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S01.E03: Every Last Minute


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Reynolds begins to build his department as Dr. Sharpe battles skepticism from a patient's parents. Meanwhile, Max helps Bloom find a solution for a pregnant patient in a tough spot, all the while continuing to avoid the reality of his diagnosis.

10/09/2018

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I completely understand the constraints of TV production, but to have dialogue about how small a preemie is while having a giant baby onscreen is funny.

Helen's plot is my favourite. She's made choices and now she's seeing those choices reflect back on her and it's tough. I'm looking forward to seeing her figure her stuff out.

The psych case of the week is always the most far-fetched. Aside from the comedy of a naked guy running around the hospital, it did nothing for me.

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53 minutes ago, vibeology said:

I completely understand the constraints of TV production, but to have dialogue about how small a preemie is while having a giant baby onscreen is funny.

That is exactly what I was coming to say! When the rich donor  peeked through the window and said what a tiny baby that was, I laughed. I know that the baby was supposed to be 8 weeks early, but she looked the size of my first son who weighed 10 lbs. Even if they couldn't have a preemie, at least have a small baby.... The story line was believable tho'....the mother not wanting to have the baby in prison...but the solution is being used IRL.

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I legit don't get the ending. Nothing has changed, right? He's not going to be able to spend the time with his wife that she needs, so....huh? Why was it being sold as a happy ending? And why in the world would the wife believe him? That scene confused the heck out of me.

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56 minutes ago, Brian Cronin said:

I legit don't get the ending. Nothing has changed, right? He's not going to be able to spend the time with his wife that she needs, so....huh? Why was it being sold as a happy ending? And why in the world would the wife believe him? That scene confused the heck out of me.

It makes no sense. So rather than the wife be with her retirement age parents (I'm assuming based on her age) who can help her out and take care of things like cooking and cleaning while she rests and make sure she isn't alone if a crisis happens again, she's going to be alone at home while he is going to be constantly at work. That is a shitty solution. But he really wants to be a dad so it's all okay. I hated it. They've really laid on all the issues with Dr. Cancer-Estranged-Pregnant-Wife-Who-Has-Just-A-Few-Months-to-Save-The-Hospital-or-Lose-His-Job. It's too much!

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2 hours ago, vibeology said:

It makes no sense. So rather than the wife be with her retirement age parents (I'm assuming based on her age) who can help her out and take care of things like cooking and cleaning while she rests and make sure she isn't alone if a crisis happens again, she's going to be alone at home while he is going to be constantly at work. That is a shitty solution. But he really wants to be a dad so it's all okay. I hated it. They've really laid on all the issues with Dr. Cancer-Estranged-Pregnant-Wife-Who-Has-Just-A-Few-Months-to-Save-The-Hospital-or-Lose-His-Job. It's too much!

I hated it too. I thought we were going to be rid of the wife and then Max shows up and gives her the puppy dog eyes and she decides to stay. I don't get it. I would have gone home to my parents and in fact I did do that. This storyline irritates me and the actress playing the wife irritates me. It is too much.

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I hope they at least hire a housekeeper or something so she can actually rest.  I didn't like that ending.

I'm also confused on his cancer.  He just now decided to get treatment?  Why was he holding off on doing that?  Was he planning on just dying but now he suddenly changed his mind because...?

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18 hours ago, vibeology said:

I completely understand the constraints of TV production, but to have dialogue about how small a preemie is while having a giant baby onscreen is funny.

The real miracle is that baby was born without an umbilical cord! She had a completely healed belly-button.

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5 hours ago, festivus said:

I hated it too. I thought we were going to be rid of the wife and then Max shows up and gives her the puppy dog eyes and she decides to stay. I don't get it. I would have gone home to my parents and in fact I did do that. This storyline irritates me and the actress playing the wife irritates me. It is too much.

They also made it sound as though CT was in another time zone. Parts of CT are a very short commute from Manhattan. He could easily have moved in with his in-laws, too. Then they could be there for her during the day, and he could prove he was going to be available in his off-hours.

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It makes no sense. So rather than the wife be with her retirement age parents (I'm assuming based on her age) who can help her out and take care of things like cooking and cleaning while she rests and make sure she isn't alone if a crisis happens again, she's going to be alone at home while he is going to be constantly at work. That is a shitty solution. But he really wants to be a dad so it's all okay. I hated it. They've really laid on all the issues with Dr. Cancer-Estranged-Pregnant-Wife-Who-Has-Just-A-Few-Months-to-Save-The-Hospital-or-Lose-His-Job. It's too much!

