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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.
00:15They don't have them.
00:21Mr. Ganderson!
00:22I panicked because I had just sent him home.
00:25We need help here!
00:27TRUE MEDICAL ENIGMAS
00:30There's something wrong with her. I think she took a pill.
00:33What's her name?
00:34I don't want her to die!
00:35None of us had seen anything like it, not even the nurses.
00:38We were very scared because the child looked bad.
00:41TRUE CASES
00:45Now I think this guy is going from bad to worse.
00:47Wait, what did you do? Did you send him home?
00:49Yeah, I did. And he almost died.
00:51That liquid you see is blood.
00:53She's got bleeding.
00:55TRUE ENIGMAS
00:58I have to do an exploratory surgery right now. I need your permission.
01:01If it wasn't an accident, we both know what the other case is.
01:08X-DIAGNOSIS
01:11Look at the camera and go.
01:12My name is Geoff Ankeny, and my specialty is family medicine.
01:16And you're a real doctor.
01:17I certainly am not an actor.
01:19I chose this case because it's very dramatic.
01:22It's a big case.
01:23My name is Charlie Rockenbarley, and I'm a real doctor.
01:27I haven't gotten used to the cameras around me yet.
01:29Every time I look, I go like this.
01:33The most interesting thing about this show is that most of the shows start with actors
01:38and people trying to teach them what drama is and what a doctor's routine is like.
01:43And this show starts with doctors, and there's a big team helping us.
01:47Like Tom, Matt, and the directors and producers try to make us tell our best stories
01:54and help us develop the actor's work.
01:57And I'm here today to tell a story that happened to me when I was a resident.
02:02It's a very bizarre and unique case.
02:05And honestly, I don't know anyone who has gone through this.
02:09It involves patients who, well, who have messed with me a lot.
02:14And you're going to meet them.
02:16So, let's go.
02:18Very well.
02:19Very well, everyone. Let's go.
02:21And action.
02:25Hi, Sammy.
02:31Is something going on between them?
02:35What's the problem?
02:36I don't know. It seems a little strange.
02:39Excuse me, I need to see a doctor right now.
02:42Here's the thing. It's very important, okay?
02:45There's a lot of doctors in there, and they're going to help you.
02:53Let's go.
02:54In life, if you don't understand a situation, someone can get hurt.
02:58In medicine, if you don't understand a situation, someone can die.
03:02Doctor, here's the thing. I have a headache, and it goes all the way to the back of my neck.
03:06I think I have West Nile.
03:08The pressure is normal, 13 by 6.
03:10A small outbreak of the West Nile virus caused a mass hysteria.
03:14We treat the normal volume of patients three times.
03:17I read about it in the paper this morning at 8.13 a.m.,
03:21and yesterday at 7.59 a.m.,
03:24the patient's blood pressure dropped to 3.6.
03:27I read about it in the paper this morning at 8.13 a.m.,
03:30and yesterday at 7.59 a.m.
03:32Is there anything else that's bothering you besides the headache?
03:35Well, here's the thing.
03:37Everyone who had a headache thought they had the virus,
03:39because it was the main symptom.
03:41It had been mentioned in all the papers and all the TV shows.
03:44Mosquitoes, I counted 23 today,
03:4726 if you count those who came here to the hospital,
03:50which should be clean.
03:52And this patient was the typical obsessive-compulsive.
03:56Oh, you forgot the right side.
03:58Excuse me?
03:59With your stethoscope, you only saw the left side, not the right.
04:02You did the same thing when you measured the pressure.
04:05I know.
04:06Okay.
04:07Go, Matt, leave it.
04:09Any other reason to think you have the virus?
04:11Two on my right arm and three on my left arm,
04:13which have been here for three days.
04:15You know, it's the time of year.
04:21Here, you see? I have it too.
04:23So we both have West Nile.
04:25I can't believe it.
04:26Is this clean?
04:27It's brand new.
04:29I did everything I could to explain to that patient
04:32that just because he had mosquito bites,
04:34didn't mean he had West Nile.
04:36But he insisted.
04:38I've never seen a West Nile case in my life,
04:40and I don't know anyone who has it.
04:42Such is the rarity of this disease.
04:44Do you feel any muscle pain?
04:46No.
04:47Okay. Fever?
04:48No.
04:49Can I have his record?
04:50Sure, and the temperature was 37.
04:52I was already 37 at home.
04:54That makes sense.
04:57Here it says you take paroxetine
04:59for obsessive-compulsive disorder.
05:01That's right.
05:05Have you taken your medicine?
05:07No, I stopped.
05:09Listen, Paul, the only way to diagnose West Nile
05:13is to do a lumbar puncture.
05:15And this is a very invasive and painful procedure.
05:19Let's do it.
05:20I would, if I thought you had it,
05:23but honestly, you have nothing to worry about.
05:25Paul's symptoms were very mild.
05:28And occupying a bed because of that
05:31would have been a wrong decision.
05:34Is that all? You're not going to give me anything?
05:36I'm going to prescribe a prescription for paroxetine.
05:39Okay?
