paul A. Ruggieri, MD, Author, The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry
'A must-see for anyone concerned about the state of health care in this country. Which should be all of us...Code Black is sobering stuff. The American health system, McGarry's film argues, is broken. But the film is undeniably inspiring, too: Despite everything that is wrong, there are nurses and doctors and technicians determined to do things right.' Steven Rea, Philadelphia Inquirer
'Code Black will be of particular interest to those contemplating a career in medicine, because the young physicians spend a fair amount of time discussing their motivations for choosing medicine, and emergency medicine in particular, as their career. In addition, Code Black offers what seems to be a fairly realistic view of what working in a big-city, public hospital ER is really like.' Sarah Boslaugh, Playback:stl
'Code Black feels like a brisk, vital report from the frontlines of emergency medicine, forged and rooted in the most intense sort of personal and professional experience.' Justin Change, Variety
'Provides an incredibly intense, and genuinely moving, glimpse into the operation of one of the nation's premier emergency medical facilities.' Frank Swietek, One Guy's Opinion
'One of the best documentaries I have ever seen, a jaw dropping look inside the birthplace of the modern Emergency Room... Code Black provides and honest portrayal of an ER while tackling some major issues with the health care system without trying to have an agenda or be preachy. It's a remarkable look inside a broken system.' Chris Hill, Cinema Assassin
'You've probably heard or read about most of the problems presented in Code Black , a compelling documentary about the struggles of an overburdened emergency room. But reading about such problems is one thing - seeing them up close is quite another.' David Lewis, San Francisco Chronicle
McGarry, Ryan (commentator)
McGarry, Ryan (film director)
McGarry, Ryan (screenwriter)
Altman, Josh (screenwriter)
Altman, Josh (film editor)
Goldstein Knowlton, Linda (film producer)
Edited by Joshua Altman; director of photography, Nelson Hume; music by James Lavino.
Distributor subjectsAmerican Studies; Anthropology; Business Practices; Emergency Medicine; Health; Healthcare Management; Management; Medicine; Nursing; Poverty; Social Justice; Social Work; Sociology
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Approximately 21 year old male
(inaudible) in the middle of the street.
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Sustained uh… two gunshot wounds.
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Uh… Actually probably about seven minutes. Seven minutes to our facility,
21 year old male, multiple gunshot wounds to left and right chest,
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is that correct? Yes.
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All right get him up. Get him up.
Get him up.
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Okay. Hold on. Hold CPR. Hold CPR.
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He’s gonna cut. Does he have a pulse?
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You got it?
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You know, if you’re an outsider,
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this looks like total chaos.
But as a doctor,
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I see unity in that chaos. There’s a team here and
all of that coming together to save someone’s life.
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Uh… chest feedback side.
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Okay, you two need to let the doctor
in to do a chest tube over here.
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But I feel like that, that spirit is
not at all involved in this debate
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and I think that this healthcare crisis is all
about team work. The US Supreme Court has said
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the Obama Healthcare law is constitutional
and therefore the law of the land.
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The individual mandate that
requires all Americans by and sure
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has deeply divided America. I
want you to know who I am.
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Our freedoms are shrinking. You
can afford health insurance.
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If you don’t, you should go to jail. And that Nancy
will you tell you this. I’m telling you this…
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You know, we’re in this crisis now and
there is a healthcare crisis and,
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and that’s what we’re being raised up in
and trained in, as we are the safety net.
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We are, when somebody needs somebody. He’s a
doctor, they can sent to the emergency room.
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So we’re gonna trained in this atmosphere and I
don’t think our role has really been defined
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and I don’t think our voice has been
heard yet. Our generation of ER docs
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and I think it’s gonna be important to kind of put our stamp on it
and say, you know, what our relationship with patients is gonna be,
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what our relationship with the
business of medicine is gonna be
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and healthcare in general.
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I remember, umm… my dad always encouraging us to, to look out for the
little guy. You know, there is that… that awkward kid in… in our class,
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in elementary school, you know,
he want to us to be his friend
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you know and, and make sure he felt
like, he wasn’t alone, you know.
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I needed my life had to mean something, you know. I do something
that was, you know, service to the world. It can just be a job to,
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to make money, you know.
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Someone is suffering, what are
you gonna do? Being a doctor,
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I have the capability to relieve
them of their suffering,
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so that’s what I’m gonna do, regardless if they
have money or no money. Hold still, hold still.
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And it doesn’t get any more
complicated than that.
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When I started this, it seemed so simple.
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We were gonna be doctors. We were gonna help
people. But what if those ideals can die?
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I mean, what if those hopes can fade
into the failure of the system.
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If you’re a young doctor, you… you have to ask
yourself. How do I protect the ideals I came here for?
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My fourth and final year of med school,
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it’s customary to kind of like go on
extended auditions in a bunch of hospitals
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because now you got to choose where you’re
gonna be for the next few years to train.
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At that point, I don’t think, I had decided,
oh, I’m gonna be a County hospital doctor
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or that’s, that’s for me. I… I had just
heard good things and I was curious.
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I mean, from day one…
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Oh, my God it was just… Initials like… I mean, it’s like
kind of crazy, I don’t know, if this is… Like, is this real?
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Because… They are true. Like, is this really for real?
I’ve been at other hospitals. I’ve been at places.
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Never seen like this before. You know, who’s… Who’s the doctors
here? Who… who… who are the nurses? Who do I even talk to?
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It’s my first day. Who do I report to? And umm…
I remember seeing, there’s very calming man.
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Turns out, it’s… it’s the… It’s the chairman. He’s the… He’s the
chairman at the time Dr. Edward Newton. But I don’t know this.
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I just… I just think, it’s a doctor and
I… I walk up to him and umm… and he says,
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oh, you know, you’re the new med student. I said, yeah… yeah.
You know, I’m like, what is this? And he said, it’s C-Booths.
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This is where… This is where our specialty was born.
This is where everything happens. This is where
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umm… you know, you’re gonna… you really gonna
learn to be a doctor. And I remember thinking,
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how the hell am I gonna hang here?
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It’s a place where physicians
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and nurses have come over
the years and really learnt
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how to deal with a large volume of really
sick people and really develop their craft.
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An emergency physician at LA County hospital,
I mean, what you, you’re same as that,
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you are part of this heritage that,
especially with the birthplace
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of emergency medicine ugly(ph) in the
world. Uh… definitely in the United States.
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This place was built in 1930.
Fast forward, what 40 years
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when they start an emergency primary residency, where they
just built one in a room. It wasn’t anything fancy set up.
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It wasn’t pre-planned. They just built a
room and people started to see patients.
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At the time that I was uh… an intern,
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the emergency department really
wasn’t an emergency department.
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It was still back in the era where uh…
emergency departments were uh… emergency rooms
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staffed by anybody uh… with a
degree, including psychiatrists,
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uh… pediatricians, dermatologists
handling gunshot wounds to the abdomen.
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Uh… No experience
particularly uh… required.
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The concept that one doctor, one emergency
physician trained in the suscitation,
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would really be the best person to resuscitate you,
is really part of the core idea of the specialty.
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And \"C-Booth\" is where that idea was born.
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By my first week
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I was still kind of trying to figure
out just what the hell is \"C-Booth.\"
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It’s havoc ground, more people
have died, that’s where footage
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than in any other location in the
United States. And on a brighter note,
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more people have been saved in that square
footage than in any other square footage
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in the United States.
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Nobody really knew what the
C and C-Booth stood for.
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Critical booth, (inaudible) booth, cardiac
booth but everyone did know it was special
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and maybe it was most special for a way,
it didn’t have. Hardly any technology.
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There was no doctors or nurse quarters. Maybe not
surprisingly that patients were in the middle
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and they were the focus.
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C-Booth sees the most critical patients. So be that a massive
heart attack. Be that severe bleeding, be that severe infection,
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an inability to breathe, any of the devastating
illnesses that uh… put you into shock.
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The sickest patients in this big,
big population in this huge city
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end up in here in C-Booth and they
keep pouring in as you can see.
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And it’s… it’s true that… that
people would come here on tours
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when we do tours for the uh… the residency, people come
to interview and they, they would want to see C-Booth
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and they would know what it was.
Let’s see C-Booth and the invariable
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uh… response was, \"that’s it?\" This is C-Booth. It’s
a very small area. But again, I always tell people,
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it’s what happens here, it’s not uh…,
it’s not the physical space itself.
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All right. Here is saline. I
need a… I need some breathing.
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Okay. Fine. All right guys. I need space.
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Okay, no rectal tone. I
need an abdominal pad.
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You can give me an abdominal
pad, please, four by fours.
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I heard this was a very difficult
and rigorous place to train
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and umm… you’re constantly deciding, is this me? Do
I fit? Can I do this? What’s the deal? Is it in?
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Yeah, it’s in. Okay, this is, this
is not… This isn’t very good.
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When… What happened? What happened? Did
he wake up? No, he didn’t wake up.
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I think the balloon just… I think it backed out. Okay,
can you take this out now? Take it out for this gagging.
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You can’t read about that stuff. You can’t learn it in a
medical school. You know, no matter how many times you’ve read
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or even done a chest tube under casual circumstances,
it’s very different from placing a chest tube
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that needs to be placed in 30 seconds.
All the way in, all the way in.
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All the way in. All the way in.
All the way in.
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I let it out open. Good.
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Good. There you go.
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It scares the, the hell out of you
and it makes you have to work hard
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and there is no excuse.
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So, Jen, can you… Wait. Hold out for a second.
Can you troubleshoot your uh… your tube?
