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00:00This program dramatizes true medical enigmas reported by the doctors themselves.
00:06The names and characteristics of the people have been altered.
00:10When we enter a hospital, we think that the doctors have all the answers.
00:16They don't have them.
00:20When a child comes to the hospital so sick...
00:24I've never been so sick.
00:26We get very scared.
00:29There are significant deposits of heart fat.
00:32Dr. Booker, the blood pressure dropped.
00:34It's like an adrenaline injection.
00:35I've never seen such a convulsion.
00:37You've never seen it because it shouldn't happen.
00:39She was dying right in front of me.
00:43We walk on the edge of the ship every day.
00:45Low saturation and tachycardia.
00:47Normal blood is not like that.
00:49Test it now.
00:51We look and try to find an answer, but there is none.
00:54We have to act quickly.
00:59The shock could save her.
01:01The shock could kill her.
01:03Oh, my God.
01:04Everyone back.
01:12I'm Rob Colvin. I practice emergency medicine.
01:15Today I'm here trying to act.
01:17We have two more doctors on the set.
01:19Dr. Garcia, who is a real doctor.
01:23And Dr. Cordelia.
01:25Cardillo.
01:27I'm Anthony Cardillo. I'm an emergency doctor.
01:29These are real cases.
01:31We're here to share stories with viewers.
01:34This story is based on a real case I attended two years ago.
01:38It was exciting. It was scary.
01:40A life or death case.
01:42This patient died several times in my hands.
01:44It was during this case that I met my fiancée.
01:46Yeah, I'm engaged to this handsome doctor here.
01:49I have the microphone, I already have the speech, the makeup, the hair.
01:53They try to make us look good.
01:55It's challenging. It requires memorization.
01:58I try to be a reasonable actor, but it's a lot of fun.
02:03What's harder, being a doctor or being an actor?
02:05I think being an actor is harder than being a doctor.
02:08Although the actor has a second chance.
02:10The doctor doesn't.
02:12Cameras. Scene 1. Take 1.
02:14Action. Cardillo.
02:16Let's go.
02:19Scene 2. Take 2.
02:22Cove, I want you to evaluate Dr. Harter today.
02:25Her last evaluation was about how she deals with patients.
02:30Come here and lie down, please.
02:32Is it hard for us both?
02:35Just the last evaluation?
02:37She says everything she thinks.
02:39Maybe it's just stress.
02:40The residents here don't have therapy sessions?
02:43Ah, the psychiatrist said it was true.
02:46Do you think doctors should have therapy sessions?
02:49I'll supervise her. Don't worry.
02:52It usually takes 18 seconds for a doctor to evaluate a patient's character.
02:57It's the time a common person takes to form their opinion about another individual.
03:01And when we make an image of a person, it's hard to think otherwise.
03:07Very well.
03:08Ah, Mrs. Ebbett, this is the doctor in charge of...
03:11How do you do? Nice to meet you.
03:13Here.
03:14Well, Doctor, he arrived here yesterday with severe diarrhea and dehydration.
03:18He spent the whole night in observation, taking serum.
03:21And when I came to release him, he had developed cyanosis and hypoxia.
03:25I see.
03:26Cyanosis is when the patient's color turns blue.
03:30It means he doesn't have enough oxygen in the bloodstream to feed the tissues.
03:36Breathing accelerated, pressure 9 by 6.
03:39I gave oxygen 10 liters with the mask, but it doesn't seem to make a difference.
03:44This monitor is the heart rate, isn't it?
03:47Yes.
03:48128 is too fast, isn't it?
03:50We're giving oxygen to try to lower it a little.
03:52In addition to that child being cyanotic, his vital signs were very altered.
03:57He was hypoxic, tachypneic, breathing very fast.
04:01He's never been so sick.
04:03I don't hear any moaning.
04:05What's his name?
04:06Josh.
04:07Josh.
04:08There was no incident.
04:10Josh.
04:11Josh.
04:12There was no incident at school, as far as I know.
04:19Josh, you can sit down, please.
04:24I don't hear any fluid in my lungs,
04:26but we're going to do a thoracic radiography and arterial gasometry.
04:30Are we going to do an echocardiogram on him, too?
04:33His mother is the manager of a local medical clinic.
04:36Now I understand. It would be great to have your help, ma'am.
04:39We're going to do the radiography first, and then we'll see.
04:42Then we'll do the echocardiogram, okay?
04:44Great, thank you.
04:45Most parents don't have medical training.
04:47They don't know what's going on with their child.
04:50They just know he's sick.
04:52They have the natural intuition that something bad is going on.
04:59Jessica Yane, 21 years old.
05:01He had a seizure in the beauty salon.
05:03I'm fine, really. I have epilepsy.
05:05I forgot to take my medicine, see?
05:09It's nothing serious.
05:10We make a lot of decisions based on the first impression,
05:13and in medicine we call that an entry-level diagnosis.
05:16As soon as I saw that patient, I knew what was going to happen.
05:20She was epileptic and had forgotten to take her anticonvulsants.
05:24I didn't even ask for a blood test.
05:27It was that simple.
05:29Show me.
05:34When a child has cyanosis,
05:36there are some hypotheses that we analyze to try to find the cause.
05:40There's a reason for it to be blue.
05:45He never had heart problems.
05:48Well, sometimes those things show up for the first time in this age.