05:40And try to take it.
05:42And when the prescription comes in,
05:44I want you to change it for another one.
05:46Got it?
05:47Okay, here's the thing. I don't need a sermon.
05:50But you need the medicine.
05:52Listen, come back if any symptoms worsen, okay?
05:55Okay.
05:57I feel a vibration in my ear.
05:58And besides that?
05:59Okay.
06:00My hair hurts.
06:01It's time to go.
06:08What's up, Charlie?
06:09What are you still doing here? Isn't your shift over?
06:12It's over, but either I stay here or I go home.
06:15And there's no food there.
06:17Residence can be a very lonely time for a lot of people.
06:21What about you? Why are you still here?
06:25And it's very difficult to establish an authentic and healthy relationship
06:29with good communication in such a stressful job.
06:33Here.
06:35Courtesy of my wife.
06:39Please.
06:40There's something wrong with her.
06:42I think she ate marijuana.
06:44Is she your daughter?
06:45No, I'm her grandmother.
06:48Let's take a look.
06:49My patient is two years old, Sandra Ruiz.
06:51And according to her grandmother, she had eaten marijuana.
06:55Please do something. I don't want her to die.
06:57Let's put her in bed now.
07:00It's very difficult for a child to die in an emergency.
07:03This is extremely rare.
07:05None of us had seen anything like it, not even the nurses.
07:08We were very scared because the child looked bad.
07:11Breathing seems a little superficial.
07:13Let's give her oxygen.
07:15Sandra, I'll look inside your mouth, okay?
07:18Mom!
07:19That's it, a two-year-old girl,
07:21weighing about eight kilos.
07:23She ate marijuana.
07:25No, it's not a joke.
07:26Each state has a poisoning control center.
07:29We wanted to talk to someone on the phone
07:31because even the best-trained doctors...
07:33Well, we don't know the best way to treat all these poisons.
07:37Great, I don't see any residue in there.
07:39Look, the control center said it's very rare for a child to ingest cannabis.
07:43News.
07:44Children eat strange things and suffocate on strange objects.
07:48We're used to that.
07:50But there are no children eating marijuana.
07:52You can't trust people when it comes to drugs.
07:54And when we're in an emergency, even less so.
07:56Where did that come from?
07:58She took it out of my bag.
07:59I had left it in the playroom.
08:01I didn't mean to.
08:07Hi, Sandra.
08:08Are you sleepy?
08:10Are you sleepy, Sandra?
08:11She said she had a stomach ache a long time ago.
08:13That's cool. Did you smoke or eat the same thing as her?
08:15No.
08:20But she can't have eaten a lot. I didn't have that much.
08:23Put a bag of urine in it.
08:24And when you have a sample, do a toxicological test.
08:26And see if there's THC.
08:28Look, the doctor said he'd never seen a child eat marijuana in 16 years.
08:33We didn't have time to check medical literature
08:36to see if this had ever happened anywhere
08:38or if it had ever been described.
08:40So we didn't get any instructions from the control center.
08:43And for me, it was embarrassing as a clinician.
08:46Collette, let's do a full blood test.
08:48I'll administer normal physiological urine.
08:58Did you see the soccer game?
09:00Yes. They lost in the last minute. It was a drug.
09:03I was finishing my shift when he showed up.
09:07Paul Gunderson.
09:09He went straight to where I was.
09:11And he remembered me, of course.
09:13Well, doctor, here's the thing.
09:15You told me to come back, and I got worse.
09:18Mr. Gunderson!
09:21We need help here!
09:24He still has a pulse.
09:26I panicked because I had just sent him home.
09:29He's still breathing.
09:31So I thought maybe he had forgotten something.
09:34Mr. Gunderson!
09:35Do you know him?
09:36More or less.
09:39Yoga for a good digestion.
09:52The heartbeats are at 110 per minute.
09:54He's got a heart attack.
09:55Mr. Gunderson, what happened?
09:57Paul Gunderson thought he had mastanial.
09:59And I thought he was crazy, and I sent him home.
10:02Four hours later, he came back, and you can bet.
10:05He was terrible.
10:06Here's the thing. I have a headache.
10:08And you think you have mastanial?
10:10All right.
10:11But what's happening to you now is more like a heart attack.
10:14Did I have a heart attack?
10:15No, you're showing symptoms of a heart attack.
10:18He had diaphoresis, which made him sweat.
10:20He was pale, which made him look pale.
10:22He passed out on the floor.
10:24A heart attack was very different, and it was my biggest concern.
10:27To start, breathe.
10:29Are you feeling pain in your chest now?
10:31Have you been diagnosed with a heart disease?
10:33Electrocardiogram is normal.
10:35All right, let's do a full blood test.
10:37I need to find a platonist.
10:38What did you do? Did you send him home?
10:40Yes, I did.
10:41I'm going to put on the apron, because I'm not going anywhere.
10:43That really wasn't my best moment.
10:46Why did he send me home?
10:50What's this story about a child ingesting marijuana?
10:53My patient is two years old, Sandra Ruiz.
10:56And according to her grandmother, she had ingested marijuana.
