S05.E15: In For a Penny

[jewel21]

Quote

As his clinical begins, Devon treats his first patient with a revolutionary medical fluid that doesn't go as planned. Meanwhile, an overdosed John Doe is rushed to Chastain, leading Conrad straight into a much bigger scandal than he expected. Then, a shocking secret regarding Cade's past is discovered.

Airdate: 03/08/2022

[bros402]

medical....fluid?

what

Also, taking bets about Cade's past:
1. Victim of domestic abuse?
2. WITSEC protectee?
3. Criminal on the run?
4. Alter ego of a superhero?

[NeenerNeener]

WITSEC for Cade. Called it quite awhile ago.

[statsgirl]

Did the medical advisor for the show quit this episode?

The science teacher puts four different antibiotics in a petrie dish and tells the class that soon they'll know which one works. Maybe. Or maybe putting all four in the same dish is just asking for cross-contamination.

Devon: Scurvy .... polio ... diabetes... diseases all cured by clinical trials.:"  Really Devon? I'm pretty sure that when the Portuguese navy discovered the cure for scurvy in the 1400s, no one knew what a clinical trial was.

Cade calls time of death, and then she looks in his bag to see what drugs he had. Shouldn't someone have looked in the beginning when they were trying to figure out how to save him. And then she texted the picture to Conrad. Really? (I don't like Cade, I know that she's is supposed to be tough and mysterious but the actress is too robotic.)

Identical twins are identical when the egg splits. After that, epigenetics takes over.

When I ha my first dose of chemotherapy, I got very sick for a week. So when it came time for my second dose, my oncologist lowered the dose. This is what is known as a 'duh' solution.

Why did Devon keep giving the treatment even though the patient got sicker and sicker?

"You followed the patient's wishes."  Aaaaargh, that is so stupid. The patient isn't an expert on reactions to clinical trials, it's the doctor who is. If the patient wished to jump off the roof of the hospital believing that the drug would make him fly, should the doctor support him?

And we end with AJ teasing Conrad/Cade. Poor Conrad.

Edited March 9, 2022 by statsgirl

[KaveDweller]

27 minutes ago, statsgirl said:

Devon: Scurvy .... polio ... diabetes... diseases all cured by clinical trials.:"  Really Devon? I'm pretty sure that when the Portuguese navy discovered the cure for scurvy in the 1400s, no one knew what a clinical trial was.

I'm also pretty sure there is no cure for diabetes. Did he actually say that? I was only half paying attention tonight.

[Bulldog]

1 hour ago, statsgirl said:

Cade calls, and then she looks in his bad to see what drugs he had. Shouldn't someone have looked in the beginning when they were trying to figure out how to save him.

This.  Wouldn't they need to know medications to see if anything would interact with the medicines they were giving him?  And I know if someone comes in unresponsive, you can't ask them about medications; but if they are carrying a bag, I can't imagine them not at least checking. 

I like Bell, but oh boy did he come off as hypocritical during the medicine board meetings.  Note to writers:  Some of us actually watched the first season. 

 

[vibeology]

13 hours ago, Bulldog said:

This.  Wouldn't they need to know medications to see if anything would interact with the medicines they were giving him?  And I know if someone comes in unresponsive, you can't ask them about medications; but if they are carrying a bag, I can't imagine them not at least checking. 

I think one of them even said "oh, I guess that's why the Narcan didn't work." WTF! You would check before/during treatment because that might be useful to know. 

Honestly this was such a hard episode to care about. I don't care about Cade, I knew the teacher wouldn't die and I knew Leela would get a win. The only plot I care about is the Dr. Death rip off with Bell. Because that podcast horrified me and I'm here for any and all takedowns of such a dangerous man.

Edited March 9, 2022 by vibeology

[EllaWycliffe]

11 hours ago, statsgirl said:

Identical twins are identical when the egg splits. After that, epigenetics takes over.

I agree but for a lay person "we're twins! our genes are identical!" was fine. This wasn't the worst error made.