05:51It could be a defect in the atrial septum or ventricle.
05:55It could also be a problem in the lungs.
05:58The cardiac silhouette looks normal.
06:00The pulmonary vasculature is also within normal limits.
06:04In this particular case, my radiography evaluation didn't help much.
06:09It was a normal thoracic radiography.
06:11There was no acute pulmonary process that could cause that kind of cyanosis
06:16or that level of cyanosis.
06:18What's the problem with this boy?
06:27I have to go. It's time to go.
06:29I hit her head so she wouldn't hit the floor.
06:31So, are they sisters?
06:33No, but people always ask that.
06:35I'm pregnant.
06:36Okay, okay, I get it. They're not sisters.
06:38No.
06:39Vital signs?
06:40Pressure 12.8, temperature 36.5, no visible bruises, no bleeding.
06:45She was excited. She was very anxious.
06:48He's so dry.
06:49I know.
06:50Doctor, I don't want to be rude, but my graduation is tomorrow
06:53and I need to take the plane in three hours to pick up my parents.
06:56I really need to go.
06:58Please, let me go. Please.
07:00Here's what we're going to do.
07:01Answer a few questions.
07:02We're going to run some tests.
07:04If everything's okay, you can leave in 30 minutes, maybe an hour.
07:07Oh, thank you so much.
07:09Doctor, she has a heart attack.
07:11It's beating at 5.30.
07:12I'm so excited about my graduation.
07:15We put Jessica on the heart monitor
07:18and she had a heart attack.
07:20In other words, her heart was beating too fast.
07:23She's graduating with a degree in economics.
07:26When there's excitement, it's like a wave of adrenaline
07:29and it can speed up the beating.
07:31What kind of anticonvulsants do you take?
07:33Only phenytoin.
07:34I usually take it before I go to bed, but last night we went to a party
07:37and I drank a little and I was...
07:40And how much is a little?
07:42Okay, it was a lot.
07:49But it was beer, just beer.
07:51Do you take other drugs?
07:53No, I only take this one.
08:00All right.
08:01Collette, let's check the level of phenytoin
08:03and do a full blood test.
08:05All right.
08:06Excuse me, dear, it'll only take a second.
08:10Collette, she's having a seizure.
08:12Don't take the blood.
08:13Emily, I need you to leave the room.
08:15Excuse me.
08:16There's no pulse.
08:17Suction.
08:20Her heart stopped.
08:23See?
08:26Defibrillation.
08:28Jessica had a cardiac arrhythmia.
08:31It's called ventricular fibrillation,
08:33when the contractions are irregular.
08:35I've never seen a seizure like this.
08:37You've never seen it because it shouldn't happen.
08:39Epilepsy doesn't cause fatal arrhythmias.
08:42It's the worst nightmare of any doctor.
08:44There's no time to think.
08:46There's only time to act.
08:51Jessica Yang, 21, arrived at the hospital with a declared epilepsy,
08:55but then her heart showed a fatal arrhythmia.
08:58Her heart stopped.
09:00She was dying right in front of me.
09:02Is that really it?
09:03I don't know.
09:04The movement of a convulsion, all that tremor,
09:06can cause a mechanical distortion in the monitor,
09:09and sometimes it can only seem to be a fibrillation.
09:12I don't believe the monitor could be wrong like that.
09:14I only had a second to make a decision.
09:17Give me the cart.
09:18The only thing that could save her
09:20would be to get her heart back to normal.
09:23What are you going to do?
09:24I want to see if I can make a reading at this rate.
09:27If she was in a convulsion and it gave her a shock,
09:30it could cause a fatal cardiac arrhythmia.
09:33So I waited for the convulsion to pass.
09:36She's still fibrillating.
09:37Noelle needs 200 joules.
09:39It's against the protocol.
09:40The protocol was made by Ares when her heart stopped beating.
09:43I understand. 200 joules.
09:45It was a difficult decision.
09:46The shock could save her.
09:48The shock could kill her.
09:49Everyone back.
09:52We can't panic.
09:54We have to put our emotions aside and trust our instincts.
09:59But what do we do?
10:07Josh Abt, 5 years old,
10:08doesn't have enough oxygen in his blood.
10:11And at that moment we didn't know why.
10:13Josh's thoracic radiography was within normal limits.
10:17Do you want me to call Josh's father?
10:20His father isn't around.
10:21I've already called my sister and she'll be here soon.
10:24I still wanted a better evaluation of his pulmonary anatomy
10:28to make sure we weren't missing anything.
10:30So I asked for a tomography to better examine his pulmonary tissue.
10:40Jessica Young's fatal cardiac arrhythmia caught us off guard
10:44and we had to reduce the shocks.
10:46We didn't know if it was the right thing to do,
10:48but even if it was, what would we do next?
10:56Dr. Harper,
10:58take a deep breath and relax.
11:03It's very easy to talk.
11:04It's always important to have a good history of the patient.
11:07In Jessica Young's case, it was crucial.
11:10I tried to get some answers from her friend, Amy.
11:13But she's very healthy.
11:15She never complained about heart problems.
11:17No, and I'm sure she'd tell me.
11:20She tells me everything.
11:25I know that epilepsy can cause cardiac fluctuations,
11:28but this is very different.
11:31I recommend administering amiodarone.