I'm with you.  I had no idea why it was better for her to be alone in Manhattan than be with people who actually appear to want to help her.  Max seems almost unbelievably self-centered given his entire reason for her to stay was all about him and his feelings.  And I can't wait to see her reaction when she finds out he has been hiding his diagnosis from her.  He's kind of awful.  

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Helen's plot is my favourite. She's made choices and now she's seeing those choices reflect back on her and it's tough. I'm looking forward to seeing her figure her stuff out.

I honestly had no idea what the patient and her wife(?) were doing.  I can't imagine a doctor agreeing to be filmed liked that, much less two people who seemed to be there strictly so they could judge Helen's choices, and walk off in a huff. 

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Didn't they say the implementation of the infant-care-in-the-prison program wouldn't be started for a few weeks? The prisoner was set to be released in six weeks so that wouldn't have helped her.

They said even though the program would take time to implement they could have a room ready immediately for new mothers. 

Edited by txhorns79
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21 hours ago, vibeology said:

The psych case of the week is always the most far-fetched. Aside from the comedy of a naked guy running around the hospital, it did nothing for me.

The Cotard delusion is a real thing.

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23 hours ago, suebee12 said:

That is exactly what I was coming to say! When the rich donor  peeked through the window and said what a tiny baby that was, I laughed. I know that the baby was supposed to be 8 weeks early, but she looked the size of my first son who weighed 10 lbs. Even if they couldn't have a preemie, at least have a small baby.... The story line was believable tho'....the mother not wanting to have the baby in prison...but the solution is being used IRL.

The huge newborn was just a small part of the issue.  We were also expected to believe that a pregnant woman would prefer that both she and her baby die rather than have the child go into foster care for a mere 6 weeks.  While it isn’t ideal, and I am sure it would be really tough on the mother; I think it is very unlikely that an infant would be permanently harmed by 6 weeks in foster care, let alone that the mother would risk death for both of them to avoid it.  

The birth was also ridiculous. Aside from Giganto-baby, a 34 weeker is going to be taken to the NICU for assessment and care very quickly after birth; no matter who the mother is and is going to be at risk for stuff like jaundice and infections and feeding problems and wouldn’t be released for a couple of weeks even if mom wasn’t in jail.  I am an OB, one of my partners delivered at 34 weeks. Despite the fact that she was a doctor as were about half her family; the kid was in the hospital a couple of weeks. And, of course, the notion that a jail could be expected to set up appropriate accommodations for a mother and baby in just a couple days was silly.

When the rich lady was giving the oncologist grief about her Birkin bag, I was hoping she’d discover Dr Max’ plan to have his wife hospitalized in a private room for the duration of her pregnancy, not because it was medically necessary, but because it was convenient for him.  He’s making a mid 6 figure salary at minimum, he can well afford to hire private nurses and whatever else she might need out of his own pocket.  He is really kind of a jerk, IMO. The nonsensical BS he spouted about wearing scrubs to run the hospital because he’s a doctor was also BS.  It’s no wonder he won’t hire help to care for his wife at home, apparently he’s too cheap to buy appropriate clothing for the office.

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2 hours ago, txhorns79 said:

 

I honestly had no idea what the patient and her wife(?) were doing.  I can't imagine a doctor agreeing to be filmed liked that, much less two people who seemed to be there strictly so they could judge Helen's choices, and walk off in a huff. 

Quite frankly, if a prospective patient showed up at my office wanting to film her interview with me, I’d not only decline, I’d recommend she look for another doctor.  The two of them were so full of themselves and very judgmental, I think the oncologist dodged a bullet when they decided to look elsewhere. The way they were grilling her as well as their hostile attitudes, made me think they were going to eventually admit they were from 60 Minutes and were filming an expose about her bogus MD degree or something.

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17 minutes ago, doodlebug said:

The huge newborn was just a small part of the issue.  We were also expected to believe that a pregnant woman would prefer that both she and her baby die rather than have the child go into foster care for a mere 6 weeks.  While it isn’t ideal, and I am sure it would be really tough on the mother; I think it is very unlikely that an infant would be permanently harmed by 6 weeks in foster care, let alone that the mother would risk death for both of them to avoid it.  

