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00:00She has a lot of headaches.
00:02It's cancer.
00:03The patient looked very sick and I didn't have a diagnosis.
00:11It seems that your daughter has a lesion in the femur.
00:13Maybe a fracture.
00:15What? How?
00:16In medicine, if we look, we find answers that are not always easy to face.
00:24An error in a case like this could be fatal.
00:27There was no way out.
00:28This is absurd. I'm going to take Kelly home now.
00:31What they said and what I saw was not coherent.
00:34Truthful enigmas.
00:38That shouldn't have happened.
00:41Oh my God.
00:42I'm not going to bleed, my daughter.
00:51I'm Dr. Anthony Cattillo. I'm a doctor and I practice emergency medicine.
00:55They're not doctors, they're actors.
00:57I'm a doctor. I'm going to teach a case that I lived.
01:00It's one of those cases that teach us a lot as a doctor.
01:03I'm Charlie Rucamboli. I'm a real doctor.
01:06This is a case that I learned a lot from.
01:09It's a very interesting case.
01:11It was one of the first times that someone's life depended on me.
01:14Rolling. Action.
01:16All right.
01:17All right.
01:25Visitors.
01:26Some are born to be doctors.
01:28It's in the blood.
01:30Precision, dedication, competitive nature.
01:34But I was never like that.
01:37I don't like deadlines, competition, and I hate being supervised.
01:42So I'm learning to adapt.
01:45As a supervisory doctor, I'm not only responsible for having patients,
01:49but I also have the great responsibility to teach residents the art of medicine
01:53and the skill of medicine.
01:56Ana Cruz, 29 years old, admitted at half past.
01:59She's not well. I spoke to another doctor.
02:03Taking on challenging cases is something that makes me a good doctor.
02:07At least I like to think that way.
02:09Give four milligrams of morphine and two of valium.
02:12Now, do they know or believe that?
02:14Maybe not.
02:15They only see the late guy running down the hall.
02:18She has a very strong headache and a pain in the eyes.
02:21My neck.
02:22Yeah, and it's very weak.
02:24Can you open your eyes for me?
02:26Visits may be the worst part of the day.
02:29The pressure to present a diagnosis,
02:32having to go through all this process in front of your colleagues,
02:35supervisors, and patients.
02:37That's kind of ridiculous.
02:39According to the medical record,
02:41a tomography was done and a subarachnoid hemorrhage was ruled out.
02:44So far.
02:45She didn't want to come to the hospital, but I insisted.
02:48It started a few hours ago at dinner.
02:54Excuse me, Dr. Lavenson.
02:56We don't have many people in the emergency room.
02:58Can you give in to some residents?
03:00When you're a resident, there's a lot of competition for the supervisors' admiration.
03:05I wouldn't be chosen.
03:06You can take Dr. Strong.
03:08He didn't choose me.
03:09It was Dr. Lavenson.
03:11And Dr. Lavenson hates me.
03:12Everyone knows.
03:13It's no secret.
03:14If you really need it, call Dr. Stark.
03:16Great.
03:17Thank you very much.
03:19We're not done here yet.
03:21Man, she hates me.
03:23Dr. Chang.
03:24The historian, please.
03:27Oh, yes.
03:28I was taken by surprise.
03:30I knew this was going to happen, since I wasn't listening.
03:34Mrs...
03:36Cruz.
03:38I didn't even know her name when I got the file.
03:40I just asked the most basic questions I could think of.
03:43Are you taking any medication?
03:46I only take ibuprofen at home.
03:53Can we rule out bleeding?
03:55If you were listening, you'd know we've already done that.
03:58Well, eliminating the most common diagnosis, what could it be?
04:02What's the difference?
04:04Silence during visits is very embarrassing.
04:07You can't even tell who you're looking at.
04:09Because if you make eye contact with someone for a long time,
04:12you're called, for sure.
04:14Well, it looks like you'll have a lot of work ahead of you.
04:17Dr. Charlie, Mrs. Cruz is now your patient.
04:19I bet you'll be able to find out what's wrong with her.
04:22Do all the tests, complete blood and urine tests,
04:24and a detailed history.
04:26And if I get calls at home, I won't like it a bit.
04:31The patient looked very sick.
04:33The supervisors didn't know what it was.
04:35And I had to give a diagnosis.
04:37It's a lot of pressure for a resident.
04:39Good luck.
04:41I had a lot of work ahead of me.
04:43It would be a long shift.
04:51Don't worry about me calling Internal Medicine.
04:53Oh, no, it's okay.
04:54Okay.
04:55Night shift at a very busy emergency room.
04:58I deal with patients while I supervise
05:00and teach Internal Medicine residents.
05:03When I read the file,
05:05I saw that it was a one-and-a-half-year-old girl,
05:07with no previous medical problems.
05:09She was crying, she was restless,
05:12and she couldn't put her weight on her left leg.
05:15Hello, how are you? I'm Dr. Cardillo.
05:17Nice to meet you.
05:18This is Dr. Strong, my assistant.
05:20She doesn't stop crying. We've tried everything.
05:23Put her here. She'll be fine.
05:25Whenever I deal with sick children,
05:27my heart tightens,
05:29because they're in pain, they're suffering.