10:59That's what her grandmother says.
11:01And she believed it?
11:02If she wanted to lie to us, why would she tell a story that would incriminate her?
11:06Maybe the truth is worse.
11:08It's hard for me to see a child suffering.
11:11I think I think of my own children, and I can't imagine anything worse.
11:16I suspected the story from the beginning.
11:18It was strange to see that.
11:20And then to know that the Poison Control Center had never seen anything like it in 16 years.
11:25Would it be the first case in 16 years?
11:28Sure, it could even be, but would it be likely?
11:33Not much.
11:34We want to run a test for altered mental state.
11:37Breathing is superficial.
11:38Dr. Whitley, I want a tomography of the head,
11:40and a radiography to rule out pneumonia,
11:42and an abdominal to look for perforations or obstruction.
11:45Well, if that's not it, keep following the list.
11:49Can I talk about a case?
11:52Sure, let's go outside.
11:54So you sent him home.
11:56And now you think he really has West Nile?
11:59He's not feverish, but he has tremors.
12:01He's not coughing, Chuck.
12:02But he has a headache. He won't stop talking about headaches.
12:05That's two out of four for West Nile.
12:07And those two symptoms can show up in anything.
12:11Exactly.
12:12Very well, then. Let's see.
12:19Well, here's the thing. My elbow...
12:21It's a convulsion.
12:23Lorraine, two milligrams of clonazepam in the vein.
12:26West Nile doesn't cause convulsions.
12:28It does, if it gets to the brain.
12:30Before, it was practically asymptomatic.
12:32Now he's got West Nile encephalitis.
12:34Is that it?
12:35No, it's improbable.
12:36Do you have any idea, then?
12:38We controlled Paul's convulsion,
12:40and I made a disturbing discovery.
12:43Oh, God.
12:44Two milligrams of clonazepam.
12:46What?
12:53Well, I was going to say we have something,
12:56but see for yourselves.
12:59No convulsions, no infiltration.
13:01Thorax radiography was normal.
13:03There was no sign of pneumonia
13:05or any other respiratory disease that we could identify.
13:08There was no damage to the mouth or esophagus.
13:10If she had swallowed something caustic,
13:13we would see evidence of that.
13:15No obstructions, either.
13:17We'd better find something soon. Let's do a tomography.
13:26I think it's an overdose.
13:28An overdose of what?
13:29He's got a stroke, and I prescribed paroxetine.
13:32You need a high dose of that drug
13:34to cause a serotonin syndrome.
13:36Paroxetine acts in the brain
13:38as a selective inhibitor for the recapture of serotonin.
13:41If he took too much,
13:42he could suffer from the so-called serotonin syndrome.
13:45You show all kinds of crazy neurological symptoms,
13:48and one of them could be a convulsion.
13:51I received the medication and said it was important to take it.
13:54He could have taken it all at once.
13:59I've seen stable patients do worse.
14:02I'm telling you, it was like that.
14:04He was fine before.
14:05At that time, it wasn't a matter of feeling bad.
14:08It was a matter of being sure he was fine
14:10and feeling bad afterwards.
14:12You know, at that time,
14:13we just want to make sure the guy leaves
14:15and you'll deal with all your guilt afterwards.
14:18Lorraine, do a gastric lavage, please.
14:21If you need me, call me.
14:24No mass, no dislocation of the middle line,
14:27no evidence of trauma.
14:29We sent the patient to a brain tomography
14:31to look for evidence of trauma or brain bleeding,
14:34and he was perfectly normal.
14:36It would be great to find a pathology that we could treat,
14:39but at that moment,
14:41I felt it was something more serious that was happening.
14:45Okay, and now?
14:46I don't know. We need more information.
14:48Let's talk.
14:51Sandra, I'm not well.
14:53And you're the only person who can give me information.
14:56I need you to be honest with me, okay?
14:59Did you take any other drugs besides marijuana?
15:02No.
15:03Did you have anyone at home with you?
15:05A boyfriend?
15:06Just David.
15:08David.
15:10David.
15:12David.
15:14David.
15:16David.
15:18David.
15:20Did she come into any other rooms?
15:23Could she have taken any of her parents' medicine,
15:25any cleaning supplies, maybe?
15:32It will be easier for you to be honest with me
15:35now than to explain this to Sandra's parents,
15:37or maybe the police.
15:40I told them everything that happened.
15:44Did you call your parents?
15:46I only have mother, and I can't talk to them.
15:48I only have a mother. She went to spend the weekend with her boyfriend.
15:54Well, it's over. There's nothing left of it. It was completely emptied.
15:57I don't see any compressed. And you?
16:00Nothing obvious.
16:01The first step, when we have an overdose case,
16:04is to remove everything that is inside the stomach before it is absorbed.
16:09Lorraine, send this gastric content to the lab.
16:11I wanted to find pieces of compressed.
16:13Because if they existed, I would know what I was dealing with.
16:16It would be an overdose.
16:17Charlie, look. It was 18 for 10 to 5 minutes.
16:20Yeah, and we were hoping it would go on.
