What Did Pratt Do When He Broke the Guy's Neck?

[Caroline]

Did Pratt's patient have some sort of malady that made intubation a bit more
precarious?

I didn't quite hear what was wrong with this patient.

Best Line of The Night: Frank saying to Carter something like, "And who is this
lovely young lady?" when Carter had returned, Kem in tow.

One of Frank's rare moments of where he stops whining and does the world a good
turn, endearing himself to the audience. Attaway, Frank. Good actor, too.

Any scene with Kerry Weaver where the youngsters of the ER are messing with her
protocol cracks me up, too. Like when she came into her office in this episode
and sees Kovac rifling through her papers, and says, mildly annoyed, 'Hey, what
are you doing?!' but doesn't lose it altogether.

S
P
O
I
L
E
R
?



Re Frank: Perhaps the writers are building to telling us more about his Downs'
Syndrome child and his relationship to him/her? (Dunno if this is rumor,
spoiler, or fact.)

[Cory]

Post by Caroline
Did Pratt's patient have some sort of malady that made intubation a bit more
precarious?
I didn't quite hear what was wrong with this patient.

I didn't catch what was wrong with the patient, per se, either, but I
got the impression that it was some sort of brittle bone disease. The
reason he was wearing the neck brace to begin with was because his neck
was "skeletally" unstable. When they tried to tube the guy, and tilted
the head back to get a better angle at intubation, the bones broke.

--- Cory

[Caroline]

Post by Cory

Post by Caroline
Did Pratt's patient have some sort of malady that made intubation a bit more
precarious?
I didn't quite hear what was wrong with this patient.

I didn't catch what was wrong with the patient, per se, either, but I
got the impression that it was some sort of brittle bone disease. The
reason he was wearing the neck brace to begin with was because his neck
was "skeletally" unstable. When they tried to tube the guy, and tilted
the head back to get a better angle at intubation, the bones broke.

Okay. This at least supports my impression that, but for this other disease, the
guy's neck would not have broken.

Wasn't Carter staring down Pratt as Pratt went in, right, with a look like,
"Pratt, don't do this. Way too risky."

OTOH, it seemed clear the guy was going to die without intubation. A pretty much
no win medical dilemma. Unless of course... tracheotomy (or whatever it is where
it's impossible to intubate)? Dunno. Maybe the guy's neck brace could not be
removed.

[Starword]

Post by Caroline
OTOH, it seemed clear the guy was going to die without intubation. A pretty much
no win medical dilemma. Unless of course... tracheotomy (or whatever it is where
it's impossible to intubate)? Dunno. Maybe the guy's neck brace could not be
removed.

Right. If a doctor can't intubate by going through the mouth for whatever
reason, they have to perform a trach and go in that way. I think the only
way that would happen with a patient like this is if a doctor working on him
knew enough about the disease to realize he/she had to go for a trach
straight out. Not sure if Carter would have known this. Possibly. I remember
he picked up Marphan's Syndrome right away when he looked at the x-ray of
the patient Dave and Jeng-mai were working on. As I recall, they gave the
patient some drug which is contraindicated for someone with Marphan's and
Carter knew this. So maybe he would've known the brittle bone guy had to be
trached.

We're supposed to think Pratt was devastated by what happened. But it seems
to me he got over his guilt PDQ. He seemed more concerned about Valerie
leaving.

Star

[Sharon too]

Post by Starword
Right. If a doctor can't intubate by going through the mouth for whatever
reason, they have to perform a trach and go in that way. I think the only
way that would happen with a patient like this is if a doctor working on him
knew enough about the disease to realize he/she had to go for a trach
straight out. Not sure if Carter would have known this. Possibly.

Carter knew. He had paged anesthesiology to do the intubation and mentioned
a special instrument or procedure. When they hadn't arrived yet he went and
personally got them. I believe those were the 2 guys with him when he walked
in the trauma room after the infamous crack we heard. Carter knew there was
enough time to wait. Pratt was impatient and/or inexperienced.

-Sharon

[Rebecca R.]

Post by Sharon too

Post by Starword
Right. If a doctor can't intubate by going through the mouth for
whatever reason, they have to perform a trach and go in that way. I
think the only way that would happen with a patient like this is if a
doctor working on

him

Post by Starword
knew enough about the disease to realize he/she had to go for a trach
straight out. Not sure if Carter would have known this. Possibly.

Carter knew. He had paged anesthesiology to do the intubation and
mentioned a special instrument or procedure. When they hadn't arrived
yet he went and personally got them. I believe those were the 2 guys
with him when he walked in the trauma room after the infamous crack we
heard. Carter knew there was enough time to wait. Pratt was impatient
and/or inexperienced.