05:32I want to help right away,
05:34but I can't afford to miss the diagnosis.
05:36Dr. Cardillo, look at her leg.
05:39It looks a little swollen.
05:41There's a little edema, a deformation,
05:43but the pulses are intact.
05:47From what I see,
05:48it looks like your daughter has a femoral injury,
05:50maybe a fracture.
05:52What? How?
05:53Well, I was going to ask you that.
05:55Did she suffer any trauma? Did anything happen?
05:58I don't know. I was changing her diaper.
06:05And then she started screaming.
06:08Nothing else?
06:09No, she started screaming for no reason.
06:13When did that happen?
06:14Last night.
06:15Can you solve that for us now?
06:17All right, but there are a lot of questions
06:19that need to be answered before we start.
06:21I started to get very worried.
06:23In cases like this, our role changes.
06:25We go from a general clinician
06:27to an almost detective role.
06:30She can't have fallen, maybe by accident.
06:32Fallen? How could she have fallen?
06:35Maybe she fell out of bed.
06:37Yes.
06:43Do you think I'd let that happen?
06:45I'm not saying it happened, ma'am.
06:47That's very common, Mrs. Parnell.
06:49Accidents happen.
06:51Look, she didn't fall out of bed or anywhere.
06:54Those are normal questions.
06:56It's just routine, okay?
06:58It's routine questions.
07:00I wasn't sure it was a fracture.
07:02It took longer.
07:04That patient needed to be under my care
07:07for a little while longer
07:09to understand the subtleties of the case.
07:11We need to take some x-rays, but it may take a while.
07:14Get the girl and let's go.
07:15Maybe we should stay.
07:17P, all right?
07:19All right.
07:21In most cases involving traumas in children,
07:25the diagnosis is correct.
07:28But that wasn't the case.
07:30Someone will come get you when we're ready, okay?
07:33All right.
07:38I didn't leave the patient's room thinking,
07:41yeah, I know what happened here.
07:43Why are you in a hurry?
07:44Well...
07:45Wait a second.
07:46I want you to do me a favor.
07:49All right.
07:50Wait, we don't know yet.
07:56All right.
07:57Uh-huh.
07:58I'll explain later.
08:18Yeah.
08:48I'll have to eat later.
08:50In this case, he didn't help.
08:51All right.
08:52I'll take a look at Ana Cruz's tests.
08:53Good luck.
08:54Now it was with me.
08:55In that case, I was alone.
08:58I was on my own in a case without a diagnosis.
09:02And I started to feel the pressure.
09:06What happened?
09:07What did you find out?
09:0815 ears, CO2-25.
09:11They stand out from the abnormal tests.
09:14And in that case, there was no mark.
09:17They were all normal.
09:19Everything seems more or less normal.
09:21It's not possible.
09:23Sometimes the symptoms point to something obvious,
09:25but it doesn't always happen.
09:27But what else could it be?
09:28When we don't know what the problem is,
09:30patients realize it.
09:32They realize if we know what we're talking about or not.
09:35And the situation can become very uncomfortable
09:38when we're not 100% sure about the possibilities.
09:44Is it cancer?
09:45I don't know yet.
09:47Please sit down.
09:48Could I say it wasn't cancer?
09:50No.
09:51Ana, I'm going to ask a few more questions,
09:53and you can write them down for me.
09:54Tracing the patient's history
09:56may be the most important part of getting to a diagnosis.
09:59If a good doctor asks the right questions,
10:01the patient will reveal what he knows.
10:03Have you traveled anywhere in the last six months?
10:05In our honeymoon a few months ago,
10:07we made a cruise.
10:10To where?
10:11To the Caribbean.
10:12I know.
10:13Do you remember eating anything different?
10:15Did you get sick?
10:20No, she's sick to eat.
10:22Did you go on another trip?
10:24We went to Vermont about three months ago.
10:27We visited some college friends.
10:33Were you bitten by a cockroach?
10:35Did you have a fever, allergies?
10:37When they said Vermont, I thought of Lyme disease.
10:39I know Lyme disease is endemic in that region,
10:41but the fact that she hadn't been bitten by a cockroach
10:43ruled out that possibility.
10:45And you've never had these symptoms before, have you?
10:48Well, more or less.
10:55Sometimes, in the last few months, I felt weak,
10:59as if my legs were giving in,
11:01but I thought it was just a dizziness, nothing more.
11:04What? I didn't know that.
11:06But why didn't you tell me anything?
11:08Because then it passed.
11:10I know.
11:11Anything else?
11:13The pain in my eyes.
11:19I've had it before, but it wasn't that bad,
11:22and it didn't last that long.
11:24Anna...
11:25I'm sorry.
11:26A saying of ours goes,
11:27when you hear shells, think of horses, not zebras.
11:30Think of what's obvious.
11:32At her age, I thought it could be multiple sclerosis.
11:35Remember anything else?
11:37Multiple sclerosis usually occurs in women
11:40in their thirties or so, with nephritis.
11:44Well, Anna, I'm going to ask for a resonance.
11:47She's going to show what a tomography doesn't show, okay?
11:52Well, we're ready to take Kelly to radiology.
11:55Can we go?
11:56Yes, you can sit here in the wheelchair.