16:22While we were analyzing the content of the stomach,
16:25Stark pointed to the blood pressure monitor, and it was high.
16:28But okay, he had been through all that.
16:30He had had a seizure. I was hoping it was really high.
16:33It turns out that soon after, his blood pressure dropped.
16:36And it wasn't just a little bit. It really dropped.
16:39Oh, that's not good.
16:41His blood pressure dropped to the floor.
16:43If he keeps going like this, he'll need dopamine.
16:45So it's better to let go.
16:47It's one of those situations where you have nothing to lean on.
16:51And I, being an inexperienced doctor, being a resident,
16:55not having much experience to go on,
16:58so I trust the numbers.
17:00It's something we cling to more as residents
17:03than the plantonists who have seen things and feel what's going on.
17:07I can't feel anything.
17:09Did he provide the emergency contract?
17:11Of course, my daughter, Tori Gunderson.
17:13Okay, I'll call her.
17:22Okay, thanks.
17:24Listen, I wanted to call...
17:26Dr. Ankeny, Sandra's results came out.
17:28Normal leukocytes, all normal.
17:30Including the toxicological.
17:32Negative for THC.
17:33That's right, no marijuana.
17:35There was no drugs in her body.
17:37Some of me was happy because I didn't know how to treat it.
17:40Some of me was very...
17:42unhappy because I thought,
17:44what do we have now?
17:46Doctors, we have problems.
17:48The pressure dropped to 6 by 3.
17:51The respiratory frequency is dropping.
17:53She has a tachycardia.
17:54Administer 150 more cc's.
17:56Bring emergency equipment.
17:58When your heart beats, it's what we call tachycardia.
18:01It can mean a lot of things,
18:03but usually if a person is bedridden
18:05and has a very high heart rate,
18:07it's to worry about at the time.
18:09Ana!
18:10Oh, my son!
18:12Hey, my dear, are you okay?
18:14Where is she?
18:15Her condition was getting worse very quickly.
18:18More than we would like.
18:20The child was getting worse,
18:22and she could really die.
18:25Excuse me, I'm sorry.
18:27Cut the blue and cut the blue for an ambulance.
18:34The last thing I remember was the black...
18:40The last thing I remember was the black...
18:43Pregnant. Tonight.
18:45On Discovery Home & Health.
18:48Mommy is here with you now.
18:51Please wake up.
18:53Sandra Ruiz suffered a considerable worsening,
18:56and we were able to stabilize her.
18:58So we needed a full history of her parents
19:01as soon as possible.
19:03Can you give me five minutes, please?
19:05Okay.
19:06Sweetie.
19:09Can we talk outside for a minute?
19:14Why this fear?
19:15Look, I understand, okay?
19:16I'm sorry, I'm doing everything I can,
19:18but now I need more information from you, right?
19:20I need to know if they're starting to give her new food.
19:23No, no, no, no.
19:25No food, no food.
19:27Our stupid grandma gave her marijuana,
19:29and it's not my fault.
19:30Calm down.
19:32The problem with the father is that he exploded,
19:34and he wasn't the kind of person
19:35who was very easy to interview or interact with.
19:38Listen, you need to focus on your daughter,
19:40not on daddy.
19:41Do you understand what I'm saying?
19:42Your daughter, okay?
19:44Focus.
19:54Come on.
19:57We need something to work on.
19:59In just four hours,
20:01Paul Ganderson went from a headache
20:03to a deadly disease,
20:05and we had no idea why.
20:07Toxicological negative.
20:09It was already an overdose.
20:10Leukocytes count, hemogram, everything normal.
20:13It was almost certain that it wasn't an overdose.
20:17Look at this.
20:19The renal function is altered.
20:21Just a little bit.
20:23What does that tell us about the neurological symptoms?
20:25He doesn't have a renal failure.
20:26Yeah, but what causes this alteration and convulsions?
20:30It's alcohol.
20:31Okay.
20:32So I checked Paul's blood tests,
20:34and everything seemed pretty normal.
20:36The liver enzymes were elevated,
20:38which could mean alcoholism and delirium tremens.
20:42If he behaved and didn't drink in the last two or three days,
20:45it could be a crisis of abstinence.
20:47That would explain the convulsions, the sweating, the tremors.
20:49And that crazy arterial pressure.
20:51And there's a connection between touch and alcoholism.
20:53Maybe it's just abstinence.
20:54Now we're making up your history.
20:56His history was a question mark.
20:59And we need to know where he was, what he did,
21:02what were his habits, what could have caused that.
21:05Was there anything interesting in Mr. Gunderson's stomach, Alex?
21:08Uh, his last meal was salad.
21:10Great.
21:12And where does that take us?
21:14I don't know, man.
21:20The temperature is 38 and a half.
21:22Then it can only be West Nile.
21:24I should never have ruled out the first hypothesis.
21:26It was his main complaint.
21:28What is this, man?
21:29It's like someone came here with gastric pain
21:31and insisted he had worms.
21:32And sometimes he does, man.
21:33The patient was getting worse quickly.
