12 quotes
Navigating Uncertainty in Comatose Patient Care
Nurse Emerson
We are dealing in an area of uncertainty. An area where there are no rules, contradictory laws and no clear social consensus as to what should be done. And the cost of care for the chronic patient has become prohibitive. This is particularly the case with the long-term comatose patient. The Jefferson Institute is a government- sponsored experimental facility designed to provide quality life support to the comatose patient. I wish to emphasize no moral or ethical position is being taken here. We do not participate in the debate over whether these patients are alive or dead or whether their care should be continued or terminated. Society will decide if there will be more of these facilities or not. In the meantime, we merely provide care as inexpensively as possible.
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Navigating Difficult Conversations in Healthcare
Dr. Harris
You've put me in a difficult position. It seems you know everything.
Dr. Wheeler
You're George.
Dr. Harris
I wonder if you can understand, if you can take the long view, the view of a person in my position.
Dr. Wheeler
You did it.
Dr. Harris
No decision is easy, Sue. It only looks that way when you're young. When you're older, everything is complicated. There is no black and white, only gray. But our society faces momentous decisions. Decisions about the right to die. About abortion. About terminal illness, prolonged coma, transplantation. Decisions about life and death. But society isn't deciding. Congress isn't deciding. The courts aren't deciding. Religion isn't deciding. Why? Because society is leaving it up to us, the experts. The doctors.
Dr. Wheeler
You're crazy.
Dr. Harris
Americans spend $125 billion a year on health. More than defense. Because Americans believe in medical care. These great hospital complexes are the cathedrals of our age. Billions of dollars, thousands of beds. A whole nation of sick people turning to us for help.
Dr. Wheeler
You, you ought to see somebody.
Dr. Harris
They're children, Sue. They trust us. We can't tell them everything. Our job is to make things easier for them. I'm sure you agree.
Dr. Wheeler
You're killing people.
Dr. Harris
We must always take the long view. Not of the individual, but of society as a whole. Because medicine is now a great social force. The individual is too small.
Dr. Harris
That's the drug. It produces abdominal spasm and peritoneal symptoms. It must be very painful. It's too bad. But look at it from the practical standpoint. Somebody has to make these decisions. We can't wait around forever. If society won't decide, we'll decide. We'll make the hard decisions.
Dr. Harris
This is Dr. Harris. Schedule an emergency appendectomy in O.R. 8. It's a member of the house staff, Dr. Wheeler. I've examined her. She requires immediate surgery.
[picks up the phone]
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Early Arrival and Introduction in the Hospital
Nurse Emerson
Can I help you?
[at the Jefferson Institute]
Dr. Wheeler
I'm Dr. Wheeler.
Nurse Emerson
You're early, aren't you, doctor?
Dr. Wheeler
Early?
Nurse Emerson
You're supposed to come on Tuesday, day after tomorrow, when the tour is scheduled.
Dr. Wheeler
The tour?
Nurse Emerson
Yes, it's every Tuesday at 11. The regular tour for physicians.
Dr. Wheeler
Could I see it now?
Nurse Emerson
I'm afraid that's impossible.
Dr. Wheeler
I just thought as long as I'm here...
Nurse Emerson
We're simply not set up for it.
Dr. Wheeler
May I speak with the physician in charge?
Nurse Emerson
There is no physician in charge.
Dr. Wheeler
Well, then, your supervisor.
Nurse Emerson
I have no supervisor.
Dr. Wheeler
Who runs the staff?
Nurse Emerson
There is no staff.
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
The Paradox of Anesthesia and Patient Awareness
Dr. Cowans
Anesthesia's the easiest job in the world until something goes wrong. It's 99% boredom and 1% scared-shitless panic.
Nurse
Doctors make the worst patients. They know too much.
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
The Simplicity of a Deadly Crime
Jim
First rule of crime: Keep It Simple. What's simple? Carbon Monoxide.
Pathology Resident
Boring.
Dr. Wheeler
Carbon Monoxide?
Jim
Sure, it's perfect. Anesthetist feeds the patient some carbon monoxide instead of oxygen. It's colorless and makes the blood very red so the surgeon doesn't notice anything funny. But the brain dies from lack of oxygen. End of operation - the patient doesn't wake up.
Dr. Wheeler
No other effects?
Pathology Resident
Sure, other effects. Cardiac irritability.
Jim
Which this case had.
Pathology Resident
You know, it'd be much better to block the neuro-muscular junction with succinylcholine. Now that's a nice murder.
Jim
Yeah, who's gonna do it?
Pathology Resident
Well, who's gonna feed you carbon monoxide?
