Posted on October 19, 2019 at 9:34 PM
by Craig Klugman, Ph.D.
Hades is a social media white supremacist celebrity comes in with a headache and a history of brain arteriovenous malformation (AVM). He says he does not want Pravesh (Indian), Nevins (female), or Feldman (Jewish) touching him. Cain (African-American) offers to do his surgery even though the patient is a violent racist. When Hades refuses help, he suddenly changes into Douglas Atwater who wants to be helped. This is a case of multiple personality disorder. Atwater signs a surgical consent. Cain doesn’t believe in the diagnosis and in an MRI he finds sclerotic tissue: If he removes it, he removes Hades. Nevins responds by saying that he’s talking about removing a portion of the brain. She urges a second opinion, a neuro consult, and his psych records. Cain says that she is only a nurse practitioner and she should never question him again. Hades returns and rescinds the consent; demanding to be discharged. In response, Cain gives the patient a dose of ketamine and knocks him unconscious, “Doing to you what you do to others. I’m taking away your right to be treated like a human being.” While removing the AVM, Bell and Nevins tell Cain not to remove the sclerotic tissue; he does anyway. Cain assaulted the patient and Bell says he won’t go down for that illegal action. Cain tells him that when they sold the hospital to Red Rock (their new corporate owners) covering for him to do anything he wants became Bell’s job. The next morning Nevins shows Cain the psych records and we learn that he didn’t cut out Hades, he cut out Atwater.
In a follow up to last week’s torturing of a patient, Pravesh falls out with Conrad saying that he can’t abide by the boundaries Conrad crosses. Pravesh tells him that “the ends do not justify the means”. So far, the implications of Conrad’s actions are losing the faith and trust of his colleagues.
In a show that started with the worst, most unethical doctors ever, it seems to have returned to those roots. This season we see doctors ignoring lines, ignoring the Hippocratic Oath, and joyfully assaulting patients. This is not how to practice medicine, this is how to get sued and arrested.
New Amsterdam (Season 2; Episode 4): Taking medicine to the streets, assisted suicide, lead poisoning
Marquis is a 32-year-old African-American who collapses while playing basketball. He has high blood pressure and an undiagnosed electrical heart problem (requires surgery and the patient doesn’t want it). Goodwin decides to spend an hour once a week in a barber shop in the neighborhood when he learns that healthy black men only go to the doctor when they don’t feel well, which means they may have undiagnosed chronic illnesses. He doesn’t last an hour there because the community does not trust doctors. So, Goodwin teaches 7 barbers how to do blood pressure checks. He also gives them pills to give out if someone has a high reading. The head of the hospital board accuses Goodwin of trying to decentralize and deprofessionalize health care (i.e. cut into their revenue stream). This storyline shows the importance of preventive care and that keeping on top of people’s health before disease becomes severe can save time, money, and lives. The irony is that medical care makes its money off of suffering and illness so that goal is not in the financial interest of the hospital.
In a second storyline, Molly is an older woman who has tried 7 different cancer therapies without success (including phase I trials). She’s clearly suffering. Sharpe accuses Castro of using the patient to further her career rather than doing what’s best for the patient. Molly talks about admiring a friend who died. She is okay with death but the middle ground between life and death is “humiliating”. She goes on with the experiments because Castro told her that her tumor is interesting. Sharpe asks if they’ve talked about hospice, but what Molly really misses is “being in control, especially now, at the end.” Later, Sharpe talks with Molly and asks her if she’s depressed (No), does she still find meaning in her life (No), how does she describe the quality of her life (lacking quality). Sharpe then puts a bottle of pills on the table and says, “These are extremely powerful pain pills…but if you take too many of them, your breathing will slow and you will die.” Sharpe then leaves the room and says if the pills are gone when she returns, she will not ask any questions. “This is your choice, no one else’s. You’re in control.” Castro later yells at Sharpe because Molly checked herself out of the hospital. The presumption is that she went home to die.
In reality, New York does not have a death with dignity act. Although one can argue that there are ethical reasons for Sharpe to act as she did, she did violate the law. Even the ethics here might be challenging. For example, using double effect an action that has both a good and bad outcome can be moral if the good outweighs the bad and the intended action is the good one. In this case, the intended action was to help the patient end her life: Is that a good? Is that the bad to end her suffering? The answer is ambiguous.
A third line takes on the social determinants of health, being exposed to toxins that are outside an individual’s control: A young boy comes in with a head laceration. We learn that he gets angry sometimes and bangs his head against the wall. His head scan is clean but he has high levels of lead in his blood. The doctors caught it early and can begin chelation therapy. Their home has lead but the city will take several months to check it out. Frome and Kapoor test the home themselves and learn that a bridge over the neighborhood was recently painted, and that scraping off the old, lead-based paint polluted the neighborhood beneath the bridge. When they bring this up to the city, officials deny any responsibility, saying there is no proof it’s their fault. Later, we learn that the boy’s mother has a picture which shows the dust from the paint falling, providing the proof they needed. The episode ends without saying what happens.