01x02 - Episode 2

[bunniefuu]

Considering the patient's age

and the fact that the size
of the kidney stones is larger than 2.5cm,

the director decided to perform PCNL,

percutaneous nephrolithotomy
to shorten the operation time

and minimize the blood loss.

That's all from me. Thank you.

Thank you for your report, Dr. Wang.

Since the patient will undergo
the operation in prone position,

Dr. Hsiao will advise us
on the way we handle

the respiratory tract and anesthesia.

Dr. Hsiao.

I'm sorry.

After evaluating the patient's condition,

I've classified the patient
under ASA class two

according to
the Anesthetic Risk Assessment.

But due to the fact
that patient's jaw bone is slightly shrunk

and she has a short neck,

it might be difficult to intubate her.

So just to be safe,

I'll use depolarizing muscle relaxant,
SCC, to induce the anesthesia.

Then, a video-guided intubation system
will be used to aid the intubation.

Is it confirmed that she doesn't have any
history of adverse reaction to anesthesia?

Based on the information
filled in by the patient

and reconfirmation
with the patient's family,

she doesn't.

We'll use depolarizing muscle relaxants
as usual.

Yes, sir.

-Dr. Wang.
-Yes.

Before the surgery, confirm with Pharmacy
and Anesthesiology Department again.

In case of an emergency,

the emergency medicine
must be fully prepared.

Yes. Ms. Xu from the Anesthesiology
Department will be in charge of this.

Yes, I've arranged it
with the pharmacy department.

Everyone,
performing the surgical demonstration

during the assessment period
can showcase our clinical expertise.

All of you know it well

how high my expectation for the healthcare
quality of our hospital is.

So every single step of the surgery
must be completed without mishap.

Do you understand?

Yes.

Ma'am, what's your name?

Mei-man Lin Zeng.

Let me take a look at your bracelet.

What is your date of birth?

February 16th, 1937.

All right.

When did you start fasting?

-Since last night.
-Since last night?

Are you allergic to any food or medicine?

-No.
-No.

Don't worry. Have a seat.

It will take quite some time.

The anesthesiologist is on his way.

Just relax.

What time did you sleep last night?

Are the video-guided intubation system

-and the muscle relaxants ready?
-Yes.

It's over there. Check them out yourself.

Hi, Mrs. Zeng.
I'm your anesthesiologist, Dr. Hsiao.

-We met last night.
-Yes.

You will undergo
percutaneous nephrolithotomy today.

I'm preparing you for general anesthesia.

Okay.

You will inhale the oxygen.

You'll feel better after this.

-Breathe slowly and listen to me.
-Okay.

Just like what I told you yesterday,

the medicines will be administered
via intravenous drip to put you to sleep.

And anesthetic gas will be used
to maintain the anesthesia.

Take a deep breath after you wake up.

Don't move. Remember what I told you.

Now, inhale slowly.

The surgery we're going to perform today
is percutaneous nephrolithotomy.

The estimated operation duration
is about one and a half hours.

Blood loss, minimum.

Begin the surgery.

Guo-zhang, Ms. Song.

-Mr. Yeh.
-I bought you some food. Have you eaten?

No, thank you.

-Have some.
-Please have some.

The surgery will take some time.

I have no appetite.

Really?

Then, would you like some drinks?

Ms. Song.

Thank you.

What about you, Guo-zhang?

Wait a minute.

Hey, the body temperature.

-Is the temperature transducer connected?
-The oral temperature.

It's still increasing.

-Maximize the infusion rate.
-All right.

-Measure the blood pressure once again.
-All right.

Get the Arterial Line Insertion ready.

How's the patient doing?

I'm sorry, sir. I need to install
the Arterial Line Insertion.

Why does she need that?

We need to measure her blood pressure now.

I want to do arterial
blood gas analysis as well.

-Check the arterial blood gas.
-All right.

Sir, the muscles have become stiff.

Muscle spasm.

How could this happen?

How could this happen to the patient?

Is there any way to eliminate it?

Sir, we need to stop the surgery.

The patient may suffer
from malignant hyperthermia.

-I'll stop the anesthetics now.
-How could this happen?

Didn't you confirm the clinical history
before the surgery?

Are you sure it's malignant hyperthermia?

I only need the arterial blood
gas result to confirm this.

The body temperature is increasing.
ETCO2 is also increasing.

The heart rate is erratic.

PaCO2 75 lactate is approaching ten.