21:35And I started to get angry with myself.
21:37Because there was no time for speculation.
21:40I want him to be hospitalized and I want a lumbar puncture.
21:43Lorraine, will you take care of that?
21:45Of course.
21:51Hello, miss.
21:52What?
21:53I didn't get anything from the parents.
21:55According to them, she's a two-year-old healthy, normal and active child.
21:59I sat in that room thinking about what could cause
22:02that kind of symptoms in a little girl.
22:05It was the most unusual case I've ever seen.
22:08Remember her brother saying that Sandra complained of stomach pain
22:11before she got to the hospital?
22:13I wrote that down.
22:14Sure.
22:15She ate weed.
22:17But she didn't eat weed and still has abdominal pain.
22:21The toxicologist was negative, really.
22:25The intestine seems hypoactive, too.
22:27Let's do an ultrasound and see if we can find out what's going on.
22:30Okay.
22:46The fluid is clear.
22:48That doesn't mean it's negative.
22:50Why? Do you think it could be an infection?
22:53No, I'm just saying.
22:58Excuse me.
22:59I got a call.
23:00Someone said my father was in a serious condition.
23:02What are you seeing?
23:04It was then that Paul's daughter, Tori, arrived.
23:07And we all hoped she would clear up the situation a little.
23:11He doesn't have an STI, does he?
23:13He's only been talking about it for two weeks.
23:15He's obsessed with mosquitoes.
23:17You can leave that for later.
23:19We'll finish in a second.
23:21Then you can fix his socks.
23:23He's got a needle in his spine, that's why.
23:25Of course.
23:26She started fixing his socks while I was doing a lumbar puncture right in the middle of the procedure.
23:33We're almost done, okay?
23:36Dolores, put a label on this.
23:38Okay.
23:39I need something more specific from the lab, not just a tumor, of course.
23:42Okay.
23:50The liver and the gallbladder seem clean.
23:54The appendix seems to be fine, too.
23:57Oh, my God. Stop at that point.
24:00It's liquid.
24:01Liquid loose.
24:03Let's do an abdominal tomography now.
24:05Liquid in the abdomen is a bad thing.
24:07There are different types of fluids that can appear there.
24:10And when they do, they almost always mean there's a problem.
24:13Let's find out what's going on with this little girl.
24:15Okay.
24:20Well, here's the thing.
24:22He complained that they were infesting his flowery garden.
24:24I told him that if that was so worrying, he should stay in there and close the windows.
24:29So, Paul Gunderson's daughter, Tori, showed up.
24:32Very kind, very nice.
24:34Some of her quirks were funny.
24:37But at the same time, when you have a dying patient,
24:40you find it more irritating than funny.
24:43He's so afraid of being bitten that he wears high heels,
24:46even with this absurd heat.
24:53Can you tell us anything else about him?
24:56It's obvious. He has a touch.
24:58He works from home.
25:00He spends most of his free time in that garden,
25:03or he cleans the house.
25:08He doesn't have any health problems.
25:10I mean, physical problems.
25:12Does he drink?
25:13Alcohol? Never.
25:15We have a brown code here.
25:18Brown code?
25:25Did you beep me?
25:26I did. We have a new symptom.
25:28Specifically?
25:29Diarrhea.
25:30Hello, I'm Tori Gunderson.
25:32Can it be food poisoning?
25:34Salmonella or retrovirus are possible hypotheses.
25:37I'm sorry to interrupt,
25:39but doesn't salmonella come from undercooked food?
25:42Well, my dad is on a raw food diet.
25:45He read something in the paper that made him paranoid.
25:48He practically only eats vegetables.
25:56We also ignore the convulsive activity
25:58that can occur in this type of food poisoning.
26:01Could it be an electrolytic disorder, malnutrition?
26:04No. All symptoms point to cholinergic syndrome.
26:07Cholinergic syndrome is an agglomeration of symptoms
26:10that makes the patient almost melt.
26:13And he melts because everything starts to leak.
26:16The eyes start to tear, you sweat,
26:19you get diaphoretic, and you have diarrhea.
26:22And Paul had it.
26:24Your autonomic nervous system is altered.
26:27Can we go back to food poisoning for a second?
26:30There is a food, a vegetable,
26:33that can explain all the symptoms.
26:36Which one?
26:37Mushrooms.
26:42Very well, there are only ten layers left.
26:45We did a computerized tomography on the girl.
26:48It is a very accurate exam that captures images
26:51in layers inside the patient's abdomen,
26:53as if you were looking inside him.
26:56With this exam, we were able to identify
26:59the liquid in the abdomen of our patient.
27:02Come here, Paul.
27:08Look, it looks like there is liquid in the retroperitoneum here.
27:11But where?
27:13I don't know.
27:20Wow!
27:30Excuse me, where is Lankney?
27:32He's in there, in the tomography.
27:34I just don't know what it is.
27:36The little girl...
27:38The girl's hematocrit, in the last exam,
27:40dropped four points in less than an hour.
27:42So this liquid is blood.
27:44She has hemorrhage.
27:46Call Brotman, let's go to surgery.