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When I rotate here as a medical student. I saw
how the seniors just commanded the place.
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Let’s go, dude. Take that off, go.
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And I thought, I want to be that person. I want
to be that calm and that cool, that collected,
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that knowledgeable, that confident.
That’s what I want.
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All right. What are our vital signs here?
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Switch her over to that one please. Emergency
medicine calls a certain type of person
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to work there.
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To actively choose and leave
a very particular lifestyle
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and choose something much different. I think
it speaks a lot to the history of that person.
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Emergency medicine was uh… a second career.
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I start doing medical research
and that was fascinating.
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But uh… my dad was diagnosed
with Alzheimer’s at the time
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and I didn’t know anything
about Alzheimer’s actually.
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Being in research,
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I PubMed about Alzheimer’s and
treatment and there was lots
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and lots and lots of articles
with numbers and graphs.
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But that was frustrating to me because I
didn’t want to be one of those researchers
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just generating data point after data point after data
point. I wanted to be the interpreter of that data
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and then have the ability to
apply to somebody who need it,
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like a patient.
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Going to emergency medicine,
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I like the hands on that there are some procedures that
needed to be done. I enjoy the patient interaction.
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I like the investigative process
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in terms of trying to figure out
what was going on with the patient.
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Umm… and I like the people. The people in
the emergency room were just different.
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I really don’t workout that much
umm… but I’m really tired right now.
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So, as I can stretch. That’s
booth 19 right there.
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Yeah, this is it, this is Friday night.
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Like I feel strangely at home even as a med student getting along
with people that have a good sense of humor, that are very relax
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but take their job seriously. You always
hear war and troops and the bonds
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and closeness of an outfit on the battlefield
and this hospital is very similar.
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It seems like such a family in that way. I
think it was hard not to be attracted to that.
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I guess, a picture of me smoking in front
of the no smoking signs is appropriate but
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it’s sort of the one break that is always respected.
If you’re having dinner, though interrupt you
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but if you’re on the ramp having a smoke,
you’re pretty much left free. Okay.
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And there’s one of the faculty who is uh… legend in
the ER world and he seem to represent the place.
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Little rough on the edges, breaking
some rules. Nobody boxed him in.
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And I think he personified the total opposite
of a constrained like regulated medical culture
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and I love that about him. Yes,
I get to pee on my property.
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You’re not putting that in the film.
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Billy once told me that emergency medicine was
blue collar work. No pretension, no attitude
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and it’s true. Most of my classmates
had no interest in status.
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They found their value in life’s moment’s
instead. My friends used to call me the epic guy
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because I loved making everything
in life, like huge, you know.
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I love running up mountains because you get
to stand on the top at the end and you feel,
00:16:40.000 --> 00:16:44.999
you know, it’s like in rocky. You get that
same feeling. That’s what life is about.
00:16:45.000 --> 00:16:49.999
It’s… You know, making love to woman and making
it seem more than just having sex, you know.
00:16:50.000 --> 00:16:54.999
00:16:55.000 --> 00:16:59.999
It’s about these moments that are
big, that are larger than life.
00:17:00.000 --> 00:17:04.999
I feel like emergency medicine
00:17:05.000 --> 00:17:09.999
is this place where, what we’re doing is much more
important than just pushing paper and making money.
00:17:10.000 --> 00:17:14.999
You’re there with staff and nurses and it’s a team and
you’re talking to patients and you’re in the thick of it
00:17:15.000 --> 00:17:19.999
and fighting to save someone’s life.
00:17:20.000 --> 00:17:24.999
00:17:25.000 --> 00:17:29.999
All right, chest to that side.
00:17:30.000 --> 00:17:34.999
(inaudible)Body to the right side.
00:17:35.000 --> 00:17:39.999
Here is the knife. All the way down.
00:17:40.000 --> 00:17:44.999
Yeah, so she will work on the bottom,
00:17:45.000 --> 00:17:49.999
she works on the top. Being a new doctor,
I think optimism overshadows realism
00:17:50.000 --> 00:17:54.999
and it’s easy to see why. You
know, they fixed the wound.
00:17:55.000 --> 00:17:59.999
He had blood but there was no life. It’s… It’s
this unfair exception to everything we’re taught.
00:18:00.000 --> 00:18:04.999
But as a doctor, be on your
values, be on your science.
00:18:05.000 --> 00:18:09.999
The system is sometimes bigger than you.
00:18:10.000 --> 00:18:14.999
Anything else to do, prep? Okay.
00:18:15.000 --> 00:18:19.999
I think we called it. We’re calling it.
Time of death, 11:46.
00:18:20.000 --> 00:18:28.000
00:18:50.000 --> 00:18:54.999
The first time I saw a patient die was actually
in C-Booth when I was volunteering in the ED
00:18:55.000 --> 00:18:59.999
in my first month of med school.
And I remember saying,
00:19:00.000 --> 00:19:04.999
this is gonna fuck me up, you know, a patient died. I was,
you know, touching a dead person for the first timed.
00:19:05.000 --> 00:19:09.999
There was an cadaver.
00:19:10.000 --> 00:19:14.999
When somebody dies here,
00:19:15.000 --> 00:19:19.999
I think it’s one of the moments that really
connects everybody in C-Booth’s together.
00:19:20.000 --> 00:19:24.999
You know, everybody has the same sorrow and a
feeling of it. We tried to do everything we could
00:19:25.000 --> 00:19:29.999
but then, also everybody just
the team reinvigorating again
00:19:30.000 --> 00:19:34.999
and getting ready for the next patient
or case to come through the door
00:19:35.000 --> 00:19:39.999
and try to make a difference there.
00:19:40.000 --> 00:19:48.000
00:19:55.000 --> 00:19:59.999
When I see my son that
he was basically dying
00:20:00.000 --> 00:20:04.999
and it was terrible. That was
the worst day of my life.
00:20:05.000 --> 00:20:09.999
00:20:10.000 --> 00:20:14.999
He’s uptake in the airway. We got vomit in the airway.
All right. I think we just go. All right. All right.
00:20:15.000 --> 00:20:19.999
I can do a rectal real quick
before you push that. Okay.
00:20:20.000 --> 00:20:24.999
00:20:25.000 --> 00:20:29.999
So this is seven and a half,
00:20:30.000 --> 00:20:34.999
23 into teeth. Skid a securing device.
00:20:35.000 --> 00:20:39.999
He’s gonna be okay. All right.
00:20:40.000 --> 00:20:44.999
00:20:45.000 --> 00:20:49.999
Thank God everything went right
and worked for my son and I just,
00:20:50.000 --> 00:20:54.999
I don’t know, I don’t have words to tell
00:20:55.000 --> 00:20:59.999
and thank the doctors is,
unbelievable feeling now than I now.
00:21:00.000 --> 00:21:04.999
That I have my kid back. All right. Well, you
take care of yourself and I’ll see you back.
00:21:05.000 --> 00:21:09.999
Pleasure meeting you. [sil.]
00:21:10.000 --> 00:21:14.999
There’s nothing that
brings people together,
00:21:15.000 --> 00:21:19.999
been struggling for something that’s
worthwhile. And what we have to struggle again
00:21:20.000 --> 00:21:24.999
was an onslaught of patients
being brought into this place.
00:21:25.000 --> 00:21:29.999
If there was a hallway spot, there
was a nurse and a doctor available.
00:21:30.000 --> 00:21:34.999
Even if they weren’t available, they would
make the time to take care of someone
00:21:35.000 --> 00:21:39.999
who’s out there sick. So
it was a cohesive team.
00:21:40.000 --> 00:21:44.999
The magic of C-Booth
00:21:45.000 --> 00:21:49.999
was that when you got up in the morning
to go to work, you knew that… that day
00:21:50.000 --> 00:21:54.999
you’re gonna get to be the best, you can be
in life. That C-Booth was gonna force you
00:21:55.000 --> 00:21:59.999
to rise up to the occasion and save that kid. Like,
there was no shirking from your responsibilities.
00:22:00.000 --> 00:22:04.999
You knew that at the end of the
day you’ve done your best.
00:22:05.000 --> 00:22:09.999
Where’s your belly? Tell me you all right?
00:22:10.000 --> 00:22:14.999
I knew at that point that being
a doctor, any where else,
00:22:15.000 --> 00:22:19.999
but here, but this brand of being
an ER doctor was not gonna cut it.
00:22:20.000 --> 00:22:28.000
00:22:30.000 --> 00:22:34.999
You remember what happened? Open your eyes. Open your eyes. He
pulled her three millimeter bilaterally symmetric and reactive.
00:22:35.000 --> 00:22:43.000
00:23:50.000 --> 00:23:54.999
00:23:55.000 --> 00:23:59.999
I had to do a year of training elsewhere, that was just a tradition and the
requirement of this place. You did your first year residency in a hospital
00:24:00.000 --> 00:24:04.999
and so when I got back, I find that
it’s not only is it a new space
00:24:05.000 --> 00:24:09.999
and a new place but it’s, to me
it feels like a new culture.
00:24:10.000 --> 00:24:18.000
00:24:25.000 --> 00:24:29.999
Which place do you like better? The old building.
How come? Too much walking in this building.
00:24:30.000 --> 00:24:38.000
00:25:05.000 --> 00:25:09.999
I think the difference between
the old generation of ER docs
00:25:10.000 --> 00:25:14.999
and our generation of ER docs is, they had
the excitement of starting a new field
00:25:15.000 --> 00:25:19.999
and basically defining it and creating a
completely different area of the hospital
00:25:20.000 --> 00:25:24.999
that they control and uh… we’re a
generation that’s starting out
00:25:25.000 --> 00:25:29.999
and we’re totally immersed in protocols,
policy rules, checklists, forms.