Jim
That's the problem. Been about a dozen of these coma cases here in the last year. They're always different. Different case, different anesthetist, different operation. Hard to imagine it's murder.
Dr. Wheeler
Are you sure?
Jim
What do you think? There's a conspiracy at the Boston Memorial Hospital, involving all the anesthetists?
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Disregarding Unexplained Medical Cases
Dr. Wheeler
Nobody else here seems to care.
Dr. Bellows
Nobody else cares?
Dr. Wheeler
Listen. There have been 10 cases of unexplained coma in young, healthy patients in the last year. Now, don't you find that surprising? You don't.
[Mark shakes his head]
Dr. Bellows
Susan, this hospital does 30,000 operations a year. I'm not surprised a few turn out with serious unexplained side effects. Medicine isn't perfect. We all accept that. Don't we?
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Facing a Terrible Reality Together
Dr. Wheeler
Mark, it's so awful! It's so terrible.
Dr. Bellows
Take it easy. Honey, slow down.
Dr. Wheeler
He was trying to kill me. And I had to keep going. And all the bodies. It's horrible!
Dr. Bellows
Take it easy. Slow down.
Dr. Wheeler
Mark, it's all happening. It's really happening. Somebody's putting people into comas. They're murdering them. No, no, really. Kelly's dead. I was down there. I found the gas line. It starts in the basement and it goes up the main tunnel then plugs into the oxygen line in the ceiling that goes to O.R. 8.
Dr. Bellows
Honey, slow down.
Dr. Wheeler
They're killing people with carbon monoxide in O.R. 8. They have a radio to turn the valve.
Dr. Bellows
I believe you.
Dr. Wheeler
All the cases happened in O.R. 8. And they all went to the Jefferson Institute. And this guy, he chased me all over. And there were so many bodies.
Dr. Bellows
It's all right. It's okay.
Dr. Wheeler
And this is real. Call the police. We have to do something! This is real, Mark. I can prove it.
Dr. Bellows
Sure, you can. You can. Just lie down.
Dr. Wheeler
This is real.
Dr. Bellows
I know you can. Now one thing at a time. I want to give you a Valium and how about a cup of tea to settle you down? A cup of hot tea? Then we're going to talk after you settle down. So you just rest right here. You just stay right here on the bed? That-a-girl. That's it. You just relax.
Dr. Wheeler
I can't...
Dr. Bellows
That's it. Just relax. Close your eyes. That's it. Okay, that-a-girl. Now, I'll get you a cup of tea.
Dr. Wheeler
You're so great, Mark.
Dr. Bellows
Stay here, honey. Just stay right here. That's a hell of a story, Susan. You really had a lot of people worried. Don't worry. Everything's going to be okay now. She came back. No, she's here now. Of course. No, I can manage that. I'll keep her here. Look, I'd better go.
[calling out from the kitchen; quietly into the phone; turns to find Susan gone]
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Daily Routine and Unwanted Affection
Dr. Bellows
Honey, come on.
Dr. Wheeler
Don't call me honey.
Dr. Bellows
I'm trying to tell you about my day. Something that happened.
Dr. Wheeler
Your days are always the same.
Dr. Bellows
What is that supposed to mean?
Dr. Wheeler
Just politics, that's all. Who said what to whom. Who's rising, who's falling. Who's made a good move, a bad move. Politics!
Dr. Bellows
Somebody has to be interested in hospital politics. You certainly are not.
Dr. Wheeler
I thought you were a surgical resident, not a political one.
Dr. Bellows
I like politics. They interest me. Just because you're always looking for...
Dr. Wheeler
You want me to heat up the dinner, is that it? I want some respect.
Dr. Bellows
Susan, come on. Don't leave again.
Dr. Wheeler
Why can't you share half the responsibility?
Dr. Bellows
I share more than half the responsibility!
Dr. Wheeler
No need to shout.
Dr. Bellows
Why are you running off? You think I want this? Let me tell you something. I make concessions for this so-called relationship.
Dr. Wheeler
I know it's hard on you politically.
Dr. Bellows
Susan, don't go.
Dr. Wheeler
You know what the trouble with you is? All you care about is being chief resident.
Dr. Bellows
You know what your trouble is? You don't want a relationship. Look at you. You run away from it.
Dr. Wheeler
This is ridiculous.
Dr. Bellows
You don't want a lover...you want a goddamn wife!
Dr. Wheeler
Bastard.
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Power Dynamics in the Medical Field
Dr. Harris
I've had a rather hysterical call from Dr. George in anesthesiology. Dr. George is a powerful person here, not only because of his position. There are other reasons.