PH is only 7.2. Obviously, it's acidosis.

Malignant hyperthermia is confirmed.
We need to use dantrolene.

Dantrolene?

Dantrolene.

Go get it now.

-We need 60mg.
-Get 60mg.

Use cold saline to lower the temperature.

The body temperature is 38.8.
It's still increasing.

Body temperature is still increasing.
Dantrolene doesn't seem to work.

It's atrial fibrillation.
She needs resuscitation.

Bring in the defibrillator.

Dress the wound.
Get ready for resuscitation.

One, two, three.

Get ready for CPR.

Stop the resuscitation.

Send her to the ICU.

What?

Her heartbeat has stopped.
Why are we sending her there?

No one has ever died on my surgical table.

Suture the wound.

Send her to the ICU.

Hey.

How is my mom?

-My mom...
-You can't go in there.

-How is she?
-We're now sending her to ICU.

Why does she need to be placed in ICU?

We must monitor her closely.

-She is...
-No, tell me now.

How did my mom's surgery go?

-Now...
-Tell me now.

She's quite unstable now.
So we need to monitor her.

What do you mean by "unstable"?
Can you clarify it?

Why did you send her there?

-To be honest...
-Please explain to her family.

-Explain it to him.
-The situation is far from optimistic.

-What do you mean by that?
-What do you mean?

I will clarify with him.

Why are you sending her there?

Is the surgery a success or failure?
You need to at least give us an answer.

We still need to monitor her closely.

Her family is over there. Explain to him.

-I want to see the director
-Stop it.

Goodness.

What actually happened?

All I can say is
that we've tried our best.

I'm sorry.

Dr. Wang.

Yes.

Everything was normal
during the general anesthesia.

During the surgery, it was suspected
that the patient had a complication

by malignant hyperthermia
due to the depolarizing muscle relaxant.

Even after Dr. Hsiao administered


the malignant hyperthermia
was not eliminated.

Even after admitting her into ICU,

she still failed to be resuscitated.

After listening to the director
and Dr. Wang,

the surgeons did not do anything wrong
during the surgery.

Does everyone agree with this?

Yes.

Now, let's discuss the reason
that induced the complication.

Basically, the complication
was caused by the anesthesia.

Sir, according to the surgical records,

although the malignant hyperthermia
was caused by anesthesia,

Dr. Hsiao had ordered
the use of dantrolene

to resuscitate the patient immediately.

With regard to the medication
for resuscitation,

after the individual interviews,

it seems to be controversial.

Dr. Luo, please elaborate.

The other day,
when I was assisting the surgery,

I was looking at Dr. Hsiao.

He looked lethargic and unfocused
in front of the monitor.

I've confirmed it, Dr. Hsiao.

You've been suffering
from insomnia, haven't you?

Yes, I do have insomnia.

Since you knew
that you have rebound insomnia

and you were lethargic
during the surgery because of it,

why did you not report
to Dr. Liao immediately?

Why did you still enter
the operation room anyway?

Because we are always tired.

Sir, there are only two anesthesiologists
in our department.

There are 200 to 300 surgeries
every month.

How can we not be lethargic?

But I think I was clear-headed enough
to perform the surgery on that day.

Our job is to save lives.

There's no way we can compromise
patients' lives due to lethargy.

According to the hospital regulations,
Dr. Hsiao will be suspended from duty

until the medical board
releases the investigation results.

That's all for the surgery post-mortem.

Everyone, dismiss.

Based on the testimonies
of the medical personnel

and the operative reports,

the patient, Mei-man Lin Zeng,

had a complication
by malignant hyperthermia

due to the anesthetics during the surgery.

But the anesthesiologist, Dr. Hsiao,

had caused the death of the patient

as he was unfocused
and lethargic during the surgery.

According to the hospital regulations,
Dr. Hsiao will be suspended from duty

until the medical board releases
the investigation results.

Just watch. I'll definitely
hold him responsible for this.

Dr. Hsiao.

Stop there!

Where do you think you're going?

How could you enter the room
without getting enough sleep?

Are you insane?

-What's a patient's life to you?
-Mr. Zeng.

-That's enough.
-b*stard!

-What are you doing?
-b*stard!

-b*stard!
-Stop!

-Stop it. That's enough.
-Stop it. Okay?

-Calm down.
-Guo-zhang, stop it.

-Okay.
-Stop it.

-Let go.
-Why should I stop?

You k*lled my mom. Don't you know that?