00:25:30.000 --> 00:25:34.999
The amount of forms that it takes
00:25:35.000 --> 00:25:39.999
to get a patient registered,
taking care of and discharge
00:25:40.000 --> 00:25:44.999
is upward of 50 to 60.
00:25:45.000 --> 00:25:49.999
I just had a patient with the simplest of complaints. It took me about
two minutes to see her. I saw her standing right here in the hallway.
00:25:50.000 --> 00:25:54.999
I don’t even need a room for her and what turns it into
a very simple complaint, there’s just tons of things
00:25:55.000 --> 00:25:59.999
you have to do in terms of documentation and
basically it took me four times as long to document
00:26:00.000 --> 00:26:04.999
as it took for me to talk to her and do the exam at the
same time. The amount of crushing regulation on hospitals,
00:26:05.000 --> 00:26:09.999
whether it’s from CMS, the federal
level, CDPH at state level,
00:26:10.000 --> 00:26:14.999
joint commission, hospital regulations.
Umm… basically they are tying your hands.
00:26:15.000 --> 00:26:19.999
With HIPPA, this ER can get fined
if we don’t log in every time
00:26:20.000 --> 00:26:24.999
we need to see a patient piece of data.
Basically what we do here is login over
00:26:25.000 --> 00:26:29.999
and over and over again.
00:26:30.000 --> 00:26:34.999
I go to the bathroom, I… I
like to you want to login.
00:26:35.000 --> 00:26:39.999
We move from a hospital that was protected
from regulation because it was impossible.
00:26:40.000 --> 00:26:44.999
You couldn’t meet the privacy standards because
we were in this old antiquated building
00:26:45.000 --> 00:26:49.999
where too many people were
jammed into too little space
00:26:50.000 --> 00:26:54.999
and so we were actually given waivers. It has nothing to do with
the county, it’s more that we move forward two decades in time,
00:26:55.000 --> 00:26:59.999
maybe more from the old facility
to here and the new building
00:27:00.000 --> 00:27:04.999
which is now all up to those standards, the
regulations have now come home to roost.
00:27:05.000 --> 00:27:13.000
00:27:20.000 --> 00:27:24.999
I think what’s amazing is, you guys have been
following me for, you know, 30 minutes now
00:27:25.000 --> 00:27:29.999
and I’ve probably spent all of
two minutes for the patient.
00:27:30.000 --> 00:27:34.999
It didn’t seem that long ago that we were
watching senior residents in C-Booth
00:27:35.000 --> 00:27:39.999
and now here we are. This is us and we’re
starting our senior year as ER doctors.
00:27:40.000 --> 00:27:44.999
I went into medicine, begin like,
this is the last frontier,
00:27:45.000 --> 00:27:49.999
intellectual hands on career and then
emergency medicine is the epitome of that
00:27:50.000 --> 00:27:54.999
and now we get to it and it’s not C-Booth
anymore and we’re at a computer,
00:27:55.000 --> 00:27:59.999
at a desk, in a chair pushing paper. That
kind of stuff eats away at me a little bit,
00:28:00.000 --> 00:28:04.999
not like the fact that you’re taking care of these
people and the gratification is still there
00:28:05.000 --> 00:28:09.999
but that stuff is, what chips away slowly and I think
that’s the biggest difference between now and then.
00:28:10.000 --> 00:28:14.999
Part of what we’re trying to
figure out now is who we are?
00:28:15.000 --> 00:28:19.999
What does it mean to mean to be a doctor in these times in
America? Like when you’re a medical student, it’s… it’s an ideal.
00:28:20.000 --> 00:28:24.999
You, you watch TV shows, you do a
rotation, you see a couple of bad cases,
00:28:25.000 --> 00:28:29.999
where you see residents be bad ass and you’re like, yeah, and it’s
just sexy and you’re like I’m gonna be a sexy doctor in the ER.
00:28:30.000 --> 00:28:34.999
When you go in and then intern year, you’re
still writing on that high and you’re like,
00:28:35.000 --> 00:28:39.999
woo, I don’t know anything, I’m not really responsible but woo, and
it’s that excitement that carries you through the rest of the year.
00:28:40.000 --> 00:28:44.999
And now I’m realizing at fourth year, the
progression from woo, excitement, to \"oh, shit\"
00:28:45.000 --> 00:28:49.999
to \"I’m responsible\" and now which is sobering. It’s
heavy. It’s sobering, yes. It’s stressful and sobering.
00:28:50.000 --> 00:28:58.000
00:29:00.000 --> 00:29:04.999
Pads please right away. CPR right away.
00:29:05.000 --> 00:29:09.999
69 Year old lady, they found her
without pulses, not breathing,
00:29:10.000 --> 00:29:14.999
completely unresponsive and
they brought her in here.
00:29:15.000 --> 00:29:19.999
00:29:20.000 --> 00:29:24.999
All right charging. Keep doing CPR.
00:29:25.000 --> 00:29:29.999
I was actually leading the Code. You carry the whole burden of
responsibility of like, organizing all the people that are in there
00:29:30.000 --> 00:29:34.999
and making sure that everyone is
doing everything appropriately.
00:29:35.000 --> 00:29:39.999
Making sure the… the gap between
thinking and acting is minimal.
00:29:40.000 --> 00:29:44.999
One amp, calcium carb, calcium, chloride.
00:29:45.000 --> 00:29:49.999
All right hold CPR, pulse quick,
pulse check, rhythm check.
00:29:50.000 --> 00:29:54.999
A lot of multi-tasking and meanwhile
like dealing with the family,
00:29:55.000 --> 00:30:03.000
talking with the family, being
their emotional support.
00:30:10.000 --> 00:30:14.999
Okay, all right. Okay, thank you.
00:30:15.000 --> 00:30:19.999
You know, people say to me, you’re like, you see patients
for a few minutes and you see, you never see them again.
00:30:20.000 --> 00:30:24.999
But I think the relationships you
develop in those… those few minutes
00:30:25.000 --> 00:30:29.999
umm… where someone is really… really
sick or, you know, on the edge of death
00:30:30.000 --> 00:30:34.999
or where they actually don’t make it, you know, are you know,
it’s the most important interactions that will you have
00:30:35.000 --> 00:30:39.999
with your patients or with their families,
you know. Unfortunately right now,
00:30:40.000 --> 00:30:44.999
it doesn’t look like she’s doing that well. We have
been resuscitating her for about 15 minutes now
00:30:45.000 --> 00:30:49.999
and she hasn’t responded.
Her heart isn’t beating
00:30:50.000 --> 00:30:54.999
umm… they are still CPR right now and giving
all the appropriate medications for treatment
00:30:55.000 --> 00:30:59.999
but it isn’t looking that good right now. I
have a hard time separating myself from it.
00:31:00.000 --> 00:31:04.999
I lost like both of my grandfathers in like the last
two years and every time I see someone like that,
00:31:05.000 --> 00:31:09.999
it’s still, it still gets me.
00:31:10.000 --> 00:31:18.000
00:31:20.000 --> 00:31:24.999
Does anyone else have any
objections uh… calling it?
00:31:25.000 --> 00:31:29.999
Call it. Okay. Hold CPR,
time of death 12:54.
00:31:30.000 --> 00:31:38.000
00:31:40.000 --> 00:31:44.999
00:31:45.000 --> 00:31:53.000
00:31:55.000 --> 00:32:03.000
00:32:15.000 --> 00:32:19.999
When you do lose those patients
00:32:20.000 --> 00:32:24.999
like we did today, you know, your
patient is then their family
00:32:25.000 --> 00:32:29.999
and helping them cope with that
moment, you know, being the one
00:32:30.000 --> 00:32:34.999
to break that news to them and doing
it in a… in a compassionate and…
00:32:35.000 --> 00:32:39.999
and very humane way. Yeah,
it’s my first opportunity,
00:32:40.000 --> 00:32:44.999
I’m gonna do that and uh… you know, I
don’t expect that to ever get easy.
00:32:45.000 --> 00:32:53.000
00:33:25.000 --> 00:33:29.999
You’re seeing people usually, what is… what is
often the worst day of their life, you know.
00:33:30.000 --> 00:33:34.999
You know, I think that’s the hardest
thing to do in our specialty.
00:33:35.000 --> 00:33:39.999
You have a patient in front of you, who is in pain, who needs
you, who needs you to take a lot of time to take care of them,
00:33:40.000 --> 00:33:44.999
but you have to love the patients in your waiting
room just as much because they might be even sicker.
00:33:45.000 --> 00:33:49.999
Is there like electronic
representation of the waiting room
00:33:50.000 --> 00:33:54.999
and when you got 300 people
tonight in the waiting room,
00:33:55.000 --> 00:33:59.999
you have to decide how… how you’re gonna manage this, how you’re gonna
see these people in what order. And so we develop that numerical score
00:34:00.000 --> 00:34:04.999
that many ERs adopt, uh… that’s based
one, two, three and four. Four is that,
00:34:05.000 --> 00:34:09.999
you know, I have a cold, I have a
broken finger. Three is I have a flu,
00:34:10.000 --> 00:34:14.999
two is, I have an appendicitis and
can die of a ruptured appendicitis
00:34:15.000 --> 00:34:19.999
and one is I’m actually having a heart attack right now and could die in
any minute. And uh… one of the sobering facts that we find here accounting
00:34:20.000 --> 00:34:24.999
is that, we have such a high volume of patients
that come to us that level two scores.