I do wish Carter had specifically said to him, 'This kid has -------name of
condition ---- and we shouldn't intubate. We need anesthesiology to do a --
-- name of procedure." Then again, that would have ruined the drama of
Greg Pratt and The Terrible Horrible No Good Very Bad Day.

Rebecca

[Sharon broj neki]

Post by Rebecca R.
I do wish Carter had specifically said to him, 'This kid has -------name of
condition ---- and we shouldn't intubate. We need anesthesiology to do a --
-- name of procedure."

Why would that have been necessary when Pratt already knew what was wrong with
the young man?

Sharon S.

[Rebecca R.]

Post by Sharon broj neki

Post by Rebecca R.
I do wish Carter had specifically said to him, 'This kid has
-------name of condition ---- and we shouldn't intubate. We need
anesthesiology to do a -- -- name of procedure."

Why would that have been necessary when Pratt already knew what was
wrong with the young man?

I wasn't clear on whether Pratt *did* know what was wrong with him, but
even if he did, maybe he didn't know that intubating would be such a risk?

Rebecca

[Sharon too]

Post by Rebecca R.
I wasn't clear on whether Pratt *did* know what was wrong with him, but
even if he did, maybe he didn't know that intubating would be such a risk?

I did, and I'm no doctor. Regardless, Carter made it clear that he was not
to be intubated. Pratt should have at least grabbed another attending before
making all hero-like.

-Sharon

[Stephanie Martinez]

Post by Sharon too

Post by Rebecca R.
I wasn't clear on whether Pratt *did* know what was wrong with him, but
even if he did, maybe he didn't know that intubating would be such a risk?

I did, and I'm no doctor. Regardless, Carter made it clear that he was not
to be intubated. Pratt should have at least grabbed another attending before
making all hero-like.
-Sharon

I don't watch this show regularly, but wasn't there an episode earlier this
year where Pratt did a procedure that Kerry told him specifically NOT to do,
and in the end, it worked. So, he's gotten used to defying what other
doctors have told him to do, and have it come out good for him and the
patient, only this time, it didn't. A very nice, subtle foreshadowing, if
indeed that is what the writers were doing. Yeah, I know, I'm giving them
too much credit, aren't I?

TrueBlueStef

[Ellen K Hursh]

Post by Stephanie Martinez

Post by Sharon too

Post by Rebecca R.
I wasn't clear on whether Pratt *did* know what was wrong with him,
but even if he did, maybe he didn't know that intubating would be
such a risk?

I did, and I'm no doctor. Regardless, Carter made it clear that he was
not to be intubated. Pratt should have at least grabbed another
attending before making all hero-like.

I don't watch this show regularly, but wasn't there an episode earlier
this year where Pratt did a procedure that Kerry told him specifically
NOT to do, and in the end, it worked. So, he's gotten used to defying
what other doctors have told him to do, and have it come out good for
him and the patient, only this time, it didn't.

What was it Susan said a while back? About knowing when to break the
rules? (No, really. I don't even remember what episode that was.)

Post by Stephanie Martinez
A very nice, subtle foreshadowing, if indeed that is what the writers
were doing. Yeah, I know, I'm giving them too much credit, aren't I?

Yeah, that's usually the way to bet with the writers. :-)

[JMH]

Post by Ellen K Hursh

Post by Stephanie Martinez

Post by Sharon too

Post by Rebecca R.
I wasn't clear on whether Pratt *did* know what was wrong with him,
but even if he did, maybe he didn't know that intubating would be
such a risk?

I did, and I'm no doctor. Regardless, Carter made it clear that he was
not to be intubated. Pratt should have at least grabbed another
attending before making all hero-like.

I don't watch this show regularly, but wasn't there an episode earlier
this year where Pratt did a procedure that Kerry told him specifically
NOT to do, and in the end, it worked. So, he's gotten used to defying
what other doctors have told him to do, and have it come out good for
him and the patient, only this time, it didn't.

What was it Susan said a while back? About knowing when to break the
rules? (No, really. I don't even remember what episode that was.)

Wasn't this with the preemie baby that he wanted to save and the mom
didn't???

[Karen]

Post by Sharon too

Post by Sharon too

Post by Rebecca R.
I wasn't clear on whether Pratt *did* know what was wrong with him, but
even if he did, maybe he didn't know that intubating would be such a

risk?