27:48A surgery room now.
27:50I think she has internal hemorrhage in the abdomen.
27:52What?
27:54I knew the patient was bleeding internally.
27:57I knew the patient was bleeding internally,
27:59and that she needed to be operated on immediately
28:01to find out where the bleeding came from and stifle it.
28:04But before I did that, I needed to tell her parents
28:07and get their permission to do the surgery.
28:10You can't cut my daughter just to do the surgery.
28:12I know, but...
28:13Am I clear?
28:15You're only going to leave a scar on my daughter for a good reason.
28:17Listen, your daughter could die if we don't do this procedure.
28:19Honey, give us permission, please.
28:22Please, Mr. Ruiz.
28:25Alex, have you analyzed Paul Gunderson's stomach?
28:28Uh-huh.
28:30I wanted to prove my theory that he could have been
28:33intoxicated by mushrooms.
28:35Any signs of mushrooms?
28:37Not that I've seen any, but those things are hard to analyze.
28:40Since he was a vegetarian and was obsessed with the garden,
28:42I thought it was a significant possibility.
28:45I did some tests and they gave a negative for West Nile.
28:48And the cell exam gave a negative for any kind of infection.
28:52You helped a lot.
28:54No, really, I'm sorry. You really helped a lot.
28:59Oh, come on!
29:04Bisturi.
29:06Bisturi.
29:08The retractors.
29:11Cutting.
29:13Current time, 4.22 a.m.
29:15Done.
29:18Fins.
29:22One more.
29:28There's the bleeding.
29:30Suction.
29:32Now we have to find out where he's coming from.
29:36What happened?
29:38The saturation dropped to 91.
29:40The lungs are full of liquid.
29:42Very well, let's apply the nitroglycerin paste.
29:45Any news from the lab?
29:47No, only negative results.
29:49There's nothing here either.
29:51Not to mention the mushrooms.
29:53Come on, Charlie, enough with the mushrooms. What else do you have?
29:55The only thing I know is that he left the hospital looking healthy and came back to this state.
29:59Great, so we have to find out what he did from the time he left the hospital to the time he came back.
30:03Tori, is there any chance your father went somewhere else and not home?
30:08No, especially with all this paranoia about mosquitoes.
30:11Saturation dropping.
30:12Okay, let's take a look.
30:14The O2 saturation measures how much of the body's hemoglobin is being oxygenated.
30:20And it's usually one of the last things to drop.
30:22And when it starts to drop, we get very worried.
30:25We have to find out what happened between the time he left and the time he came back.
30:28And the only way to do that is to send someone to his house.
30:31Let me go. I feel a little useless here.
30:34You wouldn't know what to look for, I'm sorry.
30:36My shift is over several hours ago. I just stayed to help Charlie, so I can go.
30:41Dr. Stark, what you decide to do in your free time is not up to me.
30:47Let's go, Tori.
30:50Hey, Stark.
30:52Call me, okay?
30:53Okay.
31:00What's up, Sammy?
31:11Calling Dr. Bender. Calling Dr. Bender, please.
31:21It's turned off.
31:22Sorry.
31:23You can leave it.
31:29Hey, you want me to drive for you?
31:31Uh-huh.
32:01What do you think? Maybe a congenital anomaly or something like that?
32:04No chance. Classic trauma.
32:07Did she fall off the stairs?
32:10She had no signs of trauma, no bruises, nothing.
32:14If it wasn't an accident, we know what the other hypothesis is.
32:18It's hard to even imagine a child being hit by that magnitude.
32:23And it's very painful to think that a child went through something like that.
32:27At that moment, there was no other explanation for what would have happened to her,
32:31besides some form of abuse.
32:42Oh, shit.
32:46Someone's lying to us.
32:48It happened when I was with my grandma, so I'd vote for her.
32:51Abuse cases are relatively common in the emergency room.
32:54Usually, there's another story that's not told, and people try to hide it.
32:59But it's a relatively common thing, unfortunately.
33:02We don't know when the parents left the house.
33:04It could have been one of them before they left.
33:06Guys, it's 5.30 in the morning, okay?
33:08Everyone's tired. I'm already full of this story.
33:11Don't rush.
33:12We need to follow the protocol.
33:14I'm kind of tired of so many unorthodox practices in one night.
33:19And we still don't know anything for sure, huh?
33:21I'm going to call the social service.
33:24We call the social service to verify the suspect of child abuse or negligence.
33:29Usually, the procedure is conducted by a social worker,
33:32by a doctor and a nurse trained in domestic violence issues.
33:35They are the people who officially establish who was where,
33:38doing what, gathering the information that will finally go to the police.
33:43They're alive.
33:49Relax, breathe and run.
33:52I was upset. I just got out of surgery. She almost died.
33:55And I was going to kill them.
33:57I didn't do anything.
33:58Still.
33:59This is Dr. Pamford. He's the doctor on duty tonight.
34:02How are you?
34:03And my daughter, what's going on?
34:04Your daughter had a serious rupture in the intestinal tract.
34:07You can only cause a wound like this by using a lot of force.
