S01.E08: Three Dots

[Whimsy]

A patient's treatment plan takes an unexpected turn when Max gets overly invested. Meanwhile, Reynolds celebrates his birthday with some help from the hospital and Kapoor grapples with a case that hits close to home.

[Biggie B]

I cannot stand Dr. Bloom. She is beyond annoying and idiotic - working 30 hours straight or whatever it was she was doing is dangerous to herself and to her patients. She is lucky she didn't kill someone. And all because she's mooning over Dr. Reynolds. Speaking of whom, it's clear that his budding relationship with the attorney is not going to work out. That's a shame but of course, what's a soap opera without romantic drama and miscommunication?

I remember getting my three tattoos before my radiation treatment. Fun times, except not. I'm glad we got a bit of backstory for Dr. Helen - that she had a great love with whom she was planning a future and then he died. She's my favorite character. She seems the most pragmatic and logical of all the characters, yet she's become much more "human" than she was at the very beginning. And I appreciate her friendship with Max. 

Glad Max's wife was not in this episode. 

The rabbi and the young Chinese women - their storylines seemed trite and cliched. 

[LexieLily]

4 hours ago, Biggie B said:

I remember getting my three tattoos before my radiation treatment. Fun times, except not. I'm glad we got a bit of backstory for Dr. Helen - that she had a great love with whom she was planning a future and then he died. She's my favorite character. She seems the most pragmatic and logical of all the characters, yet she's become much more "human" than she was at the very beginning. And I appreciate her friendship with Max. 

Will Max eventually be the sperm donor for Helen's baby?

[doodlebug]

4 hours ago, Biggie B said:

I cannot stand Dr. Bloom. She is beyond annoying and idiotic - working 30 hours straight or whatever it was she was doing is dangerous to herself and to her patients. She is lucky she didn't kill someone. And all because she's mooning over Dr. Reynolds. Speaking of whom, it's clear that his budding relationship with the attorney is not going to work out. That's a shame but of course, what's a soap opera without romantic drama and miscommunication?

I remember getting my three tattoos before my radiation treatment. Fun times, except not. I'm glad we got a bit of backstory for Dr. Helen - that she had a great love with whom she was planning a future and then he died. She's my favorite character. She seems the most pragmatic and logical of all the characters, yet she's become much more "human" than she was at the very beginning. And I appreciate her friendship with Max. 

Glad Max's wife was not in this episode. 

The rabbi and the young Chinese women - their storylines seemed trite and cliched. 

I thought the whole episode was trite and clichéd.  Max bonds with the rabbi because maybe his grandfather was Jewish?  Max decides to forego traditional treatment of his cancer because he doesn't want anyone he works with to know he has cancer?  And something about his interaction with the rabbi led him to that choice?

BTW, Max talked about getting into a clinical trial for 'targeted therapy' for his tumor.  The only problem is that it would be unethical to enroll a patient in a clinical trial for an unproven treatment for throat cancer when there are very effective traditional therapies for it.  Clinical trials are for patients who either have a disease for which there is no known effective treatment or for those who have gotten traditional treatment that hasn't worked.  They are meant to provide research and information to guide future therapies, they are not meant as an equivalent alternative to the traditional therapies.  I have no idea why a young, otherwise vigorous man, well educated and surely capable of understanding the way clinical trials work, would opt for one in lieu of a proven effective (although difficult and harsh) therapy. That a young guy with a baby on the way no less, would choose to forego effective treatment in hopes that an unproven therapy will work just as well is not believable. They're obviously deviating from the book her since, from what I've heard, the actual doctor in the book did indeed undergo radiation therapy.

There are some drugs which provide targeted therapy, meaning medications meant to actively destroy cancer cells while sparing normal cells, which can be used to treat throat cancer; but, in someone like Max, they would be part of a regimen that included chemotherapy and radiation, not instead of it.  And, they also wouldn't be part of a clinical trial, which I am pretty sure he said he wanted.  BTW, clinical trials are based at individual institutions who are doing that research, so unless the oncologist at New Amsterdam was participating in the research, he would have to go elsewhere for the treatment.

Edited November 21, 2018 by doodlebug

[Sentient Meat]

I can't argue that the stories weren't "trite and cliched" but the major networks are so flooded with medical shows that I'm beginning to wonder if I'm starting to earn a medical degree by osmosis.  If you watch The Resident, Grey's Anatomy, The Good Doctor, Chicago Med, New Amsterdam, and even 911... you realize that the market is saturated to the point where they are doing a karaoke scene in at least three different shows, and in two of them they are even singing the exact same song!