00:34:25.000 --> 00:34:29.999
So people who could still have
life threatening emergencies
00:34:30.000 --> 00:34:34.999
are often asked to wait uh… up to 10,
15 hours before they can be seen.
00:34:35.000 --> 00:34:39.999
And so what’s really scary to us is that while we’re in here, seeing
patients, you have no idea what’s happening to these ESI two score people
00:34:40.000 --> 00:34:44.999
that are here in it. You can see, tonight even here
is a ESI two that’s been waiting for eight hours,
00:34:45.000 --> 00:34:49.999
nine hours, ten hours, twelve hours.
00:34:50.000 --> 00:34:54.999
People are at their limits, you know, you’re out there for
15 hours and you’re sick and they can’t get to see a doctor
00:34:55.000 --> 00:34:59.999
and the frustration, you know, I… I
can’t imagine how bad it is, you know.
00:35:00.000 --> 00:35:04.999
People come here and leave
because they can’t wait anymore.
00:35:05.000 --> 00:35:09.999
I think those are pretty high stakes.
00:35:10.000 --> 00:35:14.999
I think I have a low tolerance
for making people wait
00:35:15.000 --> 00:35:19.999
because I’ve been there myself.
I’ve felt that. Go, Ryan.
00:35:20.000 --> 00:35:24.999
Let’s go, Ryan. Ryan. Ryan.
00:35:25.000 --> 00:35:29.999
00:35:30.000 --> 00:35:34.999
I went to college on a scholarship
for track and cross country.
00:35:35.000 --> 00:35:39.999
But by the middle of the academic year, I
went from being one of the top freshmen
00:35:40.000 --> 00:35:44.999
to exceedingly lower facing the theme
and then finally being left in races.
00:35:45.000 --> 00:35:49.999
I think everybody at the time
felt this is just kind of
00:35:50.000 --> 00:35:54.999
a really bad case of
freshmen, freshmen burnout.
00:35:55.000 --> 00:35:59.999
00:36:00.000 --> 00:36:04.999
I just went to my old home
pediatrician who said,
00:36:05.000 --> 00:36:09.999
let’s get an X-ray and uh… we just were
ready for him to say, stress fracture,
00:36:10.000 --> 00:36:14.999
this, you know, shoot, we found something
and uh… he started crying in the office
00:36:15.000 --> 00:36:19.999
and said, you can’t be in this office
for a minute. I need to refer you
00:36:20.000 --> 00:36:24.999
to an orthopedic oncologist right now. And you
know, we all looked at each other and said,
00:36:25.000 --> 00:36:29.999
\"what is that even… What does that mean?\" And he said,
\"you don’t have… we don’t have time to explain it.\"
00:36:30.000 --> 00:36:34.999
This looks like a really bad cancer to me and you need… you need
help right this second and we’re really late. We’re behind the ball.
00:36:35.000 --> 00:36:39.999
00:36:40.000 --> 00:36:44.999
I had a stage four lymphoma,
00:36:45.000 --> 00:36:49.999
a very rare subtype of lymphoma and
uh… within hours, I was signed up for
00:36:50.000 --> 00:36:54.999
umm… chemotherapy and radiation and
we knew, we were in for a fight.
00:36:55.000 --> 00:36:59.999
00:37:00.000 --> 00:37:04.999
And I wasn’t busy,
00:37:05.000 --> 00:37:09.999
when my family wasn’t busy, when there
wasn’t something to do, to fight the thing,
00:37:10.000 --> 00:37:14.999
that’s when the fear crept in and it was
always about the clock. Waiting on news,
00:37:15.000 --> 00:37:19.999
if the therapy is working. Waiting on
news is it, is… is there more disease
00:37:20.000 --> 00:37:24.999
that we didn’t know about?
Is it getting bigger?
00:37:25.000 --> 00:37:29.999
To wait on news that may not come
not in just in hours but in days.
00:37:30.000 --> 00:37:34.999
That’s torture. The clock was torture and
watching that dial go around is torture.
00:37:35.000 --> 00:37:43.000
00:37:45.000 --> 00:37:49.999
How long have you been here for? Since
yesterday at 1:30 in the afternoon.
00:37:50.000 --> 00:37:54.999
Get out of here. Oh, my God. God bless you.
That’s a long time. Yes.
00:37:55.000 --> 00:37:59.999
When I see somebody who has taken
four buses to get to the ER
00:38:00.000 --> 00:38:04.999
and now they’ve waited 18 hours, almost all in
me is wired to figure out how I can help them
00:38:05.000 --> 00:38:09.999
right now in the moment. Umm… I’m sorry it was such
a long wait, okay, we’re doing the best we can.
00:38:10.000 --> 00:38:14.999
Uh… I’ll see if we can find you a snack in a
second. But let me… let me get this started
00:38:15.000 --> 00:38:19.999
and we’ll go, you know, what I mean. But
what are you here for? For my sciatic nerve,
00:38:20.000 --> 00:38:24.999
which is a lot of pain, passing up. Okay. And what
are you taking for pain medication right now?
00:38:25.000 --> 00:38:29.999
I’m out of medication. So you got… Right now you
have no pain medication at all huh? I don’t know.
00:38:30.000 --> 00:38:34.999
Okay. And I keep it real. The pain medication
that I was using was Mary J. What is that? Umm…
00:38:35.000 --> 00:38:39.999
You know, Mary J. No.
00:38:40.000 --> 00:38:44.999
Marijuana. Sorry, I’m not, you know, look at
me. Look at me. I wouldn’t know what that.
00:38:45.000 --> 00:38:49.999
Oh, yeah. It’s called Mary
J and I was felt too easy
00:38:50.000 --> 00:38:54.999
to ease the pain to get me here.
00:38:55.000 --> 00:38:59.999
It’s not a private hospital. It’s a county hospital. It’s these
low income, underprivileged, people without access to care.
00:39:00.000 --> 00:39:04.999
It’s funded through a budget that’s provided by the
County Board of Supervisors and it’s taxpayer’s money.
00:39:05.000 --> 00:39:09.999
Umm… I mean there is a combination. Liked there is federal funds and
there is state funds and there is county money, but in the end,
00:39:10.000 --> 00:39:15.000
our budget is set by the County Board of
Supervisors and we are to take care of all covers.
00:39:50.000 --> 00:39:54.999
The nurse is gonna kill me! The nurse is gonna
kill me! The nurse is just gonna kill me!
00:39:55.000 --> 00:39:59.999
The nurse is gonna kill me!
00:40:00.000 --> 00:40:04.999
00:40:05.000 --> 00:40:09.999
I want Dr. (inaudible) please.
00:40:10.000 --> 00:40:14.999
(inaudible). What’s her number?
The nurse just gonna kill me.
00:40:15.000 --> 00:40:23.000
00:40:30.000 --> 00:40:34.999
You need to calm down, calm down.
00:40:35.000 --> 00:40:39.999
And the community really relies on us to…
to provide a lot of the psychiatric care
00:40:40.000 --> 00:40:44.999
because umm… I think there’s other hospitals
that would find ways to not, you know,
00:40:45.000 --> 00:40:49.999
practically not be around for this patient. One of the
things is just geography. You know, we’re here and the place
00:40:50.000 --> 00:40:54.999
where all these people end up just because
of the area and the poverty around here, so.
00:40:55.000 --> 00:40:59.999
There is more of a need at county hospital
and I think this kind of place attracts
00:41:00.000 --> 00:41:04.999
a certain kind of person.
00:41:05.000 --> 00:41:09.999
00:41:10.000 --> 00:41:14.999
I was in a car accident when I was 14
00:41:15.000 --> 00:41:19.999
uh… with a few, like really good friends.
I woke up in the ambulance
00:41:20.000 --> 00:41:24.999
uh… I was taken to the ER and was basically fine
and out of there, you know, within an hour.
00:41:25.000 --> 00:41:29.999
It was just a concussion umm… One
of my best friend wasn’t so lucky.
00:41:30.000 --> 00:41:34.999
His name is Tomas. My friend Tomas.
He had uh… like a terrible
00:41:35.000 --> 00:41:39.999
umm… traumatic brain injury and he was in the
hospital for months and months and months
00:41:40.000 --> 00:41:44.999
and uh… ultimately left in a
persistent vegetative state.
00:41:45.000 --> 00:41:49.999
You know, I felt, I had like real liked survivor’s
guilt from that. I think that was the first thing
00:41:50.000 --> 00:41:54.999
that maybe want to be around him, be at his house all the
time rather than just being his friend. So I was there,
00:41:55.000 --> 00:41:59.999
you know, at his house helping with
his care umm… helping with his,
00:42:00.000 --> 00:42:04.999
his rehab, you know. Praying for miracles with this
family. And it seemed like the one person that,
00:42:05.000 --> 00:42:09.999
that dealt with and didn’t seem to
care as much as me or his family did
00:42:10.000 --> 00:42:14.999
were the doctors, you know. My friend Tomas, you
know, he was undocumented immigrant from Mexico
00:42:15.000 --> 00:42:19.999
and his family was uninsured and, and the
care that they would get wasn’t the best
00:42:20.000 --> 00:42:24.999
and that was, you know incredibly
frustrating, you know, to see
00:42:25.000 --> 00:42:29.999
someone, you love so much
cared for so poorly.
00:42:30.000 --> 00:42:34.999
Umm… and uh… so at first, I thought
medicine was the last thing I wanted to do.
00:42:35.000 --> 00:42:39.999
00:42:40.000 --> 00:42:44.999
I was just in front of the hospital. It’s a
civic cathedral. You walk up those stairs
00:42:45.000 --> 00:42:49.999
and you look up and that is awe inspiring.