Dr. Wheeler
I gather.
Dr. Harris
What does that mean?
Dr. Wheeler
Just because he has a rich wife, he's able to throw his weight around.
Dr. Harris
You're looking for truth and justice.
Dr. Wheeler
I'm looking for fairness.
Dr. Harris
In fairness, you've challenged the professional competence of a chief of service at this hospital. And he didn't take it well. No reason he should. Now he's out for blood.
Dr. Wheeler
I've noticed.
Dr. Harris
Sue, believe me, I'm on your side for all kinds of reasons. I don't want to let another chief of service get one of my house officers fired.
Dr. Wheeler
Dr. Harris, I just wanted to look at his charts.
Dr. Harris
Sue, right now, I can protect you because you're good. And frankly, because you're a woman.
Dr. Wheeler
I don't want concessions.
Dr. Harris
At the moment, you'd better take any you can get.
Dr. Wheeler
You know what happened to Greenly?
Dr. Harris
Yes.
Dr. Wheeler
What happened?
Dr. Harris
She died.
Dr. Wheeler
How do you feel about that?
Dr. Harris
How do I feel? I feel...
Dr. Wheeler
She was my best friend. She understood me. She understood me. It's not fair. None of this is fair.
Dr. Harris
Here.
Dr. Wheeler
Nobody understands. No one.
Dr. Harris
I know, I know.
Secretary
Dr. Harris, the secretary of HEW is on the phone from Washington.
[on the intercom]
Dr. Harris
Call back. Too many of us shut ourselves off from our feelings. We don't explore them. We don't understand them. We don't understand ourselves. It's the toughest thing about our profession.
Dr. Wheeler
Dr. Harris...
Dr. Harris
I'll take care of the politics. You just look out for yourself. Take the weekend off, Sue. Go walk on the beach. Get away from the hospital.
Dr. Wheeler
I'm so embarrassed by this.
Dr. Harris
Don't be. Don't be. Our emotions are what make us human.
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Medical Emergency in Patient's Condition
Dr. Cowans
Okay, Mrs. Greenly, it's time to wake up. Okay, Nancy? Mrs. Greenly? Wake up. Nance, can you give me a cough, please? Nancy? Oh, Jesus Christ! Her pupils are fixed and dilated.
[checks her eyes]
Dr. Richards
What?
Dr. Cowans
The pupils. They're fixed. Dilated.
Dr. Richards
Oh, my God!
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Discussion on Inducing Coma Techniques
Dr. Wheeler
Jim, I know it sounds silly but, supposing you wanted to put people into a coma, what would you do?
Jim
You mean on purpose?
Pathology Resident
Diethyl para-amino tannadol.
Jim
No, no, leaves a serum trace.
Pathology Resident
Yeah, if you know to look for it.
Jim
But it also peaks alk phos. That's a real giveaway. Besides, who can get tannadol?
Pathology Resident
Well, then you can use paradine.
Jim
No, it has a taste. We'd all make great murderers. I mean, who knows better about murder than a pathologist?
Pathology Resident
It sure keeps my wife in line.
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.
Investigation into Unexplained Coma Cases
Dr. George
We have a happy lab here. It's precise. There's nothing left to chance. There are no mistakes. The charts are right here. There's no mystery. They're right here. What is it you wanted?
Dr. Wheeler
I'd like to look at them.
Dr. George
For what reason?
Dr. Wheeler
I'm interested in unexplained coma following routine surgery.
Dr. George
You're interested?
Dr. Wheeler
I'm more than interested.
Dr. George
My anesthesiology staff is more than interested. We're deeply concerned.
Dr. Wheeler
I understand.
Dr. George
I'm not sure you do.
Dr. Wheeler
Perhaps something was missed?
Dr. George
Missed? Every professor of anesthesia, most of our staff, more than 40 experts have gone over these charts. You think something was missed?
Dr. Wheeler
But if anything links them together...
Dr. George
If anything linked them, we'd know it. Here they are, 10 cases.
Dr. Wheeler
There are now 12. Different ages and sexes. Different surgeons and anesthetists. Different methods of induction. They share nothing in common except they all emerged with unexplained coma.
Dr. George
We're certainly not neglecting that problem.
Dr. Wheeler
I didn't say you were. Do you mind if I have a look?
Dr. George
I'm afraid I do mind. Thank you for your interest, however misplaced. Good afternoon.
Quotes sourced from Wikiquote (© Wikiquote contributors), licensed under CC BY-SA 4.0. Modified for formatting/length.