11:34This should regulate the heartbeats.
11:37There's no formula for this.
11:40Stay focused.
11:42In addition to yesterday's party,
11:44what else did Jessica do in the last few days?
11:47I don't know. She went out with her boyfriend.
11:55Are you sure she told you everything that happened yesterday?
11:58Listen, did Jessica use any kind of drugs?
12:01No.
12:02It's hard to treat such young patients
12:05because they still have their whole lives ahead of them.
12:07I still have a few questions for you.
12:09It's very important to make the right decision.
12:12We're dealing with people's lives,
12:14and the consequences are serious.
12:21We did a full examination on Josh Abbott.
12:25What's going on between you and Dr. Garcia?
12:28What do you mean?
12:30Wow, the color of your face says it all.
12:33I don't know.
12:36No pleural or pericardial effusions.
12:39No pulmonary edema.
12:41The thoracic tomography is normal.
12:44The tomography was normal,
12:46as was the thoracic radiography.
12:48We had no idea what it could be.
12:50We didn't have a diagnosis.
12:52What do you want us to do now?
12:54We need to think about all the situations,
12:56analyze all the hypotheses.
12:58Hemolytic anemia, hypoglycemia, polycythemia,
13:01exposure to chemical products.
13:04I received a message about Josh.
13:06When we hear that a child is getting worse rapidly,
13:10we get very scared.
13:17Tachycardia, and the saturation has dropped 8 points.
13:19Can I help? What can I do?
13:20No, ma'am. Excuse us, please.
13:22Any oxygen saturation below 92 percent...
13:24Where's his bladder? It fell on the edge of the bed.
13:26It's a bad thing. Josh Abbott's was at 85 percent.
13:29He doesn't need to be reanimated, does he?
13:31Doctor, where's the ABG?
13:33There are certain tests we have to do
13:35to treat a child with cyanosis,
13:38and one of them is arterial gasometry, or ABG.
13:41I haven't done it yet.
13:43Why not?
13:44He was moving a lot, and then I couldn't...
13:46The normal blood collection we all know
13:49is done in the venous system.
13:51It's very peripheral veins, close to the surface of the skin.
13:54The arteries are at the bottom of the tissues,
13:57and that's why they're always close to very sensitive nerves.
14:01All right, ask John right now, all right?
14:03Quick.
14:04It's a painful procedure, especially for a child.
14:13How long did the last convulsion last?
14:15Maybe five, seven minutes.
14:17Jessica Young was seriously ill,
14:20but it didn't make sense for a 21-year-old girl
14:23to have a convulsion and then a cardiac arrest.
14:26And that was the only one she had today?
14:28Yes, doctor.
14:29Oh, my God, Jessica!
14:32Good morning. How are you feeling?
14:35What's wrong with me?
14:36I want you to try to relax, all right?
14:38I have a few questions for you.
14:40Have you ever had heart problems before?
14:42Chest pain, shortness of breath?
14:44No, just... just eclipses.
14:46But she's had convulsions more often.
14:49Yeah, but they told me at the campus clinic
14:51it was because of the stress.
14:53I need to call my parents.
14:55All right, you can call them.
14:57There was something that was increasing
14:59the frequency of convulsions.
15:01The question was, what?
15:02I need a brain tomography,
15:04especially now that the frequency of convulsions has increased.
15:07But we know she didn't have any trauma
15:09and we know she has epilepsy.
15:10I know, but there may be something else besides that.
15:13We have to make sure there's no intracerebral hemorrhage,
15:16no aneurysms or tumors.
15:18I needed a precise diagnosis
15:20or a clear reason for that to be happening.
15:26He doesn't seem to have burns on his mouth or nose.
15:30But what about chemical burns?
15:32We managed to slow down Josh's heart rate,
15:35but he seemed very intoxicated.
15:38So the next hypothesis in our line of reasoning was,
15:41could Josh have some kind of toxic substance in his body?
15:45Do you live near a factory?
15:47Of course not.
15:49And anything you have at home,
15:51any poison, ink or cleaning product?
15:55No, I leave dangerous things locked up.
16:03And the medicine cabinet, did he open it by any chance?
16:06I told him not to do that, and he's very obedient.
16:15Good boy.
16:17Dr. Cardino, you'd better take a look at this.
16:20When my resident collected the blood,
16:22we had an idea of what could be going on.
16:25This isn't normal blood.
16:27His blood was dark, chocolate-colored.
16:32And this doesn't look like normal blood.
16:35Mommy will take care of you, dear.
16:42Take it easy.
16:44I asked for a brain tomography for Jessica Young.
16:46There's nothing. No hemorrhage, no tumors.
16:48What now?
16:50Doctor, the pulse and blood pressure dropped.
16:54She needs a normal saline serum.
16:56Minister Epinephrine and Noelle, start the manual respiration.
16:59Emily, I need you to wait there.
17:01She got worse quickly.
17:03Dr. Harper, we need to intubate her.
17:05Her blood pressure and heartbeat dropped,
17:07and she wasn't breathing.
17:09None of this made sense.
17:10I'm ready.
17:11I was treating her, and instead of making her condition better...
17:14Epinephrine.
17:15She only got worse.
17:17Go ahead, insert the tube.
17:19Epinephrine is like an adrenaline injection.
17:22It increased her blood pressure and heartbeat.