00:42:50.000 --> 00:42:54.999
This… this huge structure,
2,000 beds at one time
00:42:55.000 --> 00:42:59.999
and carved in stones along, you know,
all these great men of medicine.
00:43:00.000 --> 00:43:04.999
There’s the words at the
citizens of Los Angeles,
00:43:05.000 --> 00:43:09.999
taxed themselves for 10 years
to build this structure,
00:43:10.000 --> 00:43:14.999
so nobody can go without the
fruits of science and health
00:43:15.000 --> 00:43:19.999
for lack of resources.
00:43:20.000 --> 00:43:24.999
And that’s what this whole
structure stands for.
00:43:25.000 --> 00:43:29.999
00:43:30.000 --> 00:43:34.999
Being in LA, where there are so many people that are
uninsured and so many people that are living in poverty,
00:43:35.000 --> 00:43:39.999
the emergency department is where they come
00:43:40.000 --> 00:43:44.999
when they are uh… cold and tired and hungry
and sick and I think it’s kind of replaced
00:43:45.000 --> 00:43:49.999
uh… what the church is used
to be in, in the Middle Ages,
00:43:50.000 --> 00:43:54.999
you know, it’s a place where
people come for sanctuary.
00:43:55.000 --> 00:43:59.999
00:44:00.000 --> 00:44:04.999
This place stands distinctly for most of the practice
environments where we spend our faculty generally speaking
00:44:05.000 --> 00:44:09.999
talking about patient welfare, patient safety
uh… this is their mission here is we do.
00:44:10.000 --> 00:44:14.999
That is not what is happening throughout the country
at most private institutions. The, the private groups
00:44:15.000 --> 00:44:19.999
you know, I know my wife is in private practice
is almost a 100% focused on, on money.
00:44:20.000 --> 00:44:24.999
I was in a horrible pain. I have a broken bone.
Where did you go first for medical attention?
00:44:25.000 --> 00:44:29.999
At Kaizer hospital. So if you, if you have already seen that in a hospital
why are you at this one like why did you… They kicked me out of Kaizer
00:44:30.000 --> 00:44:34.999
because I don’t have a credit card. They told
me to come here so I have surgery here, so.
00:44:35.000 --> 00:44:39.999
I see and you already feel… So what
happened to this patient is totally legal.
00:44:40.000 --> 00:44:44.999
Congress passed legislation in 1986 that
requires all hospital emergency rooms to treat
00:44:45.000 --> 00:44:49.999
basically any patient with a life threatening
condition even if they can’t pay.
00:44:50.000 --> 00:44:54.999
This sets the stage for a very lope sided
safety net on the other side of the ER.
00:44:55.000 --> 00:44:59.999
Because while all of these American hospital emergency rooms
will take care of you, if you’re well enough to be discharged,
00:45:00.000 --> 00:45:04.999
getting to your next doctor might be a real
problem. What if you need surgery, a specialist
00:45:05.000 --> 00:45:09.999
or an expensive medication. Now
your options are significantly less
00:45:10.000 --> 00:45:14.999
and the public hospitals become the
only safety net these people have.
00:45:15.000 --> 00:45:19.999
I can’t imagine a situation
00:45:20.000 --> 00:45:24.999
where someone will show in my hospital needing
help and me being able to turn them away.
00:45:25.000 --> 00:45:29.999
It does boil me up to
think that, that happens.
00:45:30.000 --> 00:45:34.999
That people that need help are turned
away and I feel great that I’m at a place
00:45:35.000 --> 00:45:39.999
where I don’t ever have
to think about that.
00:45:40.000 --> 00:45:44.999
That’s why everybody is here, I mean, this is a place where
you get to work uh… twice as hard for half the price.
00:45:45.000 --> 00:45:49.999
Deal with a lot more difficult day umm… but
sometimes a lot more gratifying outcome.
00:45:50.000 --> 00:45:54.999
We provide service and healthcare
to those that need it most.
00:45:55.000 --> 00:45:59.999
So I mean the emergency
department has become
00:46:00.000 --> 00:46:04.999
the only access point for
many uh… in our country.
00:46:05.000 --> 00:46:09.999
Hey, so what’s going on? So we’re just
trying to figure out why she’s breaking out
00:46:10.000 --> 00:46:14.999
all those bumps all over her. She’s got them all
over her chest, all over her back, on her booty
00:46:15.000 --> 00:46:19.999
and it’s just getting worse. Especially
the back, the back has gotten really bad.
00:46:20.000 --> 00:46:24.999
The emergency doc is the family medicine doc of the modern
era in a lot of ways especially in a county hospital
00:46:25.000 --> 00:46:29.999
and uh… I have fell in love with it, you
know, you get to solve all problems,
00:46:30.000 --> 00:46:34.999
you know, whether just
their diabetes medications
00:46:35.000 --> 00:46:39.999
or fixing their laceration or saving
their life. You’re seeing the effects
00:46:40.000 --> 00:46:44.999
of you’re treating and benefiting these, whoever
is coming (inaudible)with the community.
00:46:45.000 --> 00:46:49.999
Like what we do here uh… makes a huge difference
in people’s lives. And he has diabetes?
00:46:50.000 --> 00:46:54.999
Yes. Okay. Is he taking insulin
for diabetes? No, he takes pills.
00:46:55.000 --> 00:46:59.999
Has a doctor like suggested
to take insulin or no?
00:47:00.000 --> 00:47:04.999
No. Never? Only the pills. The pills.
But when he was taking these…
00:47:05.000 --> 00:47:09.999
If you want to talk about access and the
non-emergent use of it in the emergency room.
00:47:10.000 --> 00:47:14.999
And umm… how much can you push that?
How much can you expect of that?
00:47:15.000 --> 00:47:19.999
There’s just only so much that we can do.
00:47:20.000 --> 00:47:28.000
00:47:35.000 --> 00:47:39.999
So we have a call recording in the emergency
system that is supposed to call it
00:47:40.000 --> 00:47:44.999
how busy we are. Uh… blue is like, there’s… it’s Christmas.
We’re handing out free hams every where. There is no one else
00:47:45.000 --> 00:47:49.999
in the emergency room. And that range is all
the way up to code black. During code black,
00:47:50.000 --> 00:47:54.999
we are so saturated that it feels like umm…
the place is gonna blow up at the seams.
00:47:55.000 --> 00:47:59.999
We are the front door for everyone
here in Los Angeles county
00:48:00.000 --> 00:48:04.999
and we take them all in and we see every
single one of them and that’s why we’re busy
00:48:05.000 --> 00:48:09.999
and patients end up waiting 18 hours and it’s not anybody’s
fault, it’s just by sheer volume, you can only do much,
00:48:10.000 --> 00:48:14.999
you only have so much physical space. You only have so
many resources, you only have so many nurses and doctors.
00:48:15.000 --> 00:48:19.999
Part of the system, the way it is.
00:48:20.000 --> 00:48:28.000
00:48:35.000 --> 00:48:39.999
So imagine, you’re gonna start a shift and you’re
walking in and you passed the waiting room
00:48:40.000 --> 00:48:44.999
and it’s over flowing. We’re in code
black and there it is in one space
00:48:45.000 --> 00:48:49.999
the most real representation of one
of our greatest problems and know,
00:48:50.000 --> 00:48:54.999
you know you’re not gonna be able to fix that problem
in a shift and it’s the feeding, it’s a little bit
00:48:55.000 --> 00:48:59.999
like losing before you start it.
00:49:00.000 --> 00:49:08.000
00:49:30.000 --> 00:49:34.999
Look at this. Look at this,
00:49:35.000 --> 00:49:39.999
20 hours man. I walk in, I see code black,
00:49:40.000 --> 00:49:44.999
that means holy shit like this is
not a shift to take around with.
00:49:45.000 --> 00:49:49.999
This is a shift where we need to find a way
to decompress this, this emergency room.
00:49:50.000 --> 00:49:54.999
00:49:55.000 --> 00:49:59.999
Hard block, no.
00:50:00.000 --> 00:50:04.999
Fourth can be pulled. I’m
an immigrant Asian child
00:50:05.000 --> 00:50:09.999
and my choices were physician, lawyer
00:50:10.000 --> 00:50:14.999
or you know like work class pianist and uh… my
mom when I was uh… you know, eight or nine,
00:50:15.000 --> 00:50:19.999
you know, she brought me this album where, where there is
a will, there is an A. So it was completely off right,
00:50:20.000 --> 00:50:24.999
it was a little way, it’s, you know, where there is a will,
there is an A and most families will be okay with a B.
00:50:25.000 --> 00:50:29.999
I mean, you’re slightly above average student. But my
dad would say like hey, I know you’re an A student.
00:50:30.000 --> 00:50:34.999
I know you’re an excel student so this is unfortunately
unacceptable. Please put your pants down. I have to spank you.
00:50:35.000 --> 00:50:39.999
And I was like, it made sense to me at the time
like this is clearly a failure of my ability
00:50:40.000 --> 00:50:44.999
to achieve my full potential. But you know, going along the
way, when I said, hey, you know, I’m thinking about medicine,
00:50:45.000 --> 00:50:49.999
it was just pure positive encouragement.
00:50:50.000 --> 00:50:54.999
00:50:55.000 --> 00:50:59.999
You know, I want to push myself and I’ll see as many patients
I’m slacking off and I know there is a patient to be seen
00:51:00.000 --> 00:51:04.999
but I’m you know, taking around
looking up at like my email.