34:10What do you mean?
34:14Mr. Ruiz, I need you to come with me, please.
34:16This is crazy. Who are you?
34:18I'm a doctor in this hospital and it's a standard procedure to ask questions.
34:21She's the one who should be questioned.
34:23Dr. Potell will talk to Anna.
34:25Mrs. Ruiz, come with me.
34:28No, why does she have to go?
34:30Let's get this over with. I want to know what happened.
34:32I'll stay with Davi.
34:33All right?
34:36I'll be right back.
34:38Mr. Ruiz, do you usually stay home alone with Sandra?
34:42I'm her father. I'm alone with my daughter all the time.
34:46But how long do you stay home with her?
34:49Without your wife or your father around?
34:51I don't know.
34:52I don't count how many times I'm alone with my own daughter.
34:56No, my husband is the kindest man I've ever met.
34:59He yells, but that's it.
35:01He never did anything. Never.
35:03And your father?
35:05Do you know him well?
35:07Did you know she smoked pot?
35:12Tell me about the pot you had in your bag.
35:14Did you smoke near the kids?
35:17Sometimes I smoke with my boyfriend.
35:20Sometimes.
35:22But never near the kids.
35:24What do you think happened?
35:27I don't know.
35:29The kids were playing by themselves.
35:31So I wasn't watching the kids.
35:38Hey, Davi.
35:40Do you like cars?
35:41They're cool, but I prefer video games.
35:44Yeah?
35:45What's your favorite?
35:47The one that kills the dragon.
35:49I almost killed it yesterday, but...
35:55Now that you know how to do it, you'll get it right next time, won't you?
35:59I already knew how to do it yesterday.
36:02Mr. Ruiz, little kids can be very stubborn.
36:05Look, I know where you're getting with these questions, and I refuse to accept these accusations.
36:10Sir, I wouldn't mind calling an officer to finish the questionnaire for me,
36:14but I guarantee that answering my questions rationally is a very bad option.
36:18Go ahead. You can call the police. I have nothing to hide.
36:21Mr. Ruiz, let's go. Just answer the questions and we'll get this over with, okay?
36:27Am I stuck?
36:30I don't know. Did you do something wrong?
36:32No.
36:33Davi, he seemed a little tense.
36:36Despite telling me what was going on, he also seemed to be afraid of getting angry.
36:41What I couldn't determine at that time was if the boy was involved.
36:45Then I thought, what? It can only be a joke.
36:49I was almost killing the dragon.
36:55And she turned off the TV.
36:59So, what happened?
37:01I got mad and pushed her.
37:07And she hit the table hard.
37:09Davi.
37:10It wasn't on purpose.
37:11I almost sent a father to jail.
37:13And in the end, it was an 11-year-old boy.
37:16I want her to be okay, that's all.
37:19I wanted to present this in a way that would protect the boy.
37:22From what I know, the child had no history of violence.
37:25And by his interaction with me, I felt comfortable in stating that he had made a childish mistake.
37:30How would I do if I were 11 years old?
37:3211 years. Call the social service.
37:34Bring everyone back to the waiting room.
37:45The saturation dropped to 85.
37:47You know what? Let's intubate him, okay?
37:49Get the cart.
37:50It was a risky procedure.
37:51He could have eaten recently.
37:53You worry about things like aspiration, things that go through the tube.
37:56And to be honest, I had only intubated 12 or 15 times in my life.
38:03Hey, Stark.
38:04What's up, Charlie? We're here.
38:06I'll take a look and keep you informed.
38:08Paul's getting worse.
38:09Whatever you have to do, do it quickly, okay?
38:13Just a second. I need to find the key.
38:21Ready.
38:22We're in.
38:24Pass the catheter.
38:26Listen to this.
38:27The guy has a bunch of garden beds right next to the pool.
38:29I'll take a look.
38:31Ready.
38:32We intubated him and put him in the respirator.
38:35And at that point, the machine was practically breathing through him.
38:39And every time his body breathed,
38:41he pushed all the air towards his lungs.
38:44Anything with the mushrooms?
38:46I don't see any place where the mushroom could be grown.
38:49Do they grow inside the house?
38:51I don't think so.
38:53So can we look inside?
38:54Sure. Let's go inside.
38:55Cool.
38:56Maybe the house is under renovation.
38:58No, I don't think so.
39:02Holy shit.
39:04What a weird smell.
39:06Damn.
39:11Saturation dropping to 87.
39:13Don't use nitroglycerin.
39:15Take 80mg of Lasix now.
39:17Okay.
39:19But he didn't say he pushed her.
39:21Son, do you understand what you did?
39:23Stop it already.
39:24There are too many culprits today.
39:26And you know what I mean.
39:27What matters is that your daughter survived the surgery.
39:30Okay?
39:31I know I shouldn't have pointed the finger so early,
39:34accusing people and...
39:36and assuming reasons that weren't correct.
39:39I think in a case as intense as this,
39:42with a beautiful girl,
39:44it's easy to do that.
39:46It's understandable.
39:47But still, it's a mistake.