17:25It was the only drug available to save her life quickly.
17:29Nasal tube.
17:32Oh, my God, no! Please!
17:35Nasal tube.
17:37Suction.
17:38What's suction?
17:40It was a normal procedure to insert a gastro-nasal tube
17:43in a patient after intubation.
17:45But when we did that...
17:46Are they compressed?
17:48We found compressed fragments in her stomach.
17:51That didn't make sense.
17:52She didn't take the phenethylamine.
17:54But nothing in this case made sense.
17:57Let's do a toxicological test.
17:59We assumed it was a possible overdose.
18:02Do you think the grandma formanda tried to kill herself?
18:05This was the scariest case I've ever faced.
18:07My 21-year-old patient died several times,
18:11and nothing I did improved her condition.
18:15In fact, she only got worse.
18:21Alex.
18:24This isn't good at all.
18:26The color of my patient's blood, Josh Abt,
18:29was very dark, a chocolate color.
18:31That's not normal blood color,
18:33but it was a very important clue
18:35to find out what was wrong
18:37and why he was cyanotic.
18:39I'll do the test now.
18:43Thanks, Alex.
18:44When blood is normal,
18:46it's usually bright red when exposed to oxygen.
18:51Chocolate blood, cyanotic, isn't like that.
18:54It remains the same color.
18:57Do you know what that is?
19:00That's...
19:04Methemoglobinemia.
19:05Methemoglobinemia.
19:07It means he wasn't transporting
19:09enough oxygen to all tissues.
19:12Was it a congenital problem?
19:14Was the child already carrying the problem
19:16from birth and was only now showing it?
19:18Or was it an induced or acquired problem?
19:21The child had ingested something.
19:23Look at this.
19:24His methemoglobin level is 42%.
19:27Isn't normal 2%?
19:292% is normal.
19:3060% we died.
19:32We had to act quickly at that moment.
19:36The lab is going to take a while to analyze this.
19:40We had to intubate Jessica Young
19:42after suffering two episodes of dangerous arrhythmias.
19:45When we inserted the gastro-nasal tube,
19:47we found compressed fragments.
19:49But she knew she hadn't taken phenytoin,
19:51so it must have been something else.
19:53The compressed were in pieces.
19:55I don't know what that is.
19:57Tell the door to open so I can get in.
19:59Are you sure it's not bullets?
20:01She sucks bullets all day.
20:03Wait a minute.
20:04A box.
20:06Full of toys.
20:08It's possible it's an overdose.
20:10Collette, Minister of Vegetable Coal.
20:12Emily, Jessica acted strangely in the last few days.
20:15She was depressed or sad.
20:18Any information about her lifestyle was crucial.
20:22Just with her weight.
20:24She didn't fit in the dress she wanted to wear to school.
20:28She resumed her diet, but that's it.
20:30She didn't fit in the dress.
20:32What size is she wearing? Zero?
20:34Well, we don't always think so, skinny.
20:36So she's bulimic.
20:37No, no, no, no, no, no, no, no, no.
20:39Emily needs to be 100% honest.
20:41There's nothing in the bag.
20:43Emily.
20:45Bulimia would explain convulsions and arrhythmias.
20:48It could be the answer that was in the bag.
20:50I don't think so.
20:52I don't think so.
20:55It could be the answer we were looking for.
20:57It could be the answer that connected all the facts.
21:00I need the results of the tests.
21:02But, no.
21:08Doctor, call the pharmacy and get a blue piece of methylene.
21:11Two milligrams per kilo.
21:13You can leave it.
21:15Our patient, Josh Abt, had a condition called methemoglobinemia.
21:19There are many lung problems
21:21in which the lungs themselves can't properly oxygenate the child's blood.
21:26The treatment is very specific.
21:28It's called blue methylene.
21:30What are the probable disorders for this case?
21:33Ah, in general, it's either congenital or acquired.
21:36Okay, if it's congenital, it could have occurred even earlier, right?
21:39Blue baby syndrome, which is usually acquired,
21:41can occur due to some kind of intoxication,
21:43whether environmental or pharmaceutical.
21:45Okay, aniline, anesthetics, nitrates, things like that.
21:48I'll ask for a blood test for the most probable substances.
21:50I'll talk to her.
21:52Hello.
21:54We found out why Josh has cyanosis.
21:57And we know how to reverse it.
21:59But we still don't know what the underlying cause is.
22:02We're reversing the process of methemoglobinemia,
22:05but we're not curing the problem.
22:07Did you hear that, Josh?
22:12Yeah, I know it could be.
22:14Dr. Cardillo.
22:15Ah, sorry to interrupt.
22:17It's okay, I was on my way out.
22:22The gossip can be fatal,
22:24because no one likes to get involved in their personal lives at work.
22:27That's the problem.
22:29Why don't you take care of Blue Baby Syndrome and wait an hour?
22:31We'll talk later.
22:33If it interests you, I think she's with you.
22:40Oh, I know I saw her name.
22:42Where are you?
22:43Alex, if you do this, you'll kill me.
22:45I need someone here to help you.
22:47Colby, how are you?
22:48I've had better days.
22:50I needed to check Jessica Yang's electrolytes
22:52to see if this could be the cause of arrhythmia and convulsions.
22:55It's here.
22:57All right, let's see.
22:58Negative for toxins.