Post by Sharon too
I did, and I'm no doctor. Regardless, Carter made it clear that he was not
to be intubated. Pratt should have at least grabbed another attending

before

Post by Sharon too
making all hero-like.
-Sharon

I don't watch this show regularly, but wasn't there an episode earlier this
year where Pratt did a procedure that Kerry told him specifically NOT to do,
and in the end, it worked. So, he's gotten used to defying what other
doctors have told him to do, and have it come out good for him and the
patient, only this time, it didn't. A very nice, subtle foreshadowing, if
indeed that is what the writers were doing. Yeah, I know, I'm giving them
too much credit, aren't I?

He also caught all kinds of hell from Carter and Romano when he cracked
a patient's chest with only Gallant present (and harrassed Gallant
horribly into _not_ going for help). The ep was Brothers and Sisters.
Might have been Pratt's very first day. Chen said, "He's good." Carter
replied, "He's dangerous." That about covers it.

Karen E.

[Ellen K Hursh]

On Tue, 13 Jan 2004 07:27:37 -0600, Karen wrote:

<snip discussion of Pratt's history of disobeying orders*>

Post by Karen
He also caught all kinds of hell from Carter and Romano when he cracked
a patient's chest with only Gallant present (and harrassed Gallant
horribly into _not_ going for help). The ep was Brothers and Sisters.
Might have been Pratt's very first day. Chen said, "He's good." Carter
replied, "He's dangerous." That about covers it.

Source of my two favorite lines: "Who the hell are you, and why are you
talking to me?" (Romano) and Abby's comment to Carter about Pratt cracking
the guy's chest (don't remember the exact line... it was more her
delivery, followed by Carter's reaction).


* "Is this the one where a doctor violates hospital policy, and/or a
direct order, to do what s/he wants to do? I love that one!", as my
husband is fond of exclaiming during an episode. (This is usually followed
by me swatting him. :-)

[Caroline]

"Stephanie Martinez" <***@cox.net> wrote
snip

Post by Stephanie Martinez
I don't watch this show regularly, but wasn't there an episode earlier this
year where Pratt did a procedure that Kerry told him specifically NOT to do,
and in the end, it worked. So, he's gotten used to defying what other
doctors have told him to do, and have it come out good for him and the
patient, only this time, it didn't. A very nice, subtle foreshadowing, if
indeed that is what the writers were doing. Yeah, I know, I'm giving them
too much credit, aren't I?

No, I think this is about right. They try to make sure the cocky get their
comeuppance. They also try to portray tough calls and that the solutions to
medicine are often not black-and-white. At times there's no knowing what the
'best solution' will be in advance. At least, this is how I see many of the
sub-plots. It jives with what I read and have experienced. ('course what kills
me is that some MDs who know there are other options will make it sound like
their way of rolling the dice has to be the best or not even tell the patient
about other options.)

Kovac also has tried to be overly heroic and been nailed for it (I think exactly
once, but pointedly), no? I believe specifically when he was trying to cut costs
at County. Kovac was clearly still in Third World Country, Doctors w/o Borders
mode. He forgot about the lawyer-shark infested waters of U.S.medical care and
what is expected at County.

[Darrell Mayeda]

Post by Stephanie Martinez
I don't watch this show regularly, but wasn't there an episode
earlier this year where Pratt did a procedure that Kerry told him
specifically NOT to do, and in the end, it worked. So, he's
gotten used to defying what other doctors have told him to do, and
have it come out good for him and the patient, only this time, it
didn't. A very nice, subtle foreshadowing, if indeed that is what
the writers were doing. Yeah, I know, I'm giving them too much
credit, aren't I?
TrueBlueStef

residents and medical students disobeying orders from higher ranked
staff and having it turn out Okay is almost SOP on this show. I
think there were only a handful of cases where it didn't. chen and
the central line, Benton and injured infant, Benton and that kid that
ended up a vegatable. Carter and Chase Now Pratt and this intubation.
--
----------------------------------------------------------------------------

Darrell Mayeda
***@hawaii.rr.com

Knight of the ERmoron Round Table.


NOTE: I'm tired of all the spam in my mailbox please leave my
last name in the body of your reply. Thanks

[Vladimir Estragon]

Post by Rebecca R.
I do wish Carter had specifically said to him, 'This kid has -------name of
condition ---- and we shouldn't intubate. We need anesthesiology to do a --
-- name of procedure." Then again, that would have ruined the drama of
Greg Pratt and The Terrible Horrible No Good Very Bad Day.

And Pratt would have said, "Yes, sir, Dr. Carter. Thank you for
stopping me."




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[Darrell Mayeda]

Post by Vladimir Estragon

Post by Rebecca R.
I do wish Carter had specifically said to him, 'This kid has -------name of
condition ---- and we shouldn't intubate. We need anesthesiology to do a --
-- name of procedure." Then again, that would have ruined the drama of
Greg Pratt and The Terrible Horrible No Good Very Bad Day.