I didn't mind New Amsterdam because I think it focuses on the human and ethical dilemmas of the hospital more than doctors hooking up.  Sure the tropes about the Asian Tiger Mom and the cultural divide between the Indian father and his son are old, but I appreciate the effort to provide genuine diversity and at least they were well acted.  Don't get me wrong, I know Ryan Murphy and Shonda have also made groundbreaking strides in this respect, but these stories represented over 2 billion people on our planet while Grey's hot Asian Doctor is a thinly written caricature at this point.

The division on the health care debate is so crucial to our nation's future that I applaud any effort to bring understanding and empathy to the discussion.  For that alone, I will continue to support this show.

Edited November 21, 2018 by Sentient Meat

[ams1001]

So she stepped in front of a subway train and her only apparent external injuries were a broken leg and a few scrapes on her face. Huh.

[MostlyC]

So she stepped in front of a subway train and her only apparent external injuries were a broken leg and a few scrapes on her face.

It happens a lot more than one would think- at least in NYC.  The space between the rails is quite deep and filthy.  I hope they gave her a tetanus shot.

Madame Gao showing up on New Amsterdam.  Hee.  But I thought she and the actress who played her daughter did an excellent job.

[ams1001]

4 minutes ago, MostlyC said:

It happens a lot more than one would think- at least in NYC.  The space between the rails is quite deep and filthy.  I hope they gave her a tetanus shot.

Interesting...

[starri]

44 minutes ago, MostlyC said:

Madame Gao showing up on New Amsterdam.

I loved that so much.

I'm going to call bullshit on how they handled that woman's suicide attempt.  Not Iggy and Vijay's attempts to work around the mother, nor Iggy's eventual insistence of bringing the mom into the therapy.  No, it's that there is a 0% chance that a suicide attempt with that high a potential lethality would not have been an automatic, involuntary admission.

[bros402]

So, Max is quite the idiot, isn't he. He will still be a patient if he is undergoing radiation. Radiation is not some magic bullet that you have no side effects from - as he was being told when getting the tattoo, he will need a tube to eat due to the effects of the radiation.

[txhorns79]

Quote

So, Max is quite the idiot, isn't he. He will still be a patient if he is undergoing radiation. Radiation is not some magic bullet that you have no side effects from - as he was being told when getting the tattoo, he will need a tube to eat due to the effects of the radiation.

While I realize the exposition is more for the audience, I feel like the writers don't recognize how it makes their characters look. 

Quote

I'm going to call bullshit on how they handled that woman's suicide attempt.  Not Iggy and Vijay's attempts to work around the mother, nor Iggy's eventual insistence of bringing the mom into the therapy.  No, it's that there is a 0% chance that a suicide attempt with that high a potential lethality would not have been an automatic, involuntary admission.

 

I was impressed they seemed to completely turn things around for the mother and daughter within what, two or three hours of the suicide attempt?  That is some amazing therapeutic skill.  But yeah, it was BS that there was no discussion of putting the woman on a hold, and the quick resolution was ridiculous.  

On a positive note, I don't know where the show is filmed, but I really do like the glass enclosed area where the characters walk from what appears to be an older area of the hospital into a newer extension.  It's a nice way to blend old and new. 

[starri]

1 hour ago, txhorns79 said:

On a positive note, I don't know where the show is filmed, but I really do like the glass enclosed area where the characters walk from what appears to be an older area of the hospital into a newer extension.  It's a nice way to blend old and new. 

That's the real Bellevue.  The masonry is the original entrance and they built the atrium over top of it about twenty years ago.  The curved walkways are part of their ambulatory medicine clinics.  It's a beautiful space.

[doodlebug]

5 hours ago, bros402 said:

So, Max is quite the idiot, isn't he. He will still be a patient if he is undergoing radiation. Radiation is not some magic bullet that you have no side effects from - as he was being told when getting the tattoo, he will need a tube to eat due to the effects of the radiation.

Exactly.  I guess we’re going to have to wait and see how badly they botch the treatment process.  I wasn’t clear whether he was only doing targeted therapy or if he was still doing radiation, too. In any event, people getting therapeutic doses of radiation to the head and neck are sick; they’re exhausted, their saliva dries up and their throat feels like a blowtorch has been taken to it. Hair loss in the field is also expected, so his sexy stubble would fall out.