Stop it.

Sir, what are you doing?
I'll call the police.

-I'm sorry. Don't call the police.
-It's fine.

Go ahead. He's a m*rder*r.

-Go ahead.
-We're sorry.

-Let's get out of here.
-All right.

-What?
-Let's go.

-Why are you staring at me?
-Let's go.

-He wasn't staring. Let's go back.
-I'll leave on my own.

Stop the bullshit.

I'm going to sue you.

Damn it, I'm going to sue you.
Just wait and see.

Let's go, Guo-zhang. Stop it.

-b*stard!
-Let's go back first.

Let's go.

It's okay.

I'm sorry. Guo-zhang didn't mean it.

-He's just not...
-I understand.

So what actually happened
during Mrs. Zeng's surgery?

Mrs. Zeng's cause of death

was due to her allergy to anesthetic
which caused malignant hyperthermia.

That eventually led
to multiple organ failures

and caused her death unfortunately.

Malignant hyperthermia

is a rare complication
due to an allergy to anesthetics.

It's often hereditary.

But this wasn't stated
in her clinical history.

Once I confirmed
it was malignant hyperthermia,

I immediately ordered dantrolene.
It's the remedy of malignant hyperthermia.

So you ordered the remedy
once you found out?

-Yes.
-But it did not work?

Now, we still don't know
which part of the procedures went wrong.

I handled it
according to the standard procedure.

But it didn't work.

You did take the necessary measures.

But why is the hospital blaming you?

I was...

I...

I wasn't at my best on that day.

The hospital needs someone to blame.

I've never...

I've never had any patient died
under anesthesia.

Wait a minute.

Let's not think too much right now.

Now, we need to find out
whether it's your fault or the hospital's.

You don't need to be upset about it

since we don't know
if it actually was your fault.

Do you still play basketball?

Basketball?

Basketball.

I've stopped playing for quite a while.

I stopped once I entered medical school.

That's too bad.

You were quite good at it.

You still remember it.

Yes.

Of course.

Guo-zhang, this is the hospital.
Calm down.

How could they handle it this way?

My mom is dead.
They should bear the responsibility.

Yes, it's their fault.
It's all their fault.

Go home first, okay?

Listen, I'll definitely hold them
responsible for this.

Okay, let me handle this.

I'll help you sort it out.
Let me investigate it.

Let's go.

-Good morning, Vina.
-Good morning.

You're here early.
Are you not hitting your sales target?

-Yes. Wait a minute.
-Yes?

Well...

-Can I ask you something?
-Okay.

Regarding Mrs. Zeng's surgery yesterday,

what actually happened?

I don't know.
I did what I was supposed to do.

I'm busy. You should ask someone else.

Dr. Wang.

I'm sorry.

I need to disturb you for a bit.

Can I ask you something?

You insisted on performing
the surgical demonstration.

Now that things have gone wrong,

you're putting the blame on us.

I wasn't going to ask you about that.

I know you've done your best
for the surgery.

But could you please tell me

what actually happened

in the operating room?

We've explained it
to the patient's family.

You're not her family member.
So I don't need to explain it to you.

Hey.

I'm off.

Bye.

Bye.

-Hey.
-Yes?

During the meeting,

I didn't stand up for you.

I'm sorry.

Because the management said...

I know.

But I know for certain

that we were keeping an eye
on the monitor.

You did respond to it immediately.

We're not at fault.

I don't think it was your fault.

Are you taking them all today?

No, I will come back and take them.
I didn't drive today.

Can you register a Facebook account?

Why should I?

Everyone has a Facebook account now.
You are outdated if you don't have one.

Just call me.

People no longer make phone calls.

All right, I've got to go.

See you again.

Bye.

Go there. What are you doing?

Stand properly. Can't you stand properly?

Be a watchman here. Do you understand?

Look there.

You'll be dead if someone comes over.

-Take off her pants.
-What are you doing?

She is shy.

Take off her pants.

Will she fall for you?
You are so outrageous.

Probably. Bring her home.

-Take her home!
-Take her home!

Take off her pants.

What are you doing?

-She is crying.
-Don't cry.

Let me see.

She is pathetic.

What are you doing?

Stop struggling.

-Don't struggle.
-What are you doing?

I'm sorry. I fell asleep.

Thank you.

Just put it there.

How long was it?

About 20 minutes.

You are here to get
a good sleep, aren't you?

Play it.

I'm sorry.

I'm sorry.