And Pratt would have said, "Yes, sir, Dr. Carter. Thank you for
stopping me."

then gone right ahead and done it anyway. Pratt and Carter haven't
gotten along very well. Pratt is the Frank burns of County.
--
----------------------------------------------------------------------------

Darrell Mayeda
***@hawaii.rr.com

Knight of the ERmoron Round Table.


NOTE: I'm tired of all the spam in my mailbox please leave my
last name in the body of your reply. Thanks

[blumeeni]

I know we're supposed to think that Pratt's actions were rash, BUT wasn't
the young man no longer breathing? They said something about waiting an
hour for some specialist team to work on him, suddenly he's not breathing,
and someone had to do something. A person can live paralyzed, but can't
live without air, so maybe Pratt's actions were the lesser of two evils.

Post by Darrell Mayeda

Post by Vladimir Estragon

Post by Rebecca R.
I do wish Carter had specifically said to him, 'This kid has -------name of
condition ---- and we shouldn't intubate. We need anesthesiology to do a --
-- name of procedure." Then again, that would have ruined the drama of
Greg Pratt and The Terrible Horrible No Good Very Bad Day.

And Pratt would have said, "Yes, sir, Dr. Carter. Thank you for
stopping me."

then gone right ahead and done it anyway. Pratt and Carter haven't
gotten along very well. Pratt is the Frank burns of County.
--
--------------------------------------------------------------------------

--

Post by Darrell Mayeda
Darrell Mayeda
Knight of the ERmoron Round Table.
NOTE: I'm tired of all the spam in my mailbox please leave my
last name in the body of your reply. Thanks

[Gina *]

I do wish Carter had specifically said to him, >>'This kid has

-------name of condition ---- and >>we shouldn't intubate. We need

anesthesiology to do a -- -- name of >>procedure." Then again, that

would have >>ruined the drama of Greg Pratt and The >>Terrible Horrible
No Good Very Bad Day.

Rebecca .