00:51:05.000 --> 00:51:09.999
My dad is like gonna appear from a corner and spank me right. It could be
like, holy shit that I can’t believe, you just that. Pull your pants down
00:51:10.000 --> 00:51:14.999
in front of like all the nurses. No, but
the, the metaphorical spanking in my mind,
00:51:15.000 --> 00:51:19.999
I guess, you would say is, you know, you should
create this correlation between your pride, your name
00:51:20.000 --> 00:51:24.999
and your pride and respect for your name.
You’re senior resident down sharing in the ER.
00:51:25.000 --> 00:51:29.999
Like I, he works really fucking hard. Chest wall
stable, no crepedance and it’s gonna be weird.
00:51:30.000 --> 00:51:34.999
We’re gonna grab the things, but don’t worry, we’re gonna
take care of you. You’re really sick right now, okay.
00:51:35.000 --> 00:51:39.999
Anthony, what’s hurting right now? In your back.
All right. Here I am as a senior resident
00:51:40.000 --> 00:51:44.999
uh… embarking on this year long
kind of mission of pushing myself,
00:51:45.000 --> 00:51:49.999
pushing my juniors and really wanting
to put a stamp on this place.
00:51:50.000 --> 00:51:54.999
Come. This is your patient, bed one.
Uh… where is uh… Deb?
00:51:55.000 --> 00:51:59.999
I want to start uh… a couple of
these called fast track chair.
00:52:00.000 --> 00:52:04.999
We could try to keep people out from the waiting roomed that could
be a quick disposition, you know, up and out of the department.
00:52:05.000 --> 00:52:09.999
And we’ve done this before. It’s not something brand-new that
I just thought of today. And the chasers had her own ideas
00:52:10.000 --> 00:52:14.999
and their own arguments of why
it was… maybe not a good idea.
00:52:15.000 --> 00:52:19.999
So no one is a fast track. Like, when they bring back their
fast track, they think they are gonna bring back a patient.
00:52:20.000 --> 00:52:24.999
It will take a half hour to see them and they’ll send them home
with an appointment and it usually does not work that way.
00:52:25.000 --> 00:52:29.999
Example today, the one he brought back with
a headache, ended up with a brain tumor.
00:52:30.000 --> 00:52:34.999
Neurosurgery console, we had to pull patients to
give them a room to consult them. She went upstairs.
00:52:35.000 --> 00:52:39.999
I know, you’ve probably seen this and thinking, this wasn’t a great
fast track example where just be in and out. Well, I would agree
00:52:40.000 --> 00:52:44.999
like disagree there’s gonna end, and I put, we put
to people that end up actually being really sick.
00:52:45.000 --> 00:52:49.999
Now those two patients benefited greatly
from what he did. Because one of them
00:52:50.000 --> 00:52:54.999
had a tumor in her brain and that was
a great catch. She could have left
00:52:55.000 --> 00:52:59.999
and she had hours to go. She could have said, ah, forget
this and the later care. And I understand your logic.
00:53:00.000 --> 00:53:04.999
It’s just, and it’s on paper, it looks perfect. Right.
It should work. There is four nurses just sitting there.
00:53:05.000 --> 00:53:09.999
But there is still the ratio. These people still
need, they still need vital. But we don’t have,
00:53:10.000 --> 00:53:14.999
and we don’t have the capacity to do that in the resuscitation hallway
and that’s the whole point is that we can’t change everything here
00:53:15.000 --> 00:53:19.999
and by trying to do our little changes
here, we just seem to get more in trouble.
00:53:20.000 --> 00:53:24.999
We’re in a kind of a crisis situation. We have nurses who are
feeling overwhelmed. Since February, I have lost 15 nurses
00:53:25.000 --> 00:53:29.999
and replaced none of them. In five,
four months, I’ve lost 15 of my staff.
00:53:30.000 --> 00:53:34.999
And the lack of staffing is because
we can’t pay nurses enough
00:53:35.000 --> 00:53:39.999
and it’s one of the most challenging places to, to work
on healthcare. So in California, the nursing ratio
00:53:40.000 --> 00:53:44.999
is one nurse to five patients, the low
level acuity patients and honestly,
00:53:45.000 --> 00:53:49.999
we compensate for being underfunded and being, you know,
under staff and everything and we just make it happen
00:53:50.000 --> 00:53:54.999
like with the fast track. But ultimately it could
be my license, they could pull my nursing license
00:53:55.000 --> 00:53:59.999
and then you know, I don’t have a job. And there
is HIPPA violation, there is nursing violation.
00:54:00.000 --> 00:54:04.999
There were hundred people out there. It doesn’t make you right. I’m not saying make
it right but I’m saying there’s something different about it out there, than in here
00:54:05.000 --> 00:54:09.999
but in here, at least, they are getting treated. Out there, it’s a
hundred people just sitting there. But in here, they’re getting treated
00:54:10.000 --> 00:54:14.999
and people’s licenses are on the line. You have to… I mean, I understand
because I’ve been here long enough, from the old hospital to this one.
00:54:15.000 --> 00:54:19.999
Right, I mean that’s the hard part too. And you see these patients, and you
want to just do more… more. You have to realize there is set rules for reasons,
00:54:20.000 --> 00:54:24.999
there are set things for reasons and
there are set areas for a reason.
00:54:25.000 --> 00:54:29.999
We can’t pay for patients in the hallway here because
it’s not acceptable. Nurses can’t go out of ratio anymore
00:54:30.000 --> 00:54:34.999
because it’s not acceptable. I mean look at, look at
C-Booth, nursing ratios, there was no such thing.
00:54:35.000 --> 00:54:39.999
That the attitude there was, this is what
we got, we’re gonna get the job done.
00:54:40.000 --> 00:54:44.999
The… The day of the \"cowboy\" and I put
that in quotes obviously is gone.
00:54:45.000 --> 00:54:49.999
You can’t just come in and do whatever you
want, however you want, whenever you want.
00:54:50.000 --> 00:54:54.999
There is a lot of oversight, there is a lot of
regulation, there is a lot of feedback that goes on.
00:54:55.000 --> 00:54:59.999
It’s a much more regulated environment. These
regulations and things likes nursing ratios
00:55:00.000 --> 00:55:04.999
and the whole of the bureaucracy
here aren’t really unique.
00:55:05.000 --> 00:55:09.999
The county, I mean, this is just an American
problem. And you start to wonder if
00:55:10.000 --> 00:55:14.999
uh… these regulations
have to be here at all.
00:55:15.000 --> 00:55:20.000
00:55:25.000 --> 00:55:29.999
When I look back at the work
00:55:30.000 --> 00:55:34.999
that was done here. I’m proud of the work that we
did here but if you were to ask me was it private
00:55:35.000 --> 00:55:39.999
or was it dignified umm… the answer to
both of those questions would often be no.
00:55:40.000 --> 00:55:48.000
00:56:00.000 --> 00:56:04.999
To be a five year old boy coming out of a car
accident or with some other type of injury
00:56:05.000 --> 00:56:09.999
and having to be next to uh… someone in alcohol
withdrawal who’s you know, uh… all over the gurney and,
00:56:10.000 --> 00:56:14.999
and obviously uh… it’s gonna be pretty
frightening for that kid. That’s not fair
00:56:15.000 --> 00:56:19.999
and uh… I don’t think it was fair for the families who had to
come in and, and visit someone who is critically ill and see,
00:56:20.000 --> 00:56:24.999
you know, that, that they had to sort of put
on with all the chaos that was going on here.
00:56:25.000 --> 00:56:29.999
I had someone who’s mother had died and,
00:56:30.000 --> 00:56:34.999
and I had to show the body to them to help them through
the, the heating process and I took that poor woman
00:56:35.000 --> 00:56:39.999
and I stuck at there in booth 17, where
we kept the urinals and the bedpans
00:56:40.000 --> 00:56:44.999
and there I showed her father.
And next door there was some man
00:56:45.000 --> 00:56:49.999
saying shit, fuck, cunt,
as he was psychotic
00:56:50.000 --> 00:56:54.999
and then I showed her to my mother.
00:56:55.000 --> 00:57:03.000
00:57:15.000 --> 00:57:19.999
And we first made the move,
umm… I was ecstatic.
00:57:20.000 --> 00:57:24.999
We have a much larger, more comfortable,
private experience for our patients
00:57:25.000 --> 00:57:29.999
and I thought this is paradise, this is so much
of what our patients have deserved for so long
00:57:30.000 --> 00:57:34.999
and then I remember hearing from some of the, the faculty and
some of the residents, oh, God we’ve lost, we’ve lost something.
00:57:35.000 --> 00:57:39.999
We have lost something. It changed the intimacy
of the experience that we had with the patients.
00:57:40.000 --> 00:57:44.999
So it was, it was basically us and the
patients and you couldn’t not talk to them.
00:57:45.000 --> 00:57:49.999
You couldn’t not interact with them. You couldn’t, you were
right there. There was no separating yourself from the patient.
00:57:50.000 --> 00:57:54.999
And what you’ll find out now when you go into any
emergency department in the country, modern uh… designs
00:57:55.000 --> 00:57:59.999
have basically separated
us from the patients.
00:58:00.000 --> 00:58:04.999
00:58:05.000 --> 00:58:09.999
When you talk about privacy and logging in, the only
things that are supposed to do the right thing,
00:58:10.000 --> 00:58:14.999
its intentions are great but really our patients
aren’t benefiting as much as they would want.
00:58:15.000 --> 00:58:19.999
HIPPA checklist, whatever it is,
00:58:20.000 --> 00:58:24.999
they’re trying to guarantee patients safety
but in doing so, they’re killing the team
00:58:25.000 --> 00:58:29.999
and killing the relationship. Okay,
you keep your head still, okay. Okay.