-I recorded this while you were asleep.
-I'm sorry.

-Did you dream about the surgery?
-I'm sorry.

No, I was dreaming...

I told you before about the dream
when I was a junior high student.

Do you think this dream is related
to your stress now?

Or could you tell me more
about this dream?

There's nothing else I can say.
It's just like what I told you.

I wake up at the same point
of the dream every time.

Hey.

Focus.

Go back to the previous question.

Where were we before you fell asleep?

The surgery failed.

Someone died.

Then, you cried.

If your judgment didn't cause
the surgery to fail,

why did you cry?

According to medical journals,

the success rate of using dantrolene
to treat malignant hyperthermia

is more than 95 percent.

But apparently, this case is one
of the five percent. Do you understand?

So you can't accept your own mistake?

No, it's because I had taken
the necessary measures

and used the medicines in time.

So this shouldn't happen.

Doctors are also humans.
Can't a doctor make mistakes?

As an anesthesiologist,
we can't make mistakes.

As a psychiatrist,
you only need to talk to your patients.

Nothing will go wrong
if you say something wrong.

I can't inject the wrong vein.
I can't make mistakes.

Mistakes are not allowed.

Mistakes are not allowed.

There's no room for mistakes.

Come here and sit down.

I want to clarify something.

Did you cry
because of your failure at work

or because you've caused someone to die?

Now, you have
two unresolved feelings in you.

I understand that you feel guilty.

But this is not
the main source of your stress.

What is it then?

If the failure rate of the surgery
is only five percent,

then why did it fail even when
you had made the right judgment?

So what are you trying to say?

Logically,

you have to figure out the problems
that cause the five percent of failures.

Would you like some hot tea?

So?

Okay, Guo-zhang.

All right, stop drinking.

Guo-zhang.

I'm sorry.

Ms. Song.

-Mr. Yeh.
-Hello.

Why is Guo-zhang so drunk?

What happened was too sudden.
Just let him drink.

Then, I will talk to him later.

Should I help you send him home?

I'm sorry, Mr. Yeh.

-Here.
-Thank you.

I want to ask you...

The anesthesiologist was actually
my classmate in junior high school.

He was?

What a coincidence.

Did he really cause the surgery's failure?

Actually, the reason why
I asked Guo-zhang out today

is to tell him

that I don't think Mrs. Zeng's case

is that simple.

Sorry, but I don't understand.

Let me put it this way.

-After the incident,
-Yes.

the hospital released the investigation
report the very next day.

That is suspicious.

It was a surgical demonstration
and the director was the main surgeon.

But the report only mentioned Dr. Hsiao.

Other details were not specified.

So I think what actually happened
in the room was different

from what was stated in the report.

So it was not
all Dr. Hsiao's fault, was it?

I won't say that it has nothing
to do with him at all.

After all, he was in the operating room.

So he should know better
about what happened in the room.

Goodness.

Guo-zhang.

Are you okay?

You've hurt yourself.

-Come on.
-Sit down.

-Sit down.
-Come on.

Are you injured?

-Mom died because of me!
-No.

Mr. Yeh, I really don't know what to do.

I really need your help.

No matter what,

I'll try my best to investigate this.

Thank you.

All right, let's go.

-Let me help you.
-Thank you.

Guo-zhang.

Come on, let's go.

Be careful.

Malignant hyperthermia

There's a kind of medicine
used in the surgery.

It's called dantrolene.

Dantrolene?

Was the medicine used?

Yes.

An old lady died. Don't you know?

It's clearly stated in the report
that dantrolene was used.

That medicine is rarely used.

How common is malignant hyperthermia?
What genes are related to it?

Did you order it?

I'm not in charge of this.

I'm not sure.

Zhu, the patient wants
to take the medicines.

-I need to get back to work.
-Zhu.

Dantrolene importer

Look at this inventory.

Renxin Hospital hasn't been ordering
dantrolene in the last two years.

You know dantrolene is rarely used.

You're lying, Jiang.

There was a surgical demonstration
two days ago.

Dantrolene was used during the surgery.

Where did they get the medicine
if you didn't sell it to them?

Wait a minute.

Look, this is our inventory.

It's all here.

Renxin Hospital hasn't ordered
this medicine in the last two years.

It's true.

Zheng-xun Hsiao, Doctor

Depolarizing muscle relaxant

MEDICAL CENTER

Hey, Dr. Hsiao.

Hi.

Your pants are unzipped.