.
IRL, Goofus would be in very big trouble. He defied the attending, he
performed a procedure which left a patient paralyzed from the chest
down, and he admitted this to the patient in question. People in medical
affairs office, legal dept, and in admin are having terrble, horrible
no-good, very bad day. That is the kind of asinine thing folks in the
medical affairs, legal, and admin offices get called in for. Mission no
1 is figuring a way to blame the patient.

~~~Gina~~~

[Caroline]

Post by Gina *

I do wish Carter had specifically said to him, >>'This kid has

-------name of condition ---- and >>we shouldn't intubate. We need

anesthesiology to do a -- -- name of >>procedure." Then again, that

would have >>ruined the drama of Greg Pratt and The >>Terrible Horrible
No Good Very Bad Day.
IRL, Goofus would be in very big trouble. He defied the attending, he
performed a procedure which left a patient paralyzed from the chest
down, and he admitted this to the patient in question. People in medical
affairs office, legal dept, and in admin are having terrble, horrible
no-good, very bad day. That is the kind of asinine thing folks in the
medical affairs, legal, and admin offices get called in for. Mission no
1 is figuring a way to blame the patient.

I am thinking Carter might possibly be in as much or maybe more trouble for not
stepping in and physically stopping Pratt. Not sure what the hierarchy of
attendings was at the time, though, since Carter just got back.

[Sharon too]

Post by Caroline
I am thinking Carter might possibly be in as much or maybe more trouble for not
stepping in and physically stopping Pratt. Not sure what the hierarchy of
attendings was at the time, though, since Carter just got back.

He did. He told Pratt not to intubate the patient - that they were calling
Anesthesiology to perform a nasal intubation and when Anesthesiology didn't
show up, IIRC, Carter told him to wait while he went to get them himself. By
the time Carter had returned Pratt had already cracked the neck. They had
time, Carter knew it and was rushing to get the right people for the job.

-Sharon

[Darrell Mayeda]

Post by Caroline

Post by Caroline
I am thinking Carter might possibly be in as much or maybe more trouble

for not

Post by Caroline
stepping in and physically stopping Pratt. Not sure what the hierarchy of
attendings was at the time, though, since Carter just got back.

He did. He told Pratt not to intubate the patient - that they were calling
Anesthesiology to perform a nasal intubation and when Anesthesiology didn't
show up, IIRC, Carter told him to wait while he went to get them himself. By
the time Carter had returned Pratt had already cracked the neck. They had
time, Carter knew it and was rushing to get the right people for the job.
-Sharon

it might be nice drama but unrealistic for this:

carter: "nurse get the hard leathers"
nurse: "hard leathers? he doesn't need hard leathers"
Carter: "get the hard leathers NOW!"
nurse goes to the closet and brings out the hard leather
restraints. Carter then forceably brings pratts arms behind his back
and fastens them together with the hard leathers.
Prat:" oh no, you're not really gonna do this to me are you?"
Carter finishes tying the hard restraints together and ties then to
the door for the supplies cabnet.
Carter:"I sure am".

this is the ONLY way to ensure Dr Pratt would comply. :|
--
----------------------------------------------------------------------------

Darrell Mayeda
***@hawaii.rr.com

Knight of the ERmoron Round Table.


NOTE: I'm tired of all the spam in my mailbox please leave my
last name in the body of your reply. Thanks

[Ellen K Hursh]

On Mon, 12 Jan 2004 01:31:26 +0000, Darrell Mayeda wrote:

<snip>

Post by Darrell Mayeda
carter: "nurse get the hard leathers"
nurse: "hard leathers? he doesn't need hard leathers"
Carter: "get the hard leathers NOW!"
nurse goes to the closet and brings out the hard leather
restraints. Carter then forceably brings pratts arms behind his back
and fastens them together with the hard leathers.
Prat:" oh no, you're not really gonna do this to me are you?"
Carter finishes tying the hard restraints together and ties then to
the door for the supplies cabnet.
Carter:"I sure am".
this is the ONLY way to ensure Dr Pratt would comply. :|

Carter: "Okay, nurses, he's all yours. Make sure he knows *exactly* how
much you appreciated his little cracks a while back, about nurses serving
the coffee while the doctors fly the plane."

Nurse: "Cool! I'll get the tazer, and Malik will fetch the Valium that he
stashed in Weaver's lab coat*."


* I'm ashamed of y'all... it took *this* much time for a "MALIK DID IT!"?

[Lori S.]

Post by Darrell Mayeda
carter: "nurse get the hard leathers"

Sounds like a porn flick I watched once. ;o)

[Ellen K Hursh]

Post by Lori S.

Post by Darrell Mayeda
carter: "nurse get the hard leathers"

Sounds like a porn flick I watched once. ;o)

Oh? Something you want to share with the class, Lori? :-)

[Lori S.]

Post by Ellen K Hursh

Post by Lori S.

Post by Darrell Mayeda
carter: "nurse get the hard leathers"

Sounds like a porn flick I watched once. ;o)

Oh? Something you want to share with the class, Lori? :-)

Well at least I wasn't the STAR!!!!!!!! LOL!!!!!!!!

[Richard3to16]

Post by Lori S.

Post by Ellen K Hursh

Post by Lori S.
Sounds like a porn flick I watched once. ;o)

Oh? Something you want to share with the class, Lori? :-)

Well at least I wasn't the STAR!!!!!!!! LOL!!!!!!!!

Supporting roles can be rewarding, too.

[Lori S.]

Post by Richard3to16

Post by Lori S.