00:58:30.000 --> 00:58:34.999
There is this sense of team
work and passion, it’s there
00:58:35.000 --> 00:58:39.999
but I feel like as soon as it’s done, it
dissipates into the computers and the charting
00:58:40.000 --> 00:58:44.999
and just sitting there and it becomes this bucket
of work, of paperwork of saving somebody’s life
00:58:45.000 --> 00:58:49.999
and that kills the passion
of saving someone’s life.
00:58:50.000 --> 00:58:58.000
00:59:05.000 --> 00:59:09.999
The patient need the lumbar puncture.
You do it on the spine
00:59:10.000 --> 00:59:14.999
and get the fluid out of it. But to do that,
I have to fill out one and eight other forms
00:59:15.000 --> 00:59:19.999
and I have to chart and it’s
taking like 25 minutes of prep
00:59:20.000 --> 00:59:24.999
just to get the procedure happen and so it’s funny like
in that moment like kind of like I’m looking for reasons
00:59:25.000 --> 00:59:29.999
to not do it, not because that I want to take care of patients
but I just don’t want to do the crap but that’s fucked up.
00:59:30.000 --> 00:59:34.999
I should, I should want to take care of
her. I should want to do that therapy now.
00:59:35.000 --> 00:59:39.999
00:59:40.000 --> 00:59:44.999
But that’s the system. I mean,
that’s not just county.
00:59:45.000 --> 00:59:49.999
Not the hospitals fault. Just… This is just a reality now in
American healthcare. We want privacy, we want regulation,
00:59:50.000 --> 00:59:54.999
we have these uh… ways of auditing, doctors and the
care here. But really what it does is in some ways,
00:59:55.000 --> 00:59:59.999
it prevents, prevents care, you know.
01:00:00.000 --> 01:00:04.999
A lot of this has nothing to do with the change in
space from there to here. A lot of it has to do
01:00:05.000 --> 01:00:09.999
with the change in the attitude for health.
Umm… there is so little tolerance for mistakes.
01:00:10.000 --> 01:00:14.999
Uh… there is so little tolerance
for the learning curve.
01:00:15.000 --> 01:00:19.999
There is so little tolerance for the
imperfections that are out there.
01:00:20.000 --> 01:00:28.000
01:00:30.000 --> 01:00:34.999
Okay, so tell things about this.
This is a work related injury.
01:00:35.000 --> 01:00:39.999
So these are usually always
uh… workers comp issues.
01:00:40.000 --> 01:00:44.999
Very commonly they become malpractice
issues which is unfortunate for us.
01:00:45.000 --> 01:00:49.999
So your chart will be looked at again. So you need to make it look really good. You
know, what I’m charting. I’m not charting to take care of the patient, I’m charting
01:00:50.000 --> 01:00:54.999
for defense purposes and just all these things
add up to be this kind of wall of bureaucracy.
01:00:55.000 --> 01:00:59.999
I, I think it’s mind-numbing. That’s
honestly what it feels like to me.
01:01:00.000 --> 01:01:04.999
As a doctor, the smallest fraction of
what I do is to take care of patients
01:01:05.000 --> 01:01:09.999
and I think as we’ve grown and we’re about to
graduate, we’re not comfortable with this.
01:01:10.000 --> 01:01:14.999
We became doctors to be with our patients
and the entire system, the whole of it
01:01:15.000 --> 01:01:19.999
isn’t letting us do that. What are you guys thinking?
You’re, you’re resident leaders, chief like,
01:01:20.000 --> 01:01:24.999
you know there are ways that we can like tangibly
bring down in the wait, the waiting room.
01:01:25.000 --> 01:01:29.999
My view uh… bringing the patients in towards us
and not just any patient, the sickest patients.
01:01:30.000 --> 01:01:34.999
So the way it was done in the hospital, the sickest patients
were literally sitting right in front of you within five feet
01:01:35.000 --> 01:01:39.999
and you always had eyes on, right.
So just take north 27 uh… 31.
01:01:40.000 --> 01:01:44.999
We have five booths in there. You scratch every
single one of them and you move as many chairs
01:01:45.000 --> 01:01:49.999
into that same space as possible. What you guys are saying is you
want to basically move fast, physically move out that to the ER,
01:01:50.000 --> 01:01:54.999
put chairs there. We want to know what the six
patients that are waiting for a bed look like
01:01:55.000 --> 01:01:59.999
even though, yes, it’s not ideal, They’re in
chairs, we are getting them all started up.
01:02:00.000 --> 01:02:04.999
I like this. I think it’s my biggest problem is seeing the
waiting room and having to be totally detached from ED
01:02:05.000 --> 01:02:09.999
and you know scrolling through page after page of
patients. Yeah, it’s a name. Your number, your age
01:02:10.000 --> 01:02:14.999
and your belly pain. That’s it. So this is
something that’s gonna require a lot of work
01:02:15.000 --> 01:02:19.999
on the part of the residents because
this is adding a large patient burden.
01:02:20.000 --> 01:02:24.999
This is our file as residents. The fourth year in
1350 in C-Booth ran the whole department, right?
01:02:25.000 --> 01:02:29.999
This is the step towards
we’re getting that back.
01:02:30.000 --> 01:02:34.999
It’s something new.
01:02:35.000 --> 01:02:39.999
It’s uh… never been done before here in LA county.
We’re taking the sickest of the sick people out front.
01:02:40.000 --> 01:02:44.999
No longer they’re seeing a nurse. No longer, they’re
seeing uh… what we call middle level provider.
01:02:45.000 --> 01:02:49.999
They are seeing a doctor, they’re seeing one of the house staff. We’re gonna make
it. We know that, we know that they’re there, we’re gonna take care of them.
01:02:50.000 --> 01:02:54.999
That’s what this uh… that’s
what this place is about.
01:02:55.000 --> 01:02:59.999
01:03:00.000 --> 01:03:04.999
So we start seeing patients directly from the
waiting room. Doctors talking to patients first
01:03:05.000 --> 01:03:09.999
and the paper work and crap coming last. And all with a
sense of urgency, I mean we’re, we’re really on our ass.
01:03:10.000 --> 01:03:14.999
And we realize oh my God, this
is, this is just like C-Booth.
01:03:15.000 --> 01:03:23.000
01:03:25.000 --> 01:03:29.999
And uh… it was amazing.
Literally, it was incredible.
01:03:30.000 --> 01:03:34.999
Just a few weeks into it, the ER
wait time actually started to drop.
01:03:35.000 --> 01:03:43.000
01:03:50.000 --> 01:03:54.999
In the end,
01:03:55.000 --> 01:03:59.999
this very simple concept had a way of renewing us.
Suddenly we were practicing medicine for the reasons
01:04:00.000 --> 01:04:04.999
that we wanted to practice medicine in the
first place. To serve, to help, to heal
01:04:05.000 --> 01:04:09.999
and the attitude went
beyond the chair experiment
01:04:10.000 --> 01:04:14.999
and suddenly in every case, we approached
in the ER. We felt a sense of adrenaline.
01:04:15.000 --> 01:04:23.000
01:04:35.000 --> 01:04:39.999
Adrenaline is a hormone, it’s been shown
when people are in traumatic situations
01:04:40.000 --> 01:04:44.999
in car accidents suddenly when they feel adrenaline,
they only see what matters and I think that,
01:04:45.000 --> 01:04:49.999
that’s sometimes ridiculously absent in
our healthcare is that we see everything
01:04:50.000 --> 01:04:54.999
but what matters. The profit,
legal consequences, legislative.
01:04:55.000 --> 01:04:59.999
That’s not what anybody really cares about when
it’s time to see a doctor and your patient.
01:05:00.000 --> 01:05:08.000
01:05:20.000 --> 01:05:24.999
You work so hard
01:05:25.000 --> 01:05:29.999
to outsmart the system but
the success of that project
01:05:30.000 --> 01:05:34.999
is heavily dependent on
01:05:35.000 --> 01:05:39.999
the well functioning of the
other areas in that department
01:05:40.000 --> 01:05:44.999
and all it takes is one thing
to kind of topple it all down.
01:05:45.000 --> 01:05:49.999
We are 48 total nurses short and yesterday, instead
of the 43, that I was supposed to have, I got 28.
01:05:50.000 --> 01:05:54.999
I can’t do business like that.
So I closed east,
01:05:55.000 --> 01:05:59.999
I also closed adult waiting. From
that I gained four, five nurses,
01:06:00.000 --> 01:06:04.999
two nursing assistants, a
clerk and a PFS worker.
01:06:05.000 --> 01:06:09.999
Not a big yield for the impact that it’s
gonna have on the emergency department
01:06:10.000 --> 01:06:14.999
but we have to do something to get the staff where we need
it. It’s always multi-factorial. When you change one thing,
01:06:15.000 --> 01:06:19.999
you have to anticipate the ripple effect.
It’s not even a ripple effect,
01:06:20.000 --> 01:06:24.999
it’s the tsunami effect
on all the other areas.
01:06:25.000 --> 01:06:33.000
01:06:45.000 --> 01:06:49.999
Since we started closure of the areas,
01:06:50.000 --> 01:06:54.999
we’ve been in code black for six days straight
and event before that, we were in code black
01:06:55.000 --> 01:06:59.999
for up to half the time anyway. The influx
doesn’t stop and here is what’s scary.
01:07:00.000 --> 01:07:04.999
It’s not gonna go away any time soon.