11 hours ago, statsgirl said:

When I ha my first dose of chemotherapy, I got very sick for a week. So when it came time for my second dose, my oncologist lowered the dose. This is what is known as a 'duh' solution.

Why did Devon keep giving the treatment even though the patient got sicker and sicker?

It wasn't strictly standard chemo. It was a special trial where they were basically zapping the guy's cancer with his own cancer cells altered to attack the cancer. It also was a last chance "this patient is essentially going to die anyway" situation where the potential payoff was worth the risk. 

 

11 hours ago, statsgirl said:

"You followed the patient's wishes."  Aaaaargh, that is so stupid. The patient isn't an expert on reactions to clinical trials, it's the doctor who is. If the patient wished to jump off the roof of the hospital believing that the drug would make him fly, should the doctor support him?

The doctor isn't allowed to decide for the patient if the patient is cognizant of the risks and consequences. The counter example is AJ's mom, who decided against the trial Devon was running and was very happy to go on palliative care. Despite AJ wanting her to choose the clinical trial so that she might live longer. 

I otherwise agree with your points and would add that if Cade was REALLY hiding from the mob because of her work with the FBI, the last thing she's going to do is reveal that openly to Hawkins who she has known for a few weeks.

[Driad]

Devon and his patient could have sung Tom Lehrer's "The Elements" instead of just reciting the names.

[Crashcourse]

I'm not at all interested in Dr. Eyebrows and her backstory.

I have a feeling AJ's mom isn't going to be around much longer because they're both too happy now.

[statsgirl]

5 hours ago, EllaWycliffe said:

I otherwise agree with your points and would add that if Cade was REALLY hiding from the mob because of her work with the FBI, the last thing she's going to do is reveal that openly to Hawkins who she has known for a few weeks.

I missed that but I agree totally. You'd think that having been careful all those years, she'd know better.

5 hours ago, EllaWycliffe said:

The doctor isn't allowed to decide for the patient if the patient is cognizant of the risks and consequences.

True, but Devon himself said that he didn't know that the teacher would react like that so not even Devon was cognizant of the risks. The teacher couldn't be if Devon wasn't. Devon could have advised him to take the trial slower.

That whole trial didn't make sense. The idea that the treatment is given in doses over a short time period instead of a dose, waiting to see the effect, then another dose, doesn't make sense.  And when Devon saw that the teacher was reacting unexpectedly, why wouldn't he pause and reassess? Many trials have been stopped midway because they were doing more harm than good. It does feel like the medical advisor checked out of this episode.

[Snazzy Daisy]

AJ: "Leela, you've reached Conrad Hawkin's level of diagnosis!" 

[circumvent]

AJ is so annoyingly childish with his mama. UGH!

I don't think clinical trials work like that, with other doctors interfering and giving their opinions. But of course, it is Conrad, the Omnipresent, Omnipotent, The Wise One, so he needs to know everything. And now he is going to do the job of the FBI - to be fair, the FBI is pretty shitty when it comes to solving cases.

Which leads me to the next comment: people overcharging Medicare is completely legal, supported and, as of late, encouraged by the government. It s called Medicare Advantage (which is not the same as Medicare run by the government) - the biggest scam won by the health insurance industry. Hassle free, guaranteed reimbursement for astronomical prices, high rate of denial for the ones who really need care. 

Edited March 10, 2022 by circumvent

[circumvent]

On 3/8/2022 at 10:28 PM, statsgirl said:

"You followed the patient's wishes."  Aaaaargh, that is so stupid. The patient isn't an expert on reactions to clinical trials, it's the doctor who is

Clinical trials are supposed to have a well-defined and understood set of parameters. Patients cannot go on dying because the drug needs more tweeks. They also need a set of protocols to adjust according to the results on each individual, considering their own medical history. One patient cannot just decide that protocols need to be waived in the middle of the trial just because they want to "keep going" because their students would be disappointed. Imagine the marketing for this drug (because in the US of A, drugs can get advertised as merchandise to be readily consumed): "in (not really controlled or following strict guidelines) studies several subjects died after side effects were too severe for the body to take but maybe you are one of the lucky ones who will not die, although the suffering led their loved ones to almost despair. Don't worry, the loved ones apologized to the doctors later"

Now we get to the unsolvable ethical dilemma about egg donors. People should stop trying to arbiter this. Science is complicated when it comes to such issues. There is never a right answer that will be accepted by all people. It gets annoying.