11:59Hold it while I take you.
12:01Okay.
12:02Come here, honey.
12:15I think part of me wanted to be right and confirm the diagnosis.
12:19But an even bigger part wanted to be wrong,
12:22because I know how devastating multiple sclerosis can be.
12:27I didn't want to tell Anna and her husband
12:29that she had this disease.
12:31It's very aggressive.
12:32It's progressive and there's no cure.
12:39When I saw the resonance, my heart stopped.
12:41I had to tell them something that would change their lives.
12:45My God.
12:47SIREN WAILS
13:17What did she say?
13:18Well, she said she turned into a fairy
13:20while she was swapping diapers, and then she started screaming.
13:26I can't believe it.
13:27At 18, a child doesn't have the muscle or strength
13:30to cause the torsion we've seen.
13:32That doesn't happen out of the blue.
13:34How do you explain the fracture?
13:37Seriously?
13:39In the world of emergency medicine,
13:41a helicoidal fracture usually indicates abuse in most cases.
13:46Usually, an adult, an older person,
13:48grabs a child and twists their leg violently,
13:51causing a helicoidal fracture like this.
13:59But they brought her to the hospital.
14:01That doesn't mean anything.
14:03Unfortunately, in most cases with children,
14:06a helicoidal fracture really indicates an abuse case.
14:10Shouldn't we talk to the orthopedist?
14:12That's what we're going to do.
14:15Hi, Charlie. How are you?
14:16Fine.
14:17Can I ask you for an opinion?
14:18Sure.
14:21An 18-month-old child, an inexplicable fracture in the femur.
14:25You hardly see a serious fracture in such a young child.
14:28Especially a helicoidal fracture in a bone like the femur.
14:32Analyze the whole skeleton and see if there are other fractures.
14:36I think we're going to have trouble.
14:38The parents?
14:39The father, mainly.
14:41In these cases, most children are abused every day.
14:44Our role as emergency doctors is to look for old fractures,
14:48and we do this by asking for a skeletal analysis.
14:51Are you sure they did this to her?
14:53Well, someone did.
14:55If we see evidence of multiple fractures,
14:58at this point, the diagnosis is no longer a possibility.
15:01It's reality.
15:07I received the results of the anacrusis resonance.
15:10And as I feared, they were devastating.
15:15Can you imagine if someone told you that the life you know is over?
15:19Charlie, I don't need to imagine.
15:21The life I knew ended the day I entered medical school.
15:25What's that?
15:26The anacrusis resonance.
15:28I saw injuries in the calculus,
15:30which is where the two halves of the brain meet.
15:33And there aren't many factors that can cause injuries in this particular region.
15:38Multiple sclerosis is at the top of the possibilities.
15:41Sclerosis?
15:43How did she react?
15:44I haven't told her yet.
15:46Well, I have to tell the parents who are suspected of child abuse.
15:49Do you want to switch?
15:51I don't think there's anything worse than going into a room and...
15:55destroying a person's life.
15:57Go on, go on. I know it's not easy, but...
15:59the sooner the better.
16:01I knew it would be hard for me.
16:04And I knew it would be even harder for them.
16:08Ana, I analyzed your resonance.
16:11And you really have injuries in the central part of the brain.
16:14Radiology believes that, due to your condition,
16:17you probably have multiple sclerosis.
16:21When I told them, they were devastated.
16:24Without a doubt, this is a moment that changes a life.
16:28They had just gotten married, they had a whole life ahead of them.
16:31And I had to say that she had a disease that would slowly destroy your brain.
16:37I'm sorry.
16:43Have a drink. It's coffee.
16:45When we make the decision to do a full skeletal analysis,
16:48we have to explain to the parents why we have to do this.
16:51Maybe it was an accident, and he's ashamed to admit it.
17:01It wasn't an easy situation.
17:04We had to hurry up and accuse the parents of abusing their daughter.
17:09Because the situation could turn around very quickly.
17:13How is she?
17:15She's fine, but the X-ray confirmed our suspicions.
17:19She has a fracture in the femur, which is the upper part of the leg,
17:22in the thigh region.
17:24Can't you find a way to get us out of here?
17:26We're trying to do that now.
17:28We were hoping they'd say,
17:30Yeah, I remember she fell out of bed. That's right.
17:32That's how she fractured her leg.
17:34But they didn't say anything, just,
17:36Wow, how did that happen?
17:38Well, we need more X-rays.
17:40The so-called skeletal analysis.
17:42More X-rays? For what?
17:44Just as a precaution, okay?
17:46You can stay here and wait while we get the X-rays.
17:48Parents who abuse their children worry a lot about themselves.
17:52And when we confront them and explain the reason
17:55why it is necessary to X-ray the whole body,
17:58they're usually hesitant.
18:00But first we need to know,
18:02has anyone else been with Kelly lately?
18:05No.
18:06A slut, maybe?
18:14No one.
18:17Can we see him?
18:18Sure. He'll walk you to the radiologist.
18:22I'll tell you what.
18:24Take the X-rays out and look right at them.
18:27When you're done,
18:29we'll take our daughter and go home.
18:32Got it?
18:34Okay.
18:36What we fear the most when it comes to this with parents
18:39is that they can run away, they can leave the emergency room.