Medical shows often take dramatic license, but I am particularly bugged when they mess with lifesaving therapies for stuff like cancer and pretend there is some magical easy way out or a curative therapy that doesn’t actually exist in real life.  Years ago, ER gave Mark Greene a brain tumor that is rapidly fatal even with treatment.  He sought out some extra special super duper new therapy and it was implied that it could be curative and that many people were alive and well years later.  The experimental treatment he got did exist in real life, but, in real life, patients who received it lived 2 MONTHS longer, not years.  It’s a disservice to patients and physicians to be so dishonest, IMO.

[starri]

26 minutes ago, doodlebug said:

Hair loss in the field is also expected, so his sexy stubble would fall out.

I'm also worried about his chest hair.  I've never gotten a radiotherapy tattoo, but I do have a number of ordinary tattoos, and even though Helen was only making three dots with India ink, I can't believe she didn't shave the area.

Nice of the celebrity oncologist to do that herself.

[Biggie B]

25 minutes ago, starri said:

Nice of the celebrity oncologist to do that herself.

Agreed. That whole scene was ridiculous. When I got my tattoos for radiation, trust me, my oncologist was not there! Everything was done by skilled technicians and nurses. But on all medical soap operas/dramas, they always show the doctors doing things like wheeling a patient to surgery or dozens of other things that again, technicians and nurses would be doing. It drives me nuts but it's one of those TV things.

[doodlebug]

34 minutes ago, starri said:

I'm also worried about his chest hair.  I've never gotten a radiotherapy tattoo, but I do have a number of ordinary tattoos, and even though Helen was only making three dots with India ink, I can't believe she didn't shave the area.

Nice of the celebrity oncologist to do that herself.

Nice of the celebrity oncologist to even know how to do it.  She even made the mold of his head for the radiation calculations.  Apparently, New Amsterdam is too poor to hire a radiation oncologist and radiation oncology technicians. And, of course, based on where his cancer seems to be located, he would probably end up with at least one tatoo somewhere on his face.  But, don't worry, no one working at the hospital will suspect a thing.

Edited November 22, 2018 by doodlebug

[ams1001]

51 minutes ago, Biggie B said:

But on all medical soap operas/dramas, they always show the doctors doing things like wheeling a patient to surgery or dozens of other things that again, technicians and nurses would be doing. It drives me nuts but it's one of those TV things.

Ha! Grey's Anatomy made a reference to orderlies last week (in a scene where the doctors were moving a patient because a lot of people couldn't make it in to work in a storm) and I was surprised they remembered such a position even exists! (I feel the same surprise when shows remember that HIPAA is a thing, though half the time they mention it because they're purposefully breaking it.)

[lkcraig316]

As a medical coder, I just couldn’t get past the fact that they were knowingly downcoding the treatment, and the hospital went along with it. And there was no thought about the payer being defrauded, just the hospital. No ethical coder would EVER go along with that. 

[ams1001]

7 minutes ago, lkcraig316 said:

As a medical coder, I just couldn’t get past the fact that they were knowingly downcoding the treatment, and the hospital went along with it. And there was no thought about the payer being defrauded, just the hospital. No ethical coder would EVER go along with that. 

I had a similar thought at the comment about defrauding the hospital - 'but not the insurance company?' (I guess if the coded treatment cost less it's in the insurance company's favor, but still.)

[doodlebug]

46 minutes ago, ams1001 said:

I had a similar thought at the comment about defrauding the hospital - 'but not the insurance company?' (I guess if the coded treatment cost less it's in the insurance company's favor, but still.)

Insurance companies are entitled to audit medical records in the course of their duties to their shareholders.  If they ask for the girl's records and discover she is being treated for depression and not whatever alternate diagnosis was being used; the jig is up and the doctors and hospital risk being tossed out of the plan.  And, of course, it would be a giant red flag to the insurance company if a psychiatrist was billing for services using non-psychiatric codes, her chart would be selected for audit toute de suite.  Even if the downcode paid less than the actual codes, insurance companies don't take kindly to fraud of any kind and it would probably trigger an even bigger audit and possibly the doctors and hospital being removed from the plans.

Meanwhile, New Amsterdam is a public hospital and is funded by taxpayers.  The doctors are public employees, just like the clerks at City Hall or cops or sanitation workers.  So, they downcode the chart and accept less payment than what it actually costs to provide the care.  Guess who makes up the difference?  I didn't hear any of the docs offer to pay for her treatment or see her in their off hours so it wouldn't be charged.  So, they are essentially stealing from the taxpayers.  I worked for a county hospital; believe me, they take this stuff seriously and the docs would be fired on the spot.