And why was the child automatically going to be put into foster care? The inmate had no relatives or family friends to take the baby for the short rest of her sentence? Isn't that the first attempt, to get a relative to take the baby? What about the baby's father? Were we to assume he was in jail too and for longer or did he/his family not know about the baby? Surely they would take her if the alternative was the baby being put into foster care, and even file for full custody if the mother gave birth in prison.

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Just now, LexieLily said:

And why was the child automatically going to be put into foster care? The inmate had no relatives or family friends to take the baby for the short rest of her sentence? Isn't that the first attempt, to get a relative to take the baby? What about the baby's father? Were we to assume he was in jail too and for longer or did he/his family not know about the baby? Surely they would take her if the alternative was the baby being put into foster care, and even file for full custody if the mother gave birth in prison.

She did say there was absolutely no one else, not a relative, no friends which, considering the fairly short duration they would’ve been needed seemed far fetched to me.

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8 hours ago, doodlebug said:

She did say there was absolutely no one else, not a relative, no friends which, considering the fairly short duration they would’ve been needed seemed far fetched to me.

Out of curiosity, how did you find their depiction of HELLP (or HELLPS, as Dr ER kept saying)?  Aside from the Mark Green syndrome where she wasn’t taken to L&D straight away. 

The Cotard delusion stuff was actually pretty close to the real thing, apart from the guy somehow getting his hands on embalming fluid and the fact that the Dam’s morgue doesn’t apparently have a lock on the door. 

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2 hours ago, starri said:

Out of curiosity, how did you find their depiction of HELLP (or HELLPS, as Dr ER kept saying)?  Aside from the Mark Green syndrome where she wasn’t taken to L&D straight away. 

The Cotard delusion stuff was actually pretty close to the real thing, apart from the guy somehow getting his hands on embalming fluid and the fact that the Dam’s morgue doesn’t apparently have a lock on the door. 

Aside from the inability to get the terminology right, I found their thinking on the diagnosis and treatment disjointed and hard to follow.  First off, delivery is certainly indicated and they got that right, but, depending on the circumstances, some consideration needs to be given to administering steroid to enhance fetal lung maturity.  Then, considering the patient's agitation and irrational behavior, some thought should've been given to cerebral edema or maybe a brain bleed if her platelets were low.  A head CT might have been indicated except I think we were supposed to think her behavior was completely reasonable.

HELLP stands for hemolysis, elevated liver enzymes and low platelets and I'm not sure we were ever told that she had all 3 of them, but, at one point, someone said she was eclamptic, which means she had a seizure which I don't think we saw, though maybe I missed it.  It is possible to have HELLP. but not eclampsia, or vice versa.  Two totally different complications of PIH, pregnancy induced hypertension, which is the underlying process.  We also don't know why a woman at risk for life threatening hemorrhage had a cesarean rather than being induced for a possible vaginal delivery which is far safer for her as long as her blood pressure, etc are carefully monitored and controlled. 

I also don't understand why the ER doc, let's call her Mark Greene, Jr,  who was in charge of managing a seriously ill patient and presumably qualified, needed Dr Miracle Max to tell her that she needed to order blood products just in case.  BTW, I would expect that the majority of non-OB docs a few years removed from their residency would not remember what HELLP stood for, let alone been sure of what to do about it.  After delivery, a patient with HELLP needs to be on Magnesium sulfate for at least 24 hours and her cardiac, pulmonary and renal function monitored carefully usually in an intensive care setting on Labor and Delivery.  People with HELLP usually feel pretty sick, BTW and magnesium sulfate tends to cause drowsiness, nausea and other fun side effects and a woman who has been on mag and undergone a cesarean wouldn't have been nearly as alert and feisty as the prisoner was.  Being up and around looking fine about 10 minutes post birth is not the way it goes.

What kind of doc is the Amazing Dr Max supposed to be?  Have they said?

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13 hours ago, starri said:

The Cotard delusion is a real thing.

Oh, I assumed it was real (most medical shows at least use real illnesses) but the circumstances around the whole thing were far-fetched. The guy was found naked, digging a grave. He managed to try to embalm himself. He got into the morgue and into a closed drawer on his own. He ran around the hospital naked for a large part of the day. I can get over one of those things but all of them makes for a ridiculous plot even if the medicine is right.