Post by Ellen K Hursh

Post by Lori S.
Sounds like a porn flick I watched once. ;o)

Oh? Something you want to share with the class, Lori? :-)

Well at least I wasn't the STAR!!!!!!!! LOL!!!!!!!!

Supporting roles can be rewarding, too.

Speaking from experience Richard???? ;o)

[Caroline]

Post by Caroline

Post by Caroline
OTOH, it seemed clear the guy was going to die without intubation. A

pretty much

Post by Caroline
no win medical dilemma. Unless of course... tracheotomy (or whatever it is

where

Post by Caroline
it's impossible to intubate)? Dunno. Maybe the guy's neck brace could not

be

Post by Caroline
removed.

Right. If a doctor can't intubate by going through the mouth for whatever
reason, they have to perform a trach and go in that way. I think the only
way that would happen with a patient like this is if a doctor working on him
knew enough about the disease to realize he/she had to go for a trach
straight out. Not sure if Carter would have known this. Possibly. I remember
he picked up Marphan's Syndrome right away when he looked at the x-ray of
the patient Dave and Jeng-mai were working on. As I recall, they gave the
patient some drug which is contraindicated for someone with Marphan's and
Carter knew this. So maybe he would've known the brittle bone guy had to be
trached.
We're supposed to think Pratt was devastated by what happened. But it seems
to me he got over his guilt PDQ. He seemed more concerned about Valerie
leaving.

If the neck (or whatever) brace, could have been removed (and quickly), so a
tracheotomy could have been performed (and quickly), I'm seeing major
disciplinary action.

But as you suggest, Pratt's response seemed a bit more muted than it would be if
he'd made a medically unforgivable, stupid mistake. I suspect it may be that all
the characters understood Pratt had little choice. So we may not see anything
more than an implied board of inquiry after this incident, where Pratt gets off
lightly or is even exonerated, as perhaps he should be.

All interesting. :-)

[Sharon Three]

Post by Caroline

Post by Caroline

Post by Caroline
OTOH, it seemed clear the guy was going to die without intubation. A

pretty much

Post by Caroline
no win medical dilemma. Unless of course... tracheotomy (or whatever it is

where

Post by Caroline
it's impossible to intubate)? Dunno. Maybe the guy's neck brace could not

be

Post by Caroline
removed.

Right. If a doctor can't intubate by going through the mouth for whatever
reason, they have to perform a trach and go in that way. I think the only
way that would happen with a patient like this is if a doctor working on him
knew enough about the disease to realize he/she had to go for a trach
straight out. Not sure if Carter would have known this. Possibly. I remember
he picked up Marphan's Syndrome right away when he looked at the x-ray of
the patient Dave and Jeng-mai were working on. As I recall, they gave the
patient some drug which is contraindicated for someone with Marphan's and
Carter knew this. So maybe he would've known the brittle bone guy had to be
trached.
We're supposed to think Pratt was devastated by what happened. But it seems
to me he got over his guilt PDQ. He seemed more concerned about Valerie
leaving.

If the neck (or whatever) brace, could have been removed (and quickly), so a
tracheotomy could have been performed (and quickly), I'm seeing major
disciplinary action.
But as you suggest, Pratt's response seemed a bit more muted than it would be if
he'd made a medically unforgivable, stupid mistake. I suspect it may be that all
the characters understood Pratt had little choice. So we may not see anything
more than an implied board of inquiry after this incident, where Pratt gets off
lightly or is even exonerated, as perhaps he should be.
All interesting. :-)

The kid had ankylosing spondylitis, an arthritis like malady that makes the
bones, especially in the spine, very stiff and brittle. It usually occurs
in men in their 20's, this kid was a little young and his case was
especially severe, but that's what he had. The joints between them fuse so
they aren't flexible, hence tilting the neck to intubate caused the brittle
bones to break, damaging the spinal cord. The kid wore the cervical collar
because his bones are like Rice Krispies and can break at the slightest
trauma.

The proper procedure would be to do an awake intubation via the nose called
a nasotracheal intubation. That's what Carter wanted anesthesia to do.
Tracheostomies are much more complicated and would be reserved for
situations where the airway was obstructed and a tube couldn't be introduced
by the nose or mouth.

Doc Sharon

PS: though it's been years since I read it, I think ankylosing spondylitis
is what Norman Cousins had in "Anatomy of an Illness", an excellent book on
serious illness from a patient's POV.

[Robin Michelle]

I have never heard of that illness, that's horrible, what causes it and is
it treatable? This past episode had my worst fear, being paralyzed.. I
just cringed when Pratt broke his neck... I hate to even think about it,
that is so horrible, I would rather die than have that happen to me.
Eeks... Poor kid...

Robin

Post by Caroline

Post by Caroline

Post by Caroline

Post by Caroline
OTOH, it seemed clear the guy was going to die without intubation. A

pretty much

Post by Caroline
no win medical dilemma. Unless of course... tracheotomy (or whatever

it is

Post by Caroline

Post by Caroline
where

Post by Caroline
it's impossible to intubate)? Dunno. Maybe the guy's neck brace

could

Post by Caroline
not