23:00But the calcium is at 6.4.
23:03Would you say it's low enough to cause convulsions and arrhythmia?
23:06Calcium is a very important ion in the body.
23:09It regulates both the heart and the brain.
23:12Let's administer calcium and see if it improves.
23:15All right.
23:16Medicine is never a precise science.
23:18You're limited by the tests you do.
23:21And at that time, I bet it would be calcium.
23:25Noelle, it's Rod.
23:26Listen, the calcium is at 6.4.
23:28We have to give you a calcium ampoule now.
23:31Don't argue, just obey.
23:34This case was so complicated
23:36and I finally thought I'd found an answer.
23:40At that time, Jessica was the most serious patient in the emergency room.
23:46Well, doctor, it's been 45 minutes since we injected the calcium.
23:49And the last convulsion was an hour ago.
23:51Excellent.
23:52Oh, it's Jessica's parents.
23:54Hi, my virus.
23:56Bring the defibrillator. It needs 1,500 joules.
23:59My bet was wrong again.
24:01I didn't know if I had another chance.
24:04Every wrong diagnosis I gave you could be the last.
24:09Hello?
24:15The saturation is back to normal.
24:17Very good, Josh.
24:18We still have to find out why this happened.
24:21But for now, it's great news.
24:23If the child had ingested a toxic substance only once,
24:27it would be curable.
24:29How are you, Josh?
24:30Fine.
24:32I'm hungry.
24:35Oh, Claire, I'm sorry I'm late.
24:37I was in traffic. I had an accident.
24:39How is he? Is he going to be okay?
24:41He's fine.
24:42We're trying to figure out why he's cyanotic or blue.
24:45The results will arrive at any moment.
24:48Claire, I brought everything you asked for.
24:51Oh, of course.
24:52I brought apple sauce, some clothes.
24:55Oh, Josh, I brought your fire truck.
24:58Hey, baby, look at that.
25:00Let's leave Josh alone with the family.
25:02We'll examine him later.
25:04You know he'll be home soon, okay?
25:08Look what Mommy has here.
25:12We treated Josh's methemoglobinemia with mediline blue.
25:16We reversed the process that was underway.
25:18Soon, the case was closed.
25:21Dr. Cardillo, is Josh okay?
25:23Suddenly, for no reason, Josh got worse again.
25:27Another disaster.
25:29He was having a hard time breathing.
25:31He was getting more cyanotic.
25:33It was my worst nightmare.
25:36Honestly, I don't know how to explain what's going on.
25:40But yesterday's party has nothing to do with it.
25:42Jessica was very sick.
25:44She was intubated.
25:45And she was taking a lot of medication.
25:48We have medication for convulsions,
25:51medication for arrhythmias,
25:53and medication to keep her blood pressure and heart stable.
25:57We transferred Jessica to the ICU
26:00because we couldn't provide the care she needed.
26:03Ma'am, where is Jessica?
26:04They're Jessica's parents.
26:05Where is our daughter?
26:07Jessica Young.
26:09Hi, Doctor, where is my daughter?
26:10Hello, I'm Dr. Colvin.
26:11I'll take you to see her.
26:13I want to prepare you for what you'll see, okay?
26:15See the tubes, see a respirator in a family member
26:20is very depressing and very scary.
26:23Doctor.
26:29My daughter.
26:33Excuse me, I know it's hard for both of you,
26:36but I still have some questions for you.
26:42Is she going to die?
26:44No, no one is going to die.
26:46Is she going to die?
26:48No, no one is going to die.
26:54I didn't have a diagnosis,
26:56and without an answer, I couldn't do anything.
27:05Our five-year-old patient, Josh Ebte,
27:07was very sick with a rare blood disorder
27:10that we diagnosed correctly and treated.
27:12But the boy was getting worse.
27:14He's still very cyanotic.
27:16I think the methylene blue isn't working properly.
27:19We were treating methemoglobinemia,
27:21but he got worse again.
27:23That's right, girl.
27:25It didn't make sense, because the methylene blue
27:27should have solved the problem.
27:29But he kept getting worse.
27:31But you said it would work.
27:35Could it be something else?
27:40We didn't understand.
27:42There's nothing wrong with his tests.
27:45No changes.
27:47Nothing.
27:49Should we give him more methylene blue?
27:51He only got worse with the blue.
27:54It was strange. We were confused.
27:56We didn't know what was wrong with him.
27:58We didn't know what to do.
28:00How did he get better the first time?
28:02There must be something more systemic.
28:04We need vitamin C via venous.
28:06Vitamin C.
28:08Dr. Whitney, we have a lot of work to do.
28:10Let's get to work.
28:13How is she?
28:15Still the same.
28:17We have to do more tests.
28:19She's too unstable now.
28:21Jessica Young had such frequent crises
28:23that we needed to be by her side all the time.
28:26The question wasn't whether this would happen,
28:28but when.
28:30I'll take your place.
28:32When a patient's heart stops beating,
28:34there may be damage to other organs.
28:37And in Jessica's case,
28:39we were especially worried about her brain.
28:41Whenever the brain runs out of oxygen,
28:43there may be brain damage.
28:45And that's what we wanted to avoid.
28:51Oh, my God!
28:53Ms. Young, wait outside, please.
28:55Dolores!
28:57Ms. Young, I need you to wait outside.