These people aren’t seen as profitable
01:07:05.000 --> 01:07:09.999
and the system will always find a way to still see them
as not profitable. So on the frontline, the feeling is,
01:07:10.000 --> 01:07:14.999
we need help. You know, we need to be
overfunded. We need to be over staffed
01:07:15.000 --> 01:07:19.999
because we’re this critical community resource and
right now, we can’t even run on all four cylinders.
01:07:20.000 --> 01:07:28.000
01:08:00.000 --> 01:08:08.000
01:08:35.000 --> 01:08:39.999
01:08:40.000 --> 01:08:44.999
It makes you wonder you know,
01:08:45.000 --> 01:08:49.999
I came here to see patients and to have a whole
unit closed with no patients and that is,
01:08:50.000 --> 01:08:54.999
it’s heartbreaking, soul crushing actually.
01:08:55.000 --> 01:08:59.999
01:09:00.000 --> 01:09:04.999
You would expect that if there
was a health authority,
01:09:05.000 --> 01:09:09.999
who understood that the problem we’re having right now is that
we can’t get people in fast enough to meet a loss of staff.
01:09:10.000 --> 01:09:14.999
They’d say, you know what,
we have emergency subsection
01:09:15.000 --> 01:09:19.999
B for that, go. Instead, I’m dealing with
01:09:20.000 --> 01:09:24.999
the county CEO who’s job
it is to run the county,
01:09:25.000 --> 01:09:29.999
not the county hospital but the county,
the whole thing, all nine million people.
01:09:30.000 --> 01:09:34.999
It’s, it’s hard to exist
with our unique mission
01:09:35.000 --> 01:09:39.999
right next to the department of fishing and game and the
department of parks and recreation and the department of,
01:09:40.000 --> 01:09:44.999
and, and the school district and everybody
else is clamoring for the same attention,
01:09:45.000 --> 01:09:49.999
the same resources, the same
money, the same fill in the blank.
01:09:50.000 --> 01:09:54.999
01:09:55.000 --> 01:09:59.999
We’re in a tough fiscal situation right
now across the country and the world
01:10:00.000 --> 01:10:04.999
and what we are the ground, we are
seeing what’s actually happening
01:10:05.000 --> 01:10:09.999
to the healthcare system.
01:10:10.000 --> 01:10:14.999
And I get really frustrated
with the debate on healthcare,
01:10:15.000 --> 01:10:19.999
you know, at the national level. You know,
the fact that the uninsured, diabetic
01:10:20.000 --> 01:10:24.999
who doesn’t get medications
because they can’t afford them,
01:10:25.000 --> 01:10:29.999
shows up in the ER and has a heart attack.
You pay for their care.
01:10:30.000 --> 01:10:34.999
You pay my salary, you pay that of the
nurse, you pay for the medicines.
01:10:35.000 --> 01:10:39.999
And if you had been willing to pay for
pennies of insulin today or pennies of very
01:10:40.000 --> 01:10:44.999
cheap inexpensive medication some manager
condition, you wouldn’t be paying for their
01:10:45.000 --> 01:10:49.999
tens of thousands of dollars of care when
they get really, really, really sick.
01:10:50.000 --> 01:10:54.999
Ultimately when you see our waiting room, you see people suffering
and you see other human beings in our country suffering,
01:10:55.000 --> 01:10:59.999
you go, you know, I don’t, I just
don’t see how this equates to
01:11:00.000 --> 01:11:04.999
at the end of the day a business and money and I,
I sometimes wish I could share that with anyone
01:11:05.000 --> 01:11:09.999
who wants to talk about healthcare before we even debate
about republican or democrat or Obama care or not whatever.
01:11:10.000 --> 01:11:14.999
Whatever your stand on that, it’s the notion of what, you know at
some point, it really is about doing the right thing for somebody.
01:11:15.000 --> 01:11:19.999
01:11:20.000 --> 01:11:24.999
A lot of people have no idea,
01:11:25.000 --> 01:11:29.999
you know, what a county hospital is or even
what it stands for or what goes on in here.
01:11:30.000 --> 01:11:34.999
Uh… there are many people that have perceptions
that county hospitals are all filled with
01:11:35.000 --> 01:11:39.999
uh… only illegal immigrants and they are quite shocked
when they come here and find a different reality.
01:11:40.000 --> 01:11:44.999
We see a lot of working poor.
01:11:45.000 --> 01:11:49.999
We see people willing to wait 15 to 20
hours and not going to work that day
01:11:50.000 --> 01:11:54.999
because they need to get medical care and this
is the only place they can get medical care.
01:11:55.000 --> 01:11:59.999
We see very rich affluent people
that suffer some type of illness,
01:12:00.000 --> 01:12:04.999
lose their health insurance and this is
now their only access to medical care.
01:12:05.000 --> 01:12:09.999
I mean, I’ve always had
insurance all my life
01:12:10.000 --> 01:12:14.999
except just recently when my business
imploded. What, what was your profession?
01:12:15.000 --> 01:12:19.999
I’m an attorney. Yeah.
01:12:20.000 --> 01:12:24.999
So uh… my business was embezzled and uh… because
of the recession now I’ve lost everything
01:12:25.000 --> 01:12:29.999
and uh… here I am now I can’t even walk.
01:12:30.000 --> 01:12:34.999
I don’t know where I’m living.
So living in my car.
01:12:35.000 --> 01:12:39.999
What are you gonna do next?
01:12:40.000 --> 01:12:44.999
Do you know?
01:12:45.000 --> 01:12:49.999
I’m 58. I don’t know.
01:12:50.000 --> 01:12:54.999
01:12:55.000 --> 01:12:59.999
In these times, it’s not hard to believe that
what separates us from having everything
01:13:00.000 --> 01:13:04.999
to losing everything. If one
thing slipped, one bad loan,
01:13:05.000 --> 01:13:09.999
one unexpected tragedy. It’s an
education that my classmates
01:13:10.000 --> 01:13:14.999
and I didn’t count on. But it’s
a reality we all have to face.
01:13:15.000 --> 01:13:19.999
I’m just a young doctor but to me,
01:13:20.000 --> 01:13:24.999
healthcare seems so broken and the
barriers to fix it appear impossible.
01:13:25.000 --> 01:13:29.999
I don’t know much about politics or the economy
but I think, I worry most about our spirit.
01:13:30.000 --> 01:13:34.999
And all that divide, it feels empty,
01:13:35.000 --> 01:13:39.999
lost, abandoned. Yet, there
are reminders all around us
01:13:40.000 --> 01:13:44.999
and what we’ve been able
to achieve together.
01:13:45.000 --> 01:13:49.999
My classmates and I are graduating
and we figured out all these.
01:13:50.000 --> 01:13:54.999
We’ll always remember in case C-Booth,
a case that seemed impossible,
01:13:55.000 --> 01:13:59.999
a case that we all could have easily given up
on. All right, I got a little story for you.
01:14:00.000 --> 01:14:04.999
And I want to sort of see how you guys
would handle this. 59 year old male
01:14:05.000 --> 01:14:09.999
comes into your ER. Did you all
agree, see your last stuff.
01:14:10.000 --> 01:14:14.999
You’re doing, minimizing chest compressions, you’re,
you know, doing all, everything you know how to do.
01:14:15.000 --> 01:14:19.999
You’re organizing well. Nothing.
01:14:20.000 --> 01:14:28.000
01:14:40.000 --> 01:14:44.999
You’re getting further on. He comes back, gets a faint
pulse initially and then loses it real quickly.
01:14:45.000 --> 01:14:49.999
You continue doing your resuscitation.
It’s not 30 minutes in,
01:14:50.000 --> 01:14:54.999
same now, this is not looking good.
01:14:55.000 --> 01:15:03.000
01:15:05.000 --> 01:15:09.999
You’re now at an hour into the code
and you say, listen this is futile.
01:15:10.000 --> 01:15:14.999
So it turns out that
01:15:15.000 --> 01:15:19.999
uh… sometimes crazy things
happen and some patients survive
01:15:20.000 --> 01:15:24.999
and they actually become a big part of your
life and so I’d actually like you to meet Ralph
01:15:25.000 --> 01:15:29.999
who is this patient. Ralph,
can you come on down?
01:15:30.000 --> 01:15:38.000
01:15:45.000 --> 01:15:49.999
I think it’s really easy to see
a story like this and say,
01:15:50.000 --> 01:15:54.999
that was a miracle but for us watching that
case was inspiring for something more.
01:15:55.000 --> 01:15:59.999
That one time a massive community
came together despite barriers,
01:16:00.000 --> 01:16:04.999
despite complications and
simply did what was right.
01:16:05.000 --> 01:16:09.999
Now, we’re facing the same challenges and 80 years from
now, I really hope people are back at this place and say,
01:16:10.000 --> 01:16:14.999
the best healthcare ideals blossomed here.
This is where we care for each other
01:16:15.000 --> 01:16:19.999
and that’s more important than anything.
I’m constantly amazed by my colleagues
01:16:20.000 --> 01:16:24.999
uh… here at LA County. They’re
willing to change things
01:16:25.000 --> 01:16:29.999
about their institution in the name of taking
care of patients and doing a better job
01:16:30.000 --> 01:16:34.999
for the people that need them. The doctors of
this hospital believe, we can do better at,
01:16:35.000 --> 01:16:39.999
it’s not a failed system, you know, that it can
be fixed and you’re gonna have people who believe
01:16:40.000 --> 01:16:44.999
first before you can
actually make it happen.
01:16:45.000 --> 01:16:49.999
01:16:50.000 --> 01:16:54.999
Yes, we’re gonna get you something
else for the pain, okay.
01:16:55.000 --> 01:17:03.000