18:42What do you think now?
18:46In a school hospital,
18:48the diagnosis of a resident is always analyzed in detail.
18:51Visits?
18:52People's lives are at stake.
18:54So, how did it go?
18:56I heard it was a case of multiple sclerosis.
18:58Bad news comes fast.
19:00First, Mr. Charlie.
19:02I was very confident.
19:04I had done a full physical exam.
19:06The diagnosis seemed solid.
19:08We have a 29-year-old woman
19:10who has generalized weakness, headaches...
19:13We were here last night, Doctor.
19:15That's right.
19:16Based on your history,
19:18we did a resonance that revealed injuries to the calciferous body,
19:21which suggests multiple sclerosis.
19:23In the case of supervisors, they try to find holes in history.
19:26Let me see.
19:27And the tests?
19:28All negative.
19:29Did you test for infectious diseases?
19:31Uh, no. Actually, we...
19:33Do it, please.
19:34You need cheap blood to deal with Dr. Levinson at this time.
19:37And how did it all start?
19:39Fast.
19:40Fast how?
19:41Last night, about 9.30.
19:42And she had symptoms of the disease, so I thought...
19:44This kind of evolution is not characteristic of this disease.
19:47Well, if it's a more aggressive subtype,
19:49it's not going to fit into any pattern.
19:51Multiple sclerosis is a probable diagnosis.
19:53Treatment pattern?
19:54Two grams of solumedrol, 30 micrograms of interferon.
19:57Multiple sclerosis is an autoimmune disease
19:59in which the body begins to attack itself,
20:01in this case, the brain.
20:02We gave her solumedrol, a strong steroid,
20:04and also interferon,
20:05to slow down her immune system
20:07and leave her in a state of remission.
20:09Are they high doses?
20:10It's an aggressive case.
20:12I agree.
20:15We convinced the supervisors
20:17that it was really multiple sclerosis.
20:19It looks like it was easy.
20:21It looked like a closed case.
20:23Am I going to get better with these drugs?
20:26The goal is to slow down your immune system
20:28until your body stops attacking itself.
20:30You're going to start taking the medication
20:32and you're going to feel better.
20:34I'll see you later.
20:35I felt really good.
20:37You know, it was a challenge, and I faced it.
20:40But to make sure, and to please Dr. Levinson,
20:42we asked for several tests for infectious diseases.
20:45But I was sure everyone would give the negative.
20:50The rest of the series is still in progress,
20:53but this one caught my attention.
20:55We asked for a complete skeletal analysis of the child
20:58in search of evidence of old fractures,
21:00which would be incompatible with her parents' history.
21:03Signs of old fractures in the ribs.
21:05Several, actually.
21:11Did you see that, Tony?
21:13Yes, I did.
21:14And it's sad.
21:15A fracture in the femur,
21:17several old fractures in the ribs,
21:19and it's only a 18-month-old girl.
21:21The parents didn't say anything?
21:23They said she had never suffered serious injuries.
21:26They lied to us.
21:28Oh, what a surprise.
21:30It was no longer a mystery.
21:32That inexplicable fracture, for no apparent reason,
21:35began to reveal its history.
21:37Now I had a child with multiple fractures.
21:40There are few ways this can happen.
21:42And unfortunately, in a large, urban emergency,
21:47child abuse is often the cause.
21:50I think it's time to call reinforcements.
21:53Reinforcements?
21:54A team that investigates child abuse.
21:56They intervene to protect the child.
21:59I don't know.
22:14Mrs. Parnell, we need to talk to you.
22:17About the X-rays?
22:19Yes, about the X-rays.
22:20Come with us, please.
22:22The nurse will stay with him.
22:24It's hard to deal with that,
22:26but at the end of the day, we're protecting a child.
22:30Very well.
22:32We've found evidence of multiple fractures,
22:36especially in the ribs.
22:39What?
22:40We don't know how they happened.
22:42But how?
22:47There's Ron's mother.
22:49Sometimes she stays with him.
22:52She's got nothing to do with this.
22:56Who are they?
22:57This is Dr. Feldman, our chief orthopedist.
23:00It's always complicated to call a child abuse team.
23:04Once we call them,
23:06there's no going back.
23:08She's bound by law to conduct a thorough investigation
23:11to find out if a child has been abused.
23:14We need to ask some questions about Kelly.
23:17I knew it wasn't a good idea.
23:19I knew it wasn't a good idea. Let's go.
23:22I don't think you can do that.
23:24Please, you'd better sit down.
23:26Wrongly accusing parents of abusing their children
23:30can lead to emotional wear and tear
23:32that they'll never forget.
23:42We gave her a high dose of steroids,
23:44and her reaction was positive.
23:46She was better, but suddenly her condition worsened.
23:48What?
23:53Based on her diagnosis and the medication she was taking...
23:56What happened to her?
23:58That shouldn't have happened.
24:02She was terrible.
24:04What happened?
24:05She's got over 40 degrees of fever,
24:07and the ibuprofen isn't working.
24:09With steroids?
24:11The fever didn't react to the ibuprofen.
24:13And the strangest thing is that with steroids,
24:15she shouldn't even have a fever.
24:17That wasn't good at all.