Post by Caroline

Post by Caroline
be

Post by Caroline
removed.

Right. If a doctor can't intubate by going through the mouth for

whatever

Post by Caroline

Post by Caroline
reason, they have to perform a trach and go in that way. I think the

only

Post by Caroline

Post by Caroline
way that would happen with a patient like this is if a doctor working

on

Post by Caroline
him

Post by Caroline

Post by Caroline
knew enough about the disease to realize he/she had to go for a trach
straight out. Not sure if Carter would have known this. Possibly. I

remember

Post by Caroline

Post by Caroline
he picked up Marphan's Syndrome right away when he looked at the x-ray

of

Post by Caroline

Post by Caroline
the patient Dave and Jeng-mai were working on. As I recall, they gave

the

Post by Caroline

Post by Caroline
patient some drug which is contraindicated for someone with Marphan's

and

Post by Caroline

Post by Caroline
Carter knew this. So maybe he would've known the brittle bone guy had

to

Post by Caroline
be

Post by Caroline

Post by Caroline
trached.
We're supposed to think Pratt was devastated by what happened. But it

seems

Post by Caroline

Post by Caroline
to me he got over his guilt PDQ. He seemed more concerned about Valerie
leaving.

If the neck (or whatever) brace, could have been removed (and quickly),

so

Post by Caroline
a

Post by Caroline
tracheotomy could have been performed (and quickly), I'm seeing major
disciplinary action.
But as you suggest, Pratt's response seemed a bit more muted than it

would

Post by Caroline
be if

Post by Caroline
he'd made a medically unforgivable, stupid mistake. I suspect it may be

that all

Post by Caroline
the characters understood Pratt had little choice. So we may not see

anything

Post by Caroline
more than an implied board of inquiry after this incident, where Pratt

gets off

Post by Caroline
lightly or is even exonerated, as perhaps he should be.
All interesting. :-)

The kid had ankylosing spondylitis, an arthritis like malady that makes the
bones, especially in the spine, very stiff and brittle. It usually occurs
in men in their 20's, this kid was a little young and his case was
especially severe, but that's what he had. The joints between them fuse so
they aren't flexible, hence tilting the neck to intubate caused the brittle
bones to break, damaging the spinal cord. The kid wore the cervical collar
because his bones are like Rice Krispies and can break at the slightest
trauma.
The proper procedure would be to do an awake intubation via the nose called
a nasotracheal intubation. That's what Carter wanted anesthesia to do.
Tracheostomies are much more complicated and would be reserved for
situations where the airway was obstructed and a tube couldn't be introduced
by the nose or mouth.
Doc Sharon
PS: though it's been years since I read it, I think ankylosing spondylitis
is what Norman Cousins had in "Anatomy of an Illness", an excellent book on
serious illness from a patient's POV.

[DawnK]

Post by Caroline

Post by Caroline

Post by Caroline

Post by Caroline
OTOH, it seemed clear the guy was going to die without intubation. A

pretty much

Post by Caroline
no win medical dilemma. Unless of course... tracheotomy (or whatever

it is

Post by Caroline

Post by Caroline
where

Post by Caroline
it's impossible to intubate)? Dunno. Maybe the guy's neck brace

could

Post by Caroline
not

Post by Caroline

Post by Caroline
be

Post by Caroline
removed.

Right. If a doctor can't intubate by going through the mouth for

whatever

Post by Caroline

Post by Caroline
reason, they have to perform a trach and go in that way. I think the

only

Post by Caroline

Post by Caroline
way that would happen with a patient like this is if a doctor working

on

Post by Caroline
him

Post by Caroline

Post by Caroline
knew enough about the disease to realize he/she had to go for a trach
straight out. Not sure if Carter would have known this. Possibly. I

remember

Post by Caroline

Post by Caroline
he picked up Marphan's Syndrome right away when he looked at the x-ray

of

Post by Caroline

Post by Caroline
the patient Dave and Jeng-mai were working on. As I recall, they gave

the

Post by Caroline

Post by Caroline
patient some drug which is contraindicated for someone with Marphan's

and

Post by Caroline

Post by Caroline
Carter knew this. So maybe he would've known the brittle bone guy had

to

Post by Caroline
be

Post by Caroline

Post by Caroline
trached.
We're supposed to think Pratt was devastated by what happened. But it

seems

Post by Caroline

Post by Caroline
to me he got over his guilt PDQ. He seemed more concerned about Valerie
leaving.

If the neck (or whatever) brace, could have been removed (and quickly),

so

Post by Caroline
a

Post by Caroline
tracheotomy could have been performed (and quickly), I'm seeing major
disciplinary action.
But as you suggest, Pratt's response seemed a bit more muted than it

would

Post by Caroline
be if

Post by Caroline
he'd made a medically unforgivable, stupid mistake. I suspect it may be

that all

Post by Caroline
the characters understood Pratt had little choice. So we may not see

anything

Post by Caroline
more than an implied board of inquiry after this incident, where Pratt

gets off

Post by Caroline
lightly or is even exonerated, as perhaps he should be.
All interesting. :-)

The kid had ankylosing spondylitis, an arthritis like malady that makes the
bones, especially in the spine, very stiff and brittle. It usually occurs
in men in their 20's, this kid was a little young and his case was