Are you leaving the hospital?

I don't need insurance.

Wait, you forgot your thermos. Here.

Thank you.

Do you know that your hospital

has not purchased dantrolene
in the last two years?

That doesn't make sense.

I gave dantrolene once we confirmed
that it was malignant hyperthermia.

If dantrolene was given in time,
why did Mrs. Zeng die?

Dantrolene does not always work
on hyperthermia.

I've done some homework.

It works 95 percent of the time.

You couldn't be so unlucky
to fall within that five percent.

Then again,

if it's not a definitive cure

as you just said,

why didn't the hospital include that
in the report and publicize it?

Why did the medical board put
all the blame on a good doctor

before the judicial decision?

Someone is running away
from the responsibility, isn't it?

It's not strange for them
to blame it on the anesthesiologist.

Otherwise, who's going to
take the blame? The director?

Sir, all your dishes are served.

-Please enjoy.
-All right.

I would like to apologize to you,
Mr. Speaker.

There was an emergent patient
the other day.

The anesthesiologist needed
to take care of that patient.

That's why we were unable to perform
the painless delivery for your wife.

Mr. Speaker, please forgive us.

I'll drink this as a punishment.

Forget it.

You couldn't have had so many doctors
involved with my wife's delivery.

It was an unreasonable request.
Don't you think so?

No.

We should've accommodated the request.

It's just that we had some issues
with the personnel deployment.

I hope you could give us another chance.

You are too humble.

I can easily persuade my wife.

But since we will be working together
a lot in the future,

you should man up and be bold.

You have the authority
to determine the rules, don't you?

Rules?

Rules must be in place

to regulate the situation.

Am I right?

Hey.

Of course.

That's why I said Mr. Speaker is generous.

He won't bother about these little things.

Here you go, Mr. Speaker.

Cheers.

But I heard that someone died

during the surgery you performed.

Although the result of the surgery
won't affect the assessment,

how could I refer my friends
to your hospital?

The surgery failed
only because of the anesthesiologist.

It has nothing to do with our director.

This is just some misunderstanding.
I hope it won't affect your trust in us.

The hospital should be held responsible
for its physician's wrongdoings.

Before the public rebuilds their trust
and confidence in your hospital,

I'm sure you know what to do
to get what you want.

Mr. Speaker, have a drink.

This is totally personal.

It has nothing do with the business.

Yes.

-Sir, let's toast for Mr. Speaker.
-Come on.

-Cheers.
-Cheers.

Sir, regarding Mr. Speaker...

I know what you want to say.

I'm the director of the hospital.

I hope the hospital can pass
the assessment more than anyone else,

but we need to hold on to our principles.

But not only is the speaker
the committee of the board,

he also has control over the factions
and profit distribution of the region.

It will be very difficult for us
if we get on his bad side.

Of course,
we can't disgruntle the villain.

But we also can't depend
on him monetarily.

Renxin Hospital did make it

as the regional teaching hospital
without his help last time.

Tzu-chiang.

I don't care how you are related to
Mr. Speaker,

but I hope your personal matters

won't affect the hospital professionally.

The next milestone for the hospital
is to become a medical institution.

In terms of budgets,
manpower and infrastructure,

I need your help to rectify
and reform them.

Remember this.

Serious problems are often monetary.

Dr. Hsiao.

My client died in your hospital
due to medical malpractice.

I think I must investigate this.

I talked to the pharmaceutical company.

That's why I'm certain
that your hospital hasn't purchased

dantrolene in last two years.

That's impossible.

But could you tell me honestly

what actually happened
in the operating room?

I've told you.
We took all the necessary measures.

I also gave her dantrolene.

Are you sure it was dantrolene?

What else would it be?

I don't know.

Are you saying that the hospital
used counterfeit drugs?

You are the physician of the hospital.

What do you think?

That's impossible.

Do you have access to it?

To what?

Dantrolene.

"Medicines that will expire
in less than a year

will be collected and disposed of
by the manufacturer."

Let me introduce him.
This is Mr. Gui-heng from the FDA.

Nice to meet you.

We need more
than their purchase order record.

But your hospital did purchase
dantrolene from them.

Now, every department
has quotas for their expenses.

It's normal to purchase cheaper products.

I heard that Dr. Hsiao
is still in the hospital,

asking around about the cost-cutting.

This hospital is sick.

If you can't change the system,
then what are you trying to change?

NEXT EPISODE

I just want to be a good physician.