28:59Finally, I was able to notice
29:01that cardiac arrhythmia was taking place
29:03before the convulsion.
29:05And I had to confirm it.
29:07Check the pulse.
29:09No pulse.
29:11The brain was running out of oxygen.
29:13I was sure the problem was the heart.
29:15Time is passing.
29:17I know what I saw.
29:19She had arrhythmia and then a convulsion.
29:21I don't doubt you.
29:23I just wonder why.
29:25It's hard to see what comes before.
29:27It's hard to see, but I was looking at the monitor
29:29when it happened.
29:31We have to take her to the hospital.
29:33We have to take her to the hospital.
29:35We have to take her to the hospital.
29:37We have to take her to the hospital.
29:39She's too unstable.
29:41She won't be able to bear the transport.
29:43It was essential to call a cardiologist
29:45to see her immediately.
29:47Colette, call the cardiologist now.
29:49Okay.
29:55We wanted to find out
29:57what was wrong with Josh Abbott.
29:59We treated the methemoglobinemia,
30:01but he got worse.
30:03The results are negative for benzene,
30:05antibacterial exposure,
30:07and local anesthesia.
30:11That doesn't make any sense.
30:13If he got better,
30:15and then got worse again,
30:17he would have been intoxicated again.
30:19They painted some rooms
30:21on the floor this weekend.
30:23Do you think it could be
30:25an aniline exposure?
30:27We'll have to think about it.
30:29You said he had diarrhea.
30:31You said he had diarrhea.
30:33That's it.
30:35So it's possible that what's causing
30:37the diarrhea is also causing
30:39the cyanosis.
30:47I want you to think about this.
30:49I'll take a look at Josh.
30:51We'll talk later.
30:53Okay.
30:55I didn't know if it was a progressive problem,
30:57if it was going to get worse.
30:59It's scary to have a child
31:01in a serious state of hypoxia
31:03without an answer.
31:05I need to be very specific
31:07and ask if Josh has been exposed
31:09to anything since he got to the hospital.
31:11But the tests don't work for that.
31:13The blood tests...
31:15They do. We're doing all of them,
31:17but I need to reduce the options.
31:19He may have been intoxicated with some food,
31:21and I know he hasn't eaten much
31:23since he was hospitalized.
31:25I'm very strict with his diet.
31:27Vegetables and grains.
31:29Actually, it's the vegetables
31:31that I'm most concerned about.
31:33Do you grow vegetables at home?
31:35Yes, I do.
31:41Did he eat any of them here at the hospital?
31:43He eats a lot of dairy products.
31:45Right, Claire?
31:47Milk, yogurt.
31:49Could any of those things make him sick?
31:51No, no, they couldn't.
31:57There's a lot of criticism,
31:59especially when a child is sick,
32:01and the family members sometimes
32:03lower their guard,
32:05open up and reveal a lot of personal information.
32:07Claire was very sick as a child,
32:09and our mother was...
32:11Well, to say she was absent
32:13is an euphemism.
32:15I understand.
32:17It's one of the doctors' privileges.
32:19It's one of the reasons we make
32:21the Hippocrates oath.
32:23I spent a lot of time taking care of her,
32:25as a child.
32:27I understand. This oath is important
32:29because people trust us.
32:31People open up in critical moments.
32:33She's trying to make up for it
32:35with Josh, of course,
32:37but I don't think she even realizes it.
32:41Josh's clinical history was clearer,
32:43and we tried to reevaluate
32:45the level of methemoglobin
32:47to see if his condition would improve
32:49or worsen.
32:51Dr. Cardillo?
32:53Josh is crying.
32:55Well, he took an injection, and...
32:57Orange tears.
32:59Where did that come from?
33:01Sometimes we're lucky,
33:03and the unexpected happens.
33:05Josh cried,
33:07and it was that cry that revealed
33:09crucial evidence to solve the mystery.
33:11Sometimes the facts of life
33:13are in your favor.
33:15A simple blood sample
33:17to reevaluate the level of methemoglobin,
33:19and the boy started crying.
33:21And his tears were orange.
33:23This was a definitive proof
33:25that Josh's problem
33:27was caused by a pharmaceutical toxin.
33:31Hi, Alex.
33:33Yeah, one second.
33:35Ready.
33:37I got it.
33:39Phenazopyridine.
33:41Phenazopyridine?
33:43But how is he taking phenazopyridine?
33:45We didn't give him anything like that.
33:47How could there be a drug in his body
33:49that is not suitable
33:51for a five-year-old boy?
33:53Pharmacy error?
33:55I doubt it.
33:57He's in a controlled environment at the hospital.
33:59There's something wrong here.
34:13The blood flow seems normal,
34:15but the right ventricle is dilated.
34:17Do you see any escape?
34:19Uh-uh.
34:21I don't see a tricuspid problem,
34:23but there are significant fat deposits
34:25in the heart and scar tissue.
34:27A 21-year-old person
34:29usually has a strong, healthy heart,
34:31but instead, what we found in Jessica
34:33was a very weak and dilated heart.
34:35And that affected the electrical conduction
34:37of the heart,
34:39causing frequent arrhythmias.
34:41Whatever it is, it's nothing new.
34:43What are you thinking?
34:45Well, I have to do an EPS.