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2 hours ago, starri said:

Out of curiosity, how did you find their depiction of HELLP (or HELLPS, as Dr ER kept saying)?  Aside from the Mark Green syndrome where she wasn’t taken to L&D straight away. 

The Cotard delusion stuff was actually pretty close to the real thing, apart from the guy somehow getting his hands on embalming fluid and the fact that the Dam’s morgue doesn’t apparently have a lock on the door. 

Can you imagine the JCAHO/sentinel event report required to explain how a deadly fluid was somehow out in the open and not under lock and key?  Formalin is a carcinogen, it has to be labelled and locked up tight at all times.

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21 hours ago, txhorns79 said:

I honestly had no idea what the patient and her wife(?) were doing.  I can't imagine a doctor agreeing to be filmed liked that, much less two people who seemed to be there strictly so they could judge Helen's choices, and walk off in a huff.  

We had a guy show up for his colonoscopy with his film crew. I told them I wasn't participating unless I was paid union scale. Our department head shut the whole thing down with the ultimatum: stop filming or cancel the procedure. After going through the bowel prep the night before, he wasn't about to leave unscoped.

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1 hour ago, Flyin.Bryan said:

I couldn't get over that couple's "It took us three weeks to get this appointment!". For a new patient to get in to see a super famous doctor? I have a hard time getting into my existing doctor's schedule three weeks out.

I think there was a diagnosis of cancer already made and they were coming to the doc to start chemotherapy.  The show calls her an oncologist, which usually means that she administers chemotherapy.  There are also surgical oncologists and radiation oncologists; but I suspect the show will pretend that she did 3 separate residencies (internal medicine, general surgery, and radiology) followed by 3 separate fellowships (hematology/oncology, surgical oncology and radiation oncology).  No one would ever actually do this, of course, if only because it would take around 20 years to finish them all.

Anyway, when it comes to specialists in an area like oncology where there is a time issue for starting treatment; doctors would have set aside patient appointments to get new patients in to be seen in timely fashion.  Three weeks might be a little long, but not unreasonable and would not affect prognosis.  I live in a big city, work at a major hospital system.  A friend's husband (she also works with the same system) was diagnosed with cancer and it took 2 weeks to get an appointment with the oncologist, although his appointment was moved up when he began having problems.  Considering their attitudes, I suspect these women spent considerable time researching all their options and deciding which doctors to interview; so, it could well be the timeline was stretched to accommodate their busy schedules. I'll bet they had 6 or more of those interrogations set up and then planned to go home rewatch the tapes a dozen times, maybe enlist friends and family in the decision making, and then choose a doctor. They would then notify the lucky doc and expect an immediate appointment at their convenience and that the doc would prostrate himself/herself at their feet thanking such awesome people for selecting him or her.  In other words, I doubt the waiting period for an appointment was the limiting factor.  And, yes, there are a lot of people who behave like this at doctor's appointments including in the ER.  The doctor who is 'chosen' by these sorts gets nothing but headaches as they generally expect the entire world to revolve around them and their problems.  They want 24/7 instant access to their doctor of choice, no matter what; office appointments to be scheduled at their convenience and last as long as they want which will often be an hour or more and will express shock and dismay that the doctor might have to cut short their appointment after 40 minutes due to other people's needs. 

Just this past week, a pregnant patient came to the front desk at my officeand demanded her doctor's personal cell phone number, stating she was uncomfortable speaking to anyone but her and needed to be able to reach her anytime she wanted and was sure the doctor would want to be available to her in this way.  She didn't get the number.  Amazingly, my partner, having well over 100 pregnant patients at any given time, a surgical schedule, a call schedule as well as a husband and 2 young kids; wasn't on board with giving it to her.

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11 minutes ago, doodlebug said:

There are also surgical oncologists and radiation oncologists; but I suspect the show will pretend that she did 3 separate residencies (internal medicine, general surgery, and radiology) followed by 3 separate fellowships (hematology/oncology, surgical oncology and radiation oncology). 

I think they did have her say that she'd done multiple fellowships.  I have no idea what rational human being would want to do that to themselves, but I guess they did try to handwave it.  Plus, she's probably an MBBS, and I've never been able to figure out how medical education in the UK works.

I've had patients try to record before, but the nice thing about being in units that lock from the outside is that we can more closely regulate patients/family trying to play Spielberg.  