24:19Why is this happening?
24:20I thought she'd feel better with steroids.
24:22Anna.
24:23Anna.
24:25I was very worried,
24:27and I decided to call a neurologist right away.
24:29Yeah, it's urgent.
24:31Dr. Charlie.
24:33I'll find out what it is, okay?
24:35Then I started to think I had the wrong diagnosis.
24:44The patient with multiple sclerosis suddenly got worse.
24:46Anna Cruz now has over 40 degrees of fever.
24:49It looks like an interferon reaction.
24:51Is she allergic to medication?
24:53No, but it can have side effects.
24:55The resident neurologist was practically convinced
24:58that it was a reaction to the medication she took.
25:00I know this can happen,
25:02but I didn't think it would be this way.
25:04A lumbar puncture.
25:06At that time, I started to think that maybe...
25:08I was wrong.
25:10We have to do a lumbar puncture on your wife.
25:12No.
25:13If there's bleeding, she could die.
25:16It's okay.
25:18It's okay.
25:20It was a very tense moment,
25:22because a mistake in a case like this could be fatal.
25:30Kelly, let's get more blood now, okay?
25:32I want to do some more tests.
25:36Doing blood tests is a good idea
25:38whenever there's a question.
25:40When nothing seems to work,
25:42what do we do?
25:44We blame the blood tests.
25:46I was hoping there was a mistake in one of the tests,
25:49so we checked everything again.
25:52This shouldn't have happened.
25:54Not like this.
25:56No, I needed to be certain.
25:59I didn't know what was going on anymore.
26:07I was sure of the child's diagnosis,
26:10but I wanted to be wrong.
26:12The investigation into mistreatment had begun,
26:14and there was increasing tension
26:16in the emergency department.
26:18Is there anyone else besides the two of you
26:20who is alone with Kelly?
26:22A relative? A family friend?
26:26Well...
26:28Tania!
26:29She said she had nothing to do with it.
26:38Ron's mother is the only one who stays with Kelly.
26:41Kelly's grandmother has been taking care of her lately.
26:44Tania! This is serious!
26:46As it usually happens,
26:48parents are very agitated.
26:50And there's no way,
26:52there's no way to avoid the emotional wear and tear
26:54that the parents are going to face.
26:56Two days ago, do you think she hurt Ken?
26:58What?
27:00I don't believe you're thinking something like that.
27:02What should I be thinking, Ron?
27:04They just told us
27:06that someone mistreated our daughter.
27:08This is absurd!
27:10I'm taking Kelly home right now!
27:12Ron!
27:14This behavior is quite predictable,
27:16unfortunately.
27:18But it is the procedure we adopted
27:20to avoid the repetition of abuse against the child.
27:24Take care of my daughter!
27:32It's ready.
27:34You should teach patience at medical school.
27:36It's there.
27:38To make an electrophoresis,
27:40there is a specific pattern for multiple sclerosis.
27:42Negative bandage pattern for the disease.
27:44What? Are you sure?
27:46The pattern would be clear as day.
27:48Yeah, but it doesn't always show up, does it?
27:50In a case as serious as hers,
27:52there's no way it doesn't show up.
27:54I don't think it's multiple sclerosis.
27:56That blew me away.
27:58All the confidence I had in that diagnosis
28:00was down the drain.
28:02And all the certainty of knowing what I was doing
28:04also fell apart.
28:06It's scary to ask supervisors for help.
28:08Harper!
28:09I'm busy.
28:10I went back to zero.
28:12There was nothing I could do.
28:14So I did the only thing I could.
28:18Hey, I've got a problem.
28:20Stark had a rough week
28:22and he was sleeping.
28:24And he didn't want to know about me
28:26or...
28:28my problem.
28:30But there was no other way.
28:32Anna Cruz doesn't have sclerosis.
28:34I've got the same problem.
28:36The problem is, I don't know what she's got.
28:38The tests didn't say anything?
28:42Low glucose.
28:50So it could be bacterial.
28:52Great.
28:54The tests showed a low glucose rate,
28:56which wasn't exactly the biggest news in the world.
28:58It's even a normal finding.
29:00But sometimes, when there's a bacterial infection,
29:02the bacteria eats the glucose
29:04and causes it to decrease
29:06in the brain's spinal fluid.
29:08Good.
29:10So?
29:12Neurotic, weakness, I don't know.
29:14Lyme. Lyme should be on your list.
29:16I've thought about it.
29:18But the test was negative.
29:20I'll do the test again.
29:22It's being redone.
29:24And I'm also reviewing HIV and syphilis.
29:26HIV and syphilis.
29:32At that time, the lab called me.
29:34The lab is expensive.
29:36Turn off the lights when I leave, okay?
29:38No, you come with me.
29:40No, no, no.
29:42Come on. Get up.
29:44Time was running out.
29:46And...
29:48the case was getting more and more complicated.
29:50Things were getting more and more confusing.
29:52And I wanted Tom there with me
29:54to help me with the information.
29:56I didn't know what to expect.
29:58And I talked to him.
30:00And Tom was always available to help me.
30:02Lyme, negative.
30:04When we checked again,
30:06all possible infectious diseases,
30:08the tests didn't accuse anything.
30:10HIV, negative.