New Amsterdam has a huge department of psychiatry and surely has a nice outpatient clinic.  A clinic that undoubtedly receives public funds to provide treatment to people who cannot afford to pay. The young lady appeared to be over 18.  Having her go to the business office, give them information about her personal finances and then get 'rated' to receive care at reduced or no cost would've worked and happens all the time.  

ETA:  As CEO of the hospital, Max' salary and compensation is going to be over a million bucks a year.  The senior staff physicians are all making several hundred thousand a year.  For them to jeopardize the employment of hundreds of others in order to cheat the insurance company and taxpayers without risking anything themselves is really disgusting, not admirable.  Max, if he gets fired, undoubtedly has a golden parachute which will compensate him handsomely for years.  Meanwhile, the poor billing clerk who does his bidding and fraudulently bills the charges, loses his or her far less well-paid job and ends up being broke and unemployable.  No fair.

Edited November 22, 2018 by doodlebug

[bros402]

18 hours ago, doodlebug said:

Exactly.  I guess we’re going to have to wait and see how badly they botch the treatment process.  I wasn’t clear whether he was only doing targeted therapy or if he was still doing radiation, too. In any event, people getting therapeutic doses of radiation to the head and neck are sick; they’re exhausted, their saliva dries up and their throat feels like a blowtorch has been taken to it. Hair loss in the field is also expected, so his sexy stubble would fall out.

Medical shows often take dramatic license, but I am particularly bugged when they mess with lifesaving therapies for stuff like cancer and pretend there is some magical easy way out or a curative therapy that doesn’t actually exist in real life.  Years ago, ER gave Mark Greene a brain tumor that is rapidly fatal even with treatment.  He sought out some extra special super duper new therapy and it was implied that it could be curative and that many people were alive and well years later.  The experimental treatment he got did exist in real life, but, in real life, patients who received it lived 2 MONTHS longer, not years.  It’s a disservice to patients and physicians to be so dishonest, IMO.

I bet they are going to botch it amazingly. Probably not as bad as some shows, but they are gonna botch is baaad.

Do you think they were gonna have the character do chemo, then the actor was like "no i am not gonna shave my hair"

And how long until the radiation doesn't work, then they go "IMMUNOTHERAPY! CAR-T CELLS!" or something like that?

16 hours ago, lkcraig316 said:

As a medical coder, I just couldn’t get past the fact that they were knowingly downcoding the treatment, and the hospital went along with it. And there was no thought about the payer being defrauded, just the hospital. No ethical coder would EVER go along with that. 

Yeah, I mean couldn't they just bill it under the generic visit code (versus psychotherapy) instead of "Oh we're doing TMS" (which I imagine would be much more expensive)

[MoreCoffeePlease]

Who can tell us if sperm donor sites have pictures of hot model-type men in them?

[doodlebug]

8 minutes ago, MoreCoffeePlease said:

Who can tell us if sperm donor sites have pictures of hot model-type men in them?

I'm sure there are some that do, but most give statistics without a photo.  When browsing the catalog, the potential client can enter things like height, hair color, eye color, race and even things like educational level, special skills (like athletics or music) or occupation.  Most don't include photos because it is a privacy issue.  Most donors do not want to be identified.

[eel2178]

On ‎11‎/‎21‎/‎2018 at 3:47 PM, Sentient Meat said:

I can't argue that the stories weren't "trite and cliched" but the major networks are so flooded with medical shows that I'm beginning to wonder if I'm starting to earn a medical degree by osmosis.  

You're now just as qualified as any other TV writer who prefers drama to reality. Congratulations!

[LittleIggy]

The daughter was over 21 (it was mentioned) so why was her mother even at the appointment with Dr. Kapoor? 

I can’t believe Max didn’t know even the basics of the story of Abraham and Isaac. Even if one isn’t particularly religious, the story has been the subject of paintings by famous artists. BTW, I always thought that Isaac would have some serious trust issues with dad after that incident! 😆

[doodlebug]

11 hours ago, LittleIggy said:

The daughter was over 21 (it was mentioned) so why was her mother even at the appointment with Dr. Kapoor? 