 

 

[SunnyBeBe]

I did cringe when the teacher said they had found a cure for diabetes.  I’m Type 1 and there is no cure, unless you consider a pancreas transplant, but even that is not guaranteed as permanent solution.  With there being so many diabetics, I’m astounded that there’s still so much misinformation about it.  
 

Why oh why didn’t the doctor get a legal consult before making huge decisions about accusing the doctor up for the medical board position.  If she had her phone on, both times, she could have recorded what he said to her.  
 

When you tell big secrets, you need to make sure someone isn’t within hearing range.  
 

 

Edited March 13, 2022 by SunnyBeBe

[bros402]

On 3/8/2022 at 10:28 PM, statsgirl said:

Did the medical advisor for the show quit this episode?

When I ha my first dose of chemotherapy, I got very sick for a week. So when it came time for my second dose, my oncologist lowered the dose. This is what is known as a 'duh' solution.

Why did Devon keep giving the treatment even though the patient got sicker and sicker?

"You followed the patient's wishes."  Aaaaargh, that is so stupid. The patient isn't an expert on reactions to clinical trials, it's the doctor who is. If the patient wished to jump off the roof of the hospital believing that the drug would make him fly, should the doctor support him?

They can modify the doses - or they can add more stuff, like Devon did. One guy I know with my cancer had an allergic reaction to his chemo, so they pumped him full of benadryl and steroids for dose #2 (same dosage) - but you think by dose #4.... they would've pat least PAUSED the medication administration, since it sounds like a phase 1 trial, so they are trying to figure out what works.

With trials, they usually have a clause of "The patient can exit the trial if the principal investigator believes it is in the best interests of the patient" - which Devon should have invoked

On 3/9/2022 at 10:07 AM, EllaWycliffe said:

It wasn't strictly standard chemo. It was a special trial where they were basically zapping the guy's cancer with his own cancer cells altered to attack the cancer. It also was a last chance "this patient is essentially going to die anyway" situation where the potential payoff was worth the risk. 

The doctor isn't allowed to decide for the patient if the patient is cognizant of the risks and consequences. The counter example is AJ's mom, who decided against the trial Devon was running and was very happy to go on palliative care. Despite AJ wanting her to choose the clinical trial so that she might live longer. 

Googling it, Devon was testing CAR-T immunotherapy on the patient's lung cancer - https://www.mdanderson.org/cancerwise/what-is-tumor-infiltrating-lymphocyte-til-therapy--6-things-to-know.h00-159460056.html#:~:text=CAR T cells are engineered,developed for treating solid tumors.

and CAR-T hits like a bus (or train, or your preferred method of transportation that would hurt a LOT to be hit with) with some people. So you can tank a lot before you get better.

Devon can decide if the patient should stop the trial. The clinical trial I am in has this specific phrasing in the 20 page packet I signed: "Are there other reasons why I might stop being in the study?
Yes. The study doctor may take you off the study if:
...Your health changes, and the study is no longer in your best interest"

On 3/10/2022 at 4:50 AM, circumvent said:

I don't think clinical trials work like that, with other doctors interfering and giving their opinions. But of course, it is Conrad, the Omnipresent, Omnipotent, The Wise One, so he needs to know everything. And now he is going to do the job of the FBI - to be fair, the FBI is pretty shitty when it comes to solving cases.