30:12Syphilis, positive,
30:14with the exception of syphilis.
30:16Really?
30:18Neurosyphilis.
30:20It's not just a DST, but it's a dirty DST.
30:22I know it sounds crazy,
30:24but it's like chlamydia gonorrhea syphilis.
30:28Syphilis would be the dirtiest of them all.
30:30At least she'll be happy to know
30:32she doesn't have sclerosis.
30:34Yeah, but now she has a DST.
30:36You can't always win.
30:38There are several ways to tell good news.
30:40But there's no way to be nice
30:42when talking about syphilis.
30:44Not that I know of.
30:46Stop lying. Tell the truth.
30:48I'm not lying.
30:50I overheard them talking in the bathroom.
30:52They don't know what they're saying.
30:54What do you mean they don't know?
30:56They said you had it.
30:58Don't do this to me.
31:00You know how to make an interesting story.
31:02I don't believe you trusted me.
31:04Why don't you tell the truth and stop lying?
31:06I watched them fight
31:08and I didn't know if I should interfere.
31:10But I knew that...
31:12that there was no way out.
31:14Because it was all my fault.
31:16But I got that from you.
31:20Yeah, Dad.
31:22I wish you good luck, but I'm out.
31:24I thought he was going to come after me.
31:26He was so angry.
31:28Well...
31:30she seems lucid.
31:32I don't believe my wife cheated on me.
31:38Look, David,
31:40it usually takes three to six years
31:42for the disease to get to this point.
31:44We've only been together two years.
31:46Great. You'll see she's contracted before you know it.
31:48And you probably have it too.
31:50So you need to start taking medicine.
31:52No, I don't.
31:54I just needed this.
31:56Calm down, okay?
31:58Try to stay calm.
32:00Let's go inside and see if we can fix this.
32:02It was a twist,
32:04but at least we had the diagnosis.
32:06It looked like things were going to get better.
32:08Give me my daughter.
32:10Give me my daughter.
32:12I want to take my daughter home, okay?
32:14Don't try to take my daughter away.
32:16The ambulance was called.
32:18The ambulance was called.
32:20We got a call from the radiologist.
32:22Don't take my daughter away.
32:24Dr. Cartillo to Radiology, calling Dr. Cartillo.
32:26I need to go to Radiology, okay?
32:28What do I do?
32:30Sit down, relax, and I'll be right back, okay?
32:32You don't understand, Dr. Cartillo.
32:34I was expecting worse.
32:36I was expecting more fractures in that child's body.
32:38I had no idea what it could be.
32:40At that point, we had a diagnosis
32:42and a treatment plan.
32:44But at least we were going in the right direction.
32:46Doctor,
32:48you're not going to believe this.
32:50It can only be a mistake.
32:52The husband's test gave a negative for syphilis.
32:54That put the diagnosis in doubt at the same time.
32:56For God's sake,
32:58isn't there anything coherent in this case?
33:00You know that the chances of one being positive
33:02and the other negative are minimal, right?
33:04I know.
33:06Another diagnosis had just been ruled out.
33:10I'm with the skull series.
33:12I knew you'd want to see this.
33:14Don't tell me it's worse than we thought.
33:16I examined the child's skull radiographs
33:18and I couldn't believe what I saw.
33:20Oh, my God.
33:22I can't believe it.
33:24I found additional information
33:26in the skull radiographs that changed everything.
33:28I'm taking my daughter home.
33:30Let go of me!
33:32What side are you on?
33:34Wait, guys, calm down.
33:36Calm down what?
33:38After looking at the radiographs,
33:40I came to the conclusion
33:42that there was something wrong with the girl.
33:44I think we've found out what's wrong,
33:46but we have to examine one more thing.
33:48No, that's enough.
33:50Calm down, Ron.
33:52Relax, sir.
33:54Look at the light.
33:56It's going to be all right, son.
33:58She has blue sclera.
34:00What's that?
34:02I'll explain.
34:04The radiographs.
34:06Come with me.
34:08Let's start with the skull.
34:10I carefully examined the girl's skull radiographs
34:12and I could clearly see
34:14what we call Vormian bones
34:16or small malformations in the skull
34:18where the bones failed
34:20to fuse and calcify.
34:22Did you see that in college?
34:24They're called Vormian bones.
34:26Imperfect osteogenesis.
34:28What?
34:30Oste... what?
34:32This disease makes the bones very fragile
34:34and even the slightest force
34:36can cause a fracture.
34:38We all knew imperfect osteogenesis,
34:40but it's very rare to see this kind of disease
34:42in an emergency.
34:44Then it all made sense.
34:46Sir and Mrs. Parnell, we apologize.
34:48It's the least I can do.
34:50I hope you understand that we had the best...
34:52Oh, understand. Oh, that's good.
34:54With this condition, something as simple
34:56as turning the child over to change the diaper
34:58is enough to break the bones.
35:00Those parents didn't abuse their daughter.
35:02They were parents
35:04of a child
35:06with a very serious disease.
35:08Can I hold her now?
35:10Yes, but be very careful, okay?
35:12What do you mean? You're scaring me.
35:14Your daughter has a very rare
35:16congenital genetic disease,
35:18that is, she was born with it, okay?