I can’t believe Max didn’t know even the basics of the story of Abraham and Isaac. Even if one isn’t particularly religious, the story has been the subject of paintings by famous artists. BTW, I always thought that Isaac would have some serious trust issues with dad after that incident! 😆

I wondered the same thing.  The daughter was obviously an adult, there was no reason her mother should've been present, however, I will say, as a physician, there are some sheltered young adults out there who do bring their mothers with them to the doctor and who do want Mama to speak for them.  I can see that particular young woman deferring to her mother and mother expecting to manage her health care even as an adult.  Since she was seeing Kapoor for headaches, I can see her mother being present at the visit.  As a gynecologist, I must say I find it just a bit weird when a young woman brings her mom along because she's too embarrassed to ask about birth control options, but it happens more than you'd think.

I, too, thought the story of Isaac and Abraham would be at least slightly familiar to most people, part of our cultural literacy.  It's a very well known Biblical story and there are not just works of art, but songs and poetry.  The late Leonard Cohen wrote a fairly well known song about the story, as did Joan Baez and there are entire operas and symphonies based on the story.  Even if he wasn't a practicing Jew, it seemed odd that Max acted like he'd never heard of it.

Edited November 25, 2018 by doodlebug

[eel2178]

15 hours ago, LittleIggy said:

The daughter was over 21 (it was mentioned) so why was her mother even at the appointment with Dr. Kapoor? 

I had a co-worker who insisted on attending all her adult daughter's doctors' appointments. It was because she was a control freak, which would probably also apply to the situation they used on the show.

[LittleIggy]

8 hours ago, eel2178 said:

I had a co-worker who insisted on attending all her adult daughter's doctors' appointments. It was because she was a control freak, which would probably also apply to the situation they used on the show.

Do you know if the daughter ever got out from under her thumb?

[eel2178]

17 hours ago, LittleIggy said:

Do you know if the daughter ever got out from under her thumb?

I worked with this person for three years. Her daughter was 22-25 during that time, and her mother was still going to her doctors' appointments with her.

[LittleIggy]

6 hours ago, eel2178 said:

I worked with this person for three years. Her daughter was 22-25 during that time, and her mother was still going to her doctors' appointments with her.

☹️

[Johnny Dollar]

My favorite “TV Doc with Cancer” story is still Daniel Auschlander from St Elsewhere, played by Norman Lloyd.  He was dying from liver cancer through the entire run of that show.  Mr. Lloyd just celebrated his 104th birthday a couple of weeks ago. Whatever they gave him, it obviously worked. 

[ams1001]

On 11/26/2018 at 5:16 PM, eel2178 said:

I worked with this person for three years. Her daughter was 22-25 during that time, and her mother was still going to her doctors' appointments with her.

The only time I remember my mom coming to the doctor with me as an adult was when I had the flu and a 104 fever and could barely sit up straight, and twice when I had an ear infection that made me too dizzy to drive. Except for the flu visit she stayed in the waiting room. (There was also a time that my dad came with me but we were both sick and we go to the same practice, and managed to get appointments at the same time, while I was staying at their house for a few weeks waiting to close on my condo, so it just made sense to take one car.) That said, sometimes it's good to have a second set of ears, especially if you're there for something potentially serious, so I wouldn't automatically look askance at an adult having a parent at an appointment. 

[IDreamofJoaquin]

Was that girlfriend planning the birthday just standing there in the hallway?  She was there every time Bloom went to take a nap.  It was really strange.

Edited December 4, 2018 by IDreamofJoaquin

[doodlebug]

2 hours ago, IDreamofJoaquin said:

Was that girlfriend planning the birthday just standing there in the hallway?  She was there every time Bloom went to take a nap.  It was really strange.

Yep, and she doesn't even work in the ER, so there was no reason for her to be there in the first place.  Trying to figure out the logic on this show will make your brain hurt.

[Court]

On 12/4/2018 at 8:47 AM, IDreamofJoaquin said:

Was that girlfriend planning the birthday just standing there in the hallway?  She was there every time Bloom went to take a nap.  It was really strange.

Yes, and I found it odd she didn't seem to know anything about Reynolds  

[TOWTooMuchTV]

On 11/23/2018 at 1:27 PM, MoreCoffeePlease said:

Who can tell us if sperm donor sites have pictures of hot model-type men in them?

I have a friend who purchased donor sperm. The website allowed her to see information on the donors and pictures of them as children but not current pictures. 

[bros402]

On 1/8/2019 at 10:30 PM, TOWTooMuchTV said:

I have a friend who purchased donor sperm. The website allowed her to see information on the donors and pictures of them as children but not current pictures. 

I know with the place I banked with (fertility preservation), they had stuff on the wall about how if you wanted to get sperm from a donor, they have a huge fee scheduling, with fees for stuff like "childhood photo"