34:47In an EPS study,
34:49or electrophysiological study,
34:51we send a small electric shock
34:53through a catheter
34:55to the heart.
34:57We check if the electricity
34:59is being conducted in a normal pattern
35:01or if it's failing.
35:03Do you think she can handle it?
35:05It's the only way to see
35:07where the heart is failing.
35:15All right, honey, I'll look at your arm.
35:17All right?
35:19That's it, Josh.
35:21Great.
35:23All right, Josh?
35:25What's up, girl?
35:27We're almost sure
35:29what's causing Josh's cyanosis.
35:31Aren't you going to do another toxicological test?
35:33Well, it's not the case
35:35to do more tests right now, okay?
35:37But he can't go home yet.
35:39You're right,
35:41but there's one more thing
35:43John, can you take Josh
35:45to the radiology room now
35:47to do an ultrasound of the kidneys?
35:49All right?
35:51You can go with Josh
35:53and nurse John to the exam.
35:57I want you to work with John.
35:59Make him make up an excuse
36:01for the radiology not to see Josh now.
36:03Then meet me in the lab.
36:13All right.
36:43There is a degenerative genetic condition
36:45that causes the accumulation
36:47of fat and fibrosis deposits
36:49in the heart.
36:51When it occurs,
36:53it does not allow the heart
36:55to contract normally.
36:57And in fact,
36:59it was the cause of Jessica's seizures.
37:01DAVD is a common cause
37:03of sudden death
37:05in people under 35.
37:07And in fact,
37:0980% of people die
37:11after being diagnosed.
37:13I need to tell the parents.
37:23Your daughter has a heart condition
37:25called right ventricular
37:27arrhythmogenic dysplasia.
37:29Heart?
37:31Yes, she's had it since she was born.
37:33As she got older,
37:35more fibrosis accumulated in the heart,
37:37not allowing it to beat properly.
37:39But what about the seizures?
37:41It's true.
37:43The seizures led us off course,
37:45but they occurred due to the lack
37:47of blood flow to the brain.
37:49In fact, oxygen did not reach the brain.
37:51It may seem crazy,
37:53but for years she was treated
37:55for the wrong disease.
37:57But that's impossible.
37:59They thought the diagnosis was wrong,
38:01but it was actually right.
38:03But she spent her whole life
38:05taking seizures medication.
38:07Really?
38:09So it was all a mistake?
38:11Yes, unfortunately it was.
38:13But we can treat and cure this condition.
38:15And that will also end the seizures.
38:23George was exposed to a toxic substance.
38:25And there was a way to test it,
38:27using sunflower.
38:29The color of the sunflower paper
38:31changes when tested.
38:33It was our greatest hope
38:35to solve this medical mystery.
38:47Oh my God, it's positive.
38:49So there was a reason for George
38:51to get worse every time
38:53we treated him with sunflower.
38:55It was a reason I didn't know
38:57if everyone would be willing to accept.
38:59It's time to call Dr. Garcia.
39:01It's a normal reaction,
39:03to be shaken up
39:05when you think someone is poisoning a child.
39:07Nick, I can't find the apple sauce.
39:09Where did you put it?
39:11I kept it with the rest of your kids.
39:13No, it's not here, and it's not on the table either.
39:15Well, I don't know where it is,
39:17but we can get more.
39:19Mrs. Abt?
39:21Hi.
39:23I'd like you to talk to someone.
39:25Of course.
39:27This is Dr. Garcia.
39:29What kind of doctor are you?
39:31Come in.
39:35We found out that Josh Abt
39:37was sick and cyanotic
39:39because someone was poisoning
39:41his favorite dish.
39:43And unfortunately,
39:45all the evidence pointed to his mother.
39:47Josh is my life,
39:49and when he gets sick,
39:51I don't know what to do.
39:53I think you need to take care of yourself too.
39:55Luckily, we had access
39:57to another professional
39:59for a psychiatric check-up.
40:01Well, I can tell you one thing.
40:03The mother loved having my full attention.
40:05And she also seemed to be
40:07fully responsible for Josh's recovery.
40:09Well, looking closely,
40:11there were other indications.
40:13The sister mentioned that Claire
40:15got very sick as a child,
40:17and their mother was very absent.
40:19That's very common in cases like this.
40:21So Dr. Garcia confirmed
40:23what we all suspected.
40:25No.
40:27The set of symptoms
40:29led us to Munchausen syndrome,
40:31which is a very rare mental illness.
40:33It is a psychiatric disorder
40:35in which the responsible,
40:37sometimes the mother,
40:39intentionally hurts the child.
40:41The intention
40:43is to take the child
40:45to a hospital
40:47where she can act as his savior.
40:49Ready.
40:51Mrs. Abt, can we talk outside?
40:57Yes.
41:01Dr. Garcia,
41:03I don't know how to thank you
41:05for hearing me talk about Josh's condition.
41:07Mrs. Abt,
41:09we found phenazopyridine
41:11in the apple sauce he was giving Josh.
41:13These patients don't even remember
41:15that they are offering the child
41:17a toxic substance.
41:19That's impossible.
41:21I don't even know what that is.
41:23No.
41:25Of course not.
41:27I think I would remember.
41:29Nick!
41:31The need to act as a savior
41:33is so impressive,
41:35so devastating,
41:37that it covers the intentional behavior
41:39of hurting the child.