35:20If you want, we can call a specialist
35:22who can explain in more detail...
35:24It's hard to explain the emotional wear and tear
35:26that a doctor faces in these circumstances.
35:28To discover that a child has
35:30a disease that can be fatal.
35:32For this specific condition,
35:34we don't prescribe medicine,
35:36there are no surgical corrections,
35:38there's nothing to do.
35:40This child
35:42will have a very difficult life.
35:44I'm really sorry
35:46for having to go through all this.
35:48We see a lot of children
35:50beaten up in this hospital
35:52and we couldn't take risks.
35:54We did it thinking only of Kelly's well-being.
35:56Can we take our daughter home now?
35:58Yes, you can.
36:00When we look for a diagnosis,
36:02sometimes what we find
36:04is not easy to accept.
36:06We deal with people's lives,
36:08their tragedies,
36:10and this can make our job difficult.
36:18It was a dead end.
36:20Ana Cruz's condition was getting worse
36:22and her diagnosis was wrong.
36:24She doesn't even raise her arms,
36:26and she's so weak.
36:28We did a syphilis test.
36:30We did three syphilis tests on her husband.
36:32Not one, three.
36:34They were all negative.
36:36But you said you were sure I had it.
36:38Do you use condoms?
36:40No.
36:42I had no explanation for that.
36:44And I was about to be confronted
36:46by the hospital's most rigorous supervisor.
36:48Visits?
36:50Damn, what did I say?
36:52I heard your patient is working.
36:54I knew I couldn't justify
36:56that diagnosis.
36:58It was going to be very difficult.
37:00Dr. Charlie?
37:02Dr. Stark?
37:04How is your patient today?
37:06She reacted well to the initial dose
37:08of steroids for multiple sclerosis,
37:10but then there was a reaction.
37:12We thought it was interferon.
37:14We did other tests and found out
37:16she had syphilis.
37:18We administered benzocaine and penicillin.
37:20What seems to have worsened her condition.
37:22It may be a reaction of Jerry Scherzheimer.
37:24The initial dose of penicillin
37:26in a patient with syphilis.
37:28They felt my lack of confidence
37:30when I suggested that.
37:32Could it be Jerry Scherzheimer
37:34or is it Jerry Scherzheimer?
37:36I don't know.
37:38Did the husband do the test?
37:40He did. It was negative.
37:42How can a husband be negative
37:44if his wife has syphilis?
37:46Did you consider a different diagnosis?
37:48It could still be sclerosis.
37:50Is that what you think?
37:52Well, we could wait
37:54and see how she reacts.
37:56Of course I didn't have a plan
37:58at that time.
38:00I had nothing to rely on.
38:02Maybe if we continued the medication...
38:04Can't we have a different doctor?
38:06Someone more experienced
38:08to take care of my wife?
38:10One thing is when supervisors
38:12criticize your case.
38:14Another thing is when patients
38:16call you incompetent.
38:18Dr. Charlie, out there, please.
38:20Did I make a mistake in handling this case?
38:22No. I want to find out what it is.
38:24I can find out what it is.
38:26Leave your ego aside, doctor.
38:28It's not you. It's a sick person.
38:30You're right. I'm sorry. I know.
38:32Listen, you have 12 hours
38:34to get a diagnosis
38:36or you're out.
38:38Doctors, let's continue.
38:40I really wanted to find out
38:42what was going on and I wanted to prove
38:44to myself that I could do it.
38:4612 hours? Do you think you can do it?
38:48You can bet I can.
38:50I was very worried at the time
38:52and that wasn't common for me.
38:54So, again,
38:56it's a zero.
38:58I'm going to die.
39:00Cheers.
39:02A lot of times, when you have a completely new perspective,
39:04we think about things we wouldn't think about.
39:06What else could it be?
39:08I don't know. An old bag, maybe?
39:10No. The heart rate is normal.
39:12Maybe a small tumor
39:14that we can't see.
39:16I had to check everything twice.
39:20I can only think about Lyme.
39:22What intrigued us was the positive test for syphilis
39:24and the things that would explain it.
39:26And Lyme was one of them.
39:28You've had two negative tests, Charlie.
39:30Yeah, but the Lyme disease would explain syphilis.
39:32You can't ignore science, man.
39:36Man, did you realize we've been walking in circles
39:38for 24 hours?
39:40I used so much antihistaminic and sprenasal
39:42that I don't feel the taste anymore.
39:44You're a genius.
39:46Thanks, I know. Where are you going?
39:48It was the light at the end of the tunnel.
39:50It was like a boom.
39:52And suddenly, I had a theory
39:54that all of that made sense.
39:56Charlie!
39:58Medicine is a crazy thing.
40:00It's like putting together a puzzle
40:02or solving a challenge.
40:04When you least expect it,
40:06a small piece appears
40:08that makes everything else fit.
40:10I'm sorry. What are you doing?
40:12She had multiple sclerosis, didn't she?
40:14We gave her a high dose of sulumedrol
40:16to weaken the immune response.
40:18Well, it's not possible
40:20that it weakened the Lyme reaction.
40:22Few antibodies are being produced.
40:24Exactly.
40:26And what do you want
40:28to be linked to this bacteria?
40:30So there's nothing left to show in the test?