especially severe, but that's what he had. The joints between them fuse so
they aren't flexible, hence tilting the neck to intubate caused the brittle
bones to break, damaging the spinal cord. The kid wore the cervical collar
because his bones are like Rice Krispies and can break at the slightest
trauma.
The proper procedure would be to do an awake intubation via the nose called
a nasotracheal intubation. That's what Carter wanted anesthesia to do.
Tracheostomies are much more complicated and would be reserved for
situations where the airway was obstructed and a tube couldn't be introduced
by the nose or mouth.
Doc Sharon
PS: though it's been years since I read it, I think ankylosing spondylitis
is what Norman Cousins had in "Anatomy of an Illness", an excellent book on
serious illness from a patient's POV.

Yeap, that's what the doc at work said, too, that he should have done a
naso-tracheal intubation.

Dawn

[Adam Dolan]

<<The kid had ankylosing spondylitis, an arthritis like malady that
makes the bones, especially in the spine, very stiff and brittle. It
usually occurs in men in their 20's, this kid was a little young and his
case was especially severe, but that's what he had. >>

You can read a firsthand account of living with this disease in - of all
places - the Motley Crue autobiography "The Dirt". Crue guitarist Mick
Mars suffers from this disease and discusses it in between the various
tales of debauchery.

[Rebecca R.]

Post by Caroline
But as you suggest, Pratt's response seemed a bit more muted than it
would be if he'd made a medically unforgivable, stupid mistake. I
suspect it may be that all the characters understood Pratt had little
choice.

Yeah, Elizabeth's response was pretty muted, too. Knowing how she can go
off on people for being rash or stupid, I think it meant something that she
didn't. Even though she could sympathize because she paralyzed that guy a
few years ago, she still could have chewed Pratt a new one for what he did,
if it was totally his fault...

Rebecca

[JMH]

Post by Rebecca R.

Post by Caroline
But as you suggest, Pratt's response seemed a bit more muted than it
would be if he'd made a medically unforgivable, stupid mistake. I
suspect it may be that all the characters understood Pratt had little
choice.

Yeah, Elizabeth's response was pretty muted, too. Knowing how she can go
off on people for being rash or stupid, I think it meant something that she
didn't. Even though she could sympathize because she paralyzed that guy a
few years ago,

I forgot about that, maybe that's why she was yelling at him

[Rebecca R.]

Post by JMH

Post by Rebecca R.

Post by Caroline
But as you suggest, Pratt's response seemed a bit more muted than
it would be if he'd made a medically unforgivable, stupid mistake.
I suspect it may be that all the characters understood Pratt had
little choice.

Yeah, Elizabeth's response was pretty muted, too. Knowing how she can
go off on people for being rash or stupid, I think it meant something
that

she

Post by Rebecca R.
didn't. Even though she could sympathize because she paralyzed that
guy a few years ago,

I forgot about that, maybe that's why she was yelling at him

She didn't yell at him. She touched his arm and told him she was sorry.

Rebecca

[Ellen K Hursh]

Post by Caroline
OTOH, it seemed clear the guy was going to die without intubation. A
pretty much no win medical dilemma. Unless of course... tracheotomy (or
whatever it is where it's impossible to intubate)? Dunno. Maybe the
guy's neck brace could not be removed.

Not sure if Carter would have known this. Possibly. I remember he picked
up Marphan's Syndrome right away when he looked at the x-ray of the
patient Dave and Jeng-mai were working on. As I recall, they gave the
patient some drug which is contraindicated for someone with Marphan's
and Carter knew this.

TPA (tissue-type plasminogen activator) was what they gave the Marfan's
patient, because they thought* he was having an MI. Since Marfan's is a
connective-tissue problem, the guy's aorta was dissecting (that is, the
lining was tearing), and the tPA (which breaks down things like clots)
made things worse.

We're supposed to think Pratt was devastated by what happened. But it
seems to me he got over his guilt PDQ. He seemed more concerned about
Valerie leaving.

I think Valerie was pretty much just the topper to his day - he thought he
was going to get to look forward to seeing her again, and instead got:
"Huh? No, that was a boo-tay call. Ciao."


* Never mind that Chen approving tPA without actually looking at the x-ray
herself was highly stupid. (IANAD, but that's the kind of situation where
I would have looked at the x-ray even if Jesus Himself had told me that it
was clear. And this was *Malucci* saying that it was clear.)

[Richard3to16]

Does the neck break necessarily mean paralysis?

[Sharon Three]

Post by Richard3to16
Does the neck break necessarily mean paralysis?

In this guy's case, it did. They were evaluating his sensory and motor
functions below the neck and they were gone. The radiologist who looked at
the MRI said that the spinal cord had a hemorrhage from the trauma that was
likely to have caused permanent damage.

Doc Sharon

[Ellen K Hursh]

Post by Richard3to16
Does the neck break necessarily mean paralysis?

As Doc Sharon said, it meant paralysis in this case. But it's possible to
have a broken neck without becoming paralyzed, as long as the spinal cord
isn't damaged in the process. (IIRC, that's why the cervical collar that
people are constantly wearing when they're brought in.)