39:50I think she'll be fine.
39:52You'll be able to see her in a few minutes.
39:54Soon she'll be in recovery.
39:55I'll ask the nurse to call you, okay?
40:00I'll be right back.
40:08Wow, what's that smell?
40:10Did he leave the gas on?
40:11No, whatever it is, it's not gas.
40:13Leave the door open so I can see the place.
40:16Charlie, there's something very wrong here.
40:20Are you serious?
40:21I have to find the origin of the smell.
40:24When Tom came into the house,
40:26he smelled something horrible.
40:28He said it was really unbearable.
40:30He also noticed that all the windows
40:33were covered in plastic.
40:40Mosquito season arouses concern
40:42about the West Nile virus.
40:44Well, I'm sure it doesn't come from the fridge.
40:47I don't think it comes from his food.
40:49Tori, where does your father leave his garbage bags?
40:51In the garage.
40:52Where is it?
40:53Outside.
40:55So Tom searched everywhere
40:58trying to find the origin of the smell.
41:00He looked in the fridge, in the closets,
41:03he had no idea where the smell came from.
41:16Charlie, I found a bunch of cans.
41:18Cans of what?
41:25It's better to call Pamford.
41:27It's more serious than we thought.
41:31Here, Tori.
41:38So Tom went into the house
41:40and found that bag full of plastic cans.
41:44My father was using all of this inside the house.
41:46What?
41:47My father was using all of this inside the house.
41:50Yeah, and he also covered all the windows.
41:52It was the mosquitoes. It's my fault.
41:55I should never have told him to close all the windows.
41:58He understands everything by heart.
42:00Sometimes we gather a bunch of information
42:02that doesn't solve anything.
42:04And then we find a fact.
42:06And after that, everything makes sense.
42:08All of these ingredients are organophosphates.
42:10These substances overload the body.
42:13The muscles, the glands.
42:16That's why there was all that liquid in the lungs.
42:18These substances weren't made to be absorbed by the human skin.
42:22But in massive doses, they can be.
42:25And that's what was happening to Paul.
42:27So, what are you saying?
42:29That your father had an overdose of pesticides.
42:39Can you give me a little more of that?
42:41Anyone who has ever seen an insect being attacked by an insecticide
42:45has already observed that it walks a little,
42:47starts to wriggle, and then it dies.
42:50That's how it works.
42:52And that man received such a large dose
42:55that he was having symptoms that we would only see in an insect.
43:04Very well.
43:06Look, let's send the urine test to the lab
43:08and check the organophosphates.
43:10But remember, it's a presumed diagnosis.
43:13But it's consistent.
43:15I didn't say we weren't going to treat the patient.
43:17Of course we will.
43:18The problem is that he was without oxygen for a while
43:21and could have suffered some neurological damage.
43:24What is the treatment?
43:26High doses of atropine.
43:28The best treatment is pralidoxime.
43:31According to the literature we know,
43:33we could have reversed many of the effects of intoxication
43:37if we had given him the right medication in 48 hours.
43:40We have time.
43:41Great.
43:42Start.
43:43Look in the pharmacy, get the medication.
43:45Dr. Charlie, congratulations on sending Stark to Gunderson's house.
43:48I just hope it's on time.
43:58Are you feeling better, honey?
44:00Are you okay?
44:01Huh?
44:02Stark?
44:03Looks like she's going to be okay.
44:05Uh-huh.
44:06We gave her a scare, didn't we?
44:08I know.
44:09But I think she'll be fine.
44:12My two-year-old patient, Sandra Ruiz,
44:14is recovering well.
44:16She's completely stable.
44:18And we don't need to worry too much.
44:20We'll just watch her for a while
44:22and she'll be able to go home.
44:24When will she be able to eat again?
44:26It's a slow process.
44:28Dad, when is Sandra going home?
44:30In the end, social assistance determined
44:33that the brother had no real intention of hurting his sister
44:36and suspended all investigations
44:39about him and his father.
44:41I'm sorry.
44:51Dr. Baker speaking.
44:53Doctor, I have a surprise for you.
44:59So,
45:01Mr. Gunderson,
45:03how do you feel?
45:05Well, I woke up at 5.47
45:08and couldn't sleep again.
45:10So I heard 47 calls at the emergency room
45:13in less than an hour.
45:1449.
45:1647.
45:1749.
45:18Mr. Gunderson, it's great to have you back.
45:22Oh, and you'll be discharged
45:24in exactly 34 hours.
45:28You're welcome.
45:31What's going on with you?
45:32There's something going on between them.
45:34With Ankeny?
45:35I told you, he's married.
45:37You're the one who's not acting like a married man.
45:39You're the one who's not acting like a normal person.
45:42Learning to interpret someone's behavior
45:45is not something you learn in medical school.
45:48It's something you learn in life.
45:50And I think we're still learning.
45:54Hey, Tom,
45:55you asked me about my kids.
45:57I was showing Sam some pictures.
45:59Take a look.
46:05Pretty, huh?
46:06Yeah, very pretty.
46:10See?
46:12It's a beautiful family, huh?