40:32That's it.
40:34We weakened her immune system.
40:36And in this case,
40:38we also weakened her Lyme reaction.
40:40When we did the blood tests,
40:42they were negative.
40:44They could be classified as false negatives.
40:46Good theory.
40:48I just need to prove it.
40:50I need to test the bacteria.
40:52This test identifies
40:54the bacteria directly,
40:56and not her reaction to it.
40:58In other words,
41:00it's a direct test for Lyme.
41:02Listen, you're not going to ask for this test
41:04at 3.30 in the morning, are you?
41:06Not exactly.
41:08You have to have authorization.
41:10This test costs a fortune.
41:12The test will kill you.
41:14I was bad in front of the supervisors.
41:16I had two wrong diagnoses.
41:18I had a good theory,
41:20and nothing to support it.
41:22I had to do that test.
41:24She hates me.
41:26She's going to kill me anyway.
41:28If it's negative, it's my end.
41:30Charlie, no, no, Charlie, wait.
41:32I took a risk
41:34to diagnose my patient.
41:36Did you get the result?
41:38Not yet.
41:40The next morning,
41:42my neck was in a thread.
41:44I spent God knows how much money on that test.
41:46The visits would be in three minutes,
41:48and I didn't have the results.
41:50Did you know it was a difficult night?
41:52Is there anything you don't know?
41:54I had two wrong diagnoses.
41:56On the third, I'd be out.
41:58Visits!
42:00I don't trust them.
42:02You're going to support me, right?
42:04You still have doubts?
42:06My theories were all wrong.
42:08So why wouldn't this one be wrong too?
42:10Dr. Charlie,
42:12it looks like you had an appointment.
42:14I did.
42:16Let's talk here,
42:18so as not to scare the patient.
42:20Okay. As you all know,
42:22she came in with headaches.
42:24This is not a revision class, doctor.
42:30The test was positive for Lyme.
42:32And thank God I had a positive test.
42:34You don't want to tell the good news?
42:36I do, but can we do it in there?
42:38I want to tell the patient.
42:40Finally, I had proof
42:42to support my theory.
42:44I think it's a good thing he got it right.
42:46That was the part I was waiting for.
42:48I have a diagnosis.
42:50Anna, you have Lyme.
42:52But you said all the tests were negative.
42:54We don't do this test here.
42:56Who gave the authorization?
42:58Under those circumstances, it was totally necessary.
43:00I'm the one who decides that.
43:02In the sclerosis hypothesis,
43:04we gave a high dose of solumedrol.
43:06The goal was for the body to stop self-attacking.
43:08And with that, we weakened his reaction to Lyme.
43:10Few antibodies were produced
43:12to connect directly to the bacteria
43:14and there were not many left for a positive test.
43:16And this test only verified the bacteria,
43:18and not the reaction to it.
43:20And how did you get there?
43:22Too bad I...
43:24We did some research.
43:26Finally, I had a correct diagnosis
43:28and everyone was satisfied.
43:30And...
43:32that doesn't always happen in medicine.
43:34And how do we know if you're right now?
43:36First it was sclerosis, then syphilis.
43:38That could be just another mistake.
43:40Mr. Cruz,
43:42Dr. Charlie solved a case
43:44that would have deceived the most experienced doctors.
43:46He may be just a resident,
43:48but he's right.
43:50I was shocked because Levinson never supports me.
43:52And when she did that,
43:54I think everyone was surprised.
43:56I think even she was surprised.
43:58How did I get Lyme disease?
44:00I'll let you work.
44:02As for you, let's go.
44:04Good work, doctor. Very well.
44:06That was a very complicated case
44:08and the supervisors recognized that.
44:10We set up a puzzle.
44:12I felt very well.
44:14Anna, just one exposure
44:16to contract Lyme disease.
44:18But I never saw a scar on me.
44:24They are small
44:26and end up falling alone.
44:28So there's no multiple sclerosis?
44:30No syphilis?
44:32No. There's a saying in medicine that says
44:34books are black and white,
44:36but patients are gray.
44:38And it's true.
44:40You're going to start taking the right medication.
44:42Now try to rest.
44:44And I'll be fine?
44:46There's a small risk of long-term effects,
44:48but usually the recovery is complete.
44:50It wasn't a degenerative disease
44:52and it wasn't sexually transmissible.
44:54It was curable
44:56and had a good prognosis.
44:58Thank you, doctor.
45:00Look, I'm sorry for what I said.
45:02It's okay. I'm used to it.
45:04When David was satisfied,
45:06I was very satisfied too.
45:08That case was really closed.
45:14Look, it was a great performance.
45:16Yeah, tell me about it.
45:18Cases like this help us grow as doctors,
45:20and that's being a resident.
45:22Developing confidence,
45:24thinking in theory,
45:26being questioned several times,
45:28and not giving up
45:30until you do your best for the patient.
45:32Dr. Levinson,
45:34I'm sorry to interrupt,
45:36but I need another resident.
45:38Can you give me the best?
45:40Dr. Charlie.
45:44In medicine,
45:46things don't always work the way we want,
45:48and I couldn't have hoped for a better ending than this.
45:50I hope you're not disappointed, doctor.
45:52Let's see.