Trials can work like that - It seems like Conrad was part of his medical team. Devon can consult with the rest of the patient's medical team. For example, with my trial, my doctors talk to each other about my progress, and they talk to other doctors to see what they think

On 3/10/2022 at 9:41 AM, circumvent said:

Clinical trials are supposed to have a well-defined and understood set of parameters. Patients cannot go on dying because the drug needs more tweeks. They also need a set of protocols to adjust according to the results on each individual, considering their own medical history. One patient cannot just decide that protocols need to be waived in the middle of the trial just because they want to "keep going" because their students would be disappointed.

It seems like it might be an early stage trial - but yeah, Devon should've stopped the trial on the patient - just because you like the guy doesn't mean you can risk his life by putting him on a vent (especially when he pointed out that vent induced pneumonia could kill him very quickly). I mean, sure, this trial *is* for cancer patients, but they have guidelines.

[circumvent]

4 hours ago, bros402 said:

Trials can work like that - It seems like Conrad was part of his medical team. Devon can consult with the rest of the patient's medical team. For example, with my trial, my doctors talk to each other about my progress, and they talk to other doctors to see what they think

I get that, but was Conrad the guys doctor? It wan't an ED case, when you hav whatever doctors coming in and trying to figure things out, and Conrad is not a specialist on lung cancer, or any cancer, is he? I would think that the patient would have to be at least informed of his consultation. Maybe I am wrong, I just would not like to have any doctor involved in my care - like hands on, not only as another opinion -  without being at least informed of it. But in this show, Conrad has to be involved in everyone's life, in every aslect of it, I guess.

[Madding crowd]

I don’t know where they got the actress who plays Cade but she seems like a robot. I don’t believe Hawkins would be interested in her as she has zero personality. So the medical student who is Billie’s son just disappeared? And where was Billie during this episode? I’m glad Devon got a main story this week and I hope his patient lives. They need to keep looking for a new love interest for Conrad. And I hope Irving reports Dr. Robot for taking off and demanding he work an extra shift; not her call.

[statsgirl]

2 hours ago, Madding crowd said:

So the medical student who is Billie’s son just disappeared?

Kit said that he was still away after the big reveal. This episode was right after the previous one since Bell was handing the hospital back to Kit. Presumably he'll be back on the show at some time.

[Madding crowd]

Yes but Kit acted like she didn’t know where he was or authorize him taking time off. I assume he is still in a medical program and has to show up for his internship.

[bros402]

18 hours ago, circumvent said:

I get that, but was Conrad the guys doctor? It wan't an ED case, when you hav whatever doctors coming in and trying to figure things out, and Conrad is not a specialist on lung cancer, or any cancer, is he? I would think that the patient would have to be at least informed of his consultation. Maybe I am wrong, I just would not like to have any doctor involved in my care - like hands on, not only as another opinion -  without being at least informed of it. But in this show, Conrad has to be involved in everyone's life, in every aslect of it, I guess.

Honestly, it seems like Conrad might see some patients outside of an acute setting. I would not be surprised if Chastain had an outpatient clinic that they put in the hospital during the time jump, with Conrad where he sees patients. I think Conrad is internal medicine - so he would be like the guys GP if this is the case.

A patient doesn't have to be informed of another doctor being consulted. So I have a super rare cancer - I have seen 5 oncologists about it (with a sixth being a substitute) and they have mentioned that many other oncologists have been consulted on my case. I have never been told the names of those other doctors (oncologists and hematopathologists), but I know that they have been asked about my case. My current managing oncologist, along with the rest of the leukemia department know about my case - along with my local oncologist and everyone at his practice know about my case. They talk about some of the.... odder cases, get each other's opnions, etc. My oncologists also talk to my GP, neurologist, and cardiologist.

[KaveDweller]

20 hours ago, Madding crowd said:

Yes but Kit acted like she didn’t know where he was or authorize him taking time off. I assume he is still in a medical program and has to show up for his internship.

It did sound like that, but I would expect Kit would give him a little leeway to not show up for a couple days after the reveal with Billie. I assume him not be around will be a plotline in the next episode, where maybe they have to go find him?