41:41That's a big mistake.
41:43Let's discuss this in my office.
41:47You can't make these kinds of accusations.
41:49Your sister is sick.
41:51She doesn't realize it yet,
41:53but she needs a lot of help.
41:57I can't believe this is happening.
41:59We're so sorry.
42:03We knew the boy wasn't
42:05permanently intoxicated.
42:07As soon as Josh
42:09stopped ingesting the toxic substance,
42:11he got better.
42:13Now the task of social workers
42:15and psychiatrists
42:17is to thoroughly investigate
42:19and also ensure
42:21a safe place for Josh to live
42:23while his mother was treated.
42:31Oh! Oh!
42:33Is this going to trigger those metal detectors?
42:35I was thrilled to see Jessica Young
42:37recovering so well.
42:39It was a case where I felt
42:41I made a real difference
42:43in her life and in her family's lives.
42:45This is the DCI.
42:47We implanted it
42:49in your daughter's chest,
42:51just below her skin.
42:53Her condition has no cure
42:55because it's a degenerative disease,
42:57but it's a pathology
42:59that can be treated with medicines
43:01and the DCI,
43:03an implantable cardiovascular defibrillator.
43:05When the DCI detects a fatal arrhythmia,
43:07it shocks the heart
43:09to return to normal rhythm
43:11and continues to monitor your heart.
43:13And if it shows a strange rhythm
43:15or a strange beat,
43:17it takes a shock.
43:19Oh!
43:21Jessica, my friend!
43:23The training session was over
43:25and I ran to the back.
43:27They left all those speeches for you.
43:29That was the excited Jessica
43:31I met when she arrived at the emergency room.
43:35You can call him Colby.
43:37Trust me, he loves it.
43:39Hi, Colby.
43:41Hi. It's Dr. Colby for you.
43:43You're great.
43:45Not to mention I missed the best day of my life.
43:47Oh, before I forget,
43:49I have a training gift for you.
43:51What is it?
44:01Flowers.
44:03Wait, wait,
44:05I'm going to take a picture.
44:07It was a relief to have made Jessica's diagnosis.
44:09It was a treatable condition
44:11and an implantable defibrillator.
44:13Attention!
44:15One, two, three.
44:17Now you take one with mine.
44:21Did you make this?
44:23Being able to make a difference
44:25in someone's life
44:27and changing their life for the better
44:29by giving them a second chance
44:31was really extraordinary.
44:37What's up, Josh?
44:39The next Josh Abt was a perfectly healthy boy.
44:41He was no longer ingesting
44:43the toxic substance
44:45that made him metabolically ill.
44:47Are you going to play with your toys again?
44:49I will.
44:51Are you going for a walk with your favorite aunt?
44:53I will.
44:55Fortunately, Josh had a family member,
44:57his aunt, willing to take care of him
44:59while his mother was in treatment.
45:01He became a normal child again.
45:05Thank you for your kindness.
45:07You're welcome. It's our job.
45:09I never realized what was going on.
45:11As far as I know,
45:13your mother was never accused of any crime
45:15or even arrested.
45:17It's not illegal to have a psychiatric illness.
45:19You will be satisfied to know
45:21that there is a side of Dr. Noelle Harter
45:23that many people do not know.
45:25Gov, I'll tell you.
45:27If I learned something
45:29from medicine in so many years,
45:31it's that we have to be willing
45:33to change our mind.
45:35Thank you for this.
45:37You're welcome. I liked it a lot.
45:41Is that all for today?
45:43Almost.
45:45There's just one more thing I want to check
45:47before closing the day.
45:55Dr. Cardillo.
45:57I want to thank you for all your effort
45:59in helping me with the case.
46:01You're welcome.
46:03There are certain times
46:05when we can show our interest.
46:07There are certain times
46:09when we have to say to someone,
46:11Hey, you know what? I like you.
46:13Do you want to eat something?
46:15Of course. I'd love to.
46:17Great. Let's go.
46:57That's why we continue.
46:59I never thought hospital food
47:01would be so good.
47:03Great.
47:05I'm sorry. It's all yours.
47:07Doctor,
47:09her blood pressure is 14.7
47:11and it's dropping...
47:21Good night, Stark.
47:25Good night.
47:31Ah.
47:37Oh, Dr. Chan.
47:41In medicine, things don't always
47:43work the way we want them to,
47:45but I...
47:47I couldn't have hoped for a better ending than this.
47:49I hope you're not disappointed, Doctor.
47:51Let's see.
47:53This is it.
47:59Why did they put you
48:01on the same shift as me?
48:03It's going to be hard to know who's who today.
48:05Everyone has a system
48:07to keep their lives in order.
48:09Having the...
48:11All the tests
48:13we asked for were completely useless.
48:15It didn't work. Get the sedatives back.
48:17That wasn't normal at all.
48:19True enigmas.
48:23Sam, wait.
48:25Now he was in
48:27an inverted position.
48:29Help me, please!
48:31Diagnostic X
48:37Opening scene. Take 1. Cut.
48:39My name is Ted Melnick.
48:41I'm a resident in emergency medicine
48:43in Manhattan, at Mount Sinai Hospital.
48:45And I'm in the third
48:47of the four years of training.
48:49And I'll be head resident next year, which is exciting.
48:51I went to medical school
48:53in Georgia.