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19 minutes ago, starri said:

I think they did have her say that she'd done multiple fellowships.  I have no idea what rational human being would want to do that to themselves, but I guess they did try to handwave it.  Plus, she's probably an MBBS, and I've never been able to figure out how medical education in the UK works.

I've had patients try to record before, but the nice thing about being in units that lock from the outside is that we can more closely regulate patients/family trying to play Spielberg.  

The UK medical training and practice system is completely different from the US, comparison is very difficult.  I do know that foreign trained (other than Canadian) docs who come to the United States to practice must complete a full residency in their specialty before being eligible t practice.  There is also an exam to pass.  It is my understanding that it does not matter how long the doctor practiced their specialty in their home country, how well-respected they are, how skilled; every foreign trained doctor who comes to the US must do an entire residency for licensure.  Therefore, many foreign educated doctors come to the US after medical school but before doing a residency.  There's no point in doing a residency outside of the US or Canada if a doctor wants to practice in the US, it isn't recognized.  I think this is at least in part due to the big differences in medical education in other parts of the world.

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Good old Ron Rifkin certainly' has gotten the stuck-up, corporate bigwig who clashes against the hero role down pact, huh?  He is good at it, though.

I get what they were going for with Sharpe's storyline, but I found the couple to be so unnecessarily rude, that I wanted Sharpe to just cut it short and be like "Fine, leave then.  Good luck fighting that cancer!"  Which is why I know I could never be a doctor, because you have to be way more professional and mature then that!

I noticed that this show really seems to like having Frome and Kapoor team up and do their own thing, away from everyone else.  Still, Tyler Labine and Anupam Kher do work well together.

I think this was the first time Bloom and Sharpe really interacted, which was cool, although I always wonder what it is like when there are two British actors/actresses, and one has to fake an American accent, while the other can use his/her normal one.  Like during takes, Janet Montgomery is like "Damn you, Freema!  You don't have to add this on top of all your other acting choices!  You are so lucky!"

I couldn't figure out why Max's big deal at the end was because he didn't want to miss out on the birth, because isn't NYC only about two hours from Connecticut?  I'm assuming her parents would contact him once her water breaks, and he'd still have time to get there in time.

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18 hours ago, thuganomics85 said:

I noticed that this show really seems to like having Frome and Kapoor team up and do their own thing, away from everyone else.  Still, Tyler Labine and Anupam Kher do work well together.

The snark about the invisible patient was the most amused I've been by this show so far. More low-key character stuff like that, fewer existential crises, and these people might actually be tolerable.

Edited by Emma9
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They really didn't set up the Doctor Helen plot well. I get that she's in a very specific low point, psychologically, but I still can't imagine anyone being down on themselves after a display like those two ladies did in that appointment. "Where did you go to medical school?" If that actually mattered to you, you would have known it already from looking up the doctor online. The lady is a celebrity doctor. You don't go to a celebrity doctor if you don't want a celebrity doctor. When some moron comes to you because they see you on TV and then says that they don't want you to be their doctor because you're on TV, then you simply cannot take that to heart if you're the doctor. You just can't. And I don't think that any doctor really WOULD.

So I didn't buy that aspect of the Doctor Helen plot. It would have been a lot better to do more of the plot that they had the previous episode, just play up the fact that she probably HAS been slacking off on the care of the patients who are currently nominally being treated by her (but more likely are being treated by her associates under her supervision).  Derive the guilt from THAT scenario. It's a lot more realistic and it is just as compelling (it gets you to the same point where she is doubting herself). Maybe have a patient say that they'd rather go back to being treated by her associate who has been with them the entire time. 

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On 10/10/2018 at 1:25 PM, festivus said:

I hated it too. I thought we were going to be rid of the wife and then Max shows up and gives her the puppy dog eyes and she decides to stay. I don't get it. I would have gone home to my parents and in fact I did do that. This storyline irritates me and the actress playing the wife irritates me. It is too much.

When I was on bedrest, I also temporarily  moved in with my parents. I had a 3 year old at home and a husband that worked fulltime. I needed help and this was the easiest way to do it. Granted, my husband and I weren't have problems at the time and they lived 5 minutes away. I also don't like the wife at all.

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On 10/11/2018 at 10:43 AM, doodlebug said:

Aside from the inability to get the terminology right, I found their thinking on the diagnosis and treatment disjointed and hard to follow.  First off, delivery is certainly indicated and they got that right, but, depending on the circumstances, some consideration needs to be given to administering steroid to enhance fetal lung maturity.  Then, considering the patient's agitation and irrational behavior, some thought should've been given to cerebral edema or maybe a brain bleed if her platelets were low.  A head CT might have been indicated except I think we were supposed to think her behavior was completely reasonable.

HELLP stands for hemolysis, elevated liver enzymes and low platelets and I'm not sure we were ever told that she had all 3 of them, but, at one point, someone said she was eclamptic, which means she had a seizure which I don't think we saw, though maybe I missed it.  It is possible to have HELLP. but not eclampsia, or vice versa.  Two totally different complications of PIH, pregnancy induced hypertension, which is the underlying process.  We also don't know why a woman at risk for life threatening hemorrhage had a cesarean rather than being induced for a possible vaginal delivery which is far safer for her as long as her blood pressure, etc are carefully monitored and controlled. 

I also don't understand why the ER doc, let's call her Mark Greene, Jr,  who was in charge of managing a seriously ill patient and presumably qualified, needed Dr Miracle Max to tell her that she needed to order blood products just in case.  BTW, I would expect that the majority of non-OB docs a few years removed from their residency would not remember what HELLP stood for, let alone been sure of what to do about it.  After delivery, a patient with HELLP needs to be on Magnesium sulfate for at least 24 hours and her cardiac, pulmonary and renal function monitored carefully usually in an intensive care setting on Labor and Delivery.  People with HELLP usually feel pretty sick, BTW and magnesium sulfate tends to cause drowsiness, nausea and other fun side effects and a woman who has been on mag and undergone a cesarean wouldn't have been nearly as alert and feisty as the prisoner was.  Being up and around looking fine about 10 minutes post birth is not the way it goes.

What kind of doc is the Amazing Dr Max supposed to be?  Have they said?

Not a dr but as a mom who had this and delivered at 33 weeks, I agree with what you said. I found their depiction awful. I was told for the steroids to be effective, you needed 2 shots a day apart. 

 

Now I did deliver on the same day I was diagnosed with it but that was not the original plan. The original plan was pain meds, the mag, and for me to stay on hospital bedrest (hopefully) until 36/37 weeks. However, when I was moved to that room, I was in so much pain ( a lot more than this actress showed) and when I pointed out there was the band pain around my kidneys, they ran my blood tests again. Those numbers had already dropped by half and the others had increased in that hour so I delivered. I had a vaginal delivery as well. I then stayed on bedrest after delivery for 48 hours. They didn't even move me. I know it's supposed to be 24 but my body wasn't cooperating. 

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On 10/10/2018 at 5:52 PM, eel2178 said:

The real miracle is that baby was born without an umbilical cord! She had a completely healed belly-button.

And she was extremely clean and dry!

Just make Tyler Labine and Anupam Kher the leads. That would be great.

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On 10/9/2018 at 8:12 PM, vibeology said:

I completely understand the constraints of TV production, but to have dialogue about how small a preemie is while having a giant baby onscreen is funny.

 

 

On 10/9/2018 at 9:10 PM, suebee12 said:

That is exactly what I was coming to say! When the rich donor  peeked through the window and said what a tiny baby that was, I laughed. I know that the baby was supposed to be 8 weeks early, but she looked the size of my first son who weighed 10 lbs. Even if they couldn't have a preemie, at least have a small baby.... 

This article is about the regulations for using babies in CA.

https://slate.com/news-and-politics/2007/06/where-do-hollywood-babies-come-from.html

Basically the baby has to be two weeks old.  But the brand new babies in movies and on TV are always huge.  Surely there are fame hungry parents in Hollywood who would love to pimp out their little 6lb, two week olds?

One reason why I love Call the Midwife is because the just-birthed babies are more realistic looking than the majority of those on TV here (States).

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On 10/11/2018 at 3:56 PM, doodlebug said:

Can you imagine the JCAHO/sentinel event report required to explain how a deadly fluid was somehow out in the open and not under lock and key?  Formalin is a carcinogen, it has to be labelled and locked up tight at all times.

IIRC, he’d already taken the formalin before he was admitted, so that at least couldn’t be blamed